Workplace, age, and sex as mediators of olfactory function: data from the National Geographic Smell Survey

Certain medications and environmental agents are known to adversely affect chemosensation. We report data from 712,000 respondents aged 20 to 79 to the National Geographic Smell Survey that suggest that exposure to the factory workplace adversely affects the sense of smell, and that these effects interact with age. Men and women with histories of factory work reported poorer senses of smell relative to other workers. They also demonstrated objective evidence of greater impairment in odor detection. These effects were greater for men. Factory workers of all ages more frequently reported olfactory loss secondary to chemical exposure and head injury than did workers in other environments. The highest relative risk of olfactory problems secondary to head injury was in the oldest women factory workers. Thus, olfaction may behave as other senses do: Age, sex, and exposure to noxious events or agents interact to produce sensory deficits.

Preventing P2000 chaos

Acceding to the dizzy heights of nurse tutorship implies a certain willingness on the tutor's part to take on challenges and to engage in self development.

Goals and mechanisms for training otolaryngologists in the area of geriatric medicine

Population dynamics indicate that the need for services by otolaryngologist-head and neck surgeons will increase. These requirements will also be more complex because of the prevalence of other diseases in the elderly and their varied social and psychological demands. To meet that need, additional research in head and neck disorders and physiology will be necessary. Current and newly developed information relating to geriatrics in otolaryngology must be incorporated into present training and continuing education programs to provide members of our specialty with enough background to adequately diagnose and treat head and neck disorders in the elderly. Otolaryngologist - head and neck surgeons and their elderly patients will benefit from the creation of centers and fellowships that study pathologic processes and normal physiologic change, and that train a new generation of physician-scientists committed to the care of elderly head and neck patients.

The pericranial flap for reconstruction of anterior skull base defects

In 1981, the senior author first reported the use of the pericranial flap for support of the brain following resection of the anterior skull base. Since the initial report, considerable experience has been gained with this flap. It is currently deployed via a bifrontal craniotomy and is placed primarily as a support beneath the frontal lobes. The pericranial flap may also be used to repair dural laceration and defects. The sinonasal surface is routinely grafted with split-thickness skin or dermis. This technique provides an excellent barrier between the sinonasal cavity and the cerebrospinal fluid, establishing a tough, fibrous platform. Herniation of intracranial contents has not occurred. One major complication has been reported in which radiation necrosis occurred during postoperative therapy, leading to progressive devitalization of the pericranial flap. Ultimately, dural repair and closure with a latissimus dorsi free flap was required. The pericranial flap repair of anterior skull base defects has a 90% complication-free and 95% overall success rate. It is simple and extremely effective. Bone grafting has not been necessary in our experience.

Demonstration of human papillomavirus capsid antigen in carcinoma in situ of the larynx

We have undertaken a retrospective study to investigate the role of human papillomavirus (HPV) in the development of laryngeal carcinoma in situ (CIS). Sixty paraffin-embedded tissue specimens, collected from 20 patients with a history of laryngeal CIS, were examined for the presence of HPV capsid antigen. All but four individuals were men, with an average age at diagnosis of 64 years. An immunoperoxidase technique showed that 20 specimens from 14 patients contained detectable HPV capsid antigen. An independent evaluation for histopathologic features characteristic of HPV infection identified viral changes in the 14 patients as well as an additional two. No correlation was found between clinical course, as determined by histologic severity of vocal cord lesions, and presence of HPV. These results suggest that HPV should be considered an etiologic agent in the development of laryngeal CIS.