Robert L. Pincus, MD – Articles

A Study Of The Link Between Gastric Reflux And Chronic Sinusitis In Adults

Journal: Ear, Nose, & Throat Journal – May 2007

Excerpt: Much discussion is taking place regarding the role of gastric reflux disease in the development and maintenance of chronic sinus disease. We studied 31 patients in a large urban private practice who had recalcitrant chronic sinusitis despite aggressive medical and surgical therapy. After we obtained information on the severity of each patient’s sinus disease, we performed either double- or triple-catheter probe pH testing to assess the presence of reflux disease. Of the 30 patients who were successfully tested (1 patient did not tolerate probe testing), 25 demonstrated reflux disease, including 2 whose reflux reached the level of the nasopharynx. These 25 patients were placed on a proton-pump inhibitor (PPI) regimen and reassessed at least 1 month later. At follow-up, 14 of 15 evaluable patients demonstrated at least some improvement in their sinus symptoms, including 7 who experienced either a complete or almost-complete resolution of symptoms. The improvements in sinus symptoms corresponded with improvements in reflux symptoms. These findings suggest that antireflux therapy might play a role in the treatment of recalcitrant chronic sinus disease.

The role of endoscopic sinus surgery in patients with Acquired Immune Deficiency Syndrome

Journal: American Journal of Otolaryngology – 1998

Excerpt: Study looking at effectivenes and indications for endoscopic sinus surgery in patients with AIDS. The bacteriology of chronic sinusitis in patients with AIDS requiring surgery in this study is presented. Significant findings include a high incidence of both invasive and non-invasive fungal sinusitis and pseudomonas as a bacterial etiology of sinusitis in patients with AIDS. Recommendations include treatment for the bacteria pseudomonas in patients with AIDS and sinusitis. Surgical indications for patients with AIDS and sinusitis should not be different from indications in other patients.

Pathologic Quiz Case 1. Pneumocystic Lymphadenitis

Journal: Archives Of Otolaryngology–head & Neck Surgery – September 1997

Preoperative HIV Testing

Journal: Ear, Nose, & Throat Journal – March 1996

Asymptomatic Congenital Syphilis And Auditory Brainstem Response

Journal: International Journal Of Pediatric Otorhinolaryngology – September 1994

Excerpt: Untreated congenital syphilis is a known cause of hearing loss. In order to ascertain if infants are at risk of hearing loss at birth, 75 neonates with serologic evidence of syphilis and APGAR scores greater than 9 at 5 min were examined by auditory brainstem response (ABR) audiometry. All of the infants had normal ABRs. Ophthalmologic examination revealed no evidence of interstitial keratitis. Lumbar puncture was attempted on all the neonates. Cerebrospinal fluid (CSF) was successfully obtained from 41 infants and revealed no abnormalities. This study demonstrates that asymptomatic infants with serologic evidence of syphilis do not require audiologic evaluation in the neonatal period.

Otologic Neurotologic Manifestations Of HIV-related Disease

Journal: Otolaryngology–head And Neck Surgery : Official Journal Of American Academy Of Otolaryngology-Head And Neck Surgery – July 1993

Excerpt: Human immunodeficiency virus (HIV), the causative agent of acquired immunodeficiency syndrome (AIDS), has reached worldwide epidemic proportions and is increasing. Otologists, neurotologists, and audiologists practicing in metropolitan centers in North America can expect to encounter patients with HIV-related illnesses, including patients with AIDS-related complex (ARC) and AIDS. Five representative cases are presented: chronic otitis media, facial palsy, Gradenigo’s syndrome with facial paralysis, otosyphilis, and Kaposi sarcoma of the mastoid. The common link in all cases was HIV infection. This presentation discusses the management of several HIV-infected patients with otologic and neurotologic findings. HIV infection has extended to all parts of North America. The worldwide incidence is increasing. As the epidemic continues to unfold, new challenges to both the diagnosis and treatment of otologic and neurotologic disease in HIV-positive patients will confront the audiologist and otolaryngologist. Recommendations for the safety of the examining audiologist and treating physician are given.

Urgent Adenotonsillectomy For Upper Airway Obstruction

Journal: International Journal Of Pediatric Otorhinolaryngology – November 1992

Excerpt: Adenotonsillar hypertrophy has been documented to cause chronic upper airway obstruction resulting in cardiopulmonary sequelae in children. It has been less recognized that long-term adenotonsillar hypertrophy may additionally cause acute, life-threatening airway obstruction. A review of 5000 adenotonsillectomies performed at 3 New York Medical College affiliated hospitals from 1982 to 1989 showed 6 pediatric patients with progressive upper airway obstruction severe enough to necessitate intubation in the emergency room or operating room, and subsequent urgent adenotonsillectomy after cardiorespiratory stabilization. Patients were monitored in the ICU with pre- and postoperative blood gases. Observations of cyanosis, cor pulmonale, and use of accessory respiratory muscles were carefully recorded. This study illustrates that life-threatening upper airway obstruction may be due to chronic adenotonsillar enlargement and require treatment by urgent adenotonsillectomy.

Otolaryngologic Manifestations Of Child Abuse

Journal: Archives Of Otolaryngology–head & Neck Surgery – August 1992

Excerpt: Currently, awareness is growing of child abuse in the medical and lay communities. To familiarize otolaryngologists with the head and neck findings in abused children, we retrospectively analyzed 85 patients admitted to an inner-city hospital with the diagnosis of abuse or neglect. Forty-eight children (56%) had abnormalities within the head and neck region. Excluding coincidental findings, 31 children (36%) had findings that could be directly linked to physical abuse or neglect. The face was the region with the most abnormal findings in our study (25 children [30%]). Soft-tissue findings were the most numerous (27 children [32%]). The literature is reviewed on the subject of otolaryngologic manifestations of abuse.

Synovial Sarcoma Of The Head And Neck

Journal: Head & Neck – August 1992

Excerpt: Primary synovial sarcoma is an unusual tumor of the head and neck. Fewer than 75 cases have been reported in the literature. We have treated 7 additional cases; 3 in the hypopharynx, 2 in the parapharyngeal space, 1 in the oral pharynx and 1 in the posterior triangle of the neck. An enlarging cervical mass, voice change, and dysphagia were among the presenting complaints. CT revealed solitary nonhomogenous tumors from 3 to 7 cm in diameter. Microscopically, all cases showed a biphasic cellular pattern verified by immunohistochemical staining. Multimodality treatment consisted of surgery and postoperative radiation therapy with 3 patients receiving chemotherapy. Although the original pathology report was incorrect in 3 cases, clinical suspicion for synovial sarcoma ensured proper diagnosis.

Fine-needle Aspiration Of Diffuse Cervical Lymphadenopathy In Patients With Acquired Immunodeficiency Syndrome

Journal: Otolaryngology–head And Neck Surgery : Official Journal Of American Academy Of Otolaryngology-Head And Neck Surgery – November 1991

Excerpt: Although diffuse cervical lymphadenopathy is one of the earliest and most common findings in patients with AIDS, the appropriate diagnostic approach in these patients has yet to be determined. Fine-needle aspiration (FNA) was performed on 26 patients with AIDS in order to evaluate the role of FNA in patients with diffuse cervical adenopathy. Specimens were sent for cytology, bacterial culture, fungal culture, and acid-fast smear and culture. Ten patients had positive findings, including toxoplasmosis, histoplasmosis, tuberculosis, atypical mycobacterium, and methicillin-resistant staphylococcal infection. All patients with either unilateral adenopathy or lymph nodes 3 cm or larger had positive aspirates. A statistically significant difference between patients with lymph nodes smaller than 2 cm and those with nodes larger than 2 cm was found. Fine-needle aspiration of a representative node in patients with AIDS may allow prompt diagnosis of diffuse lymphadenopathy. Rapid initiation of appropriate treatment can lead to symptomatic improvement. The need for excisional biopsy of involved lymph nodes may be obviated. Fine-needle aspiration is recommended as a diagnostic tool in selected patients with diffuse cervical lymphadenopathy and AIDS.

The Otolaryngologic Manifestations Of Antley-Bixler Syndrome

Journal: Otolaryngology–head And Neck Surgery : Official Journal Of American Academy Of Otolaryngology-Head And Neck Surgery – April 1991

Medially Based Horizontal Nasolabial Flaps For Reconstruction Of Columellar Defects

Journal: Archives Of Otolaryngology–head & Neck Surgery – September 1990

Excerpt: Reconstruction of columellar defects continues to be a surgical challenge. We present the results of two child-abuse patients who were successfully treated with a technique in which medially based bilateral horizontal nasolabial flaps were used to reconstruct total columellar loss. Our technique provides adequate tissue with minimal cosmetic deformity. It also obviates the need for multiple staged procedures. We recommend the use of this method for repair of either partial or total columellar defects secondary to trauma or infection.

Head And Neck Manifestations Of The Acquired Immunodeficiency Syndrome In Children

Journal: Ear, Nose, & Throat Journal – September 1990

Excerpt: The head-and-neck manifestations of HIV infection in children are very different from those in the adult population. Recurrent bacterial and viral infections are common manifestations, and persistent sinusitis or otitis media should make the otolaryngologist suspicious of HIV infection if the child has been exposed to the virus. Other common problems include mucocutaneous and esophageal candidiasis, recurrent herpes I and II and zoster infections, parotid swelling, and cervical lymphadeopathy.

Delayed Airway Obstruction And Neck Abscess Following Manual Strangulation Injury

Journal: The Annals Of Otology, Rhinology, And Laryngology – November 1989

Excerpt: Few reports describing manual strangulation injury to the neck are found in the otolaryngologic literature. Since most victims sustain immediate fatal asphyxiation, brain anoxia, or cardiac arrest, they are usually examined by a forensic pathologist. When strangulation attempts are nonfatal, neck injuries can lead to delayed airway obstruction. If not managed in a timely fashion, these injuries can be fatal or cause permanent laryngotracheal sequelae. We describe a patient who 36 hours following manual strangulation developed acute upper airway obstruction and neck abscess necessitating tracheotomy, neck exploration, and drainage. Patients suffering this unique type of compression injury may present initially with deceptively benign symptoms and signs. We discuss the overall management of these patients, stressing the need for early imaging studies, endoscopic assessment, and continued airway monitoring in an intensive care unit.

Oropharyngeal Angioedema Associated With The Use Of Angiotensin-converting Enzyme Inhibitors

Journal: Otolaryngology–head And Neck Surgery : Official Journal Of American Academy Of Otolaryngology-Head And Neck Surgery – September 1989

Excerpt: Angioedema that occurs in the head and neck may be a serious and possibly life-threatening condition. We present two cases of oropharyngeal angioedema associated with the use of angiotensin-converting enzyme inhibitors in patients with no underlying renal failure. Angiotensin-converting enzyme-inhibiting agents are now commonly used to control hypertension. Treatment of acquired angioedema is directed first at protecting the airway by careful observation, intubation, or if necessary, tracheostomy. The causative agent is withdrawn, and the patient is treated with antihistamines and steroids until the acute episode resolves. Although not used in our patients, the treatment of angioedema with subcutaneous epinephrine has been described. As more patients are treated with angiotensin-converting enzyme inhibitors, it becomes essential for the otolaryngologist to become aware of this potentially life-threatening complication.

Nasopharyngeal Obstruction

Journal: Otolaryngologic Clinics Of North America – August 1989

Excerpt: The causes of nasopharyngeal obstruction are described. The diagnosis and treatment of each type of nasopharyngeal obstruction are presented in detail.

Nasopharyngeal Obstruction

Journal: Otolaryngologic Clinics Of North America – August 1989

Excerpt: The causes of nasopharyngeal obstruction are described. The diagnosis and treatment of each type of nasopharyngeal obstruction are presented in detail.

Mycotic Diseases Of The Neck

Journal: Ear, Nose, & Throat Journal – July 1989

Bronchoesophageal Manifestations Of Acquired Immunodeficiency Syndrome

Journal: The Annals Of Otology, Rhinology, And Laryngology – November 1988

Excerpt: Among the more common manifestations of acquired immunodeficiency syndrome (AIDS) are tumors and infections that occur in regions treated by the bronchoesophagologist. In reviewing our institutional experience in the diagnosis and treatment of 396 patients with AIDS in 1987, we have noted that 226 (57%) had some form of pneumonia and 133 (34%) had candidiasis. In this communication we discuss the various types of bronchopulmonary, oropharyngeal, and esophageal infections that have been reported among AIDS patients. We also review the universal precautions and specific guidelines recommended for safeguarding the bronchoesophagologist and other health care workers who treat these patients.

Leprosy Of The Head And Neck

Journal: Otolaryngology–head And Neck Surgery : Official Journal Of American Academy Of Otolaryngology-Head And Neck Surgery – September 1987

Severe Upper-airway Obstruction Caused By Rhinoscleroma-like Granuloma

Journal: The Mount Sinai Journal Of Medicine, New York -August 1986

Primary Adenomatous Neoplasm Of The Middle Ear

Journal: The Laryngoscope – February 1984

Excerpt: Adenomatous lesions of the temporal bone are seldom encountered in clinical practice. Four cases of primary adenocarcinoma of the middle ear are reported. All four patients presented with a mass behind an intact tympanic membrane. Two of the four patients had received radiation to the head and neck area 10 or more years prior to their developing adenocarcinoma of the middle ear space. Although this tumor is locally invasive, it does not appear to be highly aggressive and can be treated by local excision, i.e., mastoidectomy with tympanoplasty.