The fibrin/Gelfoam vehicle was the only delivery system to produce reliable damage. Ototoxic damage depended on the vehicle. We found no evidence for selective vestibular ototoxicity with gentamicin.

Although anatomic variations in the development of the nose and paranasal sinuses such as the Haller's cell do not themselves represent a disease state, in many cases they are responsible for the patient's symptoms. Particularly in the absence of extensive associated mucosal changes, these conditions may be easily overlooked unless specifically sought. Haller's cells may cause recurrent or chronic sinusitis and persistent sinugenic headache, without significant findings on physical examination including nasal endoscopy. The presence of Haller's cells on coronal CT in a patient with corresponding symptoms deserves consideration as the potential cause of the symptoms. When medical therapy is ineffective, such cases respond well to surgical therapy through the functional endoscopic approach.

An algorithm has evolved for the management of patients with acoustic neuroma. Decisions as to surgery vs. observation, surgical approach, and whether hearing preservation should be attempted depend on age, patient symptoms, size of the tumor, residual hearing, and degree of facial nerve involvement at the time of surgery. Conservative management is used for patients over 65 years of age. This consists of observation or subtotal resection through a translabyrinthine approach, depending on the absence or presence of brainstem signs or symptoms. In patients under 65 years of age, hearing preservation is attempted through the retrosigmoid approach in tumors 1.5 cm or less if pure-tone average is less than 30 dB and the discrimination score is greater than 70%. The translabyrinthine approach is our preferred approach for tumors of any size when hearing is not serviceable. A near-total excision is performed when the facial nerve cannot be separated from the tumor. The rationale for this algorithm in the management of 130 cases of acoustic neuroma over the past 17 years is presented.

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As more information on acoustic tumors is accumulated, it is apparent that the lesions may have several sites of origin. A case of an acoustic tumor arising primarily in the vestibule is presented. This case, which has been followed for seven years, supports the proposed theory that the tumor may develop from the nerves to either the saccule or the utricle.

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ABSTRACfSchwannomas are benign neoplasms arising from the peripheral nerve sheath. The sinonasal tract is an unusuallocation for these neoplasms. Because of their rarity, few series have been reported. Five previously unreported cases of schwannomas of the nose and paranasal sinuses are presented that illustrate the spectrum of disease. The clinical presentation, diagnostic work-up, clinical course, and diverse therapeutic approaches will be discussed. A management philosophy based on the diversity of these tumors and their clinical behavior, and incorporating the new diagnostic and therapeutic tools available to the clinician wi(f be presented. The implications of newer diagnostic techniques including sinonasal endoscopy, magnetic resonance imaging, and immunochemistry in the diagnosis and treatment of these tumors will be discussed. (Am J Rhinology 7: [59][60][61][62][63][64][65] 1993) S Chwannomas are benign neoplasms of peripheral nerve sheath origin. Although several other terms have been applied to these lesions, schwannoma seems to be the most appropriate name because the cell of origin is the Schwann cell. 1 The sinonasal tract is an unusual location for these An Official Abstract form is included in the this issue of The American Journal of Rhinolol!.Y Am J Rhinology 65

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