\s=b\A retrospective five-year review of patients treated for cancer of the larynx disclosed a high prevalence of hypothyroidism after combined therapy. A total of 29 patients were studied. Seven (24%) of the 29 patients had hypothyroidism develop in the posttreatment period (zero to two years). Two (22%) of the nine patients treated with surgery alone and five (25%) of 20 patients treated with a combination of surgery and radiation had hypothyroidism develop. An additional ten patients treated with radiation alone remained clinically euthyroid, and no thyroid function tests were performed. Of the five patients who became hypothyroid after treatment with a combination of surgery and radiation, two had fistulae develop that were resistant to intensive local care.They closed promptly after treatment of the hypothyroidism. Of the two patients who had hypothyroidism develop after surgery alone, one had fistulae develop that were resistant to local care, but responsive to thyroid hormone. These patients should have thyroid function tests done in the early postoperative period, and those found to be hypothyroid should be treated promptly. (Arch Otolaryngol 1982;108:289-291) One of the most difficult problems facing the head and neck sur¬ geon is wound healing. Factors influ¬ encing healing include radiation, operative technique, operating time, and postoperative care, as well as the overall nutritional and hormonal state of the patient. Infection and fistula are feared complications and

A study was conducted to assess oxygenation and respiratory changes on the first and second postoperative nights after uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea (OSA). Twelve patients were postoperatively evaluated with 8-hour nocturnal polysomnography on four occasions: (1) PREOP--night before UPPP, (2) POPN1--first postoperative night, (3) POPN2--second postoperative night, and (4) 3MOS--3-month follow-up study. Results demonstrate that apnea index (AI) and respiratory disturbance index (RDI) were significantly improved at 3MOS from PREOP levels: AI (p less than 0.01) and RDI (p less than 0.05). There were no statistical differences from PREOP to POPN1 or POPN2 for AI, RDI, lowest oxyhemoglobin saturation (LSAT), or number of desaturations (#DESAT). One of twelve patients dropped LSAT greater than 10% from PREOP to POPN1 or POPN2 (82% PREOP to 71% POPN2). Patients were grouped by PREOP LSAT greater than or equal to 80% or less than 80%, and the postoperative change in LSAT was evaluated by comparing PREOP to a value averaging POPN1 and POPN2. Patients with LSAT greater than or equal to 80% decreased by 2.6%; patients with LSAT less than 80% improved by 6.2%. This change in LSAT between groups was statistically different (p = 0.02). These data suggest that in the majority of patients, preoperative indices remain unchanged for at least 2 days after surgery, even for patients who demonstrated improvement at 3 months. However, worsening does occur in some patients. On the basis of the results of this study and clinical experience with the postoperative course, a selective management protocol is outlined.

The clinical diagnosis and laboratory identification of Leishmania braziliensis braziliensis, a parasitic disease affecting the upper aerodigestive tract, is difficult. A retrospective computer-assisted analysis of patient records was done after examination of 58 patients with mucosal leishmaniasis in an endemic area of L. braziliensis braziliensis in Bahia, Brazil during January 1987. Biopsies of clinically active and clinically inactive mucosal patients were examined for parasites using routine hematoxylin and eosin histopathology and a new technique for rapid detection of Leishmania amastigotes using a genus-specific indirect immunofluorescent assay. No amastigotes were found in specimens from seven patients with clinically inactive mucosal disease using immunofluorescent monoclonal assay techniques, whereas specimens from seven out of 14 patients with clinically active mucosal disease were positive. These results suggest that the immunofluorescent antibody technique is markedly superior in identifying the intracellular amastigote in tissue sections of mucosal biopsies when compared to histopathology techniques or with other standard tests done in rural areas of Brazil. Various clinical and laboratory test data of the entire group of patients were examined and the efficacy of treatment evaluated. The median interval of time noted between cutaneous and mucosal disease was 4.5 years. Relapse was noted in 31% of patients treated with a low dose of meglumine antimoniate (10 mg per kg of body weight). Patients treated with a high dose of meglumine antimoniate (20 mg per kg of body weight) had a relapse rate of 27.3%. A chi-square statistical analysis revealed no significant difference (chi 2 = 0.049) between the two groups. Patients were considered cured if mucosal granulations were clinically absent after 4.6 years.

We examined 26 consecutive patients with subjective tinnitus. All subjects were treated with the tricyclic antidepressant trimipramine in a double-blind study, each subject acting as his own control. All subjects were evaluated with pure tone audiometry, site of lesion testing, and auditory brain stem evoked response. The tinnitus assessment consisted of frequency and intensity matching, the determination of masking levels, and a subjective evaluation of severity. Plasma levels of trimipramine were monitored at regular intervals, and the Zung and Millon inventories were administered at the beginning and end of each study period. Nineteen subjects completed the study. Within the trimipramine group, one reported complete disappearance of his tinnitus, eight reported improvement, three no change, and seven that tinnitus was worse. Within the placebo group, eight reported improvement, seven no change, and four that tinnitus was worse. The natural history of tinnitus is such that what has been observed may reflect the evolution of the disease itself, rather than the effect of treatment. We feel that while tricyclics may not have been shown to be effective, the placebo effect played a significant role in the results obtained.

Blast injury of the ear is rarely encountered by the practicing otolaryngologist. The recent world literature on this entity is reviewed. Symptoms, patterns of injury, and clinical course are highlighted and should form the basis of management under acute and chronic circumstances.