Malignant glomus tumors

OBJECTIVES/HYPOTHESIS

To ascertain the incidence of malignancy in a large glomus and skull base series and to compare the clinical course of such patients with those who do not have malignant skull base lesions.

STUDY DESIGN

Retrospective review of all skull base surgery cases treated at the Otology Group between 1970 and 1995.

RESULTS

In a series of 175 jugulotympanic glomus tumors, 9 cases (5.1%) were identified. The surgery required for their extirpation is more extensive than nonmalignant glomus tumors. Attendant deficits and mortality from these procedures are accordingly greater. Five-year survival in this limited population was 72%. Prolonged periods of survival are possible with distant metastases.

CONCLUSIONS

This rate of malignancy should advocate against a watchful, waiting approach. Radiation therapy is not advocated as a primary modality for this type of tumor, as it may lead to recurrence/persistence with either subsequent malignant degeneration and metastases or local recurrence.

Which culprit is causing your patient's otorrhea?

Otorrhea varies in appearance and can be accompanied by a multitude of symptoms. Recognition of what various combinations indicate--whether otitis externa, chronic otitis media, Langerhans' cell histiocytosis, or basal or squamous cell carcinoma--is essential. Physicians must also be familiar with the tests appropriate for confirming otorrhea's cause. Once proper diagnosis is made, effective treatment can follow.

Hearing loss: the invisible disability

Loss of hearing is a national health problem with significant physical and psychological repercussions. Although there is no cure for certain forms of hearing loss, many patients can be helped, especially when the problem is recognized early. The authors discuss the important role of primary care physicians in early identification, management, and counseling of hearing-impaired patients.

Immunohistochemical characterization of benign laryngeal lesions

It has been proposed that laryngeal nodules and polyps represent injury to the basement membrane zone of the vocal fold. Repeated trauma from shearing forces produced by excessive or abusive phonation leads to basement membrane zone disruption and thickening. This thickening, along with poorly understood vascular changes, creates the characteristic clinical appearance of the vocal nodule or polyp. As such, to better understand vocal fold nodules it is imperative to characterize the extracellular matrix in this area of injury. Secondary to the small size and relatively acellular nature of these lesions, hematoxylin and eosin (H & E) preparations of histologic material are unsatisfying. A previous study examined this area with immunohistochemical techniques to better characterize its contents. The report, however, contained little information with regard to the clinical appearance of the lesions prior to excision. Therefore, we were prompted to review histologic material from 31 patients who underwent microsurgical excision of 41 benign lesions, vocal nodules (4), polyps (19), polypoid corditis (4), and cysts (14) with immunohistochemical techniques to characterize the patterns of fibronectin and collagen type IV within these lesions. Normal human vocal folds were stained for control. All material was correlated with the H & E preparations and the clinical diagnosis. Collagen type IV and fibronectin appeared present in relatively abnormal patterns in the areas adjacent to the lesion. This study validates earlier results. In addition, correlation with clinical data allows association of immunohistochemical staining patterns with clinical diagnosis.

Value of videostroboscopic parameters in differentiating true vocal fold cysts from polyps

Differentiating between benign true vocal fold (TVF) cysts, polyps, and nodules on the basis of their gross appearance would be advantageous in determining the need for surgical therapy. A retrospective study of 32 patients covering 31 months was done to assess the ability to differentiate these lesions on the basis of stroboscopic parameters. Stroboscopic examinations were evaluated for symmetry, amplitude, periodicity, mucosal wave, and closure. Preoperative diagnoses were validated with operative and histologic confirmation. Mucosal wave was absent or diminished in 100% of TVF cysts and present or increased in 80% of TVF polyps (P < .05). Thirty-one percent of original histopathologic diagnoses were modified after pertinent clinical information was provided to the pathologist. Therefore, stroboscopic evaluation of mucosal wave is helpful in preoperative differentiation of TVF cysts and polyps, and providing clinical information to the pathologist is critical for useful histologic information.

Prevention of pharyngocutaneous fistulas by means of laser-weld techniques

Although much has been written on methods of dealing with pharyngocutaneous fistulas once they have formed, there are few reports of methods of preventing fistula formation from occurring. We examined the use of laser-weld techniques with the neodymium:yttrium aluminum garnet (Nd:YAG) and diode lasers to seal pharyngotomy closures. Laser-weld techniques have been used successfully in many other tissues, but reports documenting use in the upper aerodigestive tract are minimal. Indocyanine-green dye-enhanced collagen and fibrinogen were studied as laser solder materials for the diode laser. Twenty-nine experimental animals were studied. Neither the Nd:YAG nor the diode laser was successful in preventing fistula formation. Tensiometric studies documented significant strength of the laser welds ex vivo, but this finding was not clinically significant.