The specific performance of intrinsic laryngeal muscles has been difficult to evaluate, especially in living subjects. To reproduce natural contractions, we artificially induced orderly recruitment of their innervating axons according to the size principle. In 5 dogs, both recurrent laryngeal nerves (RLNs) were stimulated with 50 through 10 Hz, 300 to 1000 microA currents while 600 Hz, 1000 to 0 microA decreasing blocking currents were administered. Surface electromyography electrodes placed on the thyroarytenoid, posterior cricoarytenoid, and lateral cricoarytenoid muscles were used to determine the amplitudes (in mA) of compound muscle action potentials. There was a highly statistically significant difference (P<.004) between the thyroarytenoideus which had the fastest rate of recruitment (8.38%), and posterior cricoarytenoideus, which had the slowest (4.81%). There was an intermediate recruitment rate (6.72%) of the lateral cricoarytenoideus, a divergence attributed to a more equal distribution in fast and slow types of myofibers and a smaller sample. We submit that RLN axons can be recruited in an orderly manner according to their sizes and that the rates are unique to the muscle classes they innervate. The parameters defining these contraction patterns may offer key information for laryngeal pacing.

Patients with syphilis may go to an otolaryngologist for their initial evaluation. Given that the incidence of syphilis is increasing, otolaryngologists should be aware of the various presenting signs and symptoms. We describe here two patients who had oral manifestations of syphilis at presentation and review the natural history of the disease and the associated diagnostic and treatment options.

Nodular fasciitis is a benign, pseudosarcomatous proliferative lesion of soft tissue. Only 7% to 20% of these tumors are located in the head and neck with ear involvement being extremely rare. We present a patient with nodular fasciitis arising in the external auditory canal (EAC). CASE REPORTA 39-year-old man came to our emergency department with a 2-week history of a mass protruding from the left ear. Examination revealed a fungating, ulcerative lesion protruding from the left EAC and filling the concha (Fig 1). The mass was associated with minimal pain and drainage. CT done in the emergency department revealed the mass to be confined to the left EAC without middle ear invasion (Fig 2). The patient was then scheduled for an MRI and follow-up in the otology clinic. The MRI showed a high-signal mass throughout the left EAC and middle ear cavity with extension inferiorly to involve the parotid gland, temporomandibular joint, masseter, and pterygoid muscles. There was no evidence of great vessel or lymph node involvement (Fig 3). In addition a biopsy was obtained with the patient under local anesthesia. Pathologic evaluation revealed an ulcerated, mesenchymal proliferation. Distinction between a low-grade sarcoma and a benign reactive process was extremely difficult. The patient was prepared to undergo an extensive resection of the left temporal bone. The specimen was then sent for outside pathologic consultation. This confirmed the presence of a reactive process. The lesion was comprised of flat, spindled cells with a "tissue culture-like" appearance. There was also a focus of metaplastic bone. Mitoses were present with minimal nuclear atypia (Fig 4). The lesion was diagnosed as nodular fasciitis.Subsequently, the patient was taken to the operating room where he underwent a local excision that included approximately one third of the left EAC.

No statistically or clinically significant benefits were derived from perioperative systemic corticosteroid treatment in this sample of 28 adults treated with UPPP alone or in combination with tonsillectomy or septoplasty, or both. Some individuals tolerate post-UPPP discomfort without a narcotic analgesic.

Laryngeal adduction for swallowing chiefly involves contraction of the thyroarytenoid and lateral cricoarytenoid muscles to seal the glottic chink. Vocal cord elongation supplements closure through cricoarytenoid activation. Relaxation of the posterior cricoarytenoid muscle is also involved in the swallowing process. Recent interest has focused on stimulating the laryngeal nerves to protect the lower airway from conditions where normal muscular coordination may be disrupted (e.g., in aspiration following stroke). Unfortunately, electrical stimulation results in a generalized contraction of all the dependent intrinsic laryngeal muscles because the larger, more excitable axons fire before their smaller counterparts can be activated. In the physiological state, however, the smaller fibers are recruited first. The current study focuses on electronic manipulation of force in the glottic muscles involved in deglutition. We used a stimulator that could selectively activate the intrinsic laryngeal muscles based on their specific motor unit architectures. In 5 dogs, the circuit recruited the axons in the recurrent and superior laryngeal nerves from small to large. The muscles were identified according to the differential recruitment rates of their compound muscle action potentials as they appeared on the graph. The smaller axons in the thyroarytenoid recruited faster than the large ones found in the lateral cricoarytenoid muscles, with intermediate figures observed with the cricothyroid. The posterior cricoarytenoid presented with the slowest recruitment rates, as expected from this muscle's highest contingent of larger motor units. Latencies between the onsets of stimulations and muscle saturations also appeared stable. This approach to manipulating glottic force saves energy because it allows stimulating the adductory muscles with minimal interference from their abductor antagonist.