(BQ) Part 2 book “Ballenger’s otorhinolaryngology head and neck surgery” has contents: Anatomy and physiology of the oral cavity, deep head and neck space infections, airway management in the infant and child, congenital anomalies of the larynx,… and other contents.
▼ PEDIATRIC OTORHINOLARYNGOLOGY 62 Microtia, Canal Atresia, and Middle Ear Anomalies Simon C Parisier, MD Jose N Fayad, MD Charles P Kimmelman, MD Anthony P Sclafani, MD George Alexiades MD The child born with a malformed ear faces a lifelong hearing and communication impairment along with the social stigma of a facial deformity Associated disturbances of the vestibular system may add the developmental hurdle of a motor delay Frequently, there are additional anomalies, such as mandibular hypoplasia, as well as other facial and skeletal deformities There may be dysfunction of associated neural pathways, including cranial nerves and intracranial structures Additionally, there are psychological factors to be considered, including parental guilt, peer ridicule, and the shame of “being different.” Educationally and economically, these hearing-impaired children face the prospect of limited opportunities The appropriate management involves recognizing the problems and limitations of therapy, which need to be thoroughly understood by the parents and, when appropriate, the patient EMBRYOLOGY OF ATRESIA AND MICROTIA In the to mm embryo (3 to weeks), the first indications of aural ontogenesis are the first and second branchiomeric structures and the otic placode, an ectodermal thickening on the lateral surface of the head opposite the fourth ventricle The placode invaginates to first form a pit and then a vesicle detached from its surface origin This otocyst forms the inner ear membranous structures, with the endolymphatic duct developing first at the mm stage, followed by the appearance of the semicircular ducts and the cochlear diverticulum at the 15 mm stage (6 weeks) By the end of the third month, the cochlea is fully coiled The cranial nerves entering the otocyst exert an inductive influence to produce neuroepithelium, BDBK005-CH62.indd 759 for which retinoic acid is a potent morphogen Retinoic acid receptors are uniquely expressed in the developing organ of Corti; medications that affect retinoic acid metabolism, such as isotretinoin (Accutane, Roche, Nutley, New Jersey), can lead to embryopathies, including inner ear malformation.1 The cochleovestibular ganglia develop from the otic placode epithelium The nerve fibers themselves not only influence sensory cell development but are also directed to the developing inner ear by the sensory cells.2 As the membranous structures of the inner ear form, they become enveloped in a cartilaginous capsule, which eventually gives rise to the petrous portion of the temporal bone Concurrently, the structures that originate from the first pharyngeal pouch develop separately but adjacent to the otic capsule derivatives The pouch begins to form in the to mm embryo and expands into a tubotympanic recess, which will eventually give rise to the eustachian tube, middle ear space, and mastoid air cell system The third branchial arch migrates superiorly to the level of the recess, and its artery (the internal carotid) comes to lie dorsal to the eustachian tube Variations in this relationship may result in a lateralized displacement of the internal carotid artery into the middle ear space In adults, an ectopic carotid artery can be mistaken for a middle ear mass, such as a glomus tumor As the pharyngeal pouches form in the to mm embryo, corresponding grooves develop on the external surface of the nascent cervical region The first of these branchial clefts deepens until it approaches the tubotympanic recess, being separated only by the thin layer of mesoderm destined to become the middle fibrous layer of the tympanic membrane Subsequently, in the 30 mm embryo (8 weeks), the primordial external canal becomes occluded by an ectodermal plug By the twenty-first week, this begins to resorb to form the definitive external auditory canal, replete with its hair and glandular appendages Aberrations in the canalization process can lead to stenosis, canal tortuosity, or fibrous or osseous obliteration Since middle ear structures develop independently, the tympanic cavity and ossicles may be normal Defects in the canalization process may also be associated with faulty formation of the pinna, which arises in the to 11 mm embryo from six mesodermal thickenings These hillocks surround the entrance of the first branchial cleft The first branchial arch cartilage (Meckel cartilage) forms the tragus and superior helical crus; the remainder of the pinna derives from the second arch cartilage (Reichert cartilage), although some authorities posit a hyoid arch derivation for all but the tragus The developing auricular appendage migrates from its initial position in the lower face toward the temporal area This movement occurs along the fusion plane of the first and second branchial arches The auricle is initially located anteriorly in a horizontal axis; with development of the branchial structures it migrates from its original position in the lower face laterally, and as its axis rotates, it assumes a more vertical angulation Branchial cleft dysmorphogenesis can impede this migration and leave the pinna in a low, transverse orientation (Figure 1) As the middle ear forms, the separation between the first pharyngeal pouch and cleft is filled in by mesenchyme In the mm embryo (6 weeks), part of the connective tissue condenses to form the malleus handle; the subsequent expansion of the tympanic cavity 8/21/08 3:54:47 AM 760 PART IV / Pediatric Otorhinolaryngology ETIOLOGY OF AURAL ATRESIA Figure This child’s auricle has not migrated from its embryonic low, transverse position superiorly is delayed until the cartilaginous otic capsule fully forms The expansion of the first pharyngeal pouch results in the envelopment of the ossicles in an endodermal epithelium The ossicles predominantly originate from mesenchymal visceral bars of the first and second arches The first arch forms the head of the malleus and body of the incus, with the second arch giving rise to the manubrium, long process of the incus, stapes superstructure, and lateral portion of the footplate The medial lamina of the footplate is derived from the otic capsule The obturator foramen of the stapes forms around the stapedial artery, which usually remains diminutive while the stapes enlarges If variations in vascular development cause enlargement of the artery, a conductive hearing loss may result from impairment of stapes motion As the derivatives of the first pharyngeal pouch continue to extend into the developing temporal bone, the antrum, mastoid air cells, and petrous pyramid cells begin to form Most mastoid development is postnatal; abnormalities that arrest middle ear formation result in a poorly pneumatized bone The facial nerve is intimately related to the development of the middle and inner ear structures outlined above The blastema of the stapes is adjacent to the seventh nerve, which divides the second (hyoid) visceral mesenchymal bar into a laterohyale, stapes blastema, and interhyale The interhyale forms the stapedius tendon, whereas the laterohyale forms part of the bony fallopian canal and pyramid Thus, the development of the stapes is closely related to that of the facial nerve Abnormalities in the development of the stapes are frequently associated with facial nerve anomalies This relationship of facial nerve to developing middle ear structures increases the likelihood of an anomalous course of the nerve in the malformed middle ear.3,4 Development of the ear is also discussed in Chapter 2, “Development of the Ear.” BDBK005-CH62.indd 760 Atresia and microtia are part of several known syndromes associated with inherited defects or acquired embryopathies owing to intrauterine infection (rubella, syphilis), ischemic injury (hemifacial microsomia), or toxin exposure (thalidomide, isotretinoin) Although inner ear abnormalities, such as Usher syndrome, Waardenburg syndrome, and the neurofibromatoses, are becoming understood on a molecular biologic basis, the genetic basis of external and middle ear anomalies generally remains poorly characterized.5 Aural atresia occurs in approximately in 20,000 live births Although the inner and middle ears develop separately, inner ear abnormalities coexist in 12 to 50% of cases Atresia is bilateral in 30% of cases, occurring more commonly in males and in the right ear.6 Microtia occurs in in 7,000 live births and can be associated with aural atresia Microtia represents a failure of normal development of first and second branchial arch fusion It is more common in males (two-thirds) and in the right ear (60%) Ten percent of cases are bilateral Prenatal maternal history is not associated with the development of microtia Children with microtia should be screened for hemifacial microsomia and other first and second arch anomalies, and coordination of care with a maxillofacial surgeon beginning at an early age can be critical in optimizing facial symmetry It is not surprising that an embryonic insult severe enough to cause aural atresia would also affect other organ systems The following organs or systems may be anomalous in patients with atresia: neurocranium defects (Crouzon disease or craniofacial dysostosis), central nervous system (mental retardation), oral cavity (first and second branchial arch syndromes), the eye (Goldenhar syndrome), the neck (branchial fistula), the CHARGE association (coloboma, heart defect, choanal atresia, retarded growth, genitourinary defects, and ear anomalies), Treacher Collins syndrome (mandibulofacial dysostosis), Duane syndrome (abducens palsy with retracted globe), VATER complex (probable disorganization of the primitive streak with impairment of early mesodermal migration causing vertebral defects, anal atresia, tracheoesophageal fistula, renal defects, and genital anomalies), and Pierre Robin syndrome Chromosomal anomalies affecting the external and middle ears include Turner syndrome and trisomy 13 to 15, 18, 21, and 22 syndromes.7 Anomalies of the ear in the absence of syndromes are usually not familial From the above information, it is obvious that other congenital anomalies should be assiduously sought; some, such as renal dysgenesis, may not be readily apparent A chromosomal analysis may be indicated As progress is made in the identification of genes and their products in the recently mapped human genome, the genetic basis for many of these disorders may provide a means of treatment or prevention.8 The genetic and molecular determinants of malformations of the ear are discussed in Chapter 2, “Development of the Ear.” DIAGNOSIS AND EVALUATION In the more severe cases of microtia, the diagnosis is apparent on inspection of the external ear Depending on the degree of the abnormality, the microtic ear may be classified into three grades In grade I, the auricle is developed and, though misshapen, has a readily recognizable, characteristic anatomy (Figure 2) In grade II, the helix is rudimentary and the lobule developed (Figure 3) In grade III, an amorphous skin tag is present9 (Figure 4) Grade III microtia can be further described as conchal remnant or lobular remnant Lobular remnants typically present with a vertically oriented skin covered mass of deformed cartilage superiorly, extending into a soft tissue and skin portion inferiorly Conchal remnant microtias present with all of the above, with additionally a blind pouch, which represents a primitive conchal bowl In all stages, wide variations of morphology exist The pinna may be fully formed with a transverse and low-set orientation There may be accessory appendages of the pinna (pretragal tags with or without cartilage) and preauricular sinus tracts The external canal may be stenotic or atretic to varying degrees10 (Figure 5) In cases of stenosis, entrapped squamous cell epithelium may lead to a retention cholesteatoma with bone destruction Schuknecht observed that in ears with congenital meatal stenosis, all had cholesteatomas, whereas of 11 ears with partial atresia and narrowed canals had cholesteatoma.11 In 50 ears with complete atresia, only had cholesteatomas Abnormalities of the tympanic cavity alone may occur with a normal tympanic membrane and external ear In ears with conductive hearing losses and normal otoscopic examinations, isolated ossicular anomalies should be suspected (Table 1) Ossicular fixation can be produced by a variety of abnormalities and may involve the stapes, incus, or malleus Alternatively, there may be a failure of bone development producing an ossicular discontinuity, which generally involves the incus and/or stapes arch Ossicular malformations caused by abnormalities related to first or second branchial cartilaginous derivatives can frequently be surgically repaired (see Table 1, groups I and II) However, ossicular fixations owing to cochlear capsule abnormalities, especially when associated with an aberrant facial nerve, may not be surgically correctable (see Table 1, group III) Otic capsule abnormalities producing stapedial fixation are frequently associated with abnormal communication between the inner ear and the subarachnoid space In these instances, manipulation of the stapes results in a persistent gusher of cerebrospinal fluid Vascular malformations also occur in the middle ear, such as high jugular bulb, persistent stapedial artery, and anomalous course of the carotid artery.12 8/21/08 3:54:48 AM CHAPTER 62 / Microtia, Canal Atresia, and Middle Ear Anomalies 761 Table Congenital Middle Ear Abnormalities with Patent Ear Canal, Mobile Tympanic Membrane, and Conductive Loss I Ossicular fixation a Stapes fixation Deficient annular ligament Elongated pyramidal process, ossified stapedial tendon b Malleolar-incudal fixation Lateral epitympanic ankylosis Medial epitympanic ankylosis of body of incus, head of malleus Ossified anterior malleolar ligament II Ossicular discontinuity a Absent stapes arch b Deficient lenticular process of incus c Deficient long process of incus III Cochlear capsule and facial nerve anomalies a Aplasia of oval or round window b Facial nerve anomaly occluding oval window c High jugular bulb occluding the round window niche Figure This pinna exhibits a grade I microtia with canal atresia The size of the auricle and the characteristic anatomic landmarks are fairly normal A pretragal skin tag is present Figure An example of a grade II microtia The auricle is reduced in size and has a characteristic recognizable shape The inferior and superior crura have not developed, although the helix is well preserved BDBK005-CH62.indd 761 Figure Auricle showing a grade III microtia An amorphous ridge of skin and nubbins of cartilage are present in place of a recognizable, well-developed auricle Further delineation of structural abnormalities requires computed tomography (CT).13 Younger children may require sedation if they are unable to cooperate The images are processed with a bone algorithm image enhancement using 1.5 mm slices Figure A grade II to III microtia with poor formation of the superior third of the auricle and a preauricular pit, possibly because of a first branchial arch dysmorphism The lower portion of the ear, which is derived from the second branchial arch, has a relatively normal appearance The canal is stenotic, leading to the subsequent development of a retention cholesteatoma at either 1.5 or mm intervals Optimally, both axial and coronal scans are obtained, although reformatted coronal or sagittal images may be adequate Three-dimensional reconstruction may be useful in visualizing the temporal bone topography.13,14 Auditory brainstem responses (ABRs) should be performed in all children born with either microtia or atresia as neonates In cases of microtia with fairly normal canals, an ossicular malformation producing a conductive hearing loss may be present In patients with unilateral atresia, it is not unusual for the seemingly normal contralateral ear to have a hearing loss Bilateral involvement may cause masking dilemmas; such is the case when one ear