One hundred and ten patients with supraglottic squamous cell carcinoma have been randomized for preoperative radiation therapy and surgery versus surgery and postoperative radiation therapy. Data have been analyzed on 94 patients in this preliminary report. The differences between the two groups with respect to local control and survival are not statistically significant at this time. Additional accrual and continued follow-up are necessary in order to make a more definite treatment comparison.

EDITOR'S NOTE: Each of the rare lesions reported in this group of case reports initially presented as a common otologic problem: middle ear effusion. (apparent) Meniere's disease. recurrent acute otitis media. and otitis extema. Today a diagnosis of necrotizing ("malignant") otitis extema would immediately be suspected in an elderly diabetic with granulation tissueon the ear canal floor. However. the other cases would stillfool most of us, at least on the firstor second visit. The solution isnot to order excessive testsand x-ray films on every patient.A 73-year-old woman was admitted to the hospital for evaluation and treatment of paralysis of the left face. She had undergone bilateral stapedectomies several years prior to admission. Three months prior to admission she developed bilateral acute otitis media and was given antibiotic therapy. The otitis media failed to resolve, and bilateral myringotomies with placement of rympanostorny tubes were carried out. There was still no improvement. so the tubes were removed and antibiotics continued. Subsequently, left facial paralysis developed along with mild vertigo and tinnitus.Pertinent physical findings included an amber effusion in the right ear. The myringotomy on the left was still patent and allowed passage of amber fluid. Tuning fork tests were consistent with a bilateral conductive hearing loss. There was complete paralysis of the entire left face.Laboratory studies included a white blood cell count of 1O,7oo/mm", with a shift to the left. Blood glucose was 178 mg/dl. Temporal bone tomograms and computerized tomography of the head revealed opacification of the mastoid air cells without bone destruction. There was mucosal thickening in the left sphenoid sinus. Intravenous cefazolin was begun, and subsequent cultures grew a bacillus species sensitive to clindamycin, which was added to the regimen. Audiologic assessment revealed profound hearing loss bilaterally. HowFrom the Departmentof Otorhinolaryngology and Human Communication, University of Pennsylvania School of Medicine.

Subcertification in otolaryngology-head and neck surgery has been under consideration since certification in otolaryngology was initiated 55 years ago. In the last year the American Board of Otolaryngology has had a committee studying the proposition of subcertification under the leadership of Brian McCabe. In view of this renewed interest in subcertification, the Teachers' Section Committee, which is currently composed of Max-weJl Abramson, Gershon J. Spector, Eiji Yanagisawa, and me, developed this program to explore the effects of subcertification on residency training in otolaryngology-head and neck surgery. Subcertification as it is currently being considered by the American Board of Otolaryngology would be in the subspecialties of otology, head and neck surgery, facial plastic and reconstructi ve surgery, bronchoesophagology, and aJlergy. A similar case could be made for pediatric otolaryngology.Most students of the proposition of subcertification think of it as an additional step foJlowing certification by the American Board of Otolaryngology. As currently articulated, subcertification would be based on identification and recognition of those physicians who by training, interest, and inclination have fitted them-selves to practice a subspecialty with a high level of expertise. TypicaJly, subcertification would occur 3 to 5 years after certification by the primary board and would be based on an examination which, at least in part, would be written (multiple-choice type).There is debate regarding the percentage of certified otolaryngologists that would avail themselves of the opportunity to obtain subcertification. My personal belief is that it wiJl be very high (in excess of 50%) for established diplomates of the American Board of Otolaryngology and would approach 100% for subsequent graduates of our training programs because of pressures relating to hospital appointments, professional liability , and third-party payers.It might be weJl to consider the reasoning for and against subcertification. In favor of subcertification, there is the perception that the field of otolaryngology-head and neck surgery is broad and that many of its practitioners, for reasons of achieving exceJlence and promoting the development of new knowledge in the field, have limited or devoted their practice mainly to one subspecialty and deserve recognition of their expertise. Furthermore, many believe that this expertise or subspecialization should be encouraged. Many areas of otolaryngology-head and neck surgery interface with other disciplines, and practitioners of subspecialties of otolaryngology-head and neck surgery need this recognition by the profession, hospitals, patients, and the public in view of the nature of certification and subcertification existing or proposed by other primary boards.Against subcertification, there is the opinion that otolaryngology-head and neck surgery as an intellectual discipline would be weakened and that the 225 at UNIV REGINA LIBRARY on June 5, 2016 oto.sagepub.com Downloaded from