Barry Rasgon - Academia.edu (original) (raw)
Papers by Barry Rasgon
The Laryngoscope, 1999
To determine factors affecting the safe use of topical cocaine for anesthesia and vasoconstrictio... more To determine factors affecting the safe use of topical cocaine for anesthesia and vasoconstriction during rhinologic surgery. Study Design: Prospective, randomized study of the kinetics of cocaine absorption through human nasal mucosa in 12 consecutive patients without nasal mucosal disease who were having septoplasty or septorhinoplasty. Methods: With patients under general anesthesia, cocaine was applied topically to each nasal cavity by using cottonoid pledgets. Group I received 4 mL of a 4% solution (160 mg) of cocaine for 10 min, Group I1 received 4 mL of a 4% solution (160 mg) of cocaine for 20 min, and Group I11 received 4 mL of a 10% solution (400 mg) of cocaine for 20 min. Absorption rate was determined by measuring serum cocaine concentration at intervals of 5, 10, 15, and 20 min. Residual cocaine was extracted from the pledgets and was analyzed quantitatively by using gas chromatography and mass spectroscopy. Results: Of total cocaine applied, 35% was absorbed systemically: 17% was absorbed within 5 min, 25% within 10 min, and 32% within 15 min. Of the cocaine absorbed, 47% was absorbed within the first 5 min, 70% within 10 min, and 90% within 15 min. Two patients (16.6%), both in Group ILI, had intraoperative hypertension; one of these patients also had transient ventricular tachycardia. Conclusions: Although a 4% solution of cocaine applied to the nasal mucosa on cottonoid pledgets for 20 rnin is safe, we observed an idiosyncratic absorption rate four times greater than expected; therefore, we advise against topical use of a 10% cocaine solution for anesthesia and vasoconstriction during rhinologic surgery.
The Permanente Journal, 2012
Otolaryngology - Head and Neck Surgery, 1995
Ear, nose, & throat journal
We measured quality of life issues for both children and their parents on the premise that parent... more We measured quality of life issues for both children and their parents on the premise that parental quality of life should be an aspect of cost-effectiveness in otitis media treatment. The patients were less than 18 years of age and had had myringotomy with tube insertion at the head and neck surgery department of a large health maintenance organization. Quality of life for patients, parents, and caregivers was evaluated by telephone survey of parents or caregivers and by retrospective chart review of the number of pre- and postoperative healthcare visits and antibiotic usage. Chart review showed a significant postoperative reduction in the number of clinic visits and in use of antibiotic drugs after insertion of tympanostomy tubes. Improved postoperative hearing was noted, and tympanostomy tube insertion was shown to be safe. The chart-review cost analysis showed that tympanostomy tube insertion is a cost-effective treatment for otitis media in children, and the telephone survey re...
Background: Bell’s palsy is an acute, idiopathic, and usually unilateral paralysis of the seventh... more Background: Bell’s palsy is an acute, idiopathic, and usually unilateral paralysis of the seventh cranial (i.e., facial) nerve. Speculation regarding an association between immunization and Bell’s palsy exists; however, rigorous population-based epidemiologic studies to evaluate such an association among children are lacking. Methods: This study was conducted within the population of Kaiser Permanente Northern California. From January 2001 through December 2006, all children 18 years of age and younger diagnosed with Bell’s palsy were identified using the International Classification of Disease, 9th Revision (ICD-9) code 351.0. All Bell’s palsy cases were reviewed and adjudicated as definite, probable, or rejected by an otolaryngologist using detailed chart review data. Using a novel case-centered logistic regression model, we evaluated the association between immunization and Bell’s palsy during the 1-28 days and 29-56 days following immunization among cases who had received trival...
