Otolaryngology retirement profile in the southeastern United States.

OBJECTIVE: To document retirement-related issues and trends among otolaryngologists. STUDY DESIGN: Survey of 438 retired members in the Southern geographical region of the American Laryngological, Rhinological and Otological Society, Inc. METHODS: A questionnaire was mailed to retired members, completed anonymously, and returned to the author. RESULTS: A total of 138 (31.5%) surveys were received. Respondents' average age at retirement was 63.2 years; approximately half had retired in the last 5 years. Since 1995, most had left either a group practice (45%) or a solo practice (41%). The majority of respondents (40%) retired for previously planned or personal reasons. Two thirds of respondents reported that they were more satisfied with retirement than expected. This greater satisfaction was seen in those with a higher average income after retirement. The most common advice for colleagues still practicing was to save more money and invest more money. CONCLUSIONS: Although these results are biased because of a self-selected group of respondents, they illustrate that for this group of retired otolaryngologists, although retirement is being planned for, it is not occurring earlier than in previous years. The experience of retirement was largely positive for these respondents.

Ectodermal dysplasia: otolaryngologic manifestations and management.

OBJECTIVE: To present the otolaryngologic manifestations and management of 12 patients with the rare presentation of ectodermal dysplasia. STUDY DESIGN: A retrospective chart review combined with a patient evaluation by the specialties of genetics, dermatology, dentistry, and otolaryngology. METHODS: A review of the head and neck manifestations of the spectrum ectodermal dysplasia was undertaken by a retrospective chart review performed at a tertiary care children's hospital combined with a multidisciplinary evaluation by specialties of genetics, dermatology, dentistry, and otolaryngology. RESULTS: All 12 patients had confirmed ectodermal dysplasia by genetic evaluation with strong familial manifestations of the spectrum. Seven of 12 patients presented with X-linked hypohidrotic ectodermal dysplasia. Three of these seven were femalepatients and presented with variable expression. Common otolaryngologic manifestations included eczematoid skin changes, unusual facies, hypodontia, sparse scalp hair, chronic infections (rhinitis, pharyngitis, otitis media), epistaxis, ocular drying with corneal injury, dysphagia, hearing loss, and dysphonia. Immune evaluation was normal. Nasal cilia were deficient. CONCLUSIONS: Ectodermal dysplasia is a rare syndrome with heterogeneous manifestations secondary to hypoplasia of the mucous glands of the upper aerodigestive tract and ectodermal abnormalities. The spectrum is marked byhypohidrosis, recurrent ocular infections, chronic rhinitis, hypodontia, dystrophic nails, alopecia, and atypical facies. The recognition of this syndrome allows early management of ocular, dental, infectious, and dermatologic concerns with a multidisciplinary approach to management. Direct otolaryngologic management includes ocular and oral lubrication, treatment of infectious complications, and intervention to prevent and address hearing loss.

Laryngopharyngeal reflux and laryngeal web formation in patients with pediatric recurrent respiratory papillomas.

OBJECTIVE: To determine whether treatment of laryngopharyngeal reflux reduces the laryngeal soft tissue complications encountered in surgery for recurrent respiratory papillomas. STUDY DESIGN: Retrospective chart review. METHODS: Retrospective chart review of all pediatric patients treated for laryngeal recurrent respiratory papillomas between 1984 and 1999 was performed. Thirty-one such patients were identified. Twenty-four were at "high risk" for developing complications based on the number of operating suite visits and the presence of disease at the anterior commissure. Twelve patients underwent 24-hour double pH probe testing. RESULTS: Overall, 13 of 31 patients (42%) developed laryngeal webs. No other soft tissue complications were encountered. Of the patients who had pH probe testing, 12 of 12 (100%) had at least one pharyngeal episode of acid exposure. Of the "high-risk" patients, 10 were treated for reflux and only 2 of 10 (20%) developed webs. Eleven of 14 (79%) of the "high-risk" patients who were not treated for reflux developed webs. The difference in rate of web formation between patients treated for reflux and those not treated for reflux was statistically significant (P =.011). CONCLUSIONS: Antireflux treatments for patients undergoing surgery for laryngeal recurrent respiratory papillomas may reduce the soft tissue complications, especially scarring and web formation. Prophylactic antireflux therapy may be warranted in any patient undergoing surgery during which laryngeal mucosal disruption is anticipated.

The role of parotid biopsy in the diagnosis of pediatric Sjögren syndrome.

OBJECTIVES: To describe our experience with primary and secondary Sjögren syndrome (SS) in the pediatric population and to evaluate the effectiveness of parotid gland biopsy in the diagnosis of pediatric SS. DESIGN: Case series review of 6 pediatric patients evaluated during a 4-year period with varied head and neck manifestations of SS. SETTING: Tertiary care children's hospital. PATIENTS: Six children (4 boys and 2 girls) ranging in age from 6 to 12 years, who were diagnosed as having primary or secondary SS. INTERVENTION: Six minor salivary gland and 4 parotid gland biopsies for pathologic examination. MAIN OUTCOME MEASURES: Pathologic examination of salivary tissue consistent with SS. RESULTS: All 6 patients underwent minor salivary gland biopsy, 2 (33%) were consistent with SS, while the remaining 4 (67%) were nondiagnostic. The 4 patients with nondiagnostic minor salivary gland biopsy results went on to have parotid biopsies, of which all 4 had histologic findings consistent with SS. No complications were encountered. CONCLUSION: Parotid gland biopsy is an effective and safe means of obtaining salivary gland tissue for histologic evaluation of SS in the pediatric population.

Gastroesophageal reflux and the upper airway.

EER is a disorder commonly seen in otolaryngologic practice and differs from GERD in its clinical manifestations, pathophysiology, and response to treatment. Its association with numerous disorders in children should lead otolaryngologists to consider this diagnosis in all patients with voice, airway, and swallowing complaints.

Pediatric laryngopharyngeal reflux.

Laryngopharyngeal reflux (LPR) is common in children. It often affects the airway, and it has been associated with life-threatening disease. The diagnosis and treatment of LPR in children is somewhat different from that in adults.

Kimura's disease: a diagnostic challenge.

Kimura's disease is a rare inflammatory disorder of unknown cause, primarily seen in young Asian males. The disease is characterized by a triad of painless subcutaneous masses in the head or neck region, blood and tissue eosinophilia, and markedly elevated serum immunoglobulin E levels. We describe an 11-year-old Asian boy with Kimura's disease who presented with a chronic left neck mass. The diagnosis was based on the characteristic histopathologic findings after surgical excision in conjunction with peripheral eosinophilia and elevated serum immunoglobulin E levels. Pediatricians in western countries should be aware of the clinical presentation of Kimura's disease.