S127 – Idiopathic Facial Nerve Paralysis: Analysis of 3T MRI Images

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

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