The Permanente journal, 2009
Ear, nose, & throat journal, 1996
Chondroma of the laryngeal cartilage is a rare, benign neoplasm which can manifest as a neck mass... more Chondroma of the laryngeal cartilage is a rare, benign neoplasm which can manifest as a neck mass or, if situated within the airway, as slowly progressive obstruction, hoarseness or dyspnea. The most common location for chondroma is the posterior lamina of the cricoid cartilage; the next most common locations are the thyroid, arytenoid and epiglottic cartilages. Chondroma and low-grade chondrosarcoma are difficult to distinguish from one another histologically. Although chondrosarcoma reportedly recurs, local surgical excision without radical margins and with long-term clinical follow-up is recommended. We report one case of thyroid cartilage chondroma and include a review of radiologic studies and histopathologic analysis results. We also report a second case with severe airway obstruction caused by a large cricoid chondroma. A review of the English language biomedical literature on laryngeal chondroma is included.
Archives of otolaryngology--head & neck surgery, 1994
The Permanente journal, 2014
A man, age 62 years, presented to the clinic with a 2-week history of increased nontender, nonery... more A man, age 62 years, presented to the clinic with a 2-week history of increased nontender, nonerythematous, indurated right-sided parotid swelling. A 4 × 6-cm firm, well-circumscribed mass was palpated in the right parotid gland. A fine-needle aspiration biopsy was performed on the parotid mass with aspiration of 0.5 cc of purulent fluid with some blood. Cultures from the aspirate revealed Coccidioides immitis confirmed by DNA probe. Pathology slides revealed fungal spores. The patient was treated with 800 mg of fluconazole every day for 3 months with resolution of the parotid swelling. However, persistent cervical adenopathy remains.Although this is a rare case of acute parotid swelling, Coccidioides immitis should be considered in the differential diagnosis of parotid masses in a patient with previous coccidioidomycosis. There may be a potential for an increase in frequency and variety of atypical extrapulmonary manifestations of coccidioidomycosis that parallels the increase in c...
Ear, nose, & throat journal, 2005
We measured quality of life issues for both children and their parents on the premise that parent... more We measured quality of life issues for both children and their parents on the premise that parental quality of life should be an aspect of cost-effectiveness in otitis media treatment. The patients were less than 18 years of age and had had myringotomy with tube insertion at the head and neck surgery department of a large health maintenance organization. Quality of life for patients, parents, and caregivers was evaluated by telephone survey of parents or caregivers and by retrospective chart review of the number of pre- and postoperative healthcare visits and antibiotic usage. Chart review showed a significant postoperative reduction in the number of clinic visits and in use of antibiotic drugs after insertion of tympanostomy tubes. Improved postoperative hearing was noted, and tympanostomy tube insertion was shown to be safe. The chart-review cost analysis showed that tympanostomy tube insertion is a cost-effective treatment for otitis media in children, and the telephone survey re...
The Permanente journal, 2012
A 29-year-old woman presented from another hospital with a 10-month history of an enlarging left-... more A 29-year-old woman presented from another hospital with a 10-month history of an enlarging left-sided facial mass. Computed tomographic scan revealed a mass in the superficial lobe of the left parotid gland with left-sided cervical lymphadenopathy. The patient received a total left parotidectomy and a selective neck dissection. Histopathologic slides revealed lymphoepithelial carcinoma (LEC) that stained positive for cytokeratin, as well as Epstein-Barr virus (EBV). An LEC of the parotid is a rare salivary gland tumor accounting for less than 1% of all salivary gland tumors. As reaffirmed in our case, LEC is more common in women, occurs primarily in the parotid gland, and has an ethnic predilection. Histologic analysis reveals an infiltrative, poorly differentiated tumor nestled in a lymphoid stroma, with near 100% positivity for EBV in endemic areas. Complete resection of this poorly differentiated carcinoma followed by postoperative radiation is essential for local control.
