A M Noyek

University of Toronto, Toronto, Ontario, Canada

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Publications (118)162.34 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: To provide evidence-based recommendations for classification, diagnosis and treatment of acute, chronic and recurrent acute sinusitis in adults and children. DATA SOURCES: Review articles, textbooks, other published guidelines and recommendations of task force members. STUDY SELECTION: One hundred and seventy-one papers addressing one or all of the objectives. DATA EXTRACTION: Relevant data were collated under each objective. DATA SYNTHESIS: Validity of diagnostic and treatment evidence was assessed by using the methodological recommendations of Sackett et al and the Canadian Task Force on Periodic Health Examination, respectively. Where there was a paucity of data, consensus of task force members was reached. CONCLUSIONS: Sinusitis is classified as acute, chronic or recurrent acute disease according to duration and frequency of symptoms and response to therapy (expert opinion). Potential risk factors, concomitant diseases and complications are identified (limited evidence). Diagnosis is based on symptoms, history and physical examination. For adults, independent predictors of acute sinusitis include maxillary toothache, coloured nasal discharge, poor response to nasal decongestants/antihistamtnes and mucopurulent nasal secretions (good evidence); for children, cough, nasal discharge and fever are common (good evidence). For chronic disease that persists despite adequate therapy and recurrent acute disease, referral to a specialist for investigative measures (nasal endoscopy, computed tomography) is often necessary to determine predisposing anatomical features. Level I evidence supports the use of antibiotics for the treatment of sinusitis; selection is based on the local pattern of bacterial resistance, relative efficacy, safety and cost. Amoxicillinclavulanate, cefuroxime axetil, cefixime, ciprofloxacin and clarithromycin are approved for the treatment of acute sinusitis in Canada. Amoxicillin, amoxicillin-clavulanate and cefuroxime axetil have been shown to be effective in children. Ciprofloxadn, amoxicillin-clavulanate, clarithromycin and erythromycin have been shown to be effective in chronic disease, although no agents have been approved for this indication. Given changing patterns of bacterial resistance, more up-to-date comparative efficacy data are needed.
    No preview · Article · Jan 1998
  • R Feinmesser · E Lubin · K Segal · A Noyek
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    ABSTRACT: Thyroid cancer is the third most common solid tumor in children and adolescents. A review was made of the data on 540 such patients reported from nine large centers renowned for their experience with thyroid cancer. In respect to the pathogenesis the only factor conclusively known to promote development of thyroid cancer in the pediatric age group is irradiation, as documented by the Chernobyl experience. The evidence indicates that thyroid carcinoma in the pediatric age group is a biologically independent and more aggressive entity than in adults; paradoxically the prognosis is good. In the great majority of cases the only presenting sign was a neck mass. In a high percentage (60-80%) there were also palpable lymph nodes. The findings regarding lung metastases were not clear-cut: in most series they were present in about 10%, with a high of 28% in one group and a low of 5% in another group. Papillary carcinoma or the follicular variant of papillary carcinoma were the dominant histologic types, pure follicular carcinoma being found much less frequently than among adults with thyroid cancer. Despite the relatively advanced stage of the disease upon diagnosis, only 13 patients died of the disease, 12 to 33 years postoperatively. Recurrence rates ranged between 10% to 35%, with involvement of the lateral neck, thyroidal bed or distant sites 3 to 33 years after treatment; most failures responded to further surgery or radioactive iodine. There is almost general agreement that surgical intervention should consist of total or near total thyroidectomy despite the high rates of recurrent laryngeal nerve paralysis and hypocalcemia. In regard to neck metastases less than radical surgery has proved during the years to be sufficiently effective. Radioactive iodine, used by all at some stage of management for treatment purposes, should be used prophylactically only after due consideration in view of possible teratogenicity.
    No preview · Article · Nov 1997 · Journal of pediatric endocrinology & metabolism: JPEM

