A case of severe macroglossia resulting from trauma (tongue biting) during eclampsia and causing respiratory obstruction is described. Despite medical treatment with steroids and antibiotics for a week, followed by tracheostomy, no significant improvement was observed. After an energetic but cautious maneuver of reducing and restraining the tongue in the oral cavity, the swelling reduced dramatically in 24 to 48 hours. Earlier manual replacement of the tongue into the oral cavity is advised in order to arrest the cycle of venous and lymphatic obstruction and congestion that leads to further edema and increased tongue swelling. The mechanism of traumatic macroglossia is discussed.

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Rhinocerebral aspergillosis (RA) is becoming increasingly common in patients undergoing bone marrow transplantation (BMT). The disease can involve nearly all major head and neck structures, including the nose, paranasal sinuses, and orbits. Intracranial extension of the infection is of major concern, since this is usually a fatal complication. Our study population comprised 423 consecutive BMT patients at Hadassah University Hospital from January 1986 to August 1992. Eight patients (1.9%) developed RA, 5 of whom had underlying hematologic malignancies, and 3 of whom had severe aplastic anemia. Only 2 of the 8 patients responded completely to therapy, with a follow-up of 15 months. It appears that RA is a fatal complication in immunocompromised patients post-BMT. Early diagnosis followed by extensive surgical debridement of necrotic tissue and systemic, as well as topical, antifungal therapy with amphotericin B or its new formulations and the patient's recovery of bone marrow function may improve the outcome of this life-threatening complication.

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Not only is the cochlear part of the inner ear affected in patients suffering from MB, but the vestibular part as well. Sensorineural HL and vestibular abnormalities should both be considered as manifestations of MB.