Seminars in Oncology, 2004
Lymphatic mapping with sentinel lymph node (SLN) biopsy can accurately stage the nodal basins in ... more Lymphatic mapping with sentinel lymph node (SLN) biopsy can accurately stage the nodal basins in patients with melanoma of the trunk and extremities and has become a routine, well-accepted diagnostic method for melanoma at these anatomic locations. Melanoma of the head and neck (16% of all cases of melanoma) is complex and difficult to manage because of the rich abundant interlacing lymphatic drainage patterns, as well as watershed areas, which can lead to unusual and unexpected drainage patterns. Radioguided surgery in combination with blue dye facilitates localization of the SLN in the head and neck; however, this type of radioguided surgery is an evolving technique of some difficulty and thus requires careful coordination among the surgeon, nuclear medicine physician, and pathologist. Applications of this technique to other sites in the head and neck are currently being investigated for conditions including squamous cell carcinoma (SCC) of the oral cavity, thyroid cancer, and Merkel cell cancer. More studies of patients with head and neck cancer are needed--and technical issues must be resolved--before radioguided surgery can be recommended as the standard of care for these patients.
JAMA otolaryngology-- head & neck surgery, 2014
Currently there are few validated metrics for predicting surgical skill among otolaryngology resi... more Currently there are few validated metrics for predicting surgical skill among otolaryngology residency applicants. To determine whether manual dexterity aptitude testing in the form of soap carving during otolaryngology residency interviews at Kaiser Permanente Medical Center Oakland predicts surgical skill at the time of graduation from otolaryngology residency programs. This study was conducted to determine how applicants with the best and worst soap carvings compared at the time of graduation with respect to various metrics including visuospatial ability and manual dexterity. Over the last 25 years, applicants to the residency program at Kaiser Permanente Oakland were required to carve soap during their residency interview. The 3 best and 3 worst soap carvings from 1990 through 2006 were determined. Of the individuals who carved those soaps, 62 qualified for the study and matriculated into otolaryngology residency programs. Surveys were sent to the 62 individuals' residency p...
The Laryngoscope, 1991
A variety of hemostatic agents and techniques have been used in an attempt to reduce intraoperati... more A variety of hemostatic agents and techniques have been used in an attempt to reduce intraoperative blood loss and postoperative bleeding in tonsillectomy. The efficacy of most of these substances and techniques has been judged primarily on clinical impressions. Because of the paucity of prospective studies, a randomized, prospective, double-blind study, using the patients as their own controls, was conducted. Ninety-two patients were injected before tonsillectomy in a random, double-blind fashion with normal saline solution in one tonsil and 1:100,000 epinephrine in the other. The blood loss, time of dissection, and postoperative bleeding were recorded separately for each tonsil. Cardiac manifestations were also monitored. The tonsils injected with epinephrine had a statistically significant reduction in blood loss and dissection time when compared with those injected with normal saline. Subjectively, dissection was easier on the epinephrine-injected side. There was no difference in the incidence of postoperative hemorrhage. Cardiac manifestations of epinephrine were minimal and transient. This study demonstrates that epinephrine is useful in reducing hemorrhage during tonsillectomy and can be used safely with the appropriate inhalation anesthetics.
The Laryngoscope, 1999
To determine factors affecting the safe use of topical cocaine for anesthesia and vasoconstrictio... more To determine factors affecting the safe use of topical cocaine for anesthesia and vasoconstriction during rhinologic surgery. Study Design: Prospective, randomized study of the kinetics of cocaine absorption through human nasal mucosa in 12 consecutive patients without nasal mucosal disease who were having septoplasty or septorhinoplasty. Methods: With patients under general anesthesia, cocaine was applied topically to each nasal cavity by using cottonoid pledgets. Group I received 4 mL of a 4% solution (160 mg) of cocaine for 10 min, Group I1 received 4 mL of a 4% solution (160 mg) of cocaine for 20 min, and Group I11 received 4 mL of a 10% solution (400 mg) of cocaine for 20 min. Absorption rate was determined by measuring serum cocaine concentration at intervals of 5, 10, 15, and 20 min. Residual cocaine was extracted from the pledgets and was analyzed quantitatively by using gas chromatography and mass spectroscopy. Results: Of total cocaine applied, 35% was absorbed systemically: 17% was absorbed within 5 min, 25% within 10 min, and 32% within 15 min. Of the cocaine absorbed, 47% was absorbed within the first 5 min, 70% within 10 min, and 90% within 15 min. Two patients (16.6%), both in Group ILI, had intraoperative hypertension; one of these patients also had transient ventricular tachycardia. Conclusions: Although a 4% solution of cocaine applied to the nasal mucosa on cottonoid pledgets for 20 rnin is safe, we observed an idiosyncratic absorption rate four times greater than expected; therefore, we advise against topical use of a 10% cocaine solution for anesthesia and vasoconstriction during rhinologic surgery.