  • No preview · Article · Nov 1997 · American Journal of Otolaryngology
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    ABSTRACT: Fungal sinusitis should always be considered in the differential diagnosis of chronic or recurring sinusitis resistant to adequate medical treatment. A high index of suspicion is necessary for the diagnosis, and the clinical examination is rarely conclusive. The definitive diagnosis depends on the pathologist in most cases. We reviewed retrospectively the imaging findings, specifically computed tomography (CT) and magnetic resonance (MR), in a series of fungal sinusitis patients. Non-enhanced CT scan is more sensitive than conventional X-ray in detecting the classical focal areas of hyper-attenuation and calcification seen in soft-tissue masses of fungal sinusitis. MR findings of hypo-intense signals on T1-weighted sequences which progress to signal-void area on T2-weighted sequences, are characteristic features of fungal sinusitis; however, it is reserved for cases where intracranial invasion is suspected or CT findings are inconclusive.
    No preview · Article · Jul 1995 · Rhinology
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    ABSTRACT: A head and neck ultrasound-guided fine-needle aspiration clinic was set up to determine the role of ultrasound and ultrasound-guided fine-needle aspiration in the evaluation of patients with lesions in this region. One hundred ninety-five lesions were biopsied by ultrasound-guided fine-needle aspiration in 203 patients. Ultrasound detected 2 or more lesions in 14 (48%) of 29 patients with a clinically solitary thyroid nodule. Three (8.8%) of 34 lesions thought to be within the parotid gland were determined to be external. A pronounced learning curve was evident in the technique of ultrasound-guided fine-needle aspiration, particularly for nonpalpable disease. Adequacy of sampling for each 3-month period was 71%, 89%, and 94%, respectively. Seventy-four percent of central aspirations were satisfactory compared to 54% of peripheral aspirations. Ultrasound-guided fine-needle aspiration did not alter the clinical staging of metastatic neck disease in 8 patients having 10 neck dissections but proved useful in detecting nodal recurrence in 3 irradiated necks that did not proceed to surgery. The smallest node to harbor malignancy had 4-mm maximal axial diameter. We conclude that ultrasound and ultrasound-guided fine-needle aspiration are valuable adjuncts to the clinical examination.
    No preview · Article · Jul 1994 · The Laryngoscope
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    ABSTRACT: Advances in imaging technology have allowed accurate preoperative localization of parathyroid lesions in the majority of patients. Noninvasive techniques including high-resolution ultrasound, thallium-technetium isotope subtraction scanning, and more recently technetium 99m sestamibi, magnetic resonance, and computed tomography have replaced the more invasive techniques of angiography and venous sampling. The accuracy of imaging techniques is directly related to the examiner experience, equipment available, and parathyroid pathology involved. Preoperative localizing imaging techniques have allowed parathyroid surgeons to have more confidence in surgical exploration and to have more comfort in discussion and planning with the patient.
    No preview · Article · Jun 1994 · Operative Techniques in Otolaryngology-Head and Neck Surgery
  • F Tovi · D M Fliss · A M Noyek
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    ABSTRACT: Septic Internal Jugular Vein Thrombosis (SIJVT) is a rare but potentially life-threatening condition which necessitates early clinical recognition and rapid administration of appropriate therapy. Although termed by some authors a "forgotten disease" in the antibiotic era, this entity is still present but frequently overlooked. Deep neck infections, Lemierre syndrome, central venous catheterization and mastoiditis are the etiologies in this series. The diagnosis of SIJVT utilized CT and Doppler ultrasound imaging. The treatment included aggressive abscesses, necrotizing fasciitis, mastoiditis). Anti-coagulant agents were used in order to reduce the risks of pulmonary embolism.
    No preview · Article · Jan 1994 · The Journal of otolaryngology
