There is no single "best" approach to Zenker's diverticulum. The open, laser, and stapler methods are equally effective and have similar complication rates.

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In the context of an indeterminate fine-needle aspiration biopsy, an elevated index of suspicion for parotid malignancy may be warranted.

ObjectiveFacial nerve dysfunction can vary in severity and recovery is dependent on the character of the injury. N‐acetyl‐cysteine prevents oxidative stress and cellular damage, and its use in the setting of nerve dysfunction from crush injury has not yet been established. In this study, rats with facial nerve crush injury will be treated with n‐acetyl‐cysteine or control and functional recovery and electrophysiologic outcome will be compared.Study DesignProspective, randomized animal studyMethodsTwenty‐four Wistar rats underwent unilateral facial nerve crush injury. Rats were implanted with a subcutaneous osmotic pump filled with saline (n = 12) or n‐acetyl‐cysteine 50 mg/kg/day (n = 12). Functional and electromyographic recovery was recorded at two and four weeks postoperatively.ResultsWhen compared to untreated rats, n‐acetyl‐cysteine treated rats had a greater electromyography amplitude recovery at 2 weeks with regard to eye blink (p=0.006) but not vibrissae function. At four weeks, the electromyography amplitude recovery of the vibrissae function was greater in n‐acetyl‐cysteine treated rats (P=0.001), but the amplitude recovery difference in eye blink was only marginally significant between groups (p=0.07). The functional score was higher in n‐acetyl‐cysteine‐treated rats than in untreated rats at all of the time points.ConclusionThis study demonstrated that n‐acetyl‐cysteine facilitated facial nerve recovery with improved functional and electromyography outcomes in the setting of crush injury.Level of EvidenceNA

Objective:To assess the frequency of electrode deactivation over time in post meningitic cochlear implant (CI) recipients Study Design:Retrospective chart review Methods:A retrospective chart review of all post meningitic cochlear implant recipients at New York University from 1984 2008 was conducted. Patients with more than 2 years of follow up programming and speech perception data were included. Percent of active electrodes was calculated relative to maximum number of programmable electrodes. Frequency and pattern of electrode deactivation over time was analyzed and compared to published data on non meningitic CI patients Results:A total of 14 patients with 17 implanted ears were included. Length of follow up ranged from 2 25 years (average 7.3). A total of 9 (53%) ears experienced a reduction in active electrodes. Of these, 3 patients had deactivation of 1 electrode, 4 patients lost 2 electrodes, and the remaining 2 patients had had 5 and 6 electrodes deactivated, respectively. All patients except one had a minimum of 11 active electrodes at all times. Rate of deactivation over time was variable with loss of electrodes occurring up to 4 years post operatively. Three of the 9 ears with electrode deactivation received Nucleus 24 double array devices. Loss of electrodes was not correlated with a decline in speech perception, age at implantation or duration of deafness. There was one device failure. Conclusions:Deactivation of CI electrodes over time is common in post meningitic CI recipients (53%) and exceeds rates from non meningitic patients (1%.). Although electrode deactivation is multi factorial, anatomic considerations, such as ongoing compromise of the electrode neural interface by labyrinthitis ossificans, may contribute to deactivation in both the short and long term.A retrospective chart review of all post meningitic CI recipients at New York University from 1984 2008 was conducted. Patients with more than 2 years of follow up programming and speech perception data were included. Those with cochlear ossification resulting from processes other than meningitis, including otosclerosis, chronic otitis media, ototoxic agents, trauma or idiopathic processes were excluded. Maximum number of programmable electrodes were determined by type of device and number of electrodes inserted during implantation. Electrodes were deactivated for subjective complaints or for objective evidence of electrode malfunction. Number of deactivated electrodes following initial CI stimulation was recorded.The present study examined CI electrode deactivation over time in post meningitic CI recipients and found 9 of 17 ears (53%) with at least 1 deactivated electrode. This rate is higher than that found by previous authors in non meningitic populations. Zeitler et al (2008) found that 1% of CI recipients undergo 1 or more electrode deactivations following initial stimulation. Loss of 5 or more electrodes was correlated with device failure. 5 Carlson et al. (2010) found slightly higher rates 9% of patients in their study exp...