The Laryngoscope, 1999
Objectiues: Determine parameters for successful stapedectomy and whether this procedure can be pe... more Objectiues: Determine parameters for successful stapedectomy and whether this procedure can be performed safely by residents in a teaching hospital. Study Design: Retrospective analysis of techniques and results for 71 stapedectomy procedures. Materials and Methods: Charts were reviewed for technique, audiological test results, complications, operative time, and anesthetic used. Results: Overall, closure of the air-bone gap at 10 dB was achieved in 87% of patients. Use of general anesthesia and a laser-assisted, small-fenestra technique allowed residents to complete more operations. No severe sensorineural hearing loss was noted. Conclusions: Residents can safely and successfully perform stapes surgery using a laserassisted, small-fenestra technique.
The Laryngoscope, 2002
To test the hypothesis that patients with a variety of otolaryngologic diagnoses using telephone ... more To test the hypothesis that patients with a variety of otolaryngologic diagnoses using telephone appointment visits would be equally as satisfied as patients receiving physician office visits, the study compared telephone appointment visits with physician office visits for health maintenance organization patients who needed routine follow-up care in a head and neck surgery clinic. Randomized, nonblinded cross-sectional study. After their initial visit to either of two head and neck surgery clinics, new otolaryngology patients were randomly assigned into treatment and control groups. Patients in the treatment group (n = 73) received follow-up care in the form of telephone appointment visits, and patients in the control group (n = 80) received physician office visits for follow-up care. Study data were collected using telephone interviews and physician tracking forms. Patients receiving telephone appointment visits were significantly less satisfied with their visits than patients receiving physician office visits (chi2 = 25.4, P < .005). Patients who had physician office visits were significantly more likely than were patients in the treatment group to agree "somewhat" or "strongly" that 1) the physician addressed their questions and concerns (chi2 = 24.0, P < .005); 2) the physician provided personal care and attention (chi2 = 29.9, P <. 005); and 3) the physician provided high-quality care (chi2 = 34.5, P < .005). Patients who received telephone appointment visits were statistically significantly less satisfied with all aspects of their follow-up appointment than were patients who had physician office visits. The study findings indicate that telephone appointment visits may not be an ideal type of follow-up visit for all patients. Despite these findings, one third of patients in the treatment group would consider receiving a telephone appointment visit for future routine follow-up care, and 21.9% had no preference, perhaps a factor indicating willingness to receive a telephone appointment for a follow-up visit.
The Laryngoscope, 1989
A number of histopathologic parameters in squamous cell carcinoma of the oral cavity and orophary... more A number of histopathologic parameters in squamous cell carcinoma of the oral cavity and oropharynx have been identified as having a statistically significant correlation with regional lymph-node metastasis. These parameters have been inconsistent and not readily reproducible. In an attempt to confirm these parameters, a retrospective analysis of 22 patients with T1 to T4 squamous cell carcinoma of the oral cavity and oropharynx was performed. Initially, these patients were managed with either wide local excision or surgical excision of the primary tumor combined with radical neck dissection. There was a minimum of 3 years of follow-up. Chi-square contingency tables and Fisher's Exact Test were used to correlate histopathologic parameters with lymph-node metastasis. Statistically significant correlations were found for tumor thickness and inflammatory infiltrate.
