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Tracheomalacia resulting from tracheostomy or compressive thyroid disease often represents a difficult problem in airway management. In an attempt to improve this condition, biocompatible ceramic rings were surgically implanted in 16 patients to restore normal patency of the airway by first expanding the tracheal lumen lateral, and then in an anterior dimension. Preoperatively, patients displayed moderate to severe obstruction with marked restrictions in lifestyle, as confirmed by history, physical examination, and airway resistance studies. Additionally, three of these patients were trach-dependent at the time of implantation. Postoperatively all 16 patients have normal airway resistance parameters with a dramatic improvement in lifestyle, whereas the three with tracheostomy were successfully decannulated. The routine use of these rings has alleviated the need for rib/cartilage grafts, primary resections with anastomosis, prolonged periods of cannulation, and multiple surgeries. Our experience in the use of ceramic rings for tracheomalacia repair will be presented, highlighting selection criteria for their use, intraoperative placement, perioperative complications, and postoperative followup for a minimum of 6 months.

During a 10-year period (1984–1994) 1229 stapes operations for otosclerosis were performed at our respective institutions by experienced surgeons well trained in the various techniques. Procedures included 691 stapedectomies, 234 small-fenestrae stapedotomies, and 304 revision operations. These primary and revision cases resulted in 20 ears with severe sensorineural hearing loss or anacusis noted during the immediate postoperative period. This article will critically evaluate those procedures that resulted in profound hearing loss and attempt to determine possible reasons for this occurrence. It is hoped that these data will allow surgeons to identify before and/or during surgery patients at risk for development of this complication and therefore decrease the overall morbidity rate of this exacting procedure. (Otolaryngol Head Neck Surg 1996;115:324–8.)

Ultrasound as a diagnostic aid In the evaluation of the sinuses has been a controversial Issue. Sensitivities have been reported from 29% to 100% and specificities from 55% to 99%. These wide variations in results from previous studies may have resulted from technical differences. However, the “gold standard” most often used for comparison has been a Water's view radiograph, which has been shown to correlate poorly with intraoperative and CT scan findings. To our knowledge, no one In the English language literature has evaluated sonography of the sinuses with computed tomography as the gold standard. In addition, evaluation of the ethmoid sinus has been neglected by previous studies that have primarily assessed the maxillary sinus. We report the results of a blinded, prospective trial comprised of 41 patients examined by B-mode ultrasound with comparison to computed tomography. Frontal and maxillary sinuses were examined with traditional sonographic techniques and the ethmoid sinuses were scanned with a transglobe technique not previously evaluated in the English language literature. Excluding Isolated mucous retention cysts and focal minimal mucosal thickening (defined as <4 mm), sensitivities for ultrasound of the maxillary, frontal, and ethmoid sinuses were 100% each. Specificities were 98% for the maxillary sinus, 100% for the frontal sinus, and 94% for the ethmoid sinus. Technical aspects and implications of this and previous reports will be discussed.

A modification of the Clerf arytenoldopexy treatment for bilateral vocal cord paralysis is described; It consists of an external approach with complete unilateral division of the posterior cricoarytenoid and Interarytenold muscles. The entire arytenoid Is next mobilized and tilted laterally, then fixed Into position along the posterior margin of the thyroid cartilage by two or three permanent retention sutures. Careful placement of these sutures renders the laryngeal mucosa maximally undisturbed and Is largely responsible for the predictable results achieved with this technique. During the past 2 years, 18 patients received this static procedure, and 17 of 18 (94%) required a tracheotomy as part of the treatment because of a uniformly severe degree of glottic obstruction. All tracheotomy patients have been permanently decannulated (on an average) 14 days after surgery. The evaluation of each patient Included pre- and postoperative measurements of airway resistance that correlated well with the width of the posterior commissure, and proved Invaluable in successful decannulation efforts.

Educational objectives: To understand the techniques used in performing and interpreting rhinomanometry and acoustic rhinometry and to utilize the findings of the these studies to better treat patients with nasal obstructive symptoms.

Educational objectives: To recognize the importance of otoacoustic emissions as a sensitive means of assessing cochlear function and to use important clinical otoacoustic emission parameters as they apply to specific clinical situations.