has a conductive loss and the other a sensorineural loss These dilemmas may be minimized by using multichannel analysis of ipsilateral versus contralateral responses to determine the laterality of wave I.15 As the infant matures, behavioral audiometric evaluations must be obtained to confirm the neurophysiologic tests of hearing In children older than year, conditioned free field play audiometry should help to quantify the overall hearing levels Eventually, pure-tone and speech testing with masking should be obtained in children with fairly normal canals Impedance and stapedial reflex measures in a seemingly normal ear can provide valuable information as well as more extensive malformations occurring in Treacher Collins syndrome and hemifacial microsomia CT studies allow determination of the degree of the canal atresia, the thickness of the atresia plate (Figure 6A), the extent of pneumatization of the middle ear and mastoid, the distance between the glenoid fossa and mastoid, the intratemporal course of the facial nerve, the status of the malleus and incus, and, in some instances, the presence or absence of the stapes and oval window (Figure 6B) However, subtleties of oval and round window anatomy are often not revealed An unsuspected cholesteatoma may also be apparent The normalcy of the osseous inner ear structures is also revealed by CT 8/21/08 3:54:49 AM 762 PART IV / Pediatric Otorhinolaryngology (B) (A) Figure (A) A coronal computed tomographic (CT) scan showing a bony atresia plate (arrow) The middle ear space is normally pneumatized (B) Coronal CT scan showing a low-lying tegmen (T), which precludes construction of an external canal The middle ear cleft has not developed A rudimentary antrum is unaerated (A) Atresia surgery is contraindicated in this case Evaluation of the function of other organ systems should be considered by the otologist For example, some of the syndromal associations of atresia involve mandibular and laryngeal anomalies that can lead to airway obstruction; cardiac, renal, endocrine, and immune function should be ascertained in selected instances MANAGEMENT OF AURAL ATRESIA AND MICROTIA Nonsurgical The prime concern in the young child is the assessment and improvement of hearing When ear deformities are present, the ABR techniques outlined above are helpful in determining the type and severity of hearing loss and should be performed as early in life as possible Early amplification, auditory training, and speech therapy can improve speech and language skills In children with bilateral atresia, amplification with boneconduction aids should be provided as soon as possible, preferably within the first few months of life.16–18 In infants with a unilateral atresia and conductive hearing loss in the seemingly normal ear, an air-conduction aid should be fitted to the ear with a canal Surgical In the unilateral case with normal contralateral hearing, repair of either the microtia or the atresia is considered elective, and there is less urgency to intervene during childhood When the atresia is bilateral with acceptable-appearing auricles, reconstructive surgery can be performed at a fairly young age However, in cases of microtia that require reconstruction, atresia repair should be deferred until the initial stages of the auricular repair are completed Generally, microtia surgery requires a cartilage graft that is obtained from the lower costochondral region An adequate graft requires sufficient growth and fusion at the BDBK005-CH62.indd 762 donor site, which has usually occurred by to years of age Additionally, in bilateral cases, many authorities recommend postponing surgery for the restoration of hearing until at least age five so that pneumatization can develop.11 In children with frequent upper respiratory infections and suspected eustachian tube dysfunction, it may also be necessary to delay hearing reconstructive surgery Surgical Treatment of Congenital Conductive Hearing Loss The success of the surgical correction of congenital conductive hearing losses is related to the abnormality since a wide range of malformations is possible.10 Surgery in an ear that has an isolated ossicular malformation with an otherwise patent canal, intact tympanic membrane, aerated middle ear cleft, normal facial nerve, and mobile stapes has the potential for excellent hearing (Table 2, class I) Conversely, an ear with canal atresia, a narrowed and poorly aerated middle ear space, and an anomalously positioned facial nerve occluding the oval window is destined to have poor postoperative hearing (see Table 2, class III) Between these two extremes is an array of anomalies with variable surgical outcomes Even with sophisticated imaging techniques, the preoperative prediction of what awaits the otologist is not always accurate.19 Surgeons wishing to correct congenital conductive hearing losses are embarking on a procedure with significant potential complications Generally, the initial attempt is the procedure most likely to improve the hearing Unplanned revisions are often more complex and less successful Additionally, if a significant sensorineural hearing loss occurs after surgery in a patient with bilateral malformations, the opposite ear is effectively excluded from surgical correction since it becomes the better hearing ear Before assuming this responsibility, especially in children, the otologic surgeon must have sufficient experience to maximize the likelihood of a successful outcome The presence of a conductive hearing loss in an ear with a normal canal and mobile drumhead generally indicates that the ossicular chain is not transmitting sound energy to the cochlea Isolated ossicular malformations involving the stapes arch and long process of the incus may not be appreciated on CT studies In these cases, the middle ear can be explored by elevating a tympanomeatal flap and assessing the normalcy of the ossicular transduction mechanism If the canal is small, a postauricular approach will improve operative exposure Frequently, even the young child’s ear canal has a sufficient diameter to admit an adequately sized ear speculum, even though the length of the canal is shorter Once the middle ear is entered, the surgeon needs to decide if the chain is fixed If so, what is the cause of the fixation (see Table 1) First, the motility of the incus and malleus is ascertained Is the fixation in the epitympanum and, if not, where (Figure 7)? Drilling away the bone over the malleus head and body of the incus provides the required exposure to explore this area Is the stapedial tendon ossified? If the stapes is fixed, mobilization may produce a sustained improvement Alternatively, a stapedectomy using a replacement prosthesis with an oval window tissue graft to Table Congenital Atresia Classification Class I a Aerated normal middle ear space b Developed oval window with mobile stapes c Oval window not obstructed by facial nerve Class II a Narrowed, but aerated, middle ear space b Fixed stapes, oval window aplasia c Oval window not obstructed by facial nerve Class III a Nonaerated, hypoplastic middle ear space b Oval window obstructed by facial nerve c Tegmen low hanging, obstructs access to middle ear space Figure A coronal computed tomographic scan in a patient with a congenital conductive hearing loss caused by osseous fixation of the malleus head to the lateral epitympanic wall (arrow) 8/21/08 3:54:50 AM CHAPTER 62 / Microtia, Canal Atresia, and Middle Ear Anomalies Figure Costal cartilage framework for repair of right microtia Sixth and seventh rib cartilage is used to recreate the antihelix and conchal bowl; eighth rib cartilage is thinned and sutured to sixth and seventh rib cartilage to serve as the helical rim prevent a perilymphatic leak may be performed In some cases, the surgeon may elect to defer stapes surgery until the child is grown A gap interrupting the ossicular chain’s continuity occurs most commonly at the incudostapedial joint, either owing to absence of the lenticular process or long process of the incus or the stapes arch The presence of a mobile stapes facilitates the surgery and greatly improves the operative result A variety of techniques have proven useful in the restoration of ossicular chain continuity by means of bridging an existing gap If there is a small distance between the stapes capitulum and the long process of the incus, a tragal cartilage graft can successfully negotiate the gap Deficiencies of the long process of the incus can be corrected by either interposing the reshaped incus between the mobile stapes and the malleus handle or using an alloplastic prosthesis designed for this purpose (type III tympanoplasty) When the stapes arch is absent, similar procedures can be performed to bridge the gap from either the malleus handle or the undersurface of the drumhead to the mobile footplate (type IV tympanoplasty) A coexisting fixation of the stapes or obstruction of the oval window by the facial nerve increases the technical difficulty, yields poorer hearing results, and increases the chance of complications, such as sensorineural hearing loss or facial nerve injury.20 Surgery for Microtia and Canal Stenosis or Atresia Congenital malformations of the auricle, external canal, and middle ear may occur as isolated abnormalities or in various combinations Reconstruction of the external ear is usually performed by a plastic surgeon, whereas external auditory canal and middle ear defects are BDBK005-CH62.indd 763 763 Figure 10 Prior to the second-stage procedure, the lobular remnant is displaced anteriorly and is separate from the tail of the neohelix Figure At the conclusion of the first stage, the framework has been placed and suction drains coapt skin to the framework corrected by the otologist; both work as a team to achieve the optimal result Microtia surgery is technically difficult, and not infrequently, the results are somewhat disappointing The surgery should be performed by individuals with special expertise.21 Auricular reconstruction is an elective procedure The deformity can usually be masked by a longer hair style Generally, the slight deformity of a grade I microtia may be cosmetically acceptable Reconstruction of a moderately deformed grade II microtia must be individualized Correction of a severe grade III microtia requires several staged procedures Treatment of microtia must begin with a frank discussion of the surgical and nonsurgical options with the patient’s parents, as well as surgical timing considerations Generally, surgery is deferred until the child reaches to years of age Prior to this, the contralateral ear is undersized and underdeveloped and available costal cartilage is limited; moreover, the child is not sufficiently mature to comply and assist with postoperative care Significantly, children younger than years of age generally have not been stigmatized because of their deformity by their peers The standard surgical technique for microtia reconstruction has been well-described by Tanzer22 and subsequently refined by Brent.23 During the first stage, costal cartilage is harvested from the contralateral sixth to eighth ribs using a curvilinear incision near the medial aspect of the costal margin A template based on the contralateral ear is made from sterilized, exposed radiographic film and accurately copies the contour and size of the pertinent structures of the normal auricle (Figure 8) Using the template as a guide, the appropriate sections of costal cartilage are harvested The medial portion of the seventh rib will serve as the posterior rim of the conchal bowl and superior crus, and the synchondrosis between the sixth and seventh ribs is harvested en bloc with the seventh rib and is later sculpted to serve as the inferior crus A segment of the eighth rib is harvested separately and is used to Figure 11 At the conclusion of the second stage, the lobule has been transposed using a Z-plasty technique 8/21/08 3:54:51 AM 764 PART IV / Pediatric Otorhinolaryngology injury is identified If small, a red rubber catheter is placed through the pleural tear, and a purse string suture is placed around the periphery of the tear The suture is then tied as suction is applied through the catheter as it is withdrawn Patients are followed by serial chest X-rays to ensure that a pneumothorax does not develop Larger pleural injuries may require chest tube placement The individual pieces of cartilage are then carved using the template as a guide Finally, the eighth rib is thinned to allow it to be curled around the conchal and antihelical framework, and the two pieces are sutured to each other with clear nylon sutures It is important when constructing the framework to exaggerate features, as these will be blunted by the thicker temporal skin Next, the unusable portion of microtic appendage is removed, generally consisting of the superior “knot” of deformed cartilage; the inferior portion is retained for later reconstruction of the lobule Using the contralateral ear as a guide, the ideal position of the reconstructed auricle is determined and marked A cm curvilinear incision is then made approximately cm above the location of the superior part of the helix, and a subcutaneous dissection is performed under the markings for the auricle location and carried approximately cm beyond these markings to allow for appropriate skin draping The framework is then carefully positioned in the skin pocket, with care taken to ensure proper positioning and orientation Residual cartilage is banked subcutaneously under hair bearing temporal skin Two mm drains are then positioned to coapt the skin to the framework and to evacuate any blood or serum and are left on gentle (A) (B) (C) (D) Figure 12 During the third stage of microtia repair, the framework is elevated from the temple, the posterior scalp is advanced into the postauricular sulcus and the bare areas of the auricle and sulcus covered with a skin graft construct the helical rim which generally requires at least an cm long segment Great care is taken to dissect in a subperichondrial plane on the deep side to avoid puncture of the parietal pleura and a pneumothorax Once all cartilage is harvested, meticulous hemostasis is ensured The wound is then filled with warm, sterile saline, and positive pressure ventilation manually applied and held by the anesthesiologist for 10 seconds If no bubbles indicative of an air leak are observed, the wound is drained and closed in layers; however, if an air leak is identified, the site of pleural Figure 13 Healed auricle after three stages of repair, prior to atresia repair Blue dotted line indicates incision that will be made for the atresia repair BDBK005-CH62.indd 764 Figure 14 Placement of osseointegrated implants for attachment of a prosthetic pinna (A) The percutaneous abutments and associated wire framework used to attach the right prosthetic pinna via clips (B) The normal left pinna can be seen (C) The right prosthetic pinna in place It should be noted how similar the prosthesis appears compared to the normal pinna seen in B (D) Oblique view of the prosthetic pinna (Published with permission, copyright © 2007 P A Wackym, MD.) 8/21/08 3:54:55 AM CHAPTER 62 / Microtia, Canal Atresia, and Middle Ear Anomalies Figure 15 Surgery for canal atresia A postauricular incision is made While exposing the mastoid cortex and dysmorphic tympanic bone, the previously implanted cartilaginous auricular scaffold should be protected during retraction Figure 17 Drilling is continued until a normal-sized middle ear opening has been created Great care is taken not to drill on a mobile, deformed, but intact ossicular chain The anteriorly coursing facial nerve is identified suction for to days (Figure 9) The incision is closed with nylon suture Two to three months after the first stage, lobule creation can be performed Essentially, Z-plasty double transposition flaps reorient the vertically positioned skin tag to align with the inferior part of the helical tail while the skin from this area is transposed anteriorly to close the donor site (Figures 10 and 11) In conchal remnant microtias, transposition of the remnant can construct an inferior conchal bowl, lobule and, occasionally, an antitragus Two to three months later, the third stage of reconstruction is performed A split thickness skin graft (0.015 to 0.020 in thick) is harvested from the posterior aspect of the thigh An incision is then made approximately to 10 mm peripheral to the buried framework, from the anterior part of the helix down to the repositioned lobule The framework is then elevated, leaving a generous amount of scar and subcutaneous tissue on the medial aspect of the framework The banked costal cartilage is retrieved and sutured to the anteromedial aspects of the framework to maintain lateralization Posteriorly the scalp is undermined widely and advanced into the postauricular sulcus, and the portions of the sulcus and auricle still bare are covered with the skin graft A bolster dressing is placed into the postauricular sulcus and left for week (Figure 12) Atresia repair can be performed to months later (Figure 13) An additional stage can reconstruct the tragus using a portion of the contralateral conchal bowl as a composite graft several months after atresia repair Alternatives to this standard approach for reconstruction exist An externally mounted prosthesis can be modeled on the normal ear and can appear quite realistic However, the prosthesis needs to be mounted onto the temporal skin with adhesives on a daily basis Percutaneous osseointegrated implants can be placed into the temporal bone and used to anchor the prosthesis more securely These prostheses need lifetime care They may become dislodged at socially inconvenient times Pediatric patients may find compliance difficult and socially unacceptable; however, the cosmetic result can be vastly superior compared to the multistage reconstruction approach (Figure 14) Nagata has described a two-stage procedure using autologous rib cartilage.24 This is a technically challenging procedure, and results may not be as predictable as the Tanzer/Brent method Finally, a single stage procedure has been described using a porous high density polyethylene custom implant covered by a temporoparietal fascia flap and split thickness skin graft.25 While results can be good, if flap failure occurs early, salvage may be difficult Additionally, trauma to the implant can lead to framework cracking, and even minor injuries can lead to skin loss, implant exposure, and chronic infection Exposure of the synthetic framework to the mastoid cavity can lead to chronic implant infection and recurrent drainage, and the prior use of a temporoparietal fascia flap limits the tissue available for salvage Figure 16 Construction of a canal is begun by drilling between the glenoid fossa anteriorly and the superior temporal line The latter roughly corresponds to the tegmen (floor of the middle cranial fossa) When possible, entry into the mastoid air cells is avoided TMJ = temporomandibular joint Figure 18 The ossicular chain is reconstructed by interposing the malformed, sculpted ossicle onto the stapes Silastic sheeting, 0.005 in thick, is positioned to prevent bony ankylosis BDBK005-CH62.indd 765 765 Figure 19 Temporalis fascia is used to construct a tympanic membrane The timing of the microtia and atresia repairs requires close communication between the surgeons Because scarring interferes with the auricular repair, reconstruction of the atresia is deferred until the auricular cartilaginous scaffolding is completed However, it is important to position the reconstructed auricle correctly so that it aligns with the meatal opening and the middle ear The meatal, canal, and middle ear reconstruction is frequently performed as part of the second or third stage of the auricular reconstruction.13,26 A postauricular approach is used, with great care being taken to avoid exposing the scaffold (Figure 15) Temporalis fascia is harvested for reconstruction of the tympanic membrane The periosteum of the lateral surface of the temporal bone is elevated A bony circular canal is created by drilling between the glenoid fossa anteriorly and the tegmen plate superiorly while trying to avoid entering mastoid air cells posteriorly (Figure 16) Continuous suction irrigation cools the bone and clears away blood and bone dust while the water enhances the translucency of the wet bone This permits visualization of structures such as dura, facial nerve, and glenoid fossa through the intact thinned bone The surgeon should anticipate that the facial nerve will be located more anteriorly and more laterally than in the normal temporal bone The nerve frequently follows a C-shaped path in its course between the geniculate ganglion and its point of emergence from the temporal bone The purposeful identification of the facial nerve will prevent inadvertent injury A facial nerve monitor may facilitate identification of the nerve in atretic ears Visualization of the facial nerve as a landmark permits the opening of the atresia plate to approximate the size of a normal middle ear opening While drilling on this plate, it must be remembered that the malleus handle may be fused to it Precautions must be taken to avoid drilling on the mobilized atresia remnant since this may transmit traumatic vibratory energy through the ossicular chain to the inner ear and result in a permanent sensorineural hearing loss (Figure 17) The status of the ossicular chain is assessed If the stapes is mobile, an appropriate ossicular reconstruction is performed (Figure 18) If it is fixed or the oval window is obscured by the facial nerve, the ossicular reconstruction should be deferred Temporalis fascia is used to fabricate a 8/21/08 3:55:05 AM 766 PART IV / Pediatric Otorhinolaryngology Figure 20 A meatal opening is made through the imperforate conchal skin A rectangular, anteriorly based skin flap is debulked and rotated to line the anterior lateral third of the new canal new tympanic membrane (Figure 19) A meatal opening is made in the area of the imperforate concha, incising the skin to create a rectangularly shaped, anteriorly based conchal skin flap The underlying cartilage and soft tissue are removed to debulk the flap and create an opening that communicates with the drilled out external canal (Figure 20) The conchal flap is rotated to resurface the anterior third of the external canal and is stabilized by suturing it to the adjacent soft tissues (Figure 21) A thin split-thickness skin graft is harvested from the lower part of the abdomen and is used to resurface the remaining ear canal The canal is packed snugly with Gelfoam (Upjohn, Kalamazoo, Michigan) to compress the skin graft against the underlying bone and soft tissue The postauricular incision is reapproximated using absorbable sutures Risks and Benefits of Atresia Surgery Atresia surgery is technically demanding The results achieved are directly related to the experience and skill of the operating surgeon Generally, hearing improvement to a serviceable level can be achieved in approximately 65 to 75% of selected patients.27,28 Complications of surgery include the small risk of facial paralysis, a severe to profound sensorineural hearing loss, stenosis requiring additional surgery, persistent otor- rhea, and tympanic membrane graft failure with perforation In children with a unilateral atresia and a normal contralateral ear, surgery may not be routinely indicated.19 The potential benefit of this sophisticated surgery, that is, achieving binaural hearing, may not justify the risk of complications In binaural cases, the successful creation of an external canal, even when hearing cannot be improved, will allow the use of an ear-level airconduction hearing aid to restore hearing without using a cumbersome bone-conduction aid Thus, in bilateral cases in which the facial nerve obstructs the oval window or when a hearing improvement cannot be achieved, providing the patient with a stable, skin-lined canal is a worthy goal in and of itself Another hearing restorative technique for external auditory canal atresia is the placement of a bone anchored hearing aid (BAHA).29 This procedure involves implanting a titanium post which becomes osseointegrated into the calvaria A special hearing aid is attached to this post via a percutaneous abutment and uses bone conduction to stimulate the cochlea The titanium post requires a 3-month period for osseointegration in an adult and a 4- to 6-month period for children, before the external appliance can be attached to the abutment The use of the BAHA Figure 21 A thin, split-thickness skin graft harvested from the lower part of the abdomen is used to resurface the remainder of the canal Handling and placement of the graft are facilitated by gluing the epidermal surface to thin (0.005 in.) Silastic sheeting The raw surface of the graft is compressed against the bone by filing the canal lumen with Gelfoam BDBK005-CH62.indd 766 requires at least a bone conduction threshold in one ear to be at a minimum of 40 to 45 dB to be effective In adults, placement of the BAHA is usually performed in a one-stage procedure to implant the titanium post and abutment In children, the two-stage procedure can be employed which involves the placement of the post only and allowing it to osseointegrate for to months A second stage is then carried out which includes the thinning of the skin flap for efficient transduction as well as placement of the percutaneous abutment The external processor is fitted to weeks after the skin flap heals Frequently, a second “sleeper” fixture is placed at the same time, which allows its immediate use in the future should the first fixture ever extrude or fail to osseointegrate The BAHA system has some distinct advantages which make this procedure a viable option for atresia patients The hearing result with the BAHA is superior to an atresia repair which usually results in a mild conductive hearing loss in the best circumstances Furthermore, this procedure poses no risk to the facial nerve and is not dependent on a patent external auditory canal Succcesful atresia surgery involves a split-thickness skin graft to resurface the bony canal This may require that the child take water precautions to keep the ear dry This is not a problem with the BAHA Drawbacks include failure to osseointegrate, loss of post fixation over time, and periodic infections around the abutment if daily cleaning is not performed In addition, there are the cosmetic issues of a permanent percutaneous abutment and the depilated skin around the fixture The cosmetic issue is usually more of a concern for boys or for girls with short hair as the abutment is more apparent in these situations REFERENCES Lefebvre PP, Malgrange B, Staecker H, et al Retinoic acid stimulates regeneration of mammalian auditory hair cells Science 1993;260:692–5 Anson BJ, Davies J, Duckert LG Embryology of the ear In: Paparella MM, Shumrick DA, Gluckman JL, et al, editors Otolaryngology, 4th edition Philadelphia: JB Lippincott; 1991 p 3–21 Williams GH Developmental anatomy of the ear In: English GM, editor Otolaryngology Philadelphia: JB Lippincott; 1990 Nager GT, Proctor B Anatomic variations and anomalies involving the facial canal Otolaryngol Clin North Am 1991;24:531–53 Snow JB Preface Otolaryngol Clin North Am 1992;25: xv–i Jafek BW, Nager GT, Strife J Congenital aural atresia: Analysis of 311 cases Trans Am Acad Ophthalmol Otolaryngol 1975;80:580–95 Sando IS, Shibahara Y, Wood RP Congenital anomalies of the external and middle ear In: Bluestone CD, Stool SE, editors Pediatric Otolaryngology Philadelphia: WB Saunders; 1990 p 271–302 Bergstrom LB Anomalies of the ear In: English GM, editor Otolaryngology Philadelphia: JB Lippincott; 1990 Teunissen EB, Cremers CWRJ Classification of congenital middle ear anomalies Report on 144 ears Ann Otol Rhinol Laryngol 1993;102:606–12 10 Jahrsdoerfer RA, Yeakley JW, Aguilar EA, et al Grading system for the selection of patients with congenital aural atresia Am J Otol 1992;13:6–12 11 Schuknecht HF Congenital aural atresia Laryngoscope 1989;99:908–17 8/21/08 3:55:16 AM CHAPTER 62 / Microtia, Canal Atresia, and Middle Ear Anomalies 12 Curtin HD Congential malformations of the ear Otolaryngol Clin North Am 1988;21:317–36 13 Jahrsdoerfer RA, Garcia ET, Yeakley JW, et al Surface contour three-dimensional imaging in congenital aural atresia Arch Otolaryngol Head Neck Surg 1993;119:95–9 14 Andrews JC, Anzai Y, Mankovich NJ, et al Threedimensional CT scan reconstruction for the assessment of congenital aural atresia Am J Otol 1992;13:236–40 15 Jahrsdoerfer RA, Yeakley JW, Hall JW, et al High-resolution CT scanning and auditory brain stem response in congenital aural atresia: Patient selection and surgical correlation Otolaryngol Head Neck Surg 1985;93:292–8 16 Granstrom G, Bergstrom K, Tjellstrom A The boneanchored hearing aid and bone-anchored epithesis for congenital ear malformations Otolaryngol Head Neck Surg 1993;109:46–53 17 van der Pouw KT, Snik AF, Cremers CW Audiometric results of bilateral bone-anchored hearing aid application in BDBK005-CH62.indd 767 18 19 20 21 22 23 patients with bilateral congenital aural atresia Laryngoscope 1998;108:548–53 Tjellstrom A, Hakansson B The bone anchored hearing aid (BAHA) design principles, indications and longterm clinical results Otolaryngol Clin North Am 1995; 115:1–20 Trigg DJ, Applebaum EL Indications for the surgical repair of unilateral aural atresia in children Am J Otol 1998;19:679–84 Jahrsdoerfer RA, Lambert PR Facial nerve injury in congenital aural atresia surgery Am J Otol 1998;19:283–7 Chandrasekhar SS, De la Cruz A, Garrido E Surgery of congenital aural atresia Am J Otol 1995;16:713–7 Tanzer RC Microtia: A long-term follow-up of 44 reconstructed auricles Plast Reconstr Surg 1978;61:161–4 Brent B Technical advances in ear reconstruction with autologous rib cartilage grafts: Personal experience with 1200 cases Plast Reconstr Surg 1999;104:319–24 767 24 Nagata S A new method of total reconstruction of the auricle for microtia Plast Reconstr Surg 1993;92:187–93 25 Romo T, Fozo M, Sclafani AP Microtia reconstruction using a porous polyethylene framework Facial Plast Surg 2000;16:15–22 26 Bellucci RJ Congenital aural malformations: Diagnosis and treatment Otolaryngol Clin North Am 1981;14: 95–124 27 Shih L, Crabtree JA Long-term surgical results for congenital aural atresia Laryngoscope 1993;103:1097–102 28 Lambert PR Congenital aural atresia: Stability of surgical results Laryngoscope 1998;108:1801–5 29 Wazen JJ, Caruso M, Tjellstrom A Related articles, Longterm results with the titanium bone-anchored hearing aid: The U S experience Am J Otol 1998;19:737–41 8/21/08 3:55:20 AM BDBK005-CH62.indd 768 8/21/08 3:55:20 AM Index Bronchial thermoplasty use in therapeutic bronchoscopy, 972 Bronchiectasis, 965 Bronchogenic carcinoma/lung cancer, 966 Bronchology, overview of, 963 Bronchoscopic airway evaluation, 808 Bronchoscopy training of, 973 Brow ptosis, 743, 744f Brow-tip aesthetic lines (BTALs), 639, 640f Buccal space infection, 786 Buccopharyngeal fascia—of deep cervical fascia, 510 Bulbous nasal tip, 647, 648f Burning mouth syndrome, 476 Burns, 193 C Caloric testing, 138-39 CAM See Complementary and alternative medicine Canal cholesteatoma, 196-97 Canal stenosis See Atresia Canal Wall Down Mastoidectomy, 226-27, 226f Canalicular adenoma, 1136 Cancer immunotherapy, mechanistic goal of, 1055 Cancer development of, 997-98 progression model of, 1013 therapy dealing with tumor immune evasion, 1009-11 Candida albicans, 778 Candidiasis, 892 Canine space infection, 786 CAPD See Central auditory processing disorder Carbon dioxide laser, 713-14 Carcinoma in situ treatment outcomes, 1127 Carotid arteries relationship with optic nerves, 513-14 Carotid artery pain, 588-89 Cartilage-incision technique, 628 Cartilage-sparing technique, 628 Causes of common cold, 519-20, 522t epistaxis, 551, 551t facial paralysis, 395 gustatory dysfunction, 475-78 headaches, 585 infectious rhinitis, 559, 559t laryngeal paralysis, 924-25 laryngeal stenosis, 901 midface (Le Fort) fractures, 691 muscle misuse disorders of larynx, 931-32 olfactory dysfunction, 468-72 otitis media, 519, 519t prenatal airway compromise, 805 rhinitis, 522t sinusitis, 522t supraglottitis, 527t supralaryngeal airway obstruction, 809-12 Cavernous sinus