The Laryngoscope, 1999
To determine factors affecting the safe use of topical cocaine for anesthesia and vasoconstrictio... more To determine factors affecting the safe use of topical cocaine for anesthesia and vasoconstriction during rhinologic surgery. Study Design: Prospective, randomized study of the kinetics of cocaine absorption through human nasal mucosa in 12 consecutive patients without nasal mucosal disease who were having septoplasty or septorhinoplasty. Methods: With patients under general anesthesia, cocaine was applied topically to each nasal cavity by using cottonoid pledgets. Group I received 4 mL of a 4% solution (160 mg) of cocaine for 10 min, Group I1 received 4 mL of a 4% solution (160 mg) of cocaine for 20 min, and Group I11 received 4 mL of a 10% solution (400 mg) of cocaine for 20 min. Absorption rate was determined by measuring serum cocaine concentration at intervals of 5, 10, 15, and 20 min. Residual cocaine was extracted from the pledgets and was analyzed quantitatively by using gas chromatography and mass spectroscopy. Results: Of total cocaine applied, 35% was absorbed systemically: 17% was absorbed within 5 min, 25% within 10 min, and 32% within 15 min. Of the cocaine absorbed, 47% was absorbed within the first 5 min, 70% within 10 min, and 90% within 15 min. Two patients (16.6%), both in Group ILI, had intraoperative hypertension; one of these patients also had transient ventricular tachycardia. Conclusions: Although a 4% solution of cocaine applied to the nasal mucosa on cottonoid pledgets for 20 rnin is safe, we observed an idiosyncratic absorption rate four times greater than expected; therefore, we advise against topical use of a 10% cocaine solution for anesthesia and vasoconstriction during rhinologic surgery.
The Permanente Journal, 2012
Otolaryngology - Head and Neck Surgery, 1995
Ear, nose, & throat journal
We measured quality of life issues for both children and their parents on the premise that parent... more We measured quality of life issues for both children and their parents on the premise that parental quality of life should be an aspect of cost-effectiveness in otitis media treatment. The patients were less than 18 years of age and had had myringotomy with tube insertion at the head and neck surgery department of a large health maintenance organization. Quality of life for patients, parents, and caregivers was evaluated by telephone survey of parents or caregivers and by retrospective chart review of the number of pre- and postoperative healthcare visits and antibiotic usage. Chart review showed a significant postoperative reduction in the number of clinic visits and in use of antibiotic drugs after insertion of tympanostomy tubes. Improved postoperative hearing was noted, and tympanostomy tube insertion was shown to be safe. The chart-review cost analysis showed that tympanostomy tube insertion is a cost-effective treatment for otitis media in children, and the telephone survey re...
Background: Bell’s palsy is an acute, idiopathic, and usually unilateral paralysis of the seventh... more Background: Bell’s palsy is an acute, idiopathic, and usually unilateral paralysis of the seventh cranial (i.e., facial) nerve. Speculation regarding an association between immunization and Bell’s palsy exists; however, rigorous population-based epidemiologic studies to evaluate such an association among children are lacking. Methods: This study was conducted within the population of Kaiser Permanente Northern California. From January 2001 through December 2006, all children 18 years of age and younger diagnosed with Bell’s palsy were identified using the International Classification of Disease, 9th Revision (ICD-9) code 351.0. All Bell’s palsy cases were reviewed and adjudicated as definite, probable, or rejected by an otolaryngologist using detailed chart review data. Using a novel case-centered logistic regression model, we evaluated the association between immunization and Bell’s palsy during the 1-28 days and 29-56 days following immunization among cases who had received trival...
The Permanente journal, 2009
Ear, nose, & throat journal, 1996
Chondroma of the laryngeal cartilage is a rare, benign neoplasm which can manifest as a neck mass... more Chondroma of the laryngeal cartilage is a rare, benign neoplasm which can manifest as a neck mass or, if situated within the airway, as slowly progressive obstruction, hoarseness or dyspnea. The most common location for chondroma is the posterior lamina of the cricoid cartilage; the next most common locations are the thyroid, arytenoid and epiglottic cartilages. Chondroma and low-grade chondrosarcoma are difficult to distinguish from one another histologically. Although chondrosarcoma reportedly recurs, local surgical excision without radical margins and with long-term clinical follow-up is recommended. We report one case of thyroid cartilage chondroma and include a review of radiologic studies and histopathologic analysis results. We also report a second case with severe airway obstruction caused by a large cricoid chondroma. A review of the English language biomedical literature on laryngeal chondroma is included.
Archives of otolaryngology--head & neck surgery, 1994
The Permanente journal, 2014
A man, age 62 years, presented to the clinic with a 2-week history of increased nontender, nonery... more A man, age 62 years, presented to the clinic with a 2-week history of increased nontender, nonerythematous, indurated right-sided parotid swelling. A 4 × 6-cm firm, well-circumscribed mass was palpated in the right parotid gland. A fine-needle aspiration biopsy was performed on the parotid mass with aspiration of 0.5 cc of purulent fluid with some blood. Cultures from the aspirate revealed Coccidioides immitis confirmed by DNA probe. Pathology slides revealed fungal spores. The patient was treated with 800 mg of fluconazole every day for 3 months with resolution of the parotid swelling. However, persistent cervical adenopathy remains.Although this is a rare case of acute parotid swelling, Coccidioides immitis should be considered in the differential diagnosis of parotid masses in a patient with previous coccidioidomycosis. There may be a potential for an increase in frequency and variety of atypical extrapulmonary manifestations of coccidioidomycosis that parallels the increase in c...
Ear, nose, & throat journal, 2005
We measured quality of life issues for both children and their parents on the premise that parent... more We measured quality of life issues for both children and their parents on the premise that parental quality of life should be an aspect of cost-effectiveness in otitis media treatment. The patients were less than 18 years of age and had had myringotomy with tube insertion at the head and neck surgery department of a large health maintenance organization. Quality of life for patients, parents, and caregivers was evaluated by telephone survey of parents or caregivers and by retrospective chart review of the number of pre- and postoperative healthcare visits and antibiotic usage. Chart review showed a significant postoperative reduction in the number of clinic visits and in use of antibiotic drugs after insertion of tympanostomy tubes. Improved postoperative hearing was noted, and tympanostomy tube insertion was shown to be safe. The chart-review cost analysis showed that tympanostomy tube insertion is a cost-effective treatment for otitis media in children, and the telephone survey re...
The Permanente journal, 2012
A 29-year-old woman presented from another hospital with a 10-month history of an enlarging left-... more A 29-year-old woman presented from another hospital with a 10-month history of an enlarging left-sided facial mass. Computed tomographic scan revealed a mass in the superficial lobe of the left parotid gland with left-sided cervical lymphadenopathy. The patient received a total left parotidectomy and a selective neck dissection. Histopathologic slides revealed lymphoepithelial carcinoma (LEC) that stained positive for cytokeratin, as well as Epstein-Barr virus (EBV). An LEC of the parotid is a rare salivary gland tumor accounting for less than 1% of all salivary gland tumors. As reaffirmed in our case, LEC is more common in women, occurs primarily in the parotid gland, and has an ethnic predilection. Histologic analysis reveals an infiltrative, poorly differentiated tumor nestled in a lymphoid stroma, with near 100% positivity for EBV in endemic areas. Complete resection of this poorly differentiated carcinoma followed by postoperative radiation is essential for local control.
