Rarely, patients develop severe idiopathic subglottic stenosis. In 34 years, we have observed this disorder in 52 patients. All but 1 of the patients were female--a finding that suggests a hormonal cause. Without treatment, the airway progressively narrows--in some cases, until the patient requires tracheotomy. Laser submucosal resection and rotation mucosal flaps open and stabilize the airway and provide effective palliation. However, unlike traumatic subglottic stenosis, which has been cured with this technique, the idiopathic form causes submucosal fibrosis that regenerates spontaneously. Thus, treatment helps, but does not cure, the patient. The characteristic pathological finding is of submucosal dense fibrotic tissue with evidence of chronic inflammation. The clinical findings and treatment are here discussed.

PCR is significantly more sensitive than nasal swab cultures in detecting the presence of fungi in nasal mucosa. In addition, our study suggests that the presence of fungi alone is insufficient to implicate it as the pathogen in chronic sinusitis.

Studies have shown that the lamina propria plays an important role in voice production. Recent studies have analyzed the presence of different proteins and quantified their extent in the lamina propria, but no similar study has yet been done on cellular makeup. The distribution of three different cell types in the lamina propria of 22 human vocal folds was studied. These types are fibroblasts, macrophages, and myofibroblasts. The roles of these cells in the extracellular matrix are described. Their distribution was quantified with use of an image-analysis system. We arbitrarily divided the lamina propria into five sections (each representing 20% of the lamina propria) and compared cell numbers among these sections. Gender comparisons were also made. From these studies it is evident that the cellular distribution in the lamina propria is not uniform. Fibroblasts were more abundant in the deepest 20% of the lamina propria (p < 0.008), myofibroblasts were more abundant in the most superficial 20% (p < 0.016), and in the 36% of our samples that contained macrophages in the lamina propria, there was a significantly higher number of macrophages in the first 20% of the lamina propria (p < 0.003). The only significant gender difference was that women had twice as many macrophages in the most superficial 20% of the lamina propria as men (p < 0.05). The higher myofibroblast activity in the first 20% could indicate that the superficial layer is a region of constant repair. The increased number of macrophages in the superficial layer likely indicates an inflammatory response to inhalants (because of the role of macrophages in the inflammatory response and the fact that only 36% of the patients showed any macrophage activity at all).

The objective of this study was to determine whether brow elevation occurs as a result of paralysis of brow depressors after botulinum toxin A injection. The study's design was a prospective case series with pretreatment and posttreatment outcome evaluation with statistical analysis at a university-based division of facial plastic surgery private clinic. Twenty-two patients of a consecutive sample desiring a cosmetic enhancement underwent injection of botulinum toxin A directed to brow depressors. Injections consisted of 7 to 10 units of botulinum toxin A (Botox, Allergan, Irvine, Calif.) into selected brow depressor muscle (lateral orbicularis oculi) bilaterally. No patients withdrew for adverse effects. All patients were evaluated 2 weeks after treatment. The outcomes were measured by change in brow elevation along vertical axis extending from both midpupil and lateral canthus to the caudal row of brow hairs with eyes at neutral gaze and the head at Frankfort plane. Preintervention and postintervention brow height was measured by the primary clinical investigator. The average brow elevation from the midpupil observed after selected injection of brow depressors with botulinum toxin A was 1.02 mm (p = 0.038). The average brow elevation from the lateral canthus observed after selected injection of brow depressors with botulinum toxin A was 4.83 mm (p<0.0001). Significant temporal brow elevation occurs as the result of paralysis of brow depressors by using botulinum toxin A injection. This procedure may be considered an alternative to surgical brow elevation.