American journal of otolaryngology
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Although pain is one of the most feared consequences of cancer, pain management is rarely discussed in the literature on head and neck cancer. The pain experienced by patients with head and neck malignancies, of a biologic origin, is compounded by the emotional distress caused by alterations in function and cosmesis. Control of pain is possible, but an effective program must include more than pain medication. ⋯ Stool softeners must be provided, and anti-nausea medication is often given. Steroid drugs are regularly used to increase appetite, decrease edema, and enhance the patient's sense of well-being. Factors related to the selection and dosage of medications are discussed.
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Comparative Study
Pathology and pathogenesis of tympanic membrane retraction.
Temporal bones without evidence of otitis media, as well as temporal bones with various types of otitis media, were examined for the presence of retractions of the tympanic membrane and their related histopathologic progression to the formation of cholesteatoma. Retractions were not present in non-otitis media, purulent, or mucoid otitis media. Retractions were observed in 2.1% of temporal bones with serous otitis media and 19.5% of temporal bones with chronic otitis media. ⋯ Histopathologic changes of the middle ear cleft were associated with the type and degree of retraction. This study supports the continuum theory according to which otitis media with effusion eventually leads to a variety of sequelae and/or to chronic otitis media. The tympanic membrane appears to follow progressive changes, from simple retraction to retraction pockets and finally to cholesteatoma.
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From 1985 to 1987, 22 head and neck sites in 20 patients with recurrent tumors were treated with interstitial thermoradiotherapy (ITRT). The sites treated were 15 neck (68%), four tongue (18%), two parotid (9%), and one buccal mucosa (4%). Squamous cell carcinoma was diagnosed in 21 sites and adenocarcinoma in the other. ⋯ Serious complications occurred in two patients: one had localized soft tissue necrosis, the other had aspiration pneumonia. ITRT was well-tolerated by patients despite prior aggressive therapy. High objective response rate and low toxicity demonstrate the value of this treatment combination in the management of patients with postradiation recurrence of head and neck tumors.
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Tracheal bronchus is an aberrant bronchus that arises most often from the right tracheal wall above the carina and is the result of an additional tracheal outgrowth early in embryonic life. Its incidence ranges between 0.1 and 5%. This anomaly usually is diagnosed incidentally during bronchoscopy or bronchography performed for various respiratory problems. ⋯ Tracheal bronchus may be associated with other bronchopulmonary anomalies, tracheal stenosis, or Down's syndrome. In the absence of clinical symptoms, a diagnosis of tracheal bronchus does not require any treatment. In patients with recurrent right upper lobe disease and a tracheal bronchus, therapy should include resection of the aberrant bronchus as well as the lobe it supplies.
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Experiments performed within the last 15 years on cochleas of live animals indicate that the cochlear sound analysis is much sharper than was expected from Békésy's experiments on postmortem preparations. The mechanism underlying the sharp analysis has not yet been ascertained experimentally. ⋯ The resonance would produce a strong vibration of the tectorial membrane in the radial plane and enhance the shear motion between the membrane and the reticular lamina. Mechanical and computer models of the mechanism have allowed the authors to reproduce in detail the empirical basilar membrane as well as corresponding neural tuning curves and to account for associated cochlear nonlinearities.