Seminars in Oncology, 2004
Lymphatic mapping with sentinel lymph node (SLN) biopsy can accurately stage the nodal basins in ... more Lymphatic mapping with sentinel lymph node (SLN) biopsy can accurately stage the nodal basins in patients with melanoma of the trunk and extremities and has become a routine, well-accepted diagnostic method for melanoma at these anatomic locations. Melanoma of the head and neck (16% of all cases of melanoma) is complex and difficult to manage because of the rich abundant interlacing lymphatic drainage patterns, as well as watershed areas, which can lead to unusual and unexpected drainage patterns. Radioguided surgery in combination with blue dye facilitates localization of the SLN in the head and neck; however, this type of radioguided surgery is an evolving technique of some difficulty and thus requires careful coordination among the surgeon, nuclear medicine physician, and pathologist. Applications of this technique to other sites in the head and neck are currently being investigated for conditions including squamous cell carcinoma (SCC) of the oral cavity, thyroid cancer, and Merkel cell cancer. More studies of patients with head and neck cancer are needed--and technical issues must be resolved--before radioguided surgery can be recommended as the standard of care for these patients.
JAMA otolaryngology-- head & neck surgery, 2014
Currently there are few validated metrics for predicting surgical skill among otolaryngology resi... more Currently there are few validated metrics for predicting surgical skill among otolaryngology residency applicants. To determine whether manual dexterity aptitude testing in the form of soap carving during otolaryngology residency interviews at Kaiser Permanente Medical Center Oakland predicts surgical skill at the time of graduation from otolaryngology residency programs. This study was conducted to determine how applicants with the best and worst soap carvings compared at the time of graduation with respect to various metrics including visuospatial ability and manual dexterity. Over the last 25 years, applicants to the residency program at Kaiser Permanente Oakland were required to carve soap during their residency interview. The 3 best and 3 worst soap carvings from 1990 through 2006 were determined. Of the individuals who carved those soaps, 62 qualified for the study and matriculated into otolaryngology residency programs. Surveys were sent to the 62 individuals' residency p...
The Laryngoscope, 1991
A variety of hemostatic agents and techniques have been used in an attempt to reduce intraoperati... more A variety of hemostatic agents and techniques have been used in an attempt to reduce intraoperative blood loss and postoperative bleeding in tonsillectomy. The efficacy of most of these substances and techniques has been judged primarily on clinical impressions. Because of the paucity of prospective studies, a randomized, prospective, double-blind study, using the patients as their own controls, was conducted. Ninety-two patients were injected before tonsillectomy in a random, double-blind fashion with normal saline solution in one tonsil and 1:100,000 epinephrine in the other. The blood loss, time of dissection, and postoperative bleeding were recorded separately for each tonsil. Cardiac manifestations were also monitored. The tonsils injected with epinephrine had a statistically significant reduction in blood loss and dissection time when compared with those injected with normal saline. Subjectively, dissection was easier on the epinephrine-injected side. There was no difference in the incidence of postoperative hemorrhage. Cardiac manifestations of epinephrine were minimal and transient. This study demonstrates that epinephrine is useful in reducing hemorrhage during tonsillectomy and can be used safely with the appropriate inhalation anesthetics.
The Laryngoscope, 1999
To determine factors affecting the safe use of topical cocaine for anesthesia and vasoconstrictio... more To determine factors affecting the safe use of topical cocaine for anesthesia and vasoconstriction during rhinologic surgery. Study Design: Prospective, randomized study of the kinetics of cocaine absorption through human nasal mucosa in 12 consecutive patients without nasal mucosal disease who were having septoplasty or septorhinoplasty. Methods: With patients under general anesthesia, cocaine was applied topically to each nasal cavity by using cottonoid pledgets. Group I received 4 mL of a 4% solution (160 mg) of cocaine for 10 min, Group I1 received 4 mL of a 4% solution (160 mg) of cocaine for 20 min, and Group I11 received 4 mL of a 10% solution (400 mg) of cocaine for 20 min. Absorption rate was determined by measuring serum cocaine concentration at intervals of 5, 10, 15, and 20 min. Residual cocaine was extracted from the pledgets and was analyzed quantitatively by using gas chromatography and mass spectroscopy. Results: Of total cocaine applied, 35% was absorbed systemically: 17% was absorbed within 5 min, 25% within 10 min, and 32% within 15 min. Of the cocaine absorbed, 47% was absorbed within the first 5 min, 70% within 10 min, and 90% within 15 min. Two patients (16.6%), both in Group ILI, had intraoperative hypertension; one of these patients also had transient ventricular tachycardia. Conclusions: Although a 4% solution of cocaine applied to the nasal mucosa on cottonoid pledgets for 20 rnin is safe, we observed an idiosyncratic absorption rate four times greater than expected; therefore, we advise against topical use of a 10% cocaine solution for anesthesia and vasoconstriction during rhinologic surgery.
