The most common otolaryngologic features associated with LMBBS include SNHL, speech and language disorders, and oral and dental abnormalities. Early otolaryngologic, audiologic, speech pathology, and dental evaluation of these individuals is recommended. This is the first reported case of bifid epiglottis, a rare congenital laryngeal anomaly, found in association with LMBBS. Most patients with bifid epiglottis have additional congenital anomalies, most commonly polysyndactyly. Polysyndactyly is a feature of both LMBBS and bifid epiglottis and may be an early hallmark for the presence of other congenital anomalies.

Asymmetric sensorineural hearing loss (ASNHL) is fairly common, but it can be an indication of retrocochlear pathology. The incidence of acoustic neuroma (AN) has been estimated at 1/100,000; however, the incidence of AN in patients with ASNHL is unknown. The limitation of health care resources challenges otolaryngologists to develop reasonable cost-containment guidelines for the evaluation of patients with ASNHL for the presence of retrocochