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Within the last 10 to 15 years, a significant amount of research in tonsil surgery has focused on reduction of post-operative pain and recovery time. In order to minimize or avoid morbidity, a number of otolaryngologists in the United States and Europe have revived a historical procedure, previously known as ‘tonsillotomy’, specifically for those patients with obstructive sleep-disordered breathing (OSDB) due to adenotonsillar hypertrophy. More recently, surgeons have used terms such as partial tonsillectomy, partial intracapsular tonsillectomy or subtotal tonsillectomy to describe their procedure and have employed a variety of modern instrumentation. This return to a ‘partial’ procedure has generated a debate similar to that which occurred amongst tonsil surgeons about 100 years ago, when tonsillotomy was the most commonly performed procedure. Today, concerns about regrowth and problems with infection of the remaining tonsillar tissue have been raised. Such concerns, combined with an incomplete understanding of why the ‘partial’ procedure was abandoned in the early twentieth century, may explain why tonsil surgeons hesitate to change their approach to patients with OSDB due to adenotonsillar hypertrophy. These issues can be addressed in a meaningful way only through a detailed review of the evolution of tonsil surgery, which is presented here. This information, along with a summary of the last 10 years' experience with these techniques, supports the use of a ‘partial’ procedure in children with OSDB due to adenotonsillar hypertrophy. Future areas of research are also discussed.

Problem: We have shown that SWXJ mice develop hearing loss when immunized with the p131–150 peptide of Coch-5B2 or following transfer of activated T cells specific for the Coch 131–150 peptide. Further studies to establish associated histopathology in the cochleas of these mice were pursued in this paper. Methods: Mice were immunized with Coch 131–150 in complete Freund’s adjuvant (CFA) and euthanized 2–5 weeks later. Inner ear tissues were immunostained for detection of inflammatory cells. ABR testing to determine hearing thresholds was performed on Coch 131–150 primed mice and on age- and sex-matched control mice immunized with CFA only. Results: Inner ear inflammation was observed 5 weeks after active immunization with Coch 131–150, but not at 2, 3, or 4 weeks. Increased ABR thresholds were accompanied by substantial CD45+ immunostaining in the lower spiral ligament primarily in the high frequency region of the cochlea. Control animals showed no increase in ABR thresholds and no inner ear inflammation. Conclusion: Induction of experimental autoimmune hearing loss in mice by immunization with Coch 131–150 results in appearance of leukocytes in the inner ear. The current data support our previously reported findings that Coch-5B2 targets T cell-mediated hearing loss in SWXJ mice. Significance: Our study shows that T cells targeted against inner ear-specific antigens may mediate inner ear inflammation and hearing loss in the mouse similar to that observed in human autoimmune sensorineural hearing loss (ASNHL). Thus, our study supports a critical role of autoreactive T cells in ASNHL and provides a contemporary mouse model for evaluating new treatment strategies. Support: Grants from the Deafness Research Foundation, the Samuel Rosenthal Foundation, the Triple T Foundation, the Milton and Charlotte Kramer Foundation, and NIH NS-36054.

Rationale Autoimmune sensorineural hearing loss (ASNHL) is diagnosed by excluding ototoxicity, systemic immunologic disease, infections or tumors, and by a therapeutic response to corticosteroids. The relative prominence of B or T cells in ASNHL remains controversial. Methods We tested our hypothesis that Th1-like effector T cells have a pivotal role in ASNHL in an inner ear-specific mouse model system. We searched for immunogenic peptides within inner ear proteins using our binding motif for IA s and IA q MHC class II molecules. ELISA was used to characterize the T cell cytokine profile. Disease induction was achieved by active immunization with the peptide and adoptive transfer of peptide-activated T cells. Results β-Tectorin 71-90 and Coch protein 131-150 induced a Th1-like effector immune responses in primed mice. Mice immunized with either β-tectorin 71-90 or Coch protein 131-150 showed increased hearing thresholds when compared to non-treated age- and sex- matched controls (p=0.010 and 0.024) and ovalbumin treated controls (p=0.012 and 0.017). Furthermore, increased hearing thresholds were observed in SWXJ mice after adoptive transfer of β-tectorin 71-90 or Coch protein 131-150 activated T cells (p=0.002 and 0.018). Conclusion β-Tectorin 71-90 and Coch protein 131-150 peptides induce Th1-like effector T cell immune responses in SWXJ mice. Active and passive immunization with these peptides induce hearing loss, which leads to the establishment of an inner ear-specific mouse model for ASNHL. These data show that Th1-like effector T cells may have a pivotal role in the etiopathogenesis of ASNHL.

Objective: The purpose of this study was to determine the prevalence of occult papillary thyroid cancer (OPTC) in a sample of cadavers from Guatemala, a country in Central America. Study design and setting: This was a cross-sectional study of cadaver samples. We analyzed 150 glands that were removed during autopsy from 150 cadavers (34 women and 116 men) who were admitted to the morgue of the Judicial Bureau between January and March 2000. Results: A total of 17 glands showed macroscopic evidence of disease, but only 3 glands (1 female and 2 males) showed microscopic evidence of malignancy. This corresponded to a 2% prevalence rate (range, 0.4–5.7%). The sex prevalence of OPTC was 2.9% (range, 0.07–15%) for females and 1.7% (range, 0.2–6.1%) for males. No significant difference was noted (P = .47, exact unconditional test). The male-to-female ratio was 1:1.7. Conclusion: We concluded that the prevalence of OPTC in Guatemala is low but comparable to literature reports. Occult papillary thyroid carcinoma appears to have no sex predilection as opposed to the clinically evident papillary thyroid carcinoma, which develops more commonly in females. Significance: Occult papillary thyroid carcinoma is a much more common pathology than clinically evident thyroid cancer, and the clinical implications still need to be determined.