The Laryngoscope, 1999
Objectiues: Determine parameters for successful stapedectomy and whether this procedure can be pe... more Objectiues: Determine parameters for successful stapedectomy and whether this procedure can be performed safely by residents in a teaching hospital. Study Design: Retrospective analysis of techniques and results for 71 stapedectomy procedures. Materials and Methods: Charts were reviewed for technique, audiological test results, complications, operative time, and anesthetic used. Results: Overall, closure of the air-bone gap at 10 dB was achieved in 87% of patients. Use of general anesthesia and a laser-assisted, small-fenestra technique allowed residents to complete more operations. No severe sensorineural hearing loss was noted. Conclusions: Residents can safely and successfully perform stapes surgery using a laserassisted, small-fenestra technique.
The Laryngoscope, 2002
To test the hypothesis that patients with a variety of otolaryngologic diagnoses using telephone ... more To test the hypothesis that patients with a variety of otolaryngologic diagnoses using telephone appointment visits would be equally as satisfied as patients receiving physician office visits, the study compared telephone appointment visits with physician office visits for health maintenance organization patients who needed routine follow-up care in a head and neck surgery clinic. Randomized, nonblinded cross-sectional study. After their initial visit to either of two head and neck surgery clinics, new otolaryngology patients were randomly assigned into treatment and control groups. Patients in the treatment group (n = 73) received follow-up care in the form of telephone appointment visits, and patients in the control group (n = 80) received physician office visits for follow-up care. Study data were collected using telephone interviews and physician tracking forms. Patients receiving telephone appointment visits were significantly less satisfied with their visits than patients receiving physician office visits (chi2 = 25.4, P < .005). Patients who had physician office visits were significantly more likely than were patients in the treatment group to agree "somewhat" or "strongly" that 1) the physician addressed their questions and concerns (chi2 = 24.0, P < .005); 2) the physician provided personal care and attention (chi2 = 29.9, P <. 005); and 3) the physician provided high-quality care (chi2 = 34.5, P < .005). Patients who received telephone appointment visits were statistically significantly less satisfied with all aspects of their follow-up appointment than were patients who had physician office visits. The study findings indicate that telephone appointment visits may not be an ideal type of follow-up visit for all patients. Despite these findings, one third of patients in the treatment group would consider receiving a telephone appointment visit for future routine follow-up care, and 21.9% had no preference, perhaps a factor indicating willingness to receive a telephone appointment for a follow-up visit.
The Laryngoscope, 1989
A number of histopathologic parameters in squamous cell carcinoma of the oral cavity and orophary... more A number of histopathologic parameters in squamous cell carcinoma of the oral cavity and oropharynx have been identified as having a statistically significant correlation with regional lymph-node metastasis. These parameters have been inconsistent and not readily reproducible. In an attempt to confirm these parameters, a retrospective analysis of 22 patients with T1 to T4 squamous cell carcinoma of the oral cavity and oropharynx was performed. Initially, these patients were managed with either wide local excision or surgical excision of the primary tumor combined with radical neck dissection. There was a minimum of 3 years of follow-up. Chi-square contingency tables and Fisher's Exact Test were used to correlate histopathologic parameters with lymph-node metastasis. Statistically significant correlations were found for tumor thickness and inflammatory infiltrate.