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    ABSTRACT: This study examined the prevalence and types of human papillomavirus (HPV) DNA in oral cavity verrucous carcinoma. This was of a retrospective screening study. Formalin-fixed, paraffin-embedded tissue samples were examined by the polymerase chain reaction using DNA primers specific for HPV types 6b/11, 16, and 18. The majority of patients were seen at referral centers in Ontario, Canada. This study examined 29 oral cavity verrucous carcinomas occurring in a sample of 25 patients from four institutions between 1966 and 1992. All tumors met standardized histologic diagnostic criteria of verrucous carcinoma. The prevalence of HPV 6b/11, 16, and 18 DNA was determined by the PCR technique. The HPV DNA was detected in 12 (48%) of 25 patients. The HPV 6b/11 DNA, HPV 16 DNA, HPV 18 DNA, and HPV 16 DNA plus HPV 18 DNA, were detected in one (4%), one (4%), nine (36%), and one (4%) cases, respectively. The detection of HPV 18 DNA in 40% of oral cavity verrucous carcinomas suggests an association between the presence of HPV 18 DNA and some oral cavity verrucous carcinomas. The etiologic and prognostic significance of HPV 18 for oral cavity verrucous carcinoma remains unanswered and will require further study.
    No preview · Article · Jan 1994 · Archives of Otolaryngology - Head and Neck Surgery
  • R Roithmann · L Shankar · M Hawke · E Kassel · A M Noyek
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    ABSTRACT: We consider that the nasal cavity and the paranasal sinuses cannot be declared completely normal without a normal CT scan. While CT scans are clearly useful in the evaluation of patients with recurrent sinusitis, it is important to emphasize that they should not be employed exclusively for diagnosis. Nasal endoscopy and clinical evaluation still form the basis for the diagnosis of chronic and recurring sinusitis. The CT technique described should be used only to supplement the clinical data obtained during history-taking and the rhinoscopic/endoscopic examination and is essential before functional endoscopic sinus surgery. The complexity of the diagnostic process is simplified to patient benefit when the radiologist and the otolaryngologist form a functional interactive partnership.
    No preview · Article · Sep 1993 · The Journal of otolaryngology
  • A J Pearl · J S Chapnik · J L Freeman · J Bain · S Salem · J Kirsh · A M Noyek
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    ABSTRACT: The successful diagnosis and surgical treatment of primary hyperparathyroidism due to parathyroid adenoma benefits significantly, in our experience, from a process of pre-operative imaging localization of the parathyroid adenoma. This prospective study evaluates a window of 25 consecutive patients who underwent pre-operative imaging localization prior to successful unilateral parathyroidectomy for parathyroid adenoma. All parathyroid adenomas were successfully localized by imaging, and subsequently documented photographically in surgical correlation, and pathologically confirmed. All patients were cured biochemically. Ultrasound accurately localized 92% of adenomas (100% in the neck and extrathyroidal) while radionuclide subtraction scanning identified 60% of a smaller subset. Both DSA and CT were successful in the two cases utilized, and MRI demonstrated four of five adenomas. The high yield of these pre-operative localization studies should make them an important consideration in the routine evaluation of patients undergoing surgery for possible parathyroid adenoma. Their usefulness in directing a conservative unilateral operation may result in time and cost savings, as well as reduced surgical exposure.
    No preview · Article · Sep 1993 · The Journal of otolaryngology
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    ABSTRACT: A case report of a parotid epithelial-myoepithelial carcinoma (EMC) of intercalated ducts is presented. There were no changes in clinical characteristics or growth over a four-year period as documented by repeated clinical examination and serial ultrasounds. This neoplasm may be mistaken for an adenoid cystic carcinoma on fine needle aspiration and is believed to represent an adenocarcinoma of low malignant potential. The imperceptible growth of this epithelial-myoepithelial carcinoma is in accord with a low malignant potential.
    No preview · Article · Jul 1993 · The Journal of otolaryngology