Objective?To determine whether transcranial motor-evoked potential (TCMEP) monitoring of the facial nerve (FN) during cerebellopontine angle (CPA) tumor resection can predict both immediate and long-term postoperative FN function. Design?Retrospective review. Setting?Tertiary referral center. Main Outcome Measures?DeltaTCMEP (final-initial) and immediate and long-term facial nerve function using House Brackmann (HB) rating scale. Results?Intraoperative TCMEP data and immediate and follow-up FN outcome are reported for 52 patients undergoing CPA tumor resection. Patients with unsatisfactory facial outcome (HB >2) at follow-up had an average deltaTCMEP of 57?V, whereas those with HB I or II had a mean deltaTCMEP of 0.04?V (t?=?-2.6, p??2) facial function in the immediate postoperative period. Conclusion?Intraoperative TCMEP of the facial nerve can be a valuable adjunct to conventional facial nerve electromyography during resection of tumors at the CPA. Intraoperative deltaTCMEP >57?V may be worrisome for long-term recovery of satisfactory facial nerve function.

Objective: The family caregiver's role (FCG) is largely uninvestigated among head and neck cancer patients. 1) To better detail the role of FCG. 2) To evaluate quality of life (QoL) and psychological distress of FCGs and patients. 3) To investigate relationships between FCG's well being and patient's QoL and emotional pattern.Method: Sixty patients and their caregivers were enrolled in this observational cross-sectional study between 2008 and 2011 at the ENT Division of the University of Turin. Inclusion criteria: diagnosis of HNSCC, stage III-IV, completion of curative treatment and NED at the enrollment. Psycho-oncological tests: Distress Thermometer, STAI-Y1/Y2, Beck Depression Inventory (BDI) and Montgomery-Asberg Depression Rating Scale (MDRS), EORTC-QLQ-C30+H&N35 module and Caregiver Quality of Life Index-Cancer. Results:Patients: state and trait anxiety are 46.7% (STAI-Y1 mean value 40.2 ± 10.2; cutoff 40) and 36.7% (STAI-Y2 mean value 36.7 ± 8.2; cutoff 40) respectively; self-reported and clinicianrated depression are 31.6% (BDI mean value 8.2 ± 5.3; cutoff 9) and 48.3% (MDRS mean value 7.9 ± 5.9; cutoff 6), respectively. CGs: state and trait anxiety are 50% (STAI-Y1 mean value 42.5 ± 9.9; cutoff 40) and 41.7% (STAI-Y2 mean value 39.1 ± 8.7; cutoff 40), respectively; self-reported and clinician-rated depression are 28.3% (BDI mean value 7.3 ± 4.7; cutoff 9) and 41.7% (MDRS mean value 7.6 ± 5.8; cutoff 6), respectively. Positive association among emotional scales of patients and caregivers was observed. Patients' psychological aspects are negatively associated with CGs' QoL and vice versa. Conclusion:Anxiety and depression are often present in FCGs and cured HNC patients. Long-term patients' QoL is the result of a frail balance between FCG and patient emotional and psychological distress. A psychological support for FCG could improve patient well-being. Head and Neck Surgery the Role of Fine-Needle aspiration in Parotid Pleomorphic adenomaChristopher E. Fundakowski, MD (presenter); Jonathan Castano; Marianne Abouyared; Andrew Rivera; Rosemary Ojo, MD; Zoukaa Sargi, MD Objective: Fine-needle aspiration (FNA) biopsy is often used as a well-accepted and both sensitive and specific diagnostic adjunct in the workup of parotid masses. In the case of pleomorphic adenoma, the most common benign tumor of the parotid gland, we examine cytopathologic reports to assess the performance of FNA for this particular histologic diagnosis.Method: A total of 317 patients who underwent parotidectomy over the past 5 years and met eligibility criteria of 1) primary parotid tumor, 2) age greater than 18 years, and 3) availability of pathology (FNA, intraoperative frozen section, final pathology) were reviewed. Clinical history and demographics, physical exam findings, and intraoperative findings were noted.Results: Pleomorphic adenoma was noted on final pathology in 136 patients (42.9%). Interestingly 24 (17.6%) of these patients had initially undergone FNA and been given a incorrect diagnosis, despite the FNA being "diagnostic....