S128 – Diagnosis and Treatment of 703 Patients with Taste Disorder

undergoing insertion of Silverstein tube and microwick placement for dexamethasone infusion. The procedure was completed in an outpatient setting using either infiltration of lidocaine with epinephrine (control) or topical phenol (experimental). Dexamethasone (10mg/ml) drops were administered 3 times a day for 6 weeks, at which time the tube and wick were removed. All subjects were followed for 6 months for evidence of perforation or surgical repair. Fisher’s exact test was used for statistical analysis. RESULTS: A total of 79 patients were identified. 27 underwent lidocaine infiltration and 52 had topical phenol application. At 3 months, the perforation rate for the lidocaine group vs. the phenol group was 11% and 21%, respectively (p⫽0.21). 5 total perforations were surgically repaired (2 from the lidocaine group and 3 from the phenol group, p⫽0.27). At 6 months, there was complete resolution of perforations in the lidocaine group and only 4% of the phenol group persisted (p⫽0.43). CONCLUSIONS: Topical phenol appears to be a safe method of local anesthesia for PE tube insertion without significant increased risk of persistent perforation. Phenol also offers a cost-effective, less painful, and less time-consuming option in an outpatient setting. S126 – Missed Diagnoses in Otolaryngology Mary E. Gorman, MD (presenter); Herbert Gould, PhD; Dana W. Giel, MD; Jerome W Thompson, MD, MBA OBJECTIVES: 1) Increase awareness of common missed diagnoses in the practice of otolaryngology. 2) Identify opportunities for improvement in the quality of patient care. METHODS: Working with the State Volunteer Mutual Insurance Company of Tennessee State, we evaluated malpractice claims in otolaryngology that were closed with indemnity payment between 1981 and 2005. We identified all such claims resulting from alleged missed or delayed diagnoses by otolaryngologists. Claims were divided into two main categories based on whether the missed diagnosis was primarily otolaryngologic or non-otolaryngologic. RESULTS: A total of 9 missed diagnosis claims were identified, representing 9% of claims overall. 6 of the 9 were otolaryngologic missed diagnoses, with the remaining 3 nonotolaryngologic diagnoses. The total indemnity payment for missed diagnosis claims was $4,072,100, representing 32% of all indemnity payments for the study period. CONCLUSIONS: Missed diagnoses represent a danger to patients and a disproportionately high percent of total indemnity payments (32%). Increased awareness of missed diagnoses is necessary to improve patient care and maintain a level of excellence within the field of otolaryngology-head and neck surgery.

P119 S127 – Idiopathic Facial Nerve Paralysis: Analysis of 3T MRI Images Sarah Mowry, MD (presenter); Claudia Kirsch, MD OBJECTIVES: 1) To describe the findings on 3 Tesla (T) MRI in patients with idiopathic facial nerve paralysis (IFP). 2) To compare 3T MRI and 1.5 T MRI images of the facial nerve in patients with and without facial paralysis. METHODS: A retrospective review of 3T MRI image from 2005-2008 for temporal bone imaging revealed 123 patients; 4 patients underwent imaging for facial paralysis. Images from 3T MRI and 1.5T MRI for these 4 patients were retrospectively assessed by a board-certified neuroradiologist and otolaryngologist blinded to the affected side and compared to normative controls. RESULTS: All patients with facial palsy demonstrated significant enhancement of the affected nerve on post-gadolinium T1 weighted images. In 3 patients with residual facial weakness (⬎12 months) demonstrated facial nerve enhancement at the geniculate ganglion and descending portions. In 1 patient, despite resolution of IFP, the nerve continued to enhance at the geniculate ganglion and descending portion of the facial nerve compared to the contralateral nerve. The 3T MRI images demonstrated improved visualization of the entire course of the facial nerve in both normal and IFP patients. Interestingly, in both normal and affected patients, the uninvolved facial nerve also demonstrated slight contrast enhancement throughout its entire course, although not as pronounced as the affected side. CONCLUSIONS: 3T imaging provides significantly improved visualization of the temporal facial nerve in both normal and patients with IFP. Gadolinium enhanced 3T imaging allowed better anatomical delineation of both normal and affected facial nerves when compared to 1.5T MRI. S128 – Diagnosis and Treatment of 703 Patients with Taste Disorder Shinya Miuchi, MD (presenter); Masanori Umemoto, MD; Atsushi Negoro, MD; Hideki Oka, MD; Tomomi Nin, MD; Masafumi Sakagami, MD, PhD OBJECTIVES: As life spans increase, the number of patients with taste disorder consulting in our taste clinic has increased. This study prospectively examined patients’ history, causes of taste disorder, and treatment outcomes. METHODS: Subjects consisted of 703 patients with taste disorder who consulted our taste clinic at the department of Otolaryngology, Hospital of Hyogo College of Medicine, between 1999 and 2007. There were 284 men and 419 women, and patient ages ranged from 12 years to 88 years with a mean age of 59.7 years. Electrogustometry (EGM) and filter paper disk method (FPD) were used to assess taste function. We also asked each patient to indicate the severity of symptoms using a visual analog scale (VAS). Patients were treated mainly with

