Otolaryngology–Head and Neck Surgery

One hundred seventeen patients with advanced squamous cell carcinoma of the head and neck were treated and placed randomly between two combination protocols, one with adriamycin and the other without. Responses (more than 50% tumor regression) were 67% overall with 63% responding to the combination without adriamycin and 82% responding to the protocol containing it. The increase in the response rate seen with the addition of adriamycin was not statistically significant. The degree of response to chemotherapy was reduced by prior radiotherapy.

Clinical experience with triamcinolone acetonide (Kenalog) injections into the nasal turbinates for allergic and vasomotor rhinitis is reported by two authors. Gratifying results have occurred in most of the over 60,000 patients treated, with no serious side effects. Two cases of intravascular injections of another corticosteroid reaching the retinal circulation are reported, and methods for preventing this complication are proposed.

Chronic bacterial tonsillitis can be validly supported etiologically by quantitative bacteriologic methods. The following observations are based on a recognition that the mere presence of bacteria is much less significant than the level of bacteria present. The chronically infected adult patient may be characterized by tonsils subclinically harboring greater than 10⁵ bacteria/gm as opposed to the control patient with 10³ bacteria/gm. Useful features in predicting high bacterial levels are (1) low number of crypts, (2) presence of nodal hypertrophy, and (3) tonsils small by actual size. Estimated tonsil size, determined preoperatively, shows no statistically significant correlation with either actual size or degree of tonsil sepsis.

Instruction in basic surgical techniques with practical experience is often minimized in the modern, compressed medical curriculum. The otolaryngologist can fulfill a major need in this area by presenting instruction in these techniques with emphasis on their application to the face. The authors have developed a course which has been refined through the experiences of over 100 medical students at the University of Colorado Medical Center and has been uniformly well received by students and administration. The outline of the didactic presentation and organization of the practicum is presented.

Hearing loss, tinnitus, and vertigo have long been associated with Paget's disease of the bone. We reviewed the records of 463 patients with Paget's disease who were seen in the otolaryngology department. Hearing loss was common. It was our observation that mixed hearing losses were part of the disease process. Sensorineural hearing loss was the most frequent loss, but it usually was not part of the disease process. Tinnitus, vertigo, or both were seen in about 20% of these patients.

For over 100 years it has been universally assumed in the literature that spastic dysphonia is a functional or psychoneurotic voice disorder. In the last few years, new data have accumulated that support the concept that spastic dysphonia is caused by an organic, rather than a functional, abnormality. Histologic examination of segments of the recurrent laryngeal nerve removed from patients with spastic dysphonia has revealed myelin abnormalities in 30% of the nerves examined. Neurologic examinations indicated brain stem or basal ganglia disturbances in some patients who had no apparent nerve disease.

Occasionally, during the course of combined (radiation plus surgery) treatment of head and neck malignancies, the patient experiences a profound response to radiotherapy alone and elects to decline the second phase of treatment, namely, surgery. After a variable interval, radiotherapy is reinstituted to a “curative” level.

A series of 14 laryngeal and oropharyngeal carcinomas, treated in this disjointed fashion, has been examined with respect to long-term survival. The prognosis is extremely unfavorable, thus supporting a basic philosophy of continuing with the prescribed surgical treatment despite a dramatic response to noncancericidal doses of radiotherapy.

The site and stage of tumor, radiation dosage, interval to completion of therapy, and incidence of local and distant metastases are examined.

It appears that every effort should be made to provide continuity in the combined therapeutic protocol if the advantages of this mode of therapy are to be effective.

The differential contribution of the inner hair cells (IHC) and the outer hair cells (OHC) in the mammalian cochlea to hearing sensitivity was assessed in six behaviorally-trained guinea pigs by comparing audiograms preadministration and postadministration of kanamycin, an antibiotic that predominantly destroys guinea pig OHC while leaving the IHC structurally unchanged. The results support the hypothesis that only the IHC of the cochlea responds to tones approximately 50 to 60 dB above the threshold of the intact cochlea.

The effects of nitrogen mustard on the electrical potentials of the inner ear were studied, and the results were correlated with the histopathologic findings which have been reported in nitrogen mustard ototoxicity. The endocochlear DC potential (EP) decreased rapidly after an injection of nitrogen mustard (NM). The amplitude of the cochlear microphonics potential (CM) diminished rapidly, and no substantial recoveries were observed. No significant changes in the magnitude of the negative potential of organ of Corti (NPOC) were observed. A large negative summating potential (SP) was recorded even when the amplitude of the CM had diminished.

The syndromes of Pickwickian, Ondine's curse, and primary alveolar hypoventilation are respiratory disorders manifesting increased sleepiness and irregular respiratory rhythms. These disorders are currently grouped as hypersomnia with periodic breathing (HPB). Polygraphic techniques have lead to a reasonable hypothesis as to the pathophysiology of the multiple variants of HPB. Discernible causes of HPB have been attributed to both central and peripheral factors. Peripheral factors encompass those conditions relating to upper airway obstruction. An acromegalic person suffering the HPB syndrome secondary to laryngeal stenosis is described.

Search of the literature thus far indicates no prior description of rhinophyma occuring in tuberous sclerosis. There have been numerous reports of the usual skin lesion, adenoma sebaceum, together with the associated manifestations of severe mental retardation and convulsive seizures.

In a 27-year-old woman, full-blown, severely deforming rhinophyma had its onset one year prior to her hospital admission. The family, horrified by her appearance, desired surgical intervention. The report includes a review of the literature and a description of the patient and of the surgical technique employed. The question of the desirability and difficulty involved in skin grafting is discussed, as are the microscopic findings and postoperative course. Particular attention is directed toward differential diagnosis and associated findings.

Management of blunt trauma to the larynx and trachea is based upon accurate assessment of the anatomic site of the injury, the tissue involved, the time since the injury, and the general status of the patient. Early and orderly diagnosis and classification result in early management, which is essential to maximize function and minimize morbidity.

To evaluate the management and treatment results of patients with blunt trauma to the larynx and trachea, a retrospective study was performed. The office charts and hospital records of all patients with blunt trauma to the larynx and trachea from 1966 through 1976 were reviewed. Conditions studied included etiology of the trauma, initial signs and symptoms, pretreatment findings, management (primary and secondary), complications, and long-term results of management.

Management results are discussed in comparison with reported results in the literature, and conclusions are presented regarding optimal treatment for the various classes of laryngotracheal injury.

A surgical procedure is described that minimizes the lifting of the hairline in rhytidectomy by locating most of the incision inside the hair. Traction of the skin is directed at producing a soft, rounded contour. The author reports good results on 30 patients in two years' time.

Appropriateness of rhytidectomy depends on psychologic factors and on biologic rather than chronologic age. Operation under general anesthesia is preferred and should be confined to a simple procedure.

However, blepharoplasty, rhinoplasty, and mentoplasty are often performed at the same time. Forehead lifting is a desirable associated procedure in which the incisions can be joined. Cutting of the muscle fibers is preferred to resection of the frontal corrugator. Minilifting to obtain Oriental slant eyes is considered a wasted effort.

The Leyla retractor is a self-retaining retractor used in the translabyrinthine removal of acoustic neuroma and middle fossa surgery. It is used to maintain constant, even pressure on a decompressed sigmoid sinus and cerebellum in translabyrinthine surgery and the temporal lobe in middle fossa surgery. The Leyla retractor provides excellent exposure and greater freedom and dexterity for the neurotologist.