Laryngeal cysts of thyroid cartilage origin are unusually rare. A patient had a degenerative cyst of the thyroid cartilage. This presented as a unilateral false cord swelling. Computed tomography helped to localize the lesion to the left thyroid ala. An external laryngeal approach was used for excisional biopsy, and this also proved to be curative. The cyst probably resulted from a traumatic episode 35 years earlier.

A 2-month-old infant developed facial paralysis with a presentation that masqueraded as a possible middle ear tumor. The cause of the paralysis eventually was related to a metabolic consequence of his underlying disorder, cystic fibrosis. To our knowledge, the association of vitamin A imbalance, pseudotumor cerebri, and facial paralysis has not previously been discussed in the otolaryngologic literature.

Seven different types of widely used metallic stapedectomy prostheses were individually placed on a millimeter scale in a plastic Petri dish. The Petri dish was moved within the core and around the magnet of a 1.5-tesla magnetic resonance imaging unit (General Electric Sigma). No movement of any of the prostheses was seen. We conclude that there is no apparent danger of these prostheses becoming displaced in stapedectomy patients subjected to the electromagnetic fields of magnetic resonance imaging units.

After years in its decrease, cervical mycobacterial adenitis is once again an increasing problem in Los Angeles County. We reviewed 54 cases of cervical lymphadenopathies treated over ten years. Twenty-five (46%) of these patients were found to have mycobacterial cervical lymphadenitis. Medical approaches often failed to conclusively diagnose this disease. In our series, none of the patients with cervical adenopathies (36%) treated only medically regressed, even after an average time of 18 months of antituberculosis drug treatment. The treatment of choice seems to be surgical excision and long-term antituberculosis drugs. Surgery provides a rapid tissue diagnosis and confirms the bacterial type, including atypical mycobacterium. This approach is simple, shortens hospitalization, is cost-effective, and carries a low morbidity.

Inverted papilloma is notorious for recurrence and occasional association with malignancy, leading most authors to recommend lateral rhinotomy as the initial surgical approach in all cases; however, conservative surgery has been reported effective in selected cases. To assess the role of conservative procedures, 90 cases of inverted papilloma were retrospectively reviewed. Associated malignancy was rare. Conservative surgery was successful in controlling some cases, but often required two or three operations. All patients with clear sinus films were cured by a single procedure. Abnormal mitotic activity was seen in some aggressive lesions and some associated with malignancy. The surgical exposure in inverted papilloma should be adequate to ensure complete excision. Selected patients with localized disease can be satisfactorily managed by conservative procedures if they are carefully followed. All tissue should be inspected for possible malignancy.

Auditory brain-stem responses (ABR) were recorded in six healthy male volunteers during intravenous infusion of lidocaine that achieved systemic blood levels similar to those seen with conduction anesthesia and antiarrhythmic therapy. Following an initial loading dose of lidocaine (1 mg/kg), subjects noted prominent tinnitus, perioral numbness, and drowsiness. All of these symptoms except drowsiness abated during continued infusion as blood concentrations reached equilibrium. All subjects noted that the click stimuli used to elicit ABR varied markedly in intensity and character throughout the lidocaine infusion. Although waves I and III were unaffected by lidocaine, wave V exhibited significant decreases in amplitude and increases in latency. Therefore, the more central components of the auditory system seem to be the prominent site of lidocaine's central nervous system effects.

Sensorineural hearing loss (SNHL) has been described clinically following chronic otitis media with effusion, but to the best of our knowledge, no studies have demonstrated SNHL in an animal model of otitis media. Using the chinchilla model of pneumococcal otitis media, significant SNHL was demonstrated after purulent otitis media, especially at higher frequencies. Animals with otitis media received penicillin G procaine treatment for five days after otitis media with effusion (OME) was first documented; resolution of middle ear infection was confirmed by middle ear effusion culture in all animals. Both the inoculated and uninoculated ears were examined by tone burst-elicited compound action potential at threshold. The inoculated ear showed a marked hearing loss of 13 to 36 dB three to four days after OME was first documented; a hearing loss up to 24 dB persisted two to five weeks after inoculation. The change in the compound action potential was highly significant at all frequencies studied. Conductive losses were largely ruled out because there was no middle ear effusion at death and the tympanogram was normal. Purulent labyrinthitis was ruled out by histopathological study. These results indicate that purulent pneumococcal otitis media in the chinchilla model causes significant SNHL and suggest that the pathogenesis of SNHL associated with chronic OME in humans may be studied in this model.

A sound-generating otoscope was compared with standard audiometric testing. Subjects of different ages and with different auditory pathologies were examined. The sound-generating otoscope was found to agree 92.4% of the time. Errors occurred more often with subjects having normal hearing. No single frequency delivered by the otoscope produced a significantly higher error rate than had been reported by other investigators. The otoscope can also be used to detect collapse of the external auditory meatus that might occur during regular audiometric testing.

The finding of heightened metabolic activity in nerve cell bodies after axonal injury has led to speculation that delaying motor nerve repair would be beneficial. Using a sciatic nerve model, 100 rats were grouped based on nerve autograft donor and recipient site variables. Animals were subjected to electrophysiologic testing at 3, 6, 9, and 12 weeks after grafting. Twitch force and nerve compound action potential parameters were calculated and compared using two-way analysis of variance. Previous studies have suggested interaction between donor and recipient variables. We cannot support these findings. Our data revealed no significant difference between immediate or delayed nerve repair or between fresh or predegenerated nerve grafts.

A total of 127 patients with histologically proved diagnosis of carcinoma of the tonsillar region and soft palate were treated over the past ten years utilizing interstitial iridium-192 implants. Eighty patients were treated for primary tumors and 47 patients for either recurrent or persistent tumors after definitive irradiation and/or surgery. All patients with primary tumors were treated by a combination of external megavoltage irradiation and interstitial iridium-192 implants, whereas patients with recurrent tumors were treated by interstitial implants alone. In the primary group, 95% of patients with T1 and T2 lesions and 79% with T3 and T4 lesions achieved complete local tumor control. The three-year absolute disease-free survival rate was 72%. Seventy-five percent local tumor control was obtained in patients with recurrent disease, with two-year absolute disease-free survival of 42%. Treatment-related complications such as soft-tissue necrosis or osteoradionecrosis occurred in 6% of patients in the primary group and 23% in recurrent group. This treatment regimen offers an excellent locoregional control with no significant functional or esthetic impairment. Most patients with primary lesions who fail this regimen can be salvaged by surgery or reirradiation using interstitial implants. Reirradiation with interstitial implants is feasible and offers a good chance of long-term local tumor control in the selected group of patients with recurrent disease for whom external irradiation and/or surgery had not been successful.