Recentl y, leukotrienes have be en imp lica ted in the mediation ofbronchoconstriction and inflanunatory cha nges in asthma. Leukotrien e levels ha ve also been sho wn to be elevated in patients wi th asthma as well as in those with sinonasa l po lyposis and sinus itis. The leukotri ene synthesis inhibito r zileuton and the leu kotri ene recep tor antagonist zafi rlukast have been shown to produce subj ective and objective improvements in patients with m ild to moderate asthma. Given thesefindings, we evaluated the efficacy ofthese two medications in co ntrolling sinonasal polyp osis and their associated sytnptoms. We treated 40 patients dia gn osed with sino nasal polyposis and sinusitis with eithe r zileuton or zafi rlukast. No othe r change lVas made in their standard therapy. Outcome measu res include d subjective int erv iews and qu estionnai re responses, as weil as office endoscop ic exa m ination s and cha rt reviews. A t study's end, 36 patient s lVer e availabl e for evaluation. Tw enty-six had tak en zafi rlukast, five had taken zileuton, andfive othe rs had switched fro m zafi rlukast to zileuton. O verall, 26 pat ients (72 %) exp erience d subj ective iniprovement iil their sytnp tomatology aft er sta rt ing their tnedica tion. Stat istica lly significant imp ro vem ent was not ed with respeet to headach e, fa cial pa in and pressure. ear di scomfort , dentalgia, purulent nasa! discharge, po stna sal drip, na sal congestion and obstru cti on, olfac tio n, and [eve r. An objective allevia tion, or at least stabilization, oj sino nasal polyp osis was see n in 50 % oj the patien ts. Fo urpatient s (11%) discontinued their m edication beca use oj side effects. We co nelude that antileuko trienes niight pl ay a significant role in co ntrolling polyp osis and sym ptoms second-Gl)' to sino nas al disease, and they tnigh t be a viable alternative to long-tertn oral ste roid therapyand rep eated surg ical debridement. From the Oivision of Otolaryngo logy , Albany (N.Y.) Medi cal College .

Laryngeal electromyography can provide prognostic information when evaluating patients with vocal cord dysfunction. Twenty-four patients were studied to determine the predictive capacity of this test. Six patients had bilateral vocal cord paralysis, constituting a total of 30 vocal cords examined. Sixteen of these cords had decreased or absent motor unit potentials, fibrillations, or positive waves. None of these patients recovered function. Fourteen cords demonstrated either normal motor unit or polyphasic potentials. Return of mobility was evident in 11 of these cords. The combined total was 27 of 30 cords correctly predicted, demonstrating a 90% accuracy rate.

No abstract

Our findings suggested that botulinum toxin type A offers a highly effective, safe, and noninvasive method of treatment in postparotidectomy sialocele.

Laryngoscopy and panendoscopy can cause airway complications. To determine the risk to the airway from reintubation following general anesthesia in otolaryngology patients, we examined recovery room and anesthesia records at the Albany Veterans Administration Medical Center covering a 10-year period. From this information we determined the incidence of recovery room reintubation and studied airway risk factors associated with otolaryngologic endoscopy. From 1975 to 1984, 10,060 surgical patients were intubated at the Albany VA Medical Center. Only 17 patients (0.17%) required reintubation. Of 1,365 otolaryngology patients intubated during the same period, 324 had laryngoscopy and 302 had panendoscopy. Significantly, four laryngoscopy patients (1.2%) and nine panendoscopy patients (3%) required recovery room intubation. Nine endoscopy patients needed reintubation within 1 hour of extubation. We conclude that the risk of postoperative airway compromise is significantly greater among patients who underwent diagnostic laryngoscopy and panendoscopy than among patients who had general anesthesia for other reasons.