A clinical and pathologic study of cis-platinum ototoxicity was performed. Twenty-four patients treated with cis-platinum for head and neck cancer were studied prospectively. Post cis-platinum hearing losses were subclinical, detected in 25% of patients, isolated to 4 and 8 kHz, and did not exceed 25 dB at any frequency. Temporal bones from a 9-year-old with frontal lobe astrocytoma and with cis-platinum ototoxicity were studied with routine and special techniques to elucidate oto and neurotoxicity. Degenerative changes in the outer hair cells in the lower turns of the cochlea, in the spiral ganglion, and cochlear nerve were the most striking findings.

Large-bore myringotomy tubes are usually reserved for the treatment of refractory middle ear effusion. Theoretically, they have an extended intubation time and a higher complication rate. There is, however, scant support of this in the literature. The duration of intubation, efficacy, and complication rates of the large-bore Paparella type II tube were compared with Paparella type I, Shepard, and Armstrong tubes. The study included 242 patients with 600 intubations. In addition, a subpopulation of patients receiving their initial intubation during this study was reviewed. Findings were similar for both groups. Paparella type II tubes had a prolonged period of intubation and a decreased reintubation rate when compared with the smaller bore tubes. Larger bore tubes had an increased complication rate when compared with the smaller bore tubes. Complications included occasional or frequent otorrhea and an increased rate of permanent perforation of the tympanic membrane. There was no instance of cholesteatoma formation secondary to intubation. Guidelines are presented for the use of the Paparella type II tube.

A 9-year review of our experience with head and neck metastases from 845 urogenital tract tumors of the kidney, prostate, bladder, testicle, spermatic cord, penis, urethra, and ureter was performed. Thirty-one (3.7%) of these tumors developed metastases to the cervical and supraclavicular lymph nodes, scalp, thyroid gland, thyroid cartilage, parotid gland, retroorbit, mandible, nasal cavity, and paranasal sinuses. Unusual cases and a review of the literature are presented. The frequency of such metastases to the head and neck from various primaries, diagnostic application of current immunohistochemical methodology, and therapeutic alternatives are emphasized.

The purpose of this study was to look at complications associated with percutaneous endoscopic gastrostomy (PEG) in a group of head and neck cancer patients. We retrospectively reviewed charts of 46 patients referred for PEG. Three of 29 patients without secured airways (10.3%) had acute airway obstruction after administration of sedation for the PEG procedure. Two required emergency tracheostomy. Three additional patients of these 29 (10.3%) presented within 2 months of their PEG attempts with tumor-related airway obstruction requiring emergency tracheostomy. There were no other serious complications noted in our review. We concluded that our group of head and neck cancer patients were at high risk for airway obstruction, especially when sedated, and that the acute risk was not directly associated with the PEG procedure. We also concluded that referral for PEG should be made in anticipation of future nutritional needs and that PEG should not be used only as a late-stage procedure.