Sphenopalatine blocks in the treatment of pain in fibromyalgia and myofascial pain syndrome.

Sphenopalatine blocks have been used to treat pain for more than 80 years. Anecdotal support for sphenopalatine ganglion blocks has been very strong in those who believe in the technique, but the research results have been inconclusive. Therefore, a double blind, placebo-controlled study was performed on 61 patients, 42 with fibromyalgia and 19 with myofascial pain syndrome. Pain was measured using visual analogue scales prior to treatment, during treatment, and 28 days after the treatment. Headaches were evaluated in frequency and location prior to and after treatment. Sphenopalatine ganglion blocks were performed under direct vision using 4% lidocaine and sterile water as a placebo. Analysis of the results showed no statistical differences between the lidocaine and the placebo groups.

Medial meatal fibrosis: the University of Western Ontario experience.

Medial meatal fibrosis is an uncommon but surgically treatable cause of conductive hearing loss. A review of 10 years experience with this entity at The University of Western Ontario revealed a total of 15 cases involving nine patients. Each of them was treated by one of four otologists. This disease may arise from either recurring or chronic infection or from chronic dermatitis, and it frequently presents with bilateral involvement. It may occur at virtually any age, and to our knowledge, this series includes the first cases of this disease to be described in children. The medical and surgical management of this condition is described in detail and the results are summarized.

Conservative management of Tumarkin's otolithic crisis.

Tumarkin's otolithic crisis (TOC), characterized by a sudden drop attack without accompanying loss of consciousness, vertigo or autonomic signs, is a rare phenomenon thought to be of peripheral origin and associated with late-stage Meniere's disease. The purpose of this paper is to describe the clinical course of TOC in our series; to discuss the relationship between TOC and the onset and symptomatology of pre-existent Meniere's disease, and to determine the management of patients with TOC.

Epiglottitis: adult and pediatric comparisons.

All cases of epiglottitis admitted to the three affiliated teaching hospitals of the University of Western Ontario over the ten year period prior to December 1986, were subjected to a retrospective chart review. The findings confirmed the suspicion of the senior authors that adult epiglottitis is almost as frequent an entity as epiglottitis in children. This probably results from an increased awareness of the disease process rather than an actual increase in incidence. Also of note is the bimodal age distribution of 0-8 years in children and 20-40 years in adults. As well, clinical presentation, causative organisms, treatment modalities and complications between adults and pediatric age groups are compared and contrasted.

Otolaryngologic manifestations of amyotrophic lateral sclerosis.

Otolaryngological manifestations were examined in a series of 250 patients diagnosed as having ALS between 1976 and 1986. Surgical intervention was only required in 10 cases due to excessive drooling and aspiration. Five patients had submandibular gland excisions with only limited improvement in respect to drooling. One case having a unilateral tympanic neurectomy had significantly better drooling control. Cricopharyngeal myotomy is helpful when dysphagia is predominantly due to cricopharyngeal spasm. In our series, tympanic neurectomy and chorda tympanectomy provide the better control of drooling for these patients and has the added advantage of being performed under local anesthesia.

Rhinological disorders in the elderly.

Aging in the nasal tissues produces anatomical and physiological changes in the elderly. The elderly have a generalized decrease in body water content of 7%, and with the degeneration of mucus-secreting cells, the effectiveness of the mucociliary system is reduced with frequent symptoms of nasal stuffiness. The fragmentation and weakening of the cartilage of the septum also causes airflow changes contributing to nasal stuffiness. The elderly also experience hormonal and metabolic changes which affect the physiologic nasal function. Epistaxis is relatively common in the elderly, and aging changes in the vascular system such as atherosclerosis contribute to the severity of epistaxis. The majority of nosebleeds in the elderly originate anteriorly due to dryness and local trauma.

Malleus to stapes assembly.

The malleus to stapes assembly is the ideal ossicular reconstruction because of its high degree of success. Unfortunately, both the malleus and the stapes have to be in good position to use this type of reconstruction making it much less common than other forms of ossiculoplasty. Over a six year period, 1976-1982, there were 20 such procedures performed, as compared to 85 cases of hemi-incus interposition ossiculoplasty in the same period. The malleus to stapes assembly technique and indications are described in this report. Reconstruction results show an 80% air-bone gap closure within 10 dB with an average improved speech reception threshold of 18 dB.

The changing nature of otological practice in a teaching centre.

The impression that otologic surgical practice is a declining segment of the specialty of otolaryngology is widespread. In an attempt to assess objectively the validity of that assumption, the authors reviewed their own experience over the 12 years 1971-82 inclusive. Five representative years out of the 12 were examined--1971, 1974, 1977, 1979, and 1982. In each of these years, the relative and absolute frequency with which six common otological procedures were performed was determined. The procedures selected for study included myringoplasty, tympanoplasty Type I, II, III and IV, and stapedectomy. In addition the relative frequency of primary vs. revision operations was assessed. The data indicate a change in the pattern of otologic surgical practice over the period, most noticeably in the ratio of primary to revision procedures. These changes have significant implications for the teaching and practice of otology in the future.

Ossiculoplasty using a hemi-incus interposition.

A damaged incus is one of the common reconstruction problems encountered by the otologic surgeon. Eighty-five hemi-incus interposition reconstructive procedures performed between 1976 and 1982 were reviewed. Reconstruction consisted of an autogenous or homologous incus bone graft interposed between the tympanic membrane and the mobile stapes superstructure. Air bone gap closure to within 20 dB was obtained in 77% of cases. Reconstruction using bone graft is better tolerated by the middle ear and the extrusion rate less than that of the biocompatible implants.

Etiology of deafness in Robarts School for the Deaf.

A survey of the children at the Robarts School for the Deaf was performed in order to determine the etiology of hearing loss, the reading ability as related to the degree of hearing loss, and the incidence of middle ear disease. The largest category for etiology was idiopathic at 31%, followed by hereditary at 22.5%, and maternal rubella at 19%. The incidence of serous otitis media was found to be 11%.

Wegener's granulomatosis with otological and nervous system involvement.

Wegener's granulomatosis usually presents to the otolaryngologist with nasal manifestations. Complications including otologic and central nervous system symptoms occur in 20-40 per cent of cases. Two such cases presented to our clinic with nasal manifestations initially, one subsequently developing otologic sequelae and one progressive sensory motor neuropathy. These patients were followed to determine the reversibility of the otologic and sensory motor neuropathy while on therapy. The otologic changes remain and this patient was required to use a hearing aid. The sensory motor neuropathy improved rapidly so that the other patient's ability to walk soon became normal but sensory deprivation continues below the ankle bilaterally. The literature concurs with findings that involvement of the central nervous system and special sense organs such as the cochlea have limited reversibility once they occur, and early detection, therapy, and prevention of such complications are most important.

Mastoid obliteration with primary ossicular reconstruction.

Soft tissue mastoid obliteration was used as a means to control a persistent draining mastoid cavity that would not respond to aggressive office management using meticulous cleansing, local antibiotics, and packing. Thirty-three draining cavities which could not be controlled medically, had soft tissue mastoid obliteration performed using a Palva flap. Of the 33 cases obliterated, 31 were successful in obtaining a dry cavity but two still required cleansing every four to six months. Primary reconstruction of the hearing mechanism was performed in 21 of the 33 cases, the others having severe pre-operative cochlear damage. Of those cases reconstructed, 13 were reconstructed using a TORP and eight were reconstructed using a hemi-incus interposition.