SCI. POSTERS

Scientific Posters

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Otolaryngology-Head and Neck Surgery, Vol 139, No 2S1, August 2008

zinc sulfate (ZnSO4 300 mg/day, or polaprezinc 150 mg/day), and in some cases with iron supplement, herbal medicine, and minor tranquilizers. RESULTS: Idiopathic taste disorder was the most common cause (271 cases, 38.5%), followed by drug-induced (131 cases, 18.6%), post-common cold (83 cases, 11.8%), psychogenic (73 cases, 10.4%), iron-deficiency (37 cases, 5.3%) and others. Deficiency of serum zinc (less than 70 ?g/dl) was found in 50-70% of cases. The recovery rate was 130/183 (71.0%) in idiopathic, 41/61 (67.2%) in post-common cold, and 24/29 (82.8%) in iron deficiency. The recovery period in drug-induced (39.7 weeks) was longer than that in other cases (20.4 weeks). Results of EGM and FPD were not always associated with the severity of symptoms. CONCLUSIONS: Treatment with zinc supplement may be useful for taste disorder. S129 – Analysis of Fine Needle Biopsy for Malignant Lymphoma Naoki Ashimori (presenter); Hiroyuki Mineta, MD; Minako Tsurita, MD OBJECTIVES: To review fine-needle aspiration biopsy(FNAB) diagnosis of malignant lymphoma retrospectively to determine the diagnostic accuracy and pitfalls. METHODS: 68 cases of malignant lymphoma and 52 cases of non-malignant lymphoma were identified between 1997 and 2004. All cases were recognized as cervical lymphadenopathy and evaluated by FNAB. Open biopsies were also performed to obtain final diagnoses. Malignant lymphomas were subclassified according to World Health Organization classifications. We compared the FNAB and final diagnostic results to determine the diagnostic accuracy and examine the false negative cases. RESULTS: 41(60%) cases had a positive diagnosis of malignant lymphoma, 21(31%) had a suspicious diagnosis, and 6(9%) had a false negative diagnosis. On histological examinations, diffuse large B cell lymphomas yielded a high positive diagnosis, whereas follicular lymphoma and Hodgkin’s disease had less positive diagnosis and there were also false negative cases. 14(39%) lymphadenitis cases had a suspicious diagnosis and some cases were difficult to differentiate from malignant lymphoma. CONCLUSIONS: FNAB is considered a useful and efficient method of estimating malignant lymphoma but diagnostic accuracy varied among lymphoma subtypes. We should remain aware of the existence of false negative cases when using this diagnostic method. S130 – Otolaryngologic Manifestations in Penphigus Vulgaris Secundino Fernandez, MD, PhD (presenter); Agustı´n Espan˜a; David Ruba San Miguel; Miren Marquina, PhD

OBJECTIVES: Pemphigus vulgaris is an autoimmune disease characterized by mucocutaneous intraepithelial blisters and pathogenic autoantibodies against desmoglein 3. There are 2 clinical forms: mucosal and mucocutaneous. The frequency of ear, nose and throat involvement in pemphigus vulgaris is not clearly defined. Only a few individual cases have been reported. The objective of this study was to determine the incidence of otolaryngologic involvement in patients with pemphigus. METHODS: We have studied prospectively all 18 patients diagnosed with PV and treated by Otolaryngology and Dermatology departments of the University Hospital of Navarra between 2001 and 2007. They were 10 cases of mucosal pemphigus and 8 cases of mucocutaneous pemphigus. All patients were evaluated by endoscopic examination. RESULTS: 15 patients presented with throat symptoms (83%), 13 pharyngeal (72%), and 8 laryngeal symptoms (44%). 16 patients (88%) had active pemphigus vulgaris lesions localized in pharyngeal and laryngeal mucosa. Laryngeal lesions were most commonly present in mucocutaneous patients. The frequency of nasal symptoms (38%) was lower than active pemphigus vulgaris lesions (63%). Oral symptoms and oral active lesions were the most frequent findings (94%). Only in 3 patients were sown erosions on the external auditory canal. CONCLUSIONS: Endoscopic evaluation in patients affected by pemphigus vulgaris allows to study more extensive areas of mucosa. By obtaining more complete information concerning the extent of the disease, a more accurate diagnosis can be made, better choice of drug and dose may be decided, and ultimately, response to treatment may be improved. S131 – Complicated Community-Acquired MRSA Sinusitis: A Case Series Christian L Stallworth, MD (presenter); K Christopher McMains, MD; Frank Miller, MD OBJECTIVES: Participants should 1) understand the similarities and differences between nosocomial methicillin-resistant Staphylococcus aureus (MRSA) and its community-acquired counterpart (CA-MRSA); 2) recognize MRSA as an evolving member of the bacterial pathogens responsible for acute bacterial rhinosinusitis (ABRS); and 3) raise suspicion of CAMRSA in the differential for cases of progressive sinusitis, with or without complications, despite conventional first-line antimicrobial therapies. METHODS: Following the retrospective review of patients presenting to an urban tertiary care institution, those patients presenting with complicated sinusitis were identified. Data collected from chart review included age, sex, presenting signs and symptoms, onset of illness, therapy initiated prior to emergent presentation, operative procedures performed and operative findings, culture organisms and sensitivities, postoperative course, and final outcomes. RESULTS: 9 patients presented with periorbital complica-