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OBJECTIVE Assess the relative efficacy and results of the round window hyaluronic acid pledget depot method for intratympanic gentamicin delivery in Meniere's disease. STUDY DESIGN Retrospective case review. SETTING Tertiary referral hospital. PATIENTS Prospective symptomatic and audiologic data were collected on 28 patients undergoing intratympanic gentamicin therapy for Meniere's disease refractory to medical treatment between 2003 and 2009. INTERVENTION All patients had the round window membrane exposed via a tympanomeatal flap, and any adhesions were removed. Hyaluronic acid pledgets soaked in 40 mg/ml of gentamicin were then packed into the round window niche and posterior mesotympanum, and the tympanomeatal flap was replaced. MAIN OUTCOME MEASURES Patients audiologic and vertigo symptom outcome scores were recorded at follow-up according to the AAO-HNS 1995 guidelines for reporting results in Meniere's disease. RESULTS Complete or substantial improvement in vertigo (class A or B) was achieved in 88.5% (23/26) of patients. Hearing loss, defined as greater than 10 dB (PTA average at 0.5, 1, 2, and 4 kHz) was noted in 12 (50%) of 24 patients including 4 patients who had developed "dead ears" (16%). The average hearing loss for all patients excluding the 4 patients with dead ears was 10.7 dB. CONCLUSION Round window hyaluronic acid pledget technique used as a sustained delivery vehicle for intratympanic gentamicin treatment for Meniere's disease produces similar rates of vertigo control compared with other techniques but a greater risk of hearing loss. We would recommend the intratympanicinjection titration technique as first line for most patients.

A 2.5-year-old boy developed a right-sided eyelid swelling 3 days after onset of chickenpox. Orbital imaging confirmed an orbital cellulitis. The response to antibiotics was poor. The patient improved with intravenous steroids and an ischemic vasculitis secondary to chickenpox was postulated as the primary cause of the severe clinical picture. [J Pediatr Ophthalmol Strabismus 2013;50:e49–e51.]

The laser (Light Amplification by Stimulated Emission of Radiation) has been used in Otolaryngology for over 20 years and is by now an accepted part of the armamentarium. A tremendous amount of work is being done in refining existing techniques and developing new ones, and this review discusses some of the recent advances.

Background The fluorescence characteristics of tissues depend upon their biochemical composition and histomorphological architecture, both of which undergo a change during malignant transformation. These changes are detectable as an alteration in the fluorescence spectral profile of the tissues. Methods Biopsy specimens from clinically suspicious lesions and normal-appearing oral mucosa were obtained from patients. Fluorescence spectroscopic measurements were obtained to study the differences between normal and dysplastic tissues and to determine the most appropriate excitation wavelength(s) for exploiting these differences. Results Fluorescence spectra from a total of 12 histologically normal (healthy mucosa or benign lesions) and ten abnormal (dysplastic or malignant) tissue samples were compared. Significant spectral differences were seen between the two groups. These differences were most marked at the excitation wavelength of 410 nm. Using this wavelength, fluorescence correctly diagnosed 20 of 22 samples studied. Conclusions This technique accurately differentiates normal from abnormal tissues in vitro and has the potential applications for in vivo use as a noninvasive diagnostic tool. © 1997 John Wiley & Sons, Inc. Head Neck 19: 27–32, 1997.

We present a case of a highly unusual stapes in the presence of a normal external ear. The stapes exhibits rudimentary anterior crus with abnormally shaped posterior crus that attached to the mid-portion of a fixed, rudimentary footplate. To our knowledge, this anomaly has not been previously documented. We review the embryological cause that may be contributing to the development of this congenitally abnormal stapes superstructure. This is to highlight the importance of the knowledge of the anatomy of the stapes and its variations especially to the otologists.

Objective: To determine the long-term control of sialorrhea in children who underwent submandibular duct rerouting (SMDR) and to identify potential preoperative predictors of outcome. Design: Retrospective chart review of children who underwent SMDR; information updated by discussion with the permanent caregiver. Setting: Tertiary care center. Patients: Children who had significant sialorrhea resulting from a variety of neuromuscular disabilities between January 1980 and December 1995. Outcome: We report the outcome on 59 patients who underwent SMDR for the treatment of sialorrhea. Patients were ascribed a preoperative sialorrhea and global neurologic deficit score. Postoperative outcome was scored as marked, moderate, no improvement, or worse. Twenty-eight of 59 (47.4%), 28 of 59 (47.4%), and 3 of 59 (5.1%) of the patients had preoperative sialorrhea scores of 3 (profuse), 2 (moderate), and 1 (mild), respectively. Twenty of 59 (33.9%), 29 of 59 (49.2%), and 10 of 59 (16.9%) had preoperative scores of 3 (severe), 2 (moderate), and 1 (mild) neurologic impairment, respectively. Mean time to follow-up of the 59 patients was 5.46 years. Postoperative improvement scores were as follows: 50.8% had marked, 28.8% had moderate, and 20% had no to minimal improvement in their sialorrhea. Two patients were transiently worse. A complication rate of 11.3% (9 of 79) was demonstrated: 7 ranulae, 1 transient swelling of the floor of the mouth, and 1 submandibular gland infection. The preoperative global neurologic deficit score was found to be more predictive of surgical outcome than sialorrhea score. (Otolaryngol Head Neck Surg 1999;120:303-7.)