  • No preview · Article · Jun 1993 · Operative Techniques in Otolaryngology-Head and Neck Surgery
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    ABSTRACT: A case of a monomorphic adenoma of the minor salivary glands situated at the base of the tongue in a 49-year-old female is reported. The patient had a prolonged clinical course of eight years' duration. The histopathologic, immunohistologic and ultra-structural findings are described. A review of the literature concerning minor salivary gland tumors and their location in the oral cavity is presented. This is the first case, to our knowledge, of a monomorphic adenoma presenting at the base of the tongue. The difficulties in its diagnosis are discussed specifically in regard to its location.
    No preview · Article · May 1993 · The Journal of otolaryngology
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    ABSTRACT: The results of palpation, ultrasound, and detailed pathology were compared in 50 patients undergoing total thyroidectomy. Of the 211 nodules recognized by pathology, palpation detected 24% and ultrasound detected 43%. There were 14 patients with palpable papillary carcinomas, and 12 of these 14 had metastatic foci in other portions of the gland. Metastatic foci would have been left in 10 patients if only a lobectomy had been performed and would have been left in 6 patients if only a subtotal thyroidectomy (as defined in this report) had been performed. Of the 33 patients with benign palpable nodules, 5 had occult papillary carcinomas. In 2 of those 5 patients, the occult carcinomas would not have been removed if a less-than-total thyroidectomy had been performed. The significance of these occult and metastatic papillary carcinomas is discussed.
    No preview · Article · Feb 1993 · The Laryngoscope
  • A M Noyek · J S Chapnik · G Wortzman · R Kandel
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    ABSTRACT: In 1986, the authors reported the CT imaging findings which were specific for the diagnosis of schwannoma of the intrasternomastoid portion of the spinal accessory nerve. This successful imaging diagnosis led to appropriate surgical management with preservation of motor nerve function. In this manuscript, magnetic resonance imaging (MRI) was utilized to correctly diagnose the identical lesion, again with the same satisfactory surgical results. Both the CT and MRI findings are unique and specific, and the purpose of this short manuscript is to identify the MRI findings and link these to the previously recorded CT radiographic signs.
    No preview · Article · Sep 1992 · The Journal of otolaryngology
  • E Reifen · A M Noyek
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    ABSTRACT: A 50-year-old man, presenting with headache, was suspected of having a malignant nasopharyngeal tumor on the basis of his CT results. A CT scan revealed diffuse calcification in a large nasopharyngeal polyp. Xeroradiography of the specimen demonstrated the calcifications to extend centrally along the stroma. The histology and the radiologic features of this choanal polyp, resulting from diffuse central calcification of the stroma, are a unique feature that might mimic malignancy.
    No preview · Article · Jul 1992 · The Journal of otolaryngology
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    ABSTRACT: This study examines patterns of early metastatic spread as recorded in 19 clinically negative, histologically positive (occult) neck dissection specimens. Microscopic metastatic deposits were detected in this study in nodes measuring 10 mm and less. No nodes with extension of tumor beyond the capsule and into adjacent structures were noted. Central necrosis was detected in only one node. We suggest that the first stages of metastatic disease as evaluated by the pathologist in clinically occult nodes are minimal and may easily evade the eyes of both pathologists and radiologists. Imaging proved to be efficacious in upstaging clinically occult necks that were previously irradiated.
    No preview · Article · May 1992 · Head & Neck
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    ABSTRACT: Detection of nasopharyngeal carcinoma primaries in patients presenting with neck node metastases may sometimes demand considerable efforts. By using the 'in situ hybridization' technique, we manage to identify the Epstein-Barr virus in neck metastases secondary to nasopharyngeal carcinomas. We propose that such identification in neck node metastases where the primary lesion is unknown indicates a nasopharyngeal primary.
    No preview · Article · May 1992 · The Journal of Laryngology & Otology
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    ABSTRACT: In nasopharyngeal carcinoma the primary lesion is often difficult to find. Metastatic lesions occur frequently but are difficult to distinguish from other head and neck tumors. The viral genome of the Epstein-Barr virus (EBV) can be identified in the cells of this carcinoma. We used the polymerase chain reaction (PCR) to test for the presence of EBV genomes in 15 samples of metastatic squamous-cell carcinoma of the neck obtained by fine-needle aspiration and in 26 samples obtained by biopsy of lymph nodes. For controls we used disease-free lymph nodes from 10 patients with various head and neck tumors, tonsillar tissue from 46 subjects, blood from 59 EBV-seropositive blood donors, and mononuclear cells from 8 patients with fatal lymphoproliferative lesions. Of the 41 malignant lesions examined, only the nine nasopharyngeal carcinomas (one primary lesion and eight metastases) contained EBV genomes. None of the 20 nodes with other types of cancer, the 10 disease-free nodes, or any of the 105 normal control samples contained detectable EBV. In two patients with suspected metastases from occult primary tumors, the presence of EBV was predictive of nasopharyngeal carcinoma; in both cases overt nasopharyngeal carcinoma developed within one year. In patients with suspected nasopharyngeal carcinoma, fine-needle aspiration can provide tissue for diagnosis by DNA amplification of EBV genomes. The presence of EBV in metastases from an occult primary tumor is predictive of the development of overt nasopharyngeal carcinoma.
    No preview · Article · Feb 1992 · New England Journal of Medicine
  • Ella Reifen · Arnold M. Noyek · J. Brendan M. Mullen
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    ABSTRACT: The prognostic value of nuclear morphometry in nasopharyngeal carcinoma (NPC) was investigated in 28 patients. Seven morphometric nuclear variables were measured on 100 randomly selected tumor cells in nasopharyngeal biopsies from 18 patients with NPC confined to the nasopharynx. The same variables were measured in 6 patients with metastatic NPC, as well as in lymph node biopsies from 4 patients with metastatic NPC. Nuclear area, nuclear perimeter, long and short nuclear axes, nuclear form factor, nucleolar area, and the ratio of nucleolar area to nuclear area were all measured. Volume-weighted mean nuclear volume was also obtained. Tumor cells from patients with NPC confined to the nasopharynx had significantly larger mean nuclear areas, perimeters, and volume-weighted mean nuclear volumes but significantly smaller nucleolar to nuclear area ratios than tumor cells from patients with nodal metastases. Assessment of nuclear form factor and diameters did not differentiate the two groups.
    No preview · Article · Feb 1992 · The Laryngoscope

Publication Stats

1k Citations
162.34 Total Impact Points


  • 1982-1997
    • University of Toronto
      • Mount Sinai Hospital
      Toronto, Ontario, Canada
  • 1975-1994
    • Mount Sinai Hospital, Toronto
      • Department of Otolaryngology
      Toronto, Ontario, Canada
    • Weill Cornell Medical College
      New York, New York, United States
  • 1993
    • Samuel Lunenfeld Research Institute
      Toronto, Ontario, Canada
  • 1991
    • Ben-Gurion University of the Negev
      Be'er Sheva`, Southern District, Israel
  • 1988
    • United Way Toronto
      Toronto, Ontario, Canada
  • 1983
    • Ear, Nose and Throat Associates of South Florida
      Boca Raton, Florida, United States
    • Sunnybrook Health Sciences Centre
      Toronto, Ontario, Canada