thrombophlebitis, 501, 502f CD44 (adhesion molecule), 1015-16 Cell adhesion molecules involved in, 1001-2 Cell density hair, 91-93 Cell migration, 93 Cell proliferation, 93 Cell-mediated immune responses, 490-91 Central airway obstruction, use in therapeutic bronchoscopy, 971 Central apnea, 794-95 Central auditory pathway, 60-62 BDBK005_Index.indd 1195 Central auditory processing disorders (CAPD), 111-12, 215 Central auditory processing, 108-10 Central nervous system (CNS), 101 presbyastasis, examination of, 340 Central skull base examination of, 510-514 mass lesions of, 512 Central sleep apnea syndromes, 988 Central vestibular disorders, 345-46 Cephaloceles, 505-10 Cerebellopontine angle as intracranial tumor cause, 415 Cerebral cortex, 107 Cerebral palsy associated with obtrusive sleep apnea, 791 Cerebrospinal fluid (CSF), 84, 615-17 Cerebrospinal fluid leaks, 505-10 Cervicogenic headache, 590-91 Cetuximab (Erbitux; IMC-225), 1037 Characteristics of aphasia, 873 autophony, 327, 328 childhood fluency disorders, 871 craniofacial anomalies, 871 craniofacial muscles, 872 primary vestibular neurons, 70 speech language impairment, 869-70 speech sound disorders, 868-69 voice disorders, 873-74 CHARGE association, 760 Cheek defects, 723-24 Chemical peeling, 712 Chemical senses, 465 Chemodenervation, 410 Chemoradiation clinical trials, 1045-47 Chemotherapy anterior skull base neoplasms, 1078 Childhood fluency disorders, 871-72 Chin augmentation, 754-55 Chloramphenicol, 277 Cholesteatoma, 217, 219-22 atticotomy, 225 biofilms in, 842-43 Cholesterol granuloma, 224 Chondroma, 879-80 Chondrosarcoma, 430-31 Chordomas, 430, 835 Chronic conditions, overview of, 557 Chronic invasive FS, 504 Chronic myeloid leukaemia (CML), 1035-36 Chronic otitis media (COM), overview of, 217 Chronic rhinosinusitis (CRS), 502-4, 573 anatomic factors associated with, 574 bone inflammation associated with, 574 due to biofilms, 574 due to dentigerous sinusitis, 575 Chronic sialadenitis, 1133 Chronic sinusitis, 501, 502f, 504f See also Acute sinusitis Chronic tonsillitis/persistent tonsillar infection, 776 Cicatricial pemphigoid, 895 Ciliary beat frequency as a mucociliary function test, 558 Classification of AIED, 308 facial pain, 583-84 fractures mandible, 679-80 maxillary (Le Fort), 691-92 gustatory disorders, 474-75 headache, 583-84 laryngeal muscle patterns, 935-40 local flaps, 717-21 Menière disease, 314t 1195 neck, 751, 752 olfactory disorders, 466 Claudin 14, 38 Cleft lip, 835-37 Cleft palate, 837 Clinical applications acoustic rhinometry, 495 nasal mucociliary clearance (NMCC), 498 nasal peak flowmetry, 497 rhinomanometry, 496-97 rhinostereometry, 497 Clinical assessment/evaluation/examination airway, 903-4 aphasia, 873 childhood fluency disorders, 871-72 chronic rhinosinusitis, 577-78 craniofacial anomalies, 871-72 craniofacial muscles, 873 dysphonia, 916 speech language impairment, 870 speech sound disorders, 869 voice disorders, 874 Clinical importance of allergic rhinitis, 532-33 Clinical laryngology, 943 Clinical manifestations hypopharynx squamous cell carcinoma, 1115 oropharynx squamous cell carcinoma, 1107-8 Clinical presentation allergic rhinitis, 538-39 anaplastic thyroid carcinoma, 1165 associated with epistaxis, 552-53 BPPV, 322 Menière disease, 314-15 otosclerosis, 248 thyroid lymphoma of thyroid glands, 1168 vestibular migraine, 319-20 vestibular neuritis, 317 VS, 419-21 Clinical protocols intratympanic gentamicin therapy, 84-85 Clivus lesions, 416-17 Clonal selection, 482 Cluster headaches, 587 Coccidioides immitis, 893 Coccidioidomycosis, 522 Coccidioidomycosis, 893 Cochlea, 3f, 4, 5-6 coding 52-53 electrical potentials, 50-51 functions of, 48-49 tuning of, 53-55 Cochlear auditory prostheses, 363 Cochlear implantation in hearing loss surgery, 179-80 Cochlear implants, 363, 389 biofilm formation on, 843-44 coding strategies, 390-93 considerations, 384-85 engineering structure, 389-90 programming, 393-94 Cochlear nucleus auditory deprivation effects, 109 central auditory processing, 108-9 Cochlear transduction process, 50 Cochlear transmitters, 51-52 Cochlin, 39 Cogan syndrome, 308, 309 Columella, 640, 658 reconstruction of, 672-74 Columellar strut graft, 649-50, 650f Colymycin, 277 Combined chemotherapy, 1044, 1045t Common cold, 519-520, 522t 8/27/08 10:57:47 PM 1196 Index Compete mastoidectomy, 225, 225f Complement soluble proteins, 485-86 Complete tracheal rings as a supralaryngeal airway obstruction cause, 811-12 Completely-in-the canal hearing aids, 123-24 Complications anterior skull base neoplasms, 1078-79 due to blepharoplasty, 746-47 brow and forehead lift, 746 associated with chronic otitis media surgery, 177-78 chronic otitis media, 177, 229 cochlear implantation, 384 cranial in OM, 231-34 deep neck space infections, 786 feeding tubes, 1067-68 intracranial in OM, 234-37 orbital rhinosinusitis, 568-70 for rigid bronchoscopy, 968, 969 squamous cell carcinoma, 1118 stapedectomy surgery, 250-51 associated with transnasal esophagoscopy, 977 associated with tympanoplasty, 244 intratympanic gentamicin therapy, 85 lower face and neck rejuvenation, 755-57 midface, 747-48 cholesteatoma, 222 COM, 222 OM, 215-16 otoplasty, 631 pediatric fractures, 686-87 percutaneous tracheostomy, 907-8 salivary gland disease treatment, 1140 scar revision, 709 stapes surgery, 175 tracheostomy, 906-7 wound healing, 704-6 Computed tomography (CT) application in laryngeal cancer diagnosis, 1122 brain with hypointense pus, 236f preoperative rhinosinusitis evaluation, 596-97 projections of temporal bone, 147-50 for rhinosinusitis, 501, 46.1 superior semicircular canal dehiscence syndrome, 328f skull base surgery, 415 superior semicircular canal dehiscence, diagnosis of, 329 temporal bone, 146-50 techniques, 1029-32 vestibular neuritis, 318 Computer-guided endoscopic sinus surgery (CGESS), 797-98 Computerized dynamic posturography sensory organization test (SOT) conditions, 142f Computerized dynamic posturography, 142 Concha bullosa, 502, 504f Conductive hearing loss, types of, 173-75 Confocal laser scanning microscopy (CLSM), 844 Congenital cholesteatoma, 20, 219 Congenital high airway obstructive syndrome (CHAOS), 805 Congenital otosclerosis, 22 Congenital sinuses, 197 Congential atresia classification, 762t Connections primary vestibular neurons, 70 Connexins, 36 Continuous positive airway pressure (CPAP), 805 Contraindications flexible fiberoptic bronchoscopy, 968 BDBK005_Index.indd 1196 intratympanic gentamicin therapy, 85 rigid bronchoscopy, 967 Converse-Hogan open sky technique, 696, 696f Corti, organ of, 24-25, 25f, 102 Cortical auditory pathways, 262 Corticosteroids for ISSNHL, 281 Corynebacterium diphtheriae, 812 Costimulatory receptor loss, 1006 Covering flaps application in nasal skin repair, 664 Coxsackie A virus, 778 Cranial neuralgias, 591-92 Craniofacial anomalies, 871 Craniofacial muscles, 872-73 Craniofacial syndromes—associated with obtrusive sleep apnea, 791 Craniopharyngiomas, 835 Cricoarytenoid joint fixation, 911-12 Cricoarytenoid joint, 911 Cricothyroid muscle, 851 Cricothyroidotomy, 905 Cristae ampullaris, development, inner ear, 24, 24f Cristae, 8-10, 8f See also Maculae Cromolyn sodium for allergic rhinitis treatment, 543 Crouzon disease, 22 Crouzon syndrome (CS), 290-92 CRS See Chronic rhinosinusitis Cryotherapy use in therapeutic bronchoscopy, 970 Cryptococcosis, 525 CSF leak, 234 in enchondral bone of inner ear, 260-61 CSF See Cerebrospinal fluid Cutaneous defects repair of, 671 Cutaneous pedicle melolabial interpolated flap, 666-67 Cyanosis, 756 Cyberknife stereotactic radiosurgery, 452-53 Cysteinyl leukotrienes use in allergic rhinitis treatment, 535 Cystic fibrosis associated with respiratory infections, 559 Cystic hygroma, 830 Cystic lesions in ear, 198 Cysts, 167 in ears, 197 Cytokine immunostimulation, 1058-59 Cytokine signaling OM, 30-31 Cytokines, 490 involved in angiogenesis in HNSCC, 1002 involved in inflammation in HNSCC, 1002 as mediators of allergic inflammation, 534 Cytomegalovirus, 778 Cytoskeletal proteins, 38-39 Cytotoxic T cells, 488 Cytotoxic T lymphocyte antigen-4 (CTLA-4), 1059 D Dacron bolster, 696 Damage ear, 265 Daytime symptoms, 790 Deafness syndrome, 37 Deafness, 289 Decompression of endolymphatic Sac, 178-79 Decongestants for allergic rhinitis treatment, 541 Decreased sound tolerance medical conditions, 353, 353t Dedo classification, 752, 752f Degeneration cochlear hair cells, 294 Delivery methods RWM, 81-82 Delivery modalities of gene therapy, 86-87 Demographics anaplastic thyroid carcinoma, 1165 Dental injury, 685-86 Dental occlusion classes, 678 Dental occlusion, 677-79 Deoxyribonucleic acid (DNA), 997 Department of Otolaryngology and Communication Sciences, 950-51 Dermabrasion (resurfacing technique), 708 Dermis, 699 See also Epidermis Dermoid cysts, 832 Detection of HNSCC tumors, 1013-17 Devices pediatric cochlear implants, 372-76 Diagnosis AIED, 307-8 allergic rhinitis, 539-510 atresia, 817 auditory processing disorders (APDs), 9.7 aural atresia, 760-62 BPPV, 322-23 cholesterol granuloma, 224 chronic rhinosinusitis, 573 COM, 222-23 cranial complications in OM, 230-31 deep head infections, 784 differential ISSNHL, 280 skull base tumors, 414 rhinitis, 557t, 557 facial pain, 584 headache, 584, 585f hearing impairment, 298-300 HNSCC, 1002-3 hypopharynx squamous cell carcinoma, 1115 intracranial complications in OM, 230-31 laryngeal cancer, 1121-22 laryngeal clefts, 820 laryngeal trauma, 899-900 laryngoceles, 819 laryngomalacia, 816 laryngopharyngeal reflux (LPR) ancillary testing, 887-88 laryngotracheal stenosis (LTS), 908 mandibular fractures, 680 Menière disease, 315 meningioma, 425-26 microtia, 760-62, 761f midface fractures, 692 molecular HNSCC, 1013 neck mass, 780 neck space infections, 784 obtrusive sleep apnea, 792 OM, 211-12 oropharyngeal malignancies, 1108-9 patient with dizziness, 135-44 PLF, 284-86 primary hyperparathyroidism, 1171 principles contact granulomus, 881 laryngoceles and saccular cysts, 880 phonotraumatic vocal-fold lesions, 877 recurrent respiratory papillomatosis, 879 8/27/08 10:57:48 PM Index reinke edema, 882 sulcus vocalis and vocal-fold scar, 881 rudimentry epiglottis, 817 saccular cysts, 819 stenosis, 823 subglottic hemangioma, 824 thyroid lymphoma of thyroid glands, 1168 vestibular migraine, 320 vestibular neuritis, 317-18 vocal fold paralysis, 821 webs, 818 WS, 293t zygomatic fractures, 688 Diarrhea, 1068 Diffusion-weighted imaging (DWI) of temporal bone, 151 Digital hearing aids, 124 Diphtheria, 526, 890 Direct laryngoscopy, development of, 956 See also Indirect mirror laryngoscopy, development of Direct laryngoscopy techniques for, 961-62 Directional microphones, 124 Diseases ear, 305 granulomatous salivary glands, 1134 inflammatory salivary glands, 1131-34 Disinfectants for otomycosis, 277 Displacement of cochlear partition, 103 Disposable and instant fit hearing aids, 124 Dix-Hallpike maneuver for BPPV diagnosis, 322 Dizziness, 131 See also Vertigo Dizziness, 343 Dome binding, 648 Door jam, 658 Dorsal hump reduction, 652-55 Dorsal profile, 637 Dosing intratympanic corticosteroids, 83 Down syndrome associated with obtrusive sleep apnea, 791 Drooling, 782 Drug-induced rhinitis, 561 Ductal papilloma, 1137 Dynamic nasal valve collapse, 643 Dysfunction eustachian tube, 201-8 middle ear, 48 E Ear canals, 54, 127 Ear lobe deformity due to excessive closure of line tensions, 757 Ear selection cochlear implant candidates, 369-70 Ear system, 47-48 Ear infected bone studies, 218 bone diseases ossicular chain development influence, 22 components, 17 defects, 627-28 disorders, inflammatory and infectious, 193-98 foreign bodies, 192 high-frequency force production, 101 malformations, 25-26 Early life exposures associated with allergic rhinitis, 531-32 Earwax removal, 91-92, 191-92 Ectopic thyroid tissue, 830 BDBK005_Index.indd 1197 Edentulous mandible, 679 Efferent auditory pathways, 7, 7f, 12 Efferent innervation of vestibular system, 72 Efferent synapses in OHC, 105 EGFR See epidermal growth factor receptor Elective neck dissection, 1099 Elective tracheostomy, 807-8 Electric and acoustic stimulation (EAS), 392 Electrical suppression for tinnitus treatment, 354-55, 354t Electrocoagulation use in therapeutic bronchoscopy, 969 Electrocochleography (ECochG) waveforms, 119f Electrocochleography, 119f, 120 BPPV, 324 for PLF diagnosis, 284-85 for vestibular migraine diagnosis 320 Electroglottography (ECG), 864 Electromyographic (EMG) evaluation, 916 Electromyography (EMG) for facial nerve function, 403 Electron microscopy for mucociliary function, 558 Electroneuronography (ENOG), 259 for facial nerve function, 402-3 facial paralysis, 398 Electronystagmography (ENG) of vestibular function, 340 for vestibular neuritis diagnosis, 318 Electrophysiological recordings, 118 Elemental heavy metal toxicity, 782 Embolization for epistaxis, 553-54 Embryogenesis, 829 Embryology aberrant thyroid tissue, 831 atresia, 759-60 ear, 627 esophagus, 848 ethmoid sinuses, 456 frontal sinuses, 456 larynx, 847-48, 849f lungs, 848 maxillary sinuses, 456 microtia, 759-60 nose, 455-56 paranasal sinuses, 456 sphenoid sinuses, 456 trachea, 848 Embryonic pinna, 18 Emergent tracheostomy in a neonate, 808 Emotion, 561 Encephalocele, 234, 564-65 Endobronchial ultrasound (EBUS) use in therapeutic bronchoscopy, 972 Endoscopic frontal sinusotomy, 608-10 Endoscopic midface suspension, 746 Endoscopic resection, 1124 Endoscopic sinus surgery simulator (ES3), 798-99 Endoscopic sinus surgery of benign sinonasal neoplasms, 620-23 for CSF leak repair, 615-17 for endoscopic sphenopalatine artery ligation, 624 for fibro-osseous lesions, 620-22 for inverted papilloma, 622-23 for nasolacrimal duct obstruction removal, 619-20 for optic nerve decompression, 619 for orbital decompression, 617-18 of pituitary gland, 624-25 of skull base, 624-25 Endoscopy laryngeal stenosis, 902 of oral cavity cancer, 1096 1197 Endotracheal tubes biofilm formation on, 843 ENOG See electroneuronography Environmental modifications for allergic rhinitis treatment, 540 Eosinophilic chronic rhinosinusitis (ECRS), 576 bacterial superantigen, association with, 576-77 Eosinophilic esophagitis, 978 Eosinophilic rhinitis syndrome, 561 Epidemiology acute rhinosinusitis, 567 AIED, 306-9 allergic rhinitis, 531 aphasia, 873 childhood fluency disorders, 871 cholesteatoma, 219 chronic rhinosinusitis, 573 COM, 217 craniofacial anomalies, 871 craniofacial muscles, 872 decreased sound tolerance, 353 hypopharynx squamous cell carcinoma, 1115 JNA, 1081 laryngeal cancer, 1121 meningioma, 425 NPC, 1082-83 obtrusive sleep apnea, 790 OM, 211 oral cavity cancer, 1092 oropharynx squamous cell carcinoma, 1107 presbyacusis of, 334-35 presbyastasis, 335 speech language impairment, 870 speech sound disorders, 869 tinnitus, 351-52 voice disorders, 873-74 VS, 418-19 Epidermal growth factor receptor (EGFR), 220 Epidermis, 699 See also Dermis Epidural abscess, 236, 570 Epigenetic changes in HNSCC development, 999 Epiglottitis, See Supraglottitis Epistaxis, 551 Epitope, 482 Equipment used in acoustic rhinometry, 494 for flexible fiberoptic bronchoscopy, 968 in nasal peak flowmetry, 497 in rhinomanometry, 495 in rhinostereometry, 497 for rigid bronchoscopy, 967 Erbium:YAG laser resurfacing, 714 Erich arch bars application in mandibular fracture repair, 681-82, 682f Erlotinib, 1037-38 Erysipelas, 560 Erythema multiforme, 779-80 Erythroplakia/ erythroplasia, 1094 Esophageal atresia, 977 Esophageal bleeding, 981 Esophageal diverticula, 979 Esophageal motility disorders, 979-80 Esophageal perforation, 980 Esophageal rings, 978-79 Esophageal strictures, 978-79 Esophageal webs, 978-79 Esophagitis, 978 Esophagology, 975-77 Esophagus anomalies associated with, 977-78 imaging of, 950-53 Esthesioneuroblastoma, 1074-75 Esthesioneuroblastoma, 509, 510f 8/27/08 10:57:48 PM 1198 Index Ethics of clinical trials, 186-87 Ethmoid sinusitis, 501, 503f, 598 Ethmoidectomy use in primary paranasal sinus surgery, 598-99 Etiology AIED, 306-7 anaplastic thyroid carcinoma, 1166-67 aphasia, 873 atresia, 817 aural atresia, 760 childhood fluency disorders, 872-73 chronic rhinosinusitis with nasal polyps, 575-77 chronic rhinosinusitis without nasal polyps, 574-75 contact granulomus, 880-81 craniofacial anomalies, 871 craniofacial muscles, 872-73 decreased sound tolerance, 353-54 deep head infections, 783 hypopharynx squamous cell carcinoma, 1115 ISSNHL, 279-80 JNA, 1081 laryngeal cancer, 1121 laryngoceles and saccular cysts, 880 Laryngotracheal stenosis (LTS), 908 neck space infections, 783 obtrusive sleep apnea, 789-90 OM, 210-11 oral cavity cancer, 1092-93, 1093t oropharynx squamous cell carcinoma, 1107 otosclerosis, 247-48 persistent postoperative rhinosinusitis, 601 phonotraumatic vocal-fold lesions, 877 recurrent respiratory papillomatosis (RRP), 879 Reinke edema, 881 speech language impairment, 870 speech sound disorders, 869 stenosis, 822-23 subglottic hemangioma, 824 sulcus vocalis and vocal-fold scar, 881 tinnitus, 351-52 vocal fold paralysis, 821 voice disorders, 874 Eustachian tube function tests, 204 Euthyroid sick syndrome See Nonthyroidal illness Evaluation BPPV, 322-23 clinical gustatory function, 475 olfactory function, 466-67 cochlear implants, 363-66 in adults, 370 decreased sound tolerance, 354 Menière disease, 315 muscle misuse disorders of larynx, 932-35 NIHL, 269-70 dizziness, 313 esophagus, 977 JNA, 1081-82 NPC, 1083-84 oral cavity cancer, 1095-96 pediatric cochlear implants, 370-72 PLF, 284-86 pretreatment radiation therapy, 1043 skull base neoplasms, 414-17 tinnitus, 353 upper airway, 989 vestibular migraine, 320 vestibular neuritis, 317-18 video swallowing, 950 Evidence-based medicine, 189-90 Evoked otoacoustic emissions, 65 Examination anterior skull base neoplasms, 1071-72 dizziness patients, 132-35 BDBK005_Index.indd 1198 eustachian tube dysfunction, 203 neck, 590 obtrusive sleep apnea, 792 olfactory dysfunction, 468 spontaneous nystagmus, 132-33 TM, 212 Excessive skin closure tension, 757 Exostosis, 198 Experimental research, 185-87 Extended endoscopic frontal sinus procedures, 610-11 External auditory canal (EAC) malformations, imaging of, 154-56 External auditory canal stenosis, 631 of external ear, 18-20, 19f External auditory meatus (EAM), 18 External carotid artery (ECA), 772 External ear auricular development, 17-18 benign neoplasms, 197 development of, 17-20, 17f, 18f determinants, genetic and molecular, 20 malignant neoplasms, 198-99 nerve supply, 4-5 diseases, 14.1-14.8 tumor-like soft tissue lesions, 197 External speech processors for pediatric cochlear implants, 374-75 Extranodal non-Hodgkin lymphoma, 1095 Extrinsic muscles, 850-51 Extubation, 807 Ex-utero intrapartum treatment (EXIT), 805 Eyelet wires, application in mandibular fracture repair, 681 Eyelid abscess, 570 F Facelift incisions, 752, 753f Face topographical regions of, 661-62 youthful and aging, 741, 741f Facial defects repair of, 721-22 Facial fractures principles of, 677t Facial nerve injury, 397 Facial nerve paralysis, 258-60 Facial nerve repair, 397, 402, 408 Facial nerve schawannoma, 429-30 Facial nerve, 13-15, 14f lesions, 418 malformations, imaging of, 167-69 special sensory function, 15 Facial pain, 583 atypical, 592-93 cervicogenic, 590-91 Facial paralysis, 232 Facial paralysis, 395-411 Facial reanimation procedures, 406-10 role of EMG, 408 Facial reconstruction implants biofilm formation on, 843 Facilitatory interactions neurons, 74 Falsetto register in voice disorders, 938 Familial aminoglycoside ototoxicity, 298 Family history associated with allergic rhinitis, 531 Fasciocutaneous flaps, 704, 728-30 FCDTC See Follicular cell derived thyroid carcinoma Feeding tubes, 1066 Fgf3 gene, 35 Fibrocytes implications for presbyastasis and presbyacusis, 340 Fibro-osseous lesions, 620-22 Fibroosseous, 1072 Fibula osteocutaneous flap, 734-36, 736f Filiform papillae, 770 First branchial cleft anomalies, 837 Fishes hair cell regeneration, 90-91 Fistula test for PLF evaluation, 284 Flap delay, 722 Flap designs, 704 Flap physiology, 699, 703-4 Flap prelamination, 722 Flaps biomechanics of, 704 cellular physiology of, 704 Flashlamp pulsed dye (FLPD) laser, 710 Flexible bronchoscopy, 968 Flexible endoscopic evaluation of swallowing (FEES) study, 951-52 Flexible fiberoptic bronchoscopy, 968-69 Flexible nasal endoscopy for preoperative rhinosinusitis evaluation, 596 Flocculonodular lobes, 74 Floor of the mouth (FOM), 773 Fluorescein for fistula detection, 285 Fluorescence in situ hybridization (FISH), 997 Follicular cell derived thyroid carcinoma (FCDTC), 1155-64 See also Anaplastic thyroid carcinoma Folliculitis, 559-60 See also Vestibulitis Forehead-brow-temple defects, 722-25 Foreign body ingestion, 980 Foreign body removal use in therapeutic bronchoscopy, 971 Formula–drug interactions, 1068 Fractional photothermolysis, 714 Fractionated stereotactic radiotherapy, 449-50 Fracture reduction, 677 Fracture repair, principles of, 677t Fractures condylar process, 683 facial, 677 frontal sinus, 697-98 mandible, 679-82 mandible body and angle of, 683 open reduction, 683 pediatric, 686-87 severe, 687 surgical approaches of, 683-85 midface (Le Fort), 691-97 structural pillars, 691-92 nasofrontal-ethmoidal, 695-97 nasofrontal-ethmoidal—reduction of, 696, 695f parasymphyseal area, 682-83 ramus, 683 temporal bone, 256-58 zygomatic, 687-90 Franciscella tularensis, 1134 Free muscle transfer, innervated, 410 Free tissue transfer flaps, 728 Frequency bands, 391, 392 Friedman staging system, 989 Friedman staging, 989 Frontal bone osteomyelitis, 571 Frontal bone nasal process of, 641 Frontal recess, 501f Frontal sinus surgery, 607-8 Frostbite, 193 FS See fungal sinusitis Functional gain measures, 126 Functional magnetic resonance imaging (FMRI), 107-8 8/27/08 10:57:48 PM Index Function of auditory brain-stem responses, 337 of olivocochlear efferent system, 60 of utricle, 68 Fundamental frequency (f0 for vocal function assessment, 861 Fundamental frequency (SDf0 ), standard deviation, 861 Fungal causes bronchitis, 529 pharyngitis, 527 rhinitis, 522 stomatitis, 524-25 Fungal sinusitis (FS), 504-5 Fungiform papillae, 770 Fungus ball, 504-5, 506f Fungus causing bronchitis Candida species, 529 C albicans, 527 causing rhinitis A fl avus, 522 A fumigatus, 522 Absidia, 522 Aspergillus, 522 Coccidioides immitis, 522 Mucor, Rhizomucor, 522 Rhinosporidium seeberi, 522 Rhizopus, 522 causing stomatitis A fumigatus, 525 Aspergillus., 525 B dermatitidis, 525 Candida, 524 Cryptococcus neoformans, 525 fusarium, 525 Geotrichum candidum, 525 Histoplasma capsulatum, 525 Mucorales, 525 Trichosporon, 525 G Galea, 741 Gamma knife radiosurgery, 443-49 Gastroesophageal junction (GEJ), 975 Gastroesophageal reflux (GER), 561, 934 Gastroesophageal reflux disease (GERD), 885-86 as a cause of muscle misuse disorders, 934 Gaze testing, 133 Gefitinib, 1038 Gene expression RNA interference, impact on, 33 Gene products identification of, 20 Gene therapy, 1038 Gene therapy inner ear, 40, 85-87 Gene transfer, 87 Generation of vestibular phase, 75 Genetic abnormality, 289 Genetic changes in HNSCC development, 999 Genetic mutations, 39 Genetics allergic rhinitis, 531 OM, 215-16 Geniculate ganglion hemangioma, 430 Geometric broken line closure technique, 708 See also W-plasty (technique) German measles (rubella) virus, 778 Giant cell arteritis, 588 Glanders, 891 Global gene expression profiling technology, 97 Glomus jugulare, 428-29 BDBK005_Index.indd 1199 Glomus tympanicum, 428 Glossoptosis as a supralaryngeal airway obstruction cause, 809-10 Glottal airflow, 862-63 Glottal compression, 937 Glottic and tracheal foreign bodies, 812 Glottic cancer treatment outcomes, 1127-28 Goiter, 101.1 Gouty Tophi, 197 G-protein coupled receptors (GPCRs), 770 G-protein–coupled receptors (GPCRs), 1039 Gracilis myocutaneous flap, 734 Granular cell tumor (myoblastoma), 879 Granular myringitis, 196 Granulomatous conditions, 563-64 Granulomatous rhinosinusitis, 505 Graves’ disease, 1145-49 Green botfly See Dermatobia hominis Group A streptococcus (GAS), 778 Group III-subperiosteal abscess, 568-69 Group II-orbital cellulites, 568 Group I-preseptal cellulites, 568 Group IV-orbital abscess, 569-70 Group V-cavernous sinus thrombosis, 570 Growth factors involved in angiogenesis in HNSCC, 1002 involved in inflammation in HNSCC, 1002 Gunning splints, application in mandibular fracture repair, 682 Gustation, 465 Gustatory neural transduction, 473 H H influenzae type b resistance, 31 Haemophilus influenzae Type b (Hib), 812 Hair cell differentiation, 94 Hair cell formation regulation of, 93-95 Hair cell regeneration mechanisms of, 92-93 Hair cell repair, 93 Hair cell stereocilia, 101 Hair cells presbyastasis, examination of, 337 Haller cells, 502, 504f, 602f Hard palate, 771, 771f Harmonic to noise ratio for vocal function assessment, 861 Harmonin, 39 Head and neck squamous cell carcinoma (HNSCC), 997 nutrition of patients with, 1063-69 therapeutic targets of, 1036-38, 1037t Headache, 583 due to chronically used substance withdrawal, 589-90 due to head/neck trauma, 587-88 due to homeostasis, 590 due to infections, 590 due to nonvascular intracranial disorders, 589 due to vascular disorders, 588-89 Headache disorders classification, 132t Health-related quality of life (HRQOL), 498 Hearing aid outcomes, 126-27 Hearing aids, 121-27 adjustment, 126-27 associated technology, 124 selection of, 126 types and styles, 121-24 Hearing impairment patients parental advice, 127-28 Hearing impairment, 89 1199 Hearing loss, 36, 208, 305-8, 334-35 age related, 297-98 causes, 103 classification through hearing threshold comparison, 117 due to TB fracture, 261-63 Hearing, 29 active processes, 105-6 Heavy metals, 275 Helper T cells, 488 Hematoma due to endoscopic sinus surgery, 631 due to rhytidectomy, 755 Hemifacial spasm, 400-1 Hemilaryngeal paralysis, 926 Hemostatic agents for epistaxis treatment, 553 Hepatocyte growth factor activation, 1001 Hereditary hearing impairment, 289 Hereditary hemorrhagic telangiectasia (HHT), 554-55, 554f Herpangina, 778 Herpes simplex virus, 889 Herpes zoster infection, 778 Heteroplasmic mutations, 39 Heterotopic neural tissue, 832 Heterozygosity, loss of, 1018 High resolution coronal magnetic resonance imaging, 517 Hinge flap, 721 HiRes 90K, 373 Hi-resolution strategy, 33.4 Histocompatibility complex proteins, 487-89 Histology of JNA, 1081 of NPC, 1084 Histopathology, 173 of hypopharynx, 1114-15 of oropharynx, 1106-7 otosclerosis, 247 of PTS, 266-68 of TTS, 266-68 Histoplasmosis, 525, 892-93 History allergic rhinitis, 531 antigen exposure, 538 bronchoscopy, 967, 968 biofilms, 840 brain injuries, 967 CRS, 577 dizziness, 132t eustachian tube dysfunction, 201 flexible fiberoptic bronchoscopy, 968 gustatory function, 475 headache, 584 hearing loss, 298-99 oral cavity, 1095 laryngoscopy, 955 lower face and neck rejuvenation, 749 NIHL, 268 nutrition status assessment, 1064-65 OM, diagnosis of, 209-10 otosclerosis, 248 PLF, 283 radiation therapy, 1043 rigid bronchoscopy, 967 unilateral vocal fold paralysis, 925 vestibular system, 131-32 zygomatic fracture, 688 HLA class I loss, 1006 Hmx3 gene, 34 Hopkins rod, 957 Horizontal projection See Axial projection Hormonal rhinitis, 560 Host defenses against OM, 31 8/27/08 10:57:48 PM 1200 Index HPV See Human papilloma virus HRQOL See Health-related quality of life, 498 Human botfly See Phaenicia sericata Human immune system, 481-82 hypersensitivity responses, 491 Human larynx, 847 Human papillomavirus (HPV), 878, 879, 889 in carcinogenesis of HNSCC, 1014 Hyoid fracture, 902 Hyperbaric oxygen (HBO) therapy, 705 Hyperpigmented scars, 709-10 Hypersensitivity reactions, 894 Hyperthyroidism, 1145 See also Hypothyroidism Hypertrophic scarring, 631, 703, 709 due to rhytidectomy, 757 Hypomobile vocal fold, 925 Hypoparathyroidism, 1173-74 Hypophonia in Parkinson’s disease, 914 Hypothyroidism, 1149-51 See also Hyperthyroidism Hypoxia, 1039 I Iatrogenic injury associated with gustatory dysfunction, 476-77 Idiopathic (Vasomotor) rhinitis, 560 Idiopathic pulmonary fibrosis, 966 Idiopathic sudden sensorineural hearing loss (ISSNHL), 279-81 IgA antibodies, 484-85 IgD antibodies, 484 IgE antibodies, 484-85 IgE immunoglobulins allergic rhinitis pathophysiology, role in, 533 IgE independent fungal inflammation, 576 IgG antibodies, 484-85, 485f IgM antibodies, 484 Iliac crest osteocutaneous flap, 737 Image-guidance systems use in otolaryngology, 797-98 Image-guided sinus surgery (IGSS), 798 Imaging anterior skull base neoplasms, 1072 COM, 223 facial nerve paralysis, 259 hypopharynx, 1024-26 inflammatory disorders, 947-48 larynx, 1024-26 mandible, 1096 mastoid malformations, 154 medical olfactory dysfunction, 468 midface fractures, 692-93 molecular of HNSCC, 1017 oral cavity, 1026-27 oropharynx squamous cell carcinoma, 1111, 1111f radiographic for cranial diagnosis, 231 regional metastases, 1095-96 salivary glands, 1027-29 suprahyoid portion of neck, 1021-24 temporal bone, 145 trachea, 949-50 Imatinib (STI-571; Gleevac), 1035-36 Immune evasion of HNSCC, 1005-11 Immune responses, 483 Immune system cells See White blood cells Immune-mediated Ménière disease, 308 Immunocompromised host infections, 894 Immunotherapy for allergic rhinitis treatment, 544-45 allergen specific, 545f BDBK005_Index.indd 1200 HNSCC, 1055-60 challenges for, 1055 costimulation based, 1059, 1060f In vitro IgE measurements for allergic rhinitis, 539 Incidence atresia, 817 laryngeal clefts, 820 laryngeal stenosis, 901 laryngoceles, 819 laryngomalacia, 815 rudimentry epiglottis, 817 saccular cysts, 819 stenosis, 822-23 subglottic hemangioma, 824 vocal fold paralysis, 821 webs, 818 Incomplete adduction conversion reaction dysphonia, 938 Indications audiologic assessment, 120-21 intratympanic gentamicin therapy, 85 flexible fiberoptic bronchoscopy, 968 of rigid bronchoscopy, 967 Indirect flexible laryngoscopy, 957-58 Indirect mirror laryngoscopy, development of, 955-56 See also Direct laryngoscopy, development of Indirect rigid laryngoscopy, 957 Indirect suppression, myeloid suppressor cells, 1009 Induction chemotherapy for HNSCC, 1047 Industrial biofilms, 840, 840, 840f Infection due to rhytidectomy, 755 Infectious esophagitis, 978 Infectious rhinitis, 558-60 Inferior parietal lobule, 111 Inflammatory bowel disease, 310 Inflammatory phase See Wound healing phases Inflammatory polyps, 197-98 Infratemporal fossa (ITF), 511, 514-16 See also Pterygopalatine fossa Infratip lobule, 640 Inhalent laryngeal trauma, 896 Inhibitory interactions neurons, 74 Inhibitory system, 73 Injection augmentation, 927-28 Inner ear biophysics, 101 Inner ear blood supply, 13 development of, 23-26, 33-34 growth factors, 35 fluids, 12-13 gene therapy, 85-87 hair cell functions, 55-56, 58f homeostatis, 35-36 malformations, imaging of, 164-67 molecular biology, 29-40 neurotransmission, 36 potassium channels, 38 surgical trauma, 175 Inner hair cells (IHCs), 58 Inner hair cells, 101-2 biophysics of, 101 Intact Canal Wall Mastoidectomy, 225-26, 226f Intensity coding in cochlea, 59-60 Intensity modulated radiation therapy (IMRT), 450-51, 1078 Interactions cell–cell contact, 94 Interarytenoid/aryepiglottic muscle, 851 Interpolation flaps, 721 Interpretation of acoustic rhinometry, 494 nasal peak flowmetry, 497 rhinomanometry, 496 Interstitial lung disease, 965-66 In-the canal hearing aids, 123 In-the ear hearing aids, 123 Intra-arterial chemotherapy, 1047-48 Intracellular signaling pathway, 94 Intracerebral abscess, 571 Intracranial abscess, 235-36 Intracranial neoplasms, 589 Intralabyrinthine schwannomas, 427 Intraluminal radiation use in therapeutic bronchoscopy, 970 Intranasal corticosteroids action of, 537 Intraoperative electrophysiologic testing for cochlear implants, 382-84 Intratympanic corticosteroids, 82-83 Intratympanic gentamicin, 84-85 Intrinsic muscles, 851 Invasive Candida laryngitis, 892 Inverted papilloma, 622-23 Inverted-V deformity, 639, 640f, 655 Investigations sinonasal disease, 557 ISSNHL, 280-81 Iodine deficiency, 1144 Iodine excess, 1144-45 Ion homeostatis molecules involved in, 38 Irritable larynx syndrome (ILS), 932, 939 ISSNHL See Idiopathic sudden sensorineural hearing loss J Jagged/Delta gene, 35 Jejunal free flap, 731-32, 732f Jervell and Lange-Nielsen syndrome (JNLS), 293-94 JNA See Juvenile nasopharyngeal angiofibroma Jugular foramen schwannoma, 429 Jugular foramen lesions, 417-18 Juvenile nasopharyngeal angiofibroma (JNA), 513, 515, 514f, 777, 1081-82 K K rhinoscleromatis, 520, 521, 528 Kadish staging system, 1074, 1074t Kaposi sarcoma, 1095 Kawasaki disease/mucocutaneous lymph node syndrome, 779 Kazanjian button, 696 Kearns–Sayre syndrome (KSS), 295 Keloids (scars), 197, 709 Keratin migration disorders, 196 Keratosis obturans, 196 Kinetics RWM, 81 Klebsiella pneumoniae, 779 L Laboratory studies of chronic rhinosinusitis, 578-79 of epitaxis, 553 primary HPT, 1172 of sarcoidosis, 966 Labyrinthectomy, 179, 179f Labyrinthitis, 233-34 Lacerations, 192, 193 Laryngeal abscess, 890 Laryngeal airway compromise, 806 See also Pharyngeal airway compromise, Neonatal nasal obstruction 8/27/08 10:57:49 PM Index Laryngeal cancer patients, 1122-23 Laryngeal cartilages, 848 ossification of, 850 Laryngeal clefts, 820-21, 820f, 821f as a supralaryngeal airway obstruction cause, 810 Laryngeal electromyography (LEMG), 927 of trauma, 945-46 Laryngeal erythema/ hyperemia, 886-87 Laryngeal framework surgery, 927-28 Laryngeal inflammatory disorders, 885 Laryngeal isometric pattern, 935-37 Laryngeal paralysis, 923 Laryngeal resistance, 863 Laryngeal saccule, 880 Laryngeal sarcoid, 894 Laryngeal stroboscopy, 960 Laryngeal trauma, 899-901 fixation techniques, 900-901 Laryngeal view, effect of speech on, 913 Laryngoceles, 819 Laryngomalacia, 815-16, 816f Laryngopharyngeal reflux (LPR), 885-86 controversies associated with, 888 laryngeal findings in, 886-87 Laryngoscopy, 952 Laryngospasm, 854 Laryngotracheal separation, 814 Laryngotracheal stenosis (LTS), 908-11 Laryngotracheoplasty, 910 Larynx muscles characteristic functions of, 856t Larynx congenital anomalies, overview of 815 imaging of, 943-48 structural abnormalities of, 943-46 trauma associated with, 899-901 Laser interferometry, 53 Laser resurfacing, 712-13 Laser therapy use in therapeutic bronchoscopy, 969 Lateral arm fasciocutaneous flap, 731, 731F Lateral compression, 937 Lateral cricoarytenoid muscle, 851 Lateral lemniscal nuclei central auditory processing, 109 Lateral osteotomy, 641, 653 Lateral projection See Sagittal projection Lateral vestibulospinal tract (LVST), 11, 10f Latissimus dorsi myocutaneous flap, 728, 732-33, 733f Latrogenic laryngeal trauma, 901-2 Le Fort I osteotomy, 1075-76 Left frontal operculum, 110 Left frontal sinus, mucocele of, 504f Leishmaniasis, 893 Leksell Gamma Knife quality assurance tests, 439 treatment planning with, 440-43 Leksell GammaPlan, 439, 440 software, 441 Leprosy (Hansen disease), 891 Leukoplakia, 781-82 Leukotriene modifiers for allergic rhinitis treatment, 544 Lichen planus, 779 Lifestyle, emotion, reflux, and technique (a-LERT), 932 Light delivery systems, 956-57 Limberg (Rhomboid) flap, 719-20 Lingual thyroid, 831 Lingual tonsillar hypertrophy, 994 Lipo-oligosaccharide (LOS), 30 Lobule, 640 Loop diuretics, 275 Lop year, 628 BDBK005_Index.indd 1201 Loss of heterozygosity (LOH), 997, 999, 1018 Lower blepharoplasty eyebrow and forehead, 745-46 Lower esophageal sphincter (LES), 887 Lower lateral cartilages (LLC), 642, 643f Lower motor neuron disorders, 915-16 See also Upper motor neuron disorders LPR See Laryngopharyngeal reflux L-strut, 657-58 Ludwig angina, 785-86 LVST See Lateral vestibulospinal tract Lymphangiomas, 830 Lymphocytes, 481 homing receptors, 483 in immune system, 482-83 Lymphoma lymphoma, 1074 M Macroglossia, 779 Macrolide antibiotics 276-77 See also Aminoglycoside antibiotics Maculae, 8-10, 8f, 10f, 12 See also Cristae Maculae development, inner ear, 24 Magnetic resonance angiography of jugular foramen, 427 of left vertebral artery, 151 of temporal bone, 151-53 Magnetic resonance imaging (MRI) comparison to CT, 512 for facial nerve paralysis, 259 laryngeal cancer diagnosis application in, 1122 for rhinosinusitis, 501 in skull base surgery, 415 for soft tissue evaluation, 468 of TB with mastoiditis, 236f of temporal bone, 150-51 techniques, 1029-32 in vestibular migraine, 320 in vestibular neuritis, 318 Magnetoencephalography (MEG), 64-65 Malar fat pad, 749 Malignant esophageal neoplasms, 981-82 Malignant mixed neoplasm, 1138-39 Malignant neoplasms, 399-400, 565, 1073 “Malignant” necrotizing otitis externa, 194-95, 195f Malingering detection, 470 by CN V stimulant, 468 Mammals hair cell regeneration, 92 Management differentiated thyroid carcinoma, 1156-57 emergent airway, 904-5 laryngeal trauma, 900 muscle misuse laryngeal disorders, 939-40 neck as NPC surgery requirement, 1087-88 of regional node metastases patients, 1099 surgical anterior skull base neoplasms, 1075-78 salivary glands, 1139 Mandible, 771 Mandibular space infection, 786 Manubrium malleus development of, 19 Masking for tinnitus treatment, 355 Masticator space infection, 786 Mastoid apex abnormalities, 415-16 Mastoidectomy, 243, 244 1201 Mastoiditis, 231-32 Matazumab (EMD7200), 1037 Maternally inherited diabetes and deafness (MIDD), 295 Maturation See Wound healing phases Maxillary infundibulum, 501f Maxillary sinus, 597-78 Maxillectomy inferior, 738 with orbital preservation, 738 with orbital removal, 738 Maximum flow declination rate, 863 Mean phonatory flow rate, 862 Measurement variations acoustic rhinometry, 495 nasal mucociliary clearance (NMCC), 498 nasal peak flowmetry, 497 rhinomanometry, 496 rhinostereometry, 497 Mechanical nasal obstruction, 561-63 Mechanisms hypopharynx squamous cell carcinoma spread, 1115 oropharynx squamous cell carcinoma spread, 1107-8 Mechanoelectric transduction, 3.8 Med-El PulsarCI100, 373-74 Medial crura, 642 Medial crural footpods, 643 Medial geniculate nucleus central auditory processing, 109-10 Medical history associated with otoplasty, 628 obtrusive sleep apnea, 789 associated with sinonasal disease, 557-58 Medical outcomes, 188 Medication dizziness, 346 diarrhea induction, 1068 otomycosis, 277 taste disturbances, 477 vestibular neuritis, 321 wound healing, 703 Medullary carcinoma of thyroid glands, 1169-71 Melkersson-Rosenthal syndrome, 401, 405 Menière disease, 314-17 systemic corticosteroids, use of, 83 Meningioma, 425-26, 509f, 513 planum sphenoidale, 513 Meningitis, 234-35, 501, 503f, 570 Mesial crus, 643 Metastasis, 508 clivus, 513, 515f Microanatomy of vestibular hair cells, 69 Microarray technology, 32 Microbiology of AOM, 210 of chronic AOM, 210-11 of COM, 217-18 of cranial complications in OM, 230 of intracranial complications in OM, 230 Microdebriders use in therapeutic bronchoscopy, 970 Microsatellite instability (MSI), 1014 Microsurgical Management Algorithm for VS treatment, 424 Microtia surgery, 763 Middle ear acoustic energy transmission, 46 development of, 20-23 effusions, 209-16 gas exchange, 203f 8/27/08 10:57:49 PM 1202 Index impedance matching, 46-47, 47f malformations, imaging of, 156-64 mesotympanic portion, muscles, 47-48 nerve supply, 4-5 OM, mucosal response, 30 stapes development, 21 Middle nasal vault, 642 Middle-ear atelectasis, 218 Midface defects soft tissue reconstruction of, 737 Midline glossectomy and lingualplasty, 994 Migraine-associated dizziness (MAD), 132, 132t Migraine-type headaches, 584-86 Minimum glottal airflow, 863 Mitochondria, 1015 Mitochondrial mutations, 39 Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes syndrome (MELAS), 295 Mitochondrial syndromic hearing impairment, 295 Möbius syndrome, 395-96 Modified barium swallow, 950-51 Mohs micrographic surgery (MMS), 198 Molecular biologic targets, 1048-51 Molecular carcinogenesis associated with HNSCC development, 998-99 Molecular changes in HNSCC development, 998-1000 Molecular detection issues, 1014 Molecular mediators of tumor progression, 1001 Molecular pathogenesis OM, 29-31 Molecular targeting rational approach, 1035-36 Molecular therapy of HNSCC, 1003 Morbidity associated with obtrusive sleep apnea (OSA), 984 Mortality associated with obtrusive sleep apnea (OSA), 984 Motion symptoms, 346 Motor preganglionic neurons of facial nerve, 14, 14f MRI See Magnetic resonance imaging Mucoceles, 503 Mucoepidermoid carcinoma (MEC), 1137 Mucopolysaccharide storage diseases associated with obtrusive sleep apnea, 791 Mucormycosis, 525 Mucosal disease and biofilms, 841 Mucosal epithelium See Epithelial cells Mucosal melanoma, 1095 Mucus, recirculation of, 603f Müller maneuver, 989 Multiple endocrine neoplasia type 1, 1172 Multiple sclerosis (MS), 914-15 Multiple systems atrophy, 914 Muscle misuse disorder, definition of, 931 Muscle misuse laryngeal disorders of the elderly, 938-39 Muscle transportation procedures, 408-9, 409f Muscular tension dysphonia, 920 Musculocutaneous flaps, 704 Mutagenesis, insertional, 31 Mutagenesis, self-directed, 31-32 Myasthenia gravis, 915 Mycobacterium tuberculosis, 521, 965 Myoclonic epilepsy with ragged Red fiber myopathy (MERRF), 295 Myoclonus, 915 Myocutaneous free flaps, 732-34 BDBK005_Index.indd 1202 Myoeptithelioma, 1136 Myogenous free flaps, 734 Myosins, 3.6 N Nasal airflow measurement of, 495 anterior method, 495 posterior method, 495 testing of, 493 temperature, 457 Nasal analysis, 635-36 base view, 640 computer-guided, 637 lower nasal vault profile, 638-39 upper nasal vault profile, 637-38 Nasal bones, 639 fixed with lead plates, 695f Nasal cavity, 493 nasal septal vasculature, 551-52, 552f source of supply, 551 Nasal congestion subjective measurement of, 493 Nasal CPAP, 990 Nasal cycle, 493 Nasal cytologic examination for rhinitis, diagnosis, 539 Nasal domes, 640 Nasal dorsum reconstruction of, 675 Nasal endoscopy use in CRS examination, 578 Nasal expiratory or inspiratory peak flow (NIPF), 558 Nasal framework, 662-64 Nasal gliomas, 564 Nasal lining flaps, 662 Nasal mucociliary clearance (NMCC) measurement of, 498 mucociliary function test, 558 Nasal obstruction causes of, 493 objective measurement of, 493 Nasal peak expiratory flow (NPEF), 497 See also Nasal peak inspiratory flow (NPIF) Nasal peak flowmetry, 497 Nasal peak inspiratory flow (NPIF), 497 See also Nasal peak expiratory flow (NPEF) Nasal peak inspiratory peak flowmeter, 497, 497f Nasal pedestal, 642 Nasal physiology, 644-45 Nasal reactivity in allergic rhinitis, 535 Nasal reconstruction, 661 Nasal root, 637 Nasal scroll, 642 Nasal septoplasty, 657 Nasal sidewall reconstruction of, 675 Nasal skin thickness, 651 Nasal surgery nomenclature of, 635 Nasal tip reconstruction of, 674-75 Nasal tuberculosis, 521 Nasal valve region, 643 Nasoethmoid encephalocele, 507f Nasoethmoid squamous cell cancer, 509, 509f Nasofacial groove, 641, 653 Naso-frontal angle, 637 Nasogastric intubation laryngeal stenosis, 902 Nasolacrimal duct cysts as a supralaryngeal airway obstruction cause, 809 Nasometry, 498-99 Nasopharyngeal adenoids, 510-514 Nasopharyngeal carcinoma (NPC), 511, 511f, 1081 lymph node metastasis from, 512 Nasopharyngeal carcinoma, 1023 Nasopharyngeal lesions examination of, 510-14 Nasopharynx, 510 lymphoma of, 512, 512f mass lesions in, 511 tumors of, 512 Natural killer (NK) cells, 481 Navigational systems use in therapeutic bronchoscopy, 972 Neck assessment, 751 congenital disorders, 829-30 mass, 780 trauma, 476 Neisseria gonorrhea, 890-91 Neonatal hyperthyroidism, 1145 See also Prenatal hyperthyroidism Neonatal intubation, 807 Neonatal nasal obstruction, 805-6 See also Pharyngeal airway compromise, Laryngeal airway compromise Neonatal sialadenitis in salivary glands, 1132-33 Neonatal suppurative sialadenitis, 1132-33 Neoplasms, 777 of larynx, 1121-29 of oral cavity, 1091-1103 of oropharynx and hypopharynx, 1105-18 of oral cavity spread, 1094-95 salivary, 1134-39 Neoplastic (Nodular) thyroid disease, 1154-55 Nerve damage due to lower face and neck rejuvenation, 756-57 Nerve sheath neoplasms, 1073 Nerve substitution procedures, 408 Neural crest cells, 17, 21 Neural reflexes involvement in allergic rhinitis pathophysiology, 535-36 Neurofibromatosis (NF2), 292 Neurofibromatosis type 2, 37 Neurogenic disorders, 913-16 Neurogenic neoplasms, 831-32 Neurogenin 1, 24-25 Neurogenin1 gene, 35 Neuroimaging , 65, 107 Neuromuscular disease associated with obtrusive sleep apnea, 791 NH mutations, 39 Nighttime symptoms, 790 NIHL See Noise-induced hearing loss Nitric oxide use in mucociliary function test, 558 NMCC See Nasal mucociliary clearance Noise exposures, 265 Noise-induced hearing loss (NIHL), 265-71 risk factors, 268-69 Noise-induced histopathology, 265-68, 266f Noise-induced pathophysiology, 265-68 Noninfectious ear canal inflammation, 196 Nonsurgical management aural atresia, 762 microtia, 762 Nonsyndromic hearing impairment, 38, 295-98 See also Syndromic hearing impairment Nonthyroidal illness (the “Euthyroid sick syndrome”), 1153-54 Nonthyroidal illness, 1153-54 Norrie disease, 295 North American blastomycosis, 522, 525 8/27/08 10:57:49 PM Index Nose as air conditioner, 499 air passage in, 493-97 airway assessment, 558 blood tests, 558 cosmetic analysis of, 637-41 defect types, 671-75 examination of, 557-58 as a filter, 497-98 function alteration, 493 mucociliary function tests, 558 as olfactory organ, 499 as a source of voice resonance, 498-99 as a subjective well-being contributor, 498 Nostril openings, 640 Notch signaling pathway uses in tissues, 24 Note flap, 720-21 NPC See Nasopharyngeal carcinoma Nucleus Freedom with Contour Advance Electrode, 372-73 Nutrition needs assessment, 1065-66 Nutrition screening, 1063-64 Nutrition status assessment, 1063-64 Nutritional support, for HNSCC patients, 1066 Nystagmus neural mechanisms, 75 O OAE See Otoacoustic emissions Obesity associated with obtrusive sleep apnea, 791 Observational research, 183-85 Observations hemilaryngeal paralysis, 927 Obtrusive sleep apnea (OSA), 789 Obturator use in palatal defect repair, 738 Occupational noise exposure, 270-71 Occupational/environmental rhinitis, 560 Oculomotor testing, 137-38 Odontogenic infections, 779 Off vertical axis rotation (OVAR), 142, 143 Office indirect laryngoscopy, 959-60 Office surgery, 961 Off-vertical axis rotation, 142 Olfaction, 465 Olfactory neuroblastoma (ONB), 507-8 Olfactory thresholds estimation of, 558 Olivocochlear efferents, 12 OM See Otitis media Oncocytic papillary cystadenoma, 1136 Oncocytomas, 1136 Open procedures revision sinus surgery, 611-12 Open-fit hearing aids, 123 Operative techniques cochlear implantation, 376-84 Ophthalmic preparations for allergic rhinitis treatment, 544 Optical-based image-guidance system, 797 Oral alimentation, 1066 Oral cavity, 771-72 blood supply to, 772 cancer—in young adults, 1095 diseases, 775-78 penetrating trauma, 781 lymphatics of, 773 reconstruction of, 1101-2 specific sites of, 1099-1101 Oral submucous fibrosis, 1094 Orbits, 516-18 BDBK005_Index.indd 1203 Oropharynx diseases, 778-79 penetrating trauma, 781 Osler-Weber-Rendu syndrome See Hereditary hemorrhagic telangiectasia Osseous, 1072 Ossicles, 760 Ossicular chain malformations, imaging of, 156-64 Ossification in cartilaginous capsule, 25 cochlea, 381-82 common cavity malformations, 381-82 Osteocutaneous free flaps, 734-37 Osteology ear canal, 229 of TB, 1-2 Osteoma, 198, 506, 508f Osteopetrosis, 396 Ostiomeatal unit obstruction, 502, 503f Otitic hydrocephalus, 237 Otitis media (OM), 29-31, 519 bacterial adherence, 29 biofilms in, 841-42 effusions, 209-16 extracellular growth, 30-31 pathogens, antibiotic resistance, 31 Otoacoustic emissions (OAEs), 36, 45, 55-56, 105-6, 115, 269-70 See also Spontaneous otoacoustic emissions clinical applications, 122t, Otoconia presbyastasis, examination of, 339 Otomycosis, 195-96, 195f Otopathology, 173 Otoplasty prominent ear, 629-31 pitfalls, 631 Otosclerosis, 247-51 Ototoxic drugs, 275-77 Ototoxicity, 273-77 monitoring of, 274-75 systematically induced, 273-74 Otx1 genes, 33 Outcome application, 188 Outcome effectiveness, 188 Outcome measure reliability, 188 Outcome measure responsiveness, 188 Outcome measure selection, 188 Outcome measure sensibility, 188 Outcomes research, 187-89 Outer ear hair cell functions, 55-56, 58f Outer hair cells (OHC), 58 biophysics of, 103-4 lateral walls, 104 stria vascularis, 104-5 structure and function of, 105 OVAR See Off vertical axis rotation Overexpression of transforming growth factor, 1000-1001 Oxygenation, 806 P p53 (tumor-suppressor gene), 1015 p53 transcription factor, 1039 Pain, innervation of, 583 Palatal defect repair of, 737-38 Palate, 835-37 Palpation of temporal arteries, 584 Panitumumab (rHuMAb-EGFr), 1037 Papillary adenoma, 427 1203 Paradoxical vocal fold movement (PVFM), 921 Paraganglioma, 427-28, 879 Paramedian forehead flap, 667-71 Paranasal sinus drainage pathways 501f Parapharyngeal space infection, 785 Parasites causing rhinitis Dermatobia hominis, 522 Leishmania genus, 522 Phaenicia sericata, 522-23 causing stomastitis Leishmaniasis, 526 Platyhelminthes, 525 T solium, 525 Taenia sagenata, 525 Parasitic causes stomatitis, 525-26 rhinitis, 522-23 Parathyroid carcinoma, 1173 Parathyroid diseases, 1143 Parathyroid gland neoplasia, 1171-74 Parathyroid gland surgery, 1181-85 Parathyroidectomy, 1184-85 Parenteral nutrition, 1068-69 Parotid injury due to platysma intervention, 757 Parotid space infections, 786 Passavant ridge, 1106 Passive cancer immunotherapy, 1055 Passive immunotherapy of HNSCC, 1055-57 Pathogenesis acute rhinosinusitis, 567-68 anaplastic thyroid carcinoma, 1166-67 cholesteatoma, 219 cholesterol granuloma, 224 COM, 218 meningioma, 425 paraganglia, 427 obtrusive sleep apnea, 789-90 OM, 210-11 tumor VS, 419 tympanosclerosis, 223 Pathologic changes in HNSCC development, 998-1000 Pathologic conditions of temporal bone, 154-71 Pathologic events during tumor development, 998, 998f Pathological behavior of vestibular afferent neurons, Pathology anaplastic thyroid carcinoma, 1165-66 anterior skull base neoplasms, 1072-75 eustachian tube dysfunction, 204-8 meningioma, 425, 426t oral cavity cancer, 1093-94 thyroid lymphoma of thyroid glands, 1168-69 tumor VS, 419 Pathophysiologic concepts laryngeal paralysis associated with, 923-24 Pathophysiology allergic rhinitis, 533-36, 534f associated with facial pain, 583 associated with headache, 583 associated with obtrusive sleep apnea (OSA), 984-86 chronic rhinosinusitis with nasal polyps, 575-77 chronic rhinosinusitis without nasal polyps, 574-75 of hypopharynx squamous cell carcinoma, 1115 of NIHL, 265 of PTS, 265-66 8/27/08 10:57:49 PM 1204 Index of TTS, 265-66 superior semicircular canal dehiscence syndrome, 327 Patient outcomes, 188 Patient presentation PLF, 283-84 Patient selection cochlear implants, 366-69 laser resurfacing, 713 otosclerosis surgery, 248 percutaneous dilational tracheostomy, 907 vestibular physical therapy, 347 Patient, self-assessment, 859 Patulous eustachian tube, 205-8 Pax gene, 33-34 PCR See Polymerase chain reaction PDS gene mutations, 38 Peak glottal airflow, 863 Pectoralis major myocutaneous flap (PMMF), 727-28 pediatric aerodigestive tract, foreign bodies, 812 Pediatric airway acquired disorders, 812-14 disorders, 809-14 evaluation, 808-9 Pediatric aspiration, 809 Pediatric bronchoscopy use in therapeutic bronchoscopy, 972-73 Pediatric chronic rhinosinusitis, 582 Pediatric OSA, 789 Pediatric sleep-disordered breathing (SDB), 789 Pedicle advancement flap, 718-19 Pedicled myocutaneous flaps, 727 Pendred syndrome (PS), 25-6, 37, 293-94, 294f Peptide-based antitumor vaccine, 1057-58, 1058f Perceptual analysis for vocal function assessment, 860 Percutaneous tracheostomy, 907-8 Perfexion, 443 Perilymphatic fistulae (PLFs), 255, 283-86 Perilymphatic gusher, 175, 295 Perilymph of scalae, Perineural spread (PNS), 507, 510f Periodic fever, adenitis, pharygitis, and aphthous ulcer (PFAPA) syndrome, 778 Peripheral nervous system, disorders of, 915-16 Peripheral vestibular disorders, 343-44, 344f Perisylvian areas in human brains, 110-11, 111f Peritonsillar cellulites, 784 Peritonsillar infection, 776 Peritonsillar space infection, 784 Permeability RWM, 81 Person with malformed ear, 759 Perturbation measures for vocal function assessment, 861 Petrous apex abnormalities, 415-16 Petrous apicitis, 233 Pharmacokinetics intratympanic gentamicin, 84 Pharmacologic therapy for allergic rhinitis, 540 for tinnitus treatment, 354 Pharyngeal airway compromise, 806 See also Neonatal nasal obstruction, Laryngeal airway compromise Pharyngeal and/or laryngeal constriction, 913 Pharyngeal cysts as a supralaryngeal airway obstruction cause, 810 Pharyngeal mucosal space, 510, 511 Pharyngeal resistance, 983 Pharyngitis, 526-27 BDBK005_Index.indd 1204 Pharynx blood supply to, 772 Phonation neurophysiology of, 855-57 Phonological awareness, 869 Phonological disorder, 868 Phonology, 869 Photodynamic therapy (PDT) use in therapeutic bronchoscopy, 970 Photoglottography (PCG), 864 Physical examination mixed pleomorphic adenoma, 427 unilateral vocal fold paralysis, 925-26 dizziness patient, 132 Physiologic principles of tympanoplasty, 239 Physiology cochlea, 48-57, 57f efferent auditory system, 60 eustachian tube, 201-3 external ear, 45, 191-98 gustatory system, 473 hypopharynx, 1114 larynx, 854-57 local flaps, 717 middle ear, 45-48 nose, 456-57 olfactory system, 465-66 oral cavity, 774 oropharynx, 1105-6 vestibular nuclei, 72 Pierre Robin sequence, 837 Pill-induced esophagitis, 978 Piriform aperture stenosis as a supralaryngeal airway obstruction cause, 809 Planktonic biofilms, 840 Plate fixation, rationale for, 900 Platysma, 750 Platysmaplasty, 750-51 Pleomorphic adenoma (benign mixed tumor), 1136 PLF See Perilymphatic fistula Plummer disease, 1149 Pneumatization of epitympanum, 21 Pneumotachometer, 495 Pollination, 537 Pollution associated with allergic rhinitis, 532 Polymerase chain reaction (PCR), Polymorphous low-grade adenocarcinoma (PLGA), 1138 Polymyxins, 277 Polyposis, 573 aspirin-sensitive nasal, 576 Polysomnography, 792-93 for sleep testing, 986-87 Position and position testing, 134 Positron emission tomography (PET), 107 for tumor evaluation, 510 Posterior cricoarytenoid muscle, 851 Postoperative care associated with tympanoplasty, 244 lower face and neck rejuvenation, 755 open reduction wounds, 686 otoplasty, 631 revision paranasal sinus surgery—612 scar revision, 708-9 zygomatic fractures, 690 Postoperative chemoradiotherapy, for HNSCC, 1047 Postoperative evaluation/management otosclerosis, 250 rhinosinusitis, 601-3 Posttraumatic headache, 587-88 Posttraumatic vestibulopathy, 263 Postural control vestibular influence of, 72 Posturography for PLF evaluation, 285 Pott puffy tumor, 501-2, 503f POU3F4 gene, 38 POU4F3 gene, 38 POU-Domain genes, 34 Practical considerations intratympanic gentamicin, 85 Preclinical applications of gene therapy, 87 Precursor T cells, 482 Predictive markers, 1051 Premalignant lesions treatment outcomes of, 1127 Premalignant progression of HNSCC, 1018 Prenatal hyperthyroidism, 1145 See also Neonatal hyperthyroidism Preoperative considerations lower face and neck, 749-52 otoplasty, 628 revision paranasal sinus surgery, 602-12 rhinosinusitis, 595-97 tympanoplasty, 239-40 Presbyacusis, 333 types of, 336 terminology of, 333-34 Presbyphonia, 937 Presentation of BPPV, 322 of JNA, 1081 of Menière disease, 314 of nasal obstruction, 809 of NPC, 1083 of rheumatoid arthritis, 310 of vestibular migraine, 319 of vestibular neuritis, 317 Presurgical considerations eyebrow, 742-43 forehead, 743 midface, 743 periorbital complex, 743 Pretransfer flap manipulation, 721-22 Prevertebral space infection, 785 Primary auditory cortex, 110 Primary ciliary dyskinesia (PCD)/ Kartagener syndrome, 837-38 associated with respiratory infections, 559 Primary hyperparathyroidism (PHPT), 1171 Primary paranasal sinus surgery, 595 perioperative considerations, 597 postoperative care, 599 Primary paranasal sinus surgery primary paranasal operations, 597 Principles acoustic rhinometry, 494 auditory system, 45 facial nerve surgery, 403-4 parathyroid gland surgery, 1183-84 rhinomanometry, 495 stereotactic head frame attachment, 436 vestibular system, 68-75 Progenitor cells (PCs), 95 Prognosis anaplastic thyroid carcinoma, 1167 hypopharynx squamous cell carcinoma, 1115-16 NPC, 1088 olfactory disorders, 472-73 oropharynx squamous cell carcinoma, 1109 Prognostic markers, 1051 Programmable hearing aids, 124 Progressive supranuclear palsy (PSP), 914 Prolapsed arytenoids, 926 8/27/08 10:57:50 PM Index Proliferative phase See Wound healing phases Prominent ear, 627 Prophylactic spreader graft, 655 Protective function neurophysiology of, 854-55 Protein markers, 285 Proteins with unknown function, 38 Proton beam irradiation, 1078 Provincial voice care resource program, 933-34 Prx1/Prx2 genes, 33 Pseudobulbar palsy, 914 Pseudomonas mallei (Burkholderia mallei), 891 Pseudosulcus vocalis, 886 Psychology for tinnitus treatment, 355 Pterygopalatine fossa (PPF), 507, 514-16 See also Infratemporal fossa Ptotic nasal tip, 648 PTS See Permanent threshold shifts Pulmonary function testing, 863 Pulmonary hypertension, 790 Pulmonary segments, 964, 964f Pure-tone audiometry, 115-17 Q Quantitative olfactory testing, 467-68 Quinine, 275 R Radial forearm fasciocutaneous flap, 728-30 Radial forearm osteocutaneous flap, 736, 736f Radiation physics, 436-39 irradiation technique, 438-39 Radiation surgery altered fractionation of, 1048 anterior skull base neoplasms, 1078 for head and neck cancer, 477 laryngeal cancer, 1126-27 laryngeal cancer, 1126-27 Radiation biologic effects of, 437 Radiographs, 501 Radiography for malignant neoplasms of larynx, 946-47 of structural and inflammatory disorders, 952-53 of temporal bone, 145-54 of temporomandibular joint (TMJ), 146 for tracheal stenosis, 949 for vocal fold paralysis, 948 Radioiodine remnant ablation, 1160 Radiology hearing impairment, 300 use in CRS examination, 579 Radionucleotide bone scans for cranial diagnosis, 231 Radioprotectors, 1051 Radiotherapy for salivary gland diseases, 1139-40 use of HNSCC treatment, 1043-51 Random flaps, 704 Ranula, 780 RAR gene, 34 Rathke cleft cyst, 512, 513f Rathke pouch cyst, 835 Rear-ear measures, 126 Reconstruction Alae, 675 of hypopharyngeal defects, 1117 of middle ear, 239-45 of oropharyngeal defects, 1111-13 scalp, 724 Recording systems use in laryngoscopy, 961 Rectus abdominis myocutaneous flap, 733-34 BDBK005_Index.indd 1205 Recurrence of NPC, 1088 Recurrent conductive hearing loss, 173-75 Recurrent parotitis in children, 1133 Recurrent respiratory papillomatosis, 778 Refeeding syndrome, 1068 Reflux esophagitis, 978 Regeneration hair cell, 89, 90-92 Regional flaps types, 727-28 Regulatory T cells involvement in allergic rhinitis pathophysiology, 536 Rehabilitation asymmetric hearing loss, 369 hypopharynx squamous cell carcinoma patients, 1118 oropharynx squamous cell carcinoma patients, 1113-14 unilateral hearing loss, 125-26 vestibular disorders, 346-49 Reinnervation for unilateral vocal fold paralysis, 929 Relapsing polychondritis, 895-96, 966 Relaxed skin tension lines (RSTL), 707 Residual conductive hearing loss, 173 Residual rests of epithelial cells, 21 Respiratory disturbance index (RDI), 776 Respiratory function neurophysiology of, 855 viruses, 470 Retention cysts, 503, 511, 511f Retinoic acid receptors, 759 Retrognathia as a supralaryngeal airway obstruction cause, 809-10 Retropharyngeal space infection, 784-85 Revision maxillary sinus surgery, 604-6 Revision paranasal sinus surgery, 601 principles of, 604 Revision rhinoplasty, 655-56 Revision sphenoid sinus surgery, 606-7 Rhabdomyosarcoma, 777 Rheumatoid arthritis, 310, 895 Rhinitis medicamentosa, 561 Rhinitis, 498 Rhinologic headaches, 591 Rhinomanometry, 495-97, 496f, 558 See also Acoustic Rhinometry pressure-flow graph, 496f Rhinophyma, 564 Rhinoplasty cosmetic septal surgery, 656-57 surgical approaches, 645-56 dressing, 655 spreader grafts, 655 surgical fundamentals, 643-56 tip fundamentals of, 646-47 Rhinoscleroma, 520-23 See also Actinomycosis, Syphilis Rhinosinusitis, 501-2 Rhinostereometry, 497 Rhytidectomy skin flaps, 755 Rhytidectomy, 755-57, 756f Riedel thyroiditis, 1152-53 Right maxillary sinus, 602f Rigid bronchoscopy, 967-68 Rigid esophagoscopy, 975-76 Risk factors aphasia, 873 allergic rhinitis, 531-32 1205 atresia surgery, 766 COM, 217 common cold, 520 flexible fiberoptic bronchoscopy, 968 hematoma, 755 skin flap necrosis, 755 hearing loss, 85, 363 hearing impairment, 121 APDs, in children, 121 central auditory nervous system dysfunction, 121 inner ear gene therapy, 87 myiasis, 526 noise-induced hearing loss (NIHL), 268-69 in poastnatal period, 299 vascular disease, 280 sinonasal malignancy, 1073 occult metastasis, 1101 distant metastatic disease, 1158 RNA interference, 32-33, 33f Robot, 799 Robotic surgical systems use in otolaryngology, 799-801 Rosenthal effect, 859 Rotation flaps, 719 Rotatory chain testing of vestibulo-ocular reflex, 138-39 Round window membrane (RWM), 81-85 Rowe-Killey disimpaction forceps, 694, 693f Rudimentry epiglottis, as a cause of stridor, 817 Rungstrom projection, 145 RWM See Round window membrane S Saccade testing, 133-34 Saccular cysts, 819 Sagittal projection in temporal bone CT, 150-51 Saliva functions, 1131 Saliva, 774 Salivary ductal carcinoma (SDC), 1138 Salivary glands, 1131 disorders, 837 Salivary production, 774 Salivary regulation, 774 Salvage surgery, 1102-3 Sarcoidosis, 894 Scalp reconstruction of, 724 Scapular fasciocutaneous flap, 731, 731f Scapular osteocutaneous flap, 736-37, 737f Scar dermabrasion (technique), 725 Scar revision, 707-12 Scarless healing, 710 Scarpa, 70-71 Scars nonsurgical treatments of, 709-10 Schistosomiasis, 893-94 Schizophrenia, 112 Schwannoma, 515, 516f Scleroderma, 310 Scleroma, 891 Scratch and sniff tests, 558 Screening of HNSCC tumors, 1013-17 Sebaceous adenomas, 1136-37 Secondary hyperparathyroidism, 1172 Secondary hypothyroidism, 1151-52 Segmental mandibulectomy defects, 738-39 Semicircular canal dysplasia, 39-40 Sense organs inner ear development of, 23-24 vestibular system, 8/27/08 10:57:50 PM 1206 Index Sensorineural hearing loss systemic corticosteroids, use of, 83 Sensory cells, 102 Sensory innervation of forehead and scalp, 741-42 Sensory neuroepithelium presbyastasis, examination of, 339 Sensory organs development of, 22-23 mechanoelectric transduction, 36 Sentinel lymph node biopsy of oral cavity cancer, 1096 Septal extension grafts, 658 Serial excision, 707 See also Simple excision Serological markers of NPC, 1087 Sharp trauma, 192 Shh gene, 35 Shield graft, 650, 652f Shiverer mouse, 40 Shy-Drager syndrome, 914 Sialolithiasis, 1133-34 Signal transducer and activator of transcription (STAT), 1038-39 Simple excision, 707 See also Serial excision Simultaneous analog stimulator (SAS), 391-92 Sinonasal polyposis, 503 Sinonasal secretions, 503 Sinonasal undifferentiated carcinoma, 1075 Sinusitis in upper respiratory tract, 520 Sjögren syndrome, 310, 896 Skin flap necrosis due to rhytidectomy, 755-56 Skin resurfacing techniques, 712-14 Skin tags, 197 Skin-testing for allergic rhinitis, 539 Skull base, 413-14 neoplasms, 413 Sleep apnea, prevalence of, 983 Sleep disorders, 988 Sleepiness, 986-88 SMAS See Superficial musculoaponeurotic system Smooth pursuit testing, 133 Snoring, 790, 989 prevalence, 983 Soft-tissue radiography for rhinitis, diagnosis, 539 SonataTI, 373-74 Sound energy, 45 Sound therapy for tinnitus treatment, 354 SPA See Sphenopalatine artery Space symptoms, 346 Spasmodic dysphonias (SDs), 917-20 Specific language impairment (SLI), 869-71 Spectral PEAK (SPEAK), 391 Speech articulation, 869 Speech audiometry, 117 Speech coding strategies, 389, 392, 394 Speech discrimination, 338 Speech frequency, 117 Speech language impairment, 869-70 Speech perception restoration, 390-91 Speech sound disorder, 868-69 Speech sound errors, 869 Speech testing, 918 Speech, 774 Speech–language disorders, 867 in adults, 872-74 in children, 867 in childhood, 867-72 Sphenoid bone in central skull base, 510 BDBK005_Index.indd 1206 Sphenoid mucocele, 505, 505f Sphenoid ostium, 501f Sphenoid sinus, 598 Sphenopalatine artery (SPA), 551 Spontaneous CSF leak, 508f Spontaneous otoacoustic emissions (SOAEs), 54, 55f, 106, 120 See also Otoacoustic emissions Sporotrichosis, 893 Squam ocolumnar junction (SCJ)/Z-line, 975 Squamous cell cancer, 426, 509f, 509, 1073, 1139 Src family kinase inhibitors, 1038 Staging AJCC system associated with, 1074 anaplastic thyroid carcinoma, 1167 hypopharynx squamous cell carcinoma, 1115-16 of JNA, 1082 of NPC, 1084-85 of oral cavity cancer, 1096 oropharynx squamous cell carcinoma, 1109 thyroid lymphoma of thyroid glands, 1168-69 associated with tympanoplasty, 243-44 Staphylococcus aureus, 705, 783 Stem cells, 95-97 Stenosis, 822-24, 822f Stenvers projection, 146 Stereocilia, 39 Stereostatic radiosurgery, 1078 skull base diseases, 435 VS, 425 Stereotactic head frame attachment, 436 Stevens-Johnson syndrome, 895 Stickler syndrome (STL), 292 Stimulation of olivocochlear efferent system, 60 Streptococcus viridans, 779 Stridor, 809 Structurally-based speech disorders, overview of, 873 Subarachnoid hemorrhage (SAH), 588 Subcutaneous fat layer, 749 Subcutaneous tissue pedicle melolabial interpolated flap, 664-66 Subdural abscess, 571 Subdural empyema, 236 Subglottic cancer treatment outcomes of, 1128 Subglottic hemangioma, 824-25, 824f Subglottic lesions, 822-24 Sublingual immunotherapy for allergic rhinitis, 545 Submental liposuction and platysmaplasty See Submentoplasty Submentoplasty, 752-54 Subperiosteal abscess, 232-33, 501, 502f Substance induced headache, 589 Superficial lamina propria (SLP), 877-78 Superficial musculoaponeurotic system, 749-50, 750f Superior olivary complex (SOC) central auditory processing, 109 Superior semicircular canal dehiscence syndrome, 326 surgical repair, 329-30, 329f Supplementary examination unilateral vocal fold paralysis, 926-27 Supporting cell proliferation, 93 Supporting cell transdifferentiation, 93 Supportive thyroiditis 1153 Suppurative thyroiditis, 1153 Supracricoid partial laryngectomy, 1123-24 Supradomal augmentation graft, 650 Supraglottal adduction, 937 Supraglottic cancer treatment outcomes of, 1128 Supraglottitis, 527-28 Supralaryngeal and laryngeal cyst formation, 810 Surgery anaplastic thyroid carcinoma, 1179-80 for chronic otitis media, 175-78 eustachian tube dysfunction, 205 of oral cavity, 1097 for otosclerosis, 173-75 Meniere syndrome, 178-79 neurotologic skull base, 413 of sleep apnea, 991-94 otosclerosis, 248-50 for tinnitus treatment, 354 thyroid gland, 1174-77 thyroid controversies associated with, 1180-81 Surgical anatomy adipose tissue, 749 eyelids, 742, 743f forehead, 741-42, 742f midface, 742, 743f mimetic facial muscles, 750-51 neurovascular structures, 749-50 parathyroid gland surgery, 1181-83 periorbital complex, 742 skin, 749 superficial musculoaponeurotic system, 749-50 temporal fossa, 742 zygoma, 688-89 Surgical approaches eyebrow, 743-46 forehead, 743-46 midface fractures, 693-95 midface, 747-48 neck space infections, 785 Surgical considerations of COM, 225-27 Surgical degloving, 646 Surgical management aural atresia, 762 microtia, 762 Surgical simulators use in otolaryngology, 798-99 Surgical technique adenotonsillectomy, 777-78 laryngeal trauma, 900 lower face and neck rejuvenation, 752-55 neck and chin, 752-55 otoplasty, 627 otoplasty, 629-30 otosclerosis, 248-49 of tympanoplasty, 239-43 upper and midface rejuvenation, 741-48 zygomatic fracture, 688 Surgical treatment adjuvant cryotherapy, 1129 atresia, 763-66 congenital conductive hearing loss, 762-63, 763f for epistaxis, 553-54 laryngeal cancer, 1123 microtia, 763-66 robotic laryngeal cancer, 1128-29 Surveillance of NPC, 1088 Susac syndrome, 309-10 Swallowing, 774 endoscopic evaluation of, 951-52 Symptoms allergic rhinitis, 532 anterior skull base neoplasms, 1071 atresia, 817 common cold, 519 compromised neonatal airways, 805-6 dizziness, 346 epidermal abscess, 236 external ear disease, 192 intubated neonatal airway, 806 8/27/08 10:57:50 PM Index hyperacusis, 328 laryngeal clefts, 820 laryngoceles, 819 laryngomalacia, 815-16 lower cranial neuropathies, 429 obtrusive sleep apnea, 790-91 PLF, 284 of vestibular dysfunction, 131 rudimentry epiglottis, 817 saccular cysts, 819 skull-base tumors, 414 sleep-disordered breathing, 983-84 snoring, 983-84 stenosis, 823 subglottic hemangioma, 824 vocal fold paralysis, 821 webs, 818 Synaptic vesicle trafficking, 39 Syndromes branchial arc development, effect on, 22 Syndromic hearing impairment, 36, 290-94 See also Nonsyndromic hearing impairment causes, 291t classification, 290t Syngamosis, 894 Syngamus laryngeus, 894 Syphilis, 523, 892 See also Actinomycosis, Rhinoscleroma Systemic corticosteroid therapy of chronic rhinosinusitis, 581 Systemic corticosteroids, 83 for allergic rhinitis treatment, 543 Systemic lupus erythematosus, 310 Systemic lupus erythematosus, 895 T T cells, 481-82 B cells, differentiation with, 482 thymus, development of, 489-90 T lymphocytes, 486 T pallidum, 523, 528 T1W postcontrast image, 501, 503f Taste afferent nerves, 473-74 Taste buds, 473 Taste, 770 Taxanes, 1044 TB See Temporal bone T-cell receptors, 486-87 Technique used in acoustic rhinometry, 494 in active rhinomanometry, 495-96 adopted for flexible fiberoptic bronchoscopy, 967-68 in nasal mucociliary clearance (NMCC), 498 in nasal peak flowmetry, 497 percutaneous tracheostomy, 907 in rhinostereometry, 497 for rigid bronchoscopy, 967-68 tracheostomy, 905-6 Tecta, 103 Tectorial membrane, 102-3 Telecanthus, 695-96 Telephone coding in cochlea, 57-58 “Telephone Place” Theory of Frequency Coding, 58-60 Telesurgery, 801 Temporal arteritis, 310 Temporal bone (TB) endolymphatic Sac neoplasms, 169-70 fibro-osseous lesions, imaging of, 170 at skull base, Temporalis muscle transposition, 409-10 Temporomandibular joint (TJ), 145, 145f BDBK005_Index.indd 1207 endolymphatic Sac neoplasms, 169-70 fibro-osseous lesions, imaging of, 170 Tension-type headaches, 586-87 Teratomas, 835 Tertiary hyperparathyroidism, 1172 Therapeutic agents, 80 Therapeutic bronchoscopy, 969-72 use in endobronchial lung volume reduction, 972 use in life-threatening hemoptysis diagnosis, 971-72 Therapeutic neck dissection, 1099 Therapeutics acute rhinosinusitis, 568 allergic rhinitis, 540-547 chronic rhinosinusitis, 579-82 for epistaxis, 553 migraine, 585-86 Thymic cyst, 831 Thyroarytenoid muscle, 851 Thyroglossal duct anomalies, 831 Thyroid diseases, 1143 hyperplastic and inflammatory, 1143-44 Thyroid lymphoma of thyroid glands, 1168-69 Thyroid metastases, 1169 Thyrotoxicosis, 1145-46 Tinnitus, 351-59 medically treatable diseases, symptom of, 352, 352t neuropsychological model, 355-58, 356f prevalence, 351-52 related problems, 353 related to sound tolerance, 352 Tip augmentation grafts, 650 Tip extension grafts, 650-51 Tip grafts, 650 Tip surgery, 651-52 Tissue engineering, 710-12 Tissue expansion, 722 Tissue microarrays, 997 TM See Tympanic membrane TMJ See Temporomandibular joint Tobacco as laryngeal cancer risk, 1121 Toluidine blue, 1018 Tomotherapy, 451-52 Tongue sensory innervation of, 769, 770t, 770f Tonotopy, 8.2 Tonsillectomy, 772, 777, 991-92 Tonsillitis biofilms in, 843 Tonsilloliths, 777 Tonsils blood supply to, 772, 772f diseases, 775-78 Topical corticosteroid therapy of chronic rhinosinusitis, 581 Topical intranasal corticosteroids for allergic rhinitis treatment, 541-43 Topical ototoxicity, 274 Tornwaldt (Thornwaldt), cyst, 511, 834-35 Total laryngectomy, 1124-25 Total ossicular replacement prostheses (TORPs), 176, 242f Toxin conjugates, 1038 Toxoplasma gondii, 1134 Toxoplasmosis, 1134 Trachea, 949 Tracheal involvement, 806 Tracheal resection and anastomosis, 910-11 Trachea neoplasms affecting, 949 Tracheomalacia as a supralaryngeal airway obstruction cause, 810-11 clinical imaging of, 950 1207 Tracheostomy tubes biofilm formation on, 843 Tracheostomy, 905-8, 991 Trachestomy laryngeal stenosis, 902 Transblepharoplasty midface suspension, 746 Transcranial magnetic stimulation (TMS) for tinnitus treatment, 355 Transduction of vestibular hair cells, 69-70, 70f Transient hypothyroidism, 1152 Transient receptor potential (TRP), 770 Transnasal esophagoscopy (TNE), 976-77, 1122 procedures, 976-77 Transnasal pressure, 495 Transoral robotic surgery (TORS), 801-3 Transorbital projection, 145-46 Transposition flaps, 719-21 Trauma, esophageal, 980-81 associated with external ear, 14.2-14.3 due to inner ear surgery, 175 inner ear, 254-55 middle ear, 253 penetrating, 258 TB, 255-63 Treacher Collins syndrome (TCS), 292 Treatment AIED, 308-9 anaplastic thyroid carcinoma, 1167-68 atresia, 817 biofilms, 844 BPPV, 324 canalith repositioning maneuvers, 324-25 horizontal canal benign paroxysmal positional vertigo, 325-26 branchial cleft anomalies, 829 cholesterol granuloma, 224 deep head infections, 784-86 of ear disorders, 40 of eustachian tube dysfunction, 204-8 hearing impairment, 300 hyperacusis, 358-59 hyperthyroidism, 1171-72 hypopharynx squamous cell carcinoma, 1116-17 implications for aphasia, 873 childhood fluency disorders, 873 craniofacial anomalies, 872 craniofacial muscles, 873 speech language impairment, 871 speech sound disorders, 869 voice disorders, 874 ISSNHL, 281 laryngeal cancer, 1122-25 expertise requirement, 1123 nonsurgical, 1125 laryngeal clefts, 820-21 laryngoceles, 819 laryngomalacia, 816 laryngopharyngeal reflux (LPR), 888, 888t laryngotracheal stenosis (LTS), 908-11 Leksell Gamma Knife, 443 speech recognition, 446f, 446 by radiosurgery, 453 mandibular fractures, 680-81 medical COM, 224 of OM, 212-15 of otosclerosis, 248 Menière disease, 315-16 meningioma, 426 midface fractures, 683-95 bone grafting, 696-97 neck space infections, 784-86 neonatal airway compromise, 806-8 8/27/08 10:57:50 PM 1208 Index NIHL, 269-70 noise-induced hearing loss, 271 obtrusive sleep apnea, 793-94 of HNSCC, 1035-39 of JNA, 1082 of NPC, 1085-87 of oral cavity cancer, 1096-99 of sleep apnea, 989-91 of unilateral vocal fold paralysis, 927 olfactory disorders, 472-73 OM, 210, 214 CAM, 214 oropharynx squamous cell carcinoma, 1109-10 parasymphyseal fractures, 683 pediatric airway, 808-9 pharmacologic BPPV, 326 planning radiation therapy, 1043-44 PLF, 286 Preoperative otosclerosis, 248 presbyacusis, 340-41 presbyastasis, 341 principles behavioral intervention, 878 contact granulomus, 881 laryngoceles and saccular cysts, 880 recurrent respiratory papillomatosis, 879 reinke edema, 882 sulcus vocalis and vocal-fold scar, 881 surgical intervention, 878 voice therapy, 878 rhinitis, 522 rudimentry epiglottis, 817 saccular cysts, 819 side effects of NPC, 1087 stenosis, 823-24 subglottic hemangioma, 825 surgical BPPV, 326 OM, 215 otosclerosis, 248-51 oropharynx squamous cell carcinoma, 1110-11 traumatized facial nerve, 260 taste dysfunction, 478 for tinnitus drugs, 354t through corticosteroids side effects, 83-84 through stem cells, 96-97 thyroid lymphoma of thyroid glands, 1169 timing traumatized facial nerve, 259-60 tinnitus, 354 tympanosclerosis, 223-24 vestibular disorders, 347-49 vestibular migraine, 320-21 pharmacotherapy, 321 vestibular neuritis, 318 vocal fold paralysis, 821-22 VS, 422-23 webs, 818-19 zygomatic fractures, 688-89 Trichinosis, 893 TTS See Temporary threshold shifts Tube clogging, 1067 Tube feeding administration, 1067 Tube feeding formulas, 1067 Tuberculosis, 891 Tularemia, 891 Tumor cure (TCT50) assays, 1044 Tumor oncogenes in HNSCC development, 999-1000 BDBK005_Index.indd 1208 Tumor suppressor genes in HNSCC development, 999 Tumors immune escape through indirect suppression of cellular immunity, 1008-9 antigen loss associated with, 1006 associated with follicular cell derived thyroid carcinoma (FCDTC), 1156 of glial origin, 513 associated with gustatory dysfunction, 476 immune escape through apoptosis control, 1006-8 immune escape through invisibility, 1005-6 immune ignorance associated with, 1006 infratemporal fossa (ITF), 514-15 of laryngeal cancer, 1122 perineural spread of, 510, 510f suprasellar, 512-13 Tympanic membrane (TM), 212, 217 Tympanic membrane external ear, 18-20 Tympanocentesis, 210 Tympanometry, 117-18, 117f Tympanoplasty, 225, 239 Tympanosclerosis, 223 Tympanostomy tubes biofilm formation on, 843 Type I tympanoplasty, 240-42, 241f Type II tympanoplasty, 242 Type III tympanoplasty, 242 Type III tympanoplasty, major columella, 242-43 Type III tympanoplasty, minor columella, 242 Type III tympanoplasty, stapes columella, 243 Type IV tympanoplasty, 243 Type V tympanoplasty, 243 U Ulnar fasciocutaneous flap, 730 Unilateral cleft lip, 836 Unilateral tonsillar enlargement, 777 Upper airway resistance syndrome (UARS), 98-89 Upper blepharoplasty eyebrow and forehead, 745 Upper esophageal sphincter (UES), 887 Upper motor neuron disorders, 914 See also Lower motor neuron disorders Upper respiratory tract (URI) bacterial infections associated with, 559-60, 567, 568 infectious diseases, overview of, 519 viral infections associated with, 559, 567 Upper vault analysis, 637-38 URI See Upper respiratory tract Usher syndrome (US), 37, 294 V Vaccine development in OM, 31 Valsava maneuver, 518 Vancomycin analogs, 277 Vancomycin, 277 Vascular anomalies, 830 Vascular compression as a supralaryngeal airway obstruction cause, 811 Vascular endothelial growth factor (VEGF), 1039 Vasculature ear canal, 229 Vectors associated with gene therapy, 85-86 VEMP responses, 329 VEMP See Vestibular evoked myogenic potential Venous thrombosis, 235 Ventilation, 806 use in therapeutic bronchoscopy, 970-71 Ventricular obliteration, 886 Verrucous carcinoma, 1094 Vertebrate inner ear stem cells, 95-96 Vertical dome division, 651, 653f Vertical partial laryngectomy, 1123 Vertigo, 131, 321 See also Dizziness of cervical, 345 Vestibular apparatus, 68-69 Vestibular function testing, 136-37 Vestibular manifestations superior semicircular canal dehiscence syndrome, 327-28 Vestibular migraine, 318-21 associated problems, 320-21 Vestibular neuritis, 317-18 Vestibular nystagmus, 75 Vestibular organs, 89 Vestibular reflexes, 75 Vestibular rehabilitation, 343 Vestibular schwannomas (VS), 413, 418-25 neurosurgical approaches, 424t Vestibular system, 131, 68-75, 131, 313-14 Vestibular-evoked myogenic potential (VEMP), 142, 144f Vestibulitis 559-60 See also Folliculitis Vestibulocerebellar connections, 72 Vestibulo-ocular fixation (VFIX), 142 Vestibulo-ocular reflex (VOR) sinusoidal gain, 141f Vestibulo-ocular reflex testing, 134 rotational chair, 141f Vestibulo-oculomotor reflex, 72 Vibromechanical activity, 45 Videoendoscopic photodocumentation, 497 Videonystagmography (VNG) of vestibular function, 340 Videostroboscopy, 916 Viral causes bronchitis, 529 pharyngitis, 526-27 rhinitis, 522 stomatitis, 524 Viral external otitis, 196 Viral infections in salivary glands, 1131-32 Viral laryngitis, 889 Viral laryngotracheitis (croup), 888-89 Viral vectors intratympanic gene therapy, 85 Virulence factors of OM, 30 Viruses isolation middle ear effusions, 210 Visceral space infection, 785 Vitamin deficiency, 782 VNG See Videonystagmography Vocal fold movement, 863-64 Vocal fold paesis, 930 Vocal fold paralysis, 821-22, 916-17 Vocal function assessment of, 859 Vocal performance assessment for vocal function assessment, 860 equipments used, 864-65 Vocal-fold cysts, 877 Vocal-fold nodules, 877 Vocal-fold polyps, 877 Voice disorders, 873-74, 913, 931 Voice function, 913 Voice function evaluation of, 916 Voice prostheses biofilm formation on, 843 Voice therapy, 918 8/27/08 10:57:51 PM Index Voice-care professionals, rehabilitation responsibility, 940 Von Ebner glands, 770 VS See Vestibular schwannomas V-Y advancement flaps, 718 W Waardenburg syndrome (WS), 37, 292-93 Warthin tumor, 1136 Weak triangle, 644 Webs, 817-819 Wegener granulomatosis (WG), 310, 505, 507f, 894, 966 BDBK005_Index.indd 1209 White blood cells, 481 Wide tip refining of, 647-48 Wound healing phases, 699-702 Wound healing, 699 factors affecting, 702-3 W-plasty (technique), 707-8 See also Geometric broken line closure technique WS See Waardenburg syndrome X X-linked deafness locus 3, 26 X-linked mixed deafness type 3, 295 1209 X-linked nonsyndromic hearing impairment, 297 See also X-linked syndromic hearing impairment X-linked syndromic hearing impairment, 294-95 See also X-linked nonsyndromic hearing impairment Z Zenker diverticulum, 952 Z-plasty (technique), 707, 720 Z-plasty double transposition flaps, 765 Zygomatic bone, 516 8/27/08 10:57:51 PM ... aerodigestive tract and its role in metastasis of squamous cell carcinoma Head Neck 20 03 ;25 : 322 – 32 11 Dodds MW, Johnson DA, Yeh CK Health benefits of saliva: A review J Dent 20 05;33 :22 3–33 12 Martin-Harris... children 27 children 26 2 children 76% abscess at surgery 91% abscess at surgery 75% abscess at surgery 76% abscess at surgery 63% abscess at surgery 81% abscess at surgery 76% abscess at surgery. .. Dysphagia 20 05 ;20 : 32 9 Linden RWA Taste Br Dent J 1993;175 :24 3–53 Hadley K, Orlandi RR, Fong KJ Basic anatomy and physiology of olfaction and taste Otolaryngol Clin North Am 20 04;37:1115 26 Spector