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We describe a rare complication of stereotactic radiotherapy for large acoustic neuromas in a patient with type 2 neurofibromatosis. We retrospectively reviewed the case of a 14-year-old girl who had [...]

The surgical management of osteoradionecrosis of the temporal bone has met with limited success because of the difficulty in accurate assessment of the viability of nonnecrotic bone intraoperatively. Failure to resect all nonviable bone results in recurrence of a necrotic focus. With the use of hyperbaric oxygen therapy to stabilize marginal bone and oral tetracycyline to label viable bone preoperatively, removal of all nonviable bone can be accomplished. Postoperatively, a second course of hyperbaric therapy enhances wound healing, thus assuring a successful outcome. This article details a successful systematic approach that was developed to resect a necrotic focus In the temporal bone of a 10-year-old boy who had undergone a full course of radiotherapy for treatment of a rhabdomyosarcoma.

Over the past several years the indications for adenoidectomy have become increasingly controversial. Attempts to justify the operation in recurrent otitis media by correlating cultures of the nasopharynx with cultures of middle ear fluid have been inconclusive. Using quantitative bacteriologic techniques, we have studied the levels of aerobic and anaerobic bacteria per gram of tissue in adenoids removed from 48 patients. In seven patients, adenoidectomy was performed for nasal obstruction alone, in 17 patients for chronic serous otitis media, and in 24 patients for recurrent suppurative and serous otitis media. Using the criterion that greater than 105organisms/gm of tissue constitutes infection, we found that 83% (20) of patients in the third group had infected adenoids, as opposed to only 15% (4) in the first and second group combined. Adenoid size measured radiographically did not correlate with the presence of infection. When recurrent suppurative and serous otitis media are unresponsive to medical therapy including antibiotics and decongestants, adenoidectomy should be considered in addition to myringotomy and ventilation tubes.

Surgical intervention is indicated in Meniere's disease when symptoms persist in spite of an adequate trial of medical therapy. At The Otology Group, three surgical procedures are employed for the individual not responding to medical management. These are (1) the endolymphatic mastoid shunt, (2) the middle fossa vestibular nerve section, and (3) the translabyrinthine labyrinthectomy. The selection of the surgical procedures depends on a number of factors, including age, severity of symptoms, status of the contralateral ear, and hearing in the affected ear. As a general rule, if the patient has serviceable hearing, the first operation suggested is the endolymphatic shunt because of its low morbidity. Should this procedure fail, the middle fossa approach is recommended if the patient is not over 60 years of age. Translabyrinthine labyrinthectomy is recommended for those patients over 60 years of age as well as for younger patients with unilateral profound hearing loss.

• A new micromanipulator with microspot capability has been developed for carbon dioxide laser surgery in otolaryngology. The instrument features new infrared optics, which provide smaller laser spot sizes than those achievable with conventional micromanipulators (300 μm using a 400-mm operating microscope lens). The conventional red helium-neon aiming laser is replaced with a nonlaser fiberoptic image, and a power defocus control on the joystick manipulator eliminates external defocus controls. Less surrounding tissue trauma occurs with this new instrument by using a higher power density with average power settings of 1 to 2 W for cutting and ablation of tissue. Eight patients with benign laryngeal disease and one patient with dysplastic changes of the vocal cord were treated successfully without complications.(Arch Otolaryngol Head Neck Surg 1988;114:1012-1015)

• The terms "adenoiditis" and "adenoid hyperplasia" are often used interchangeably to describe posterior nasal obstruction in children, tending to obscure indications for adenoidectomy. To more clearly define the role of the adenoid bed in nasal obstruction and its relationship to aural disease, we examined tissue obtained at adenoidectomy from 22 children via the quantitative bacteriological technique. In three patients, adenoidectomy was performed for nasal obstruction alone, in nine patients for serous otitis media and nasal obstruction, and in ten patients for nasal obstruction with serous otitis media and recurrent bacterial otitis. Using the criteria that 105 bacteria per gram of tissue indicates infection, 90% of the patients in the last group had infected adenoids vs 8% of the patients in the first two groups. Quantitative immunoglobulin levels, WBC counts, or preoperative antibiotic therapy was not helpful in determining which patients had infected adenoids. Pressure-equalizing tubes were placed when appropriate. A follow-up of nine to 22 months is included.(Arch Otolaryngol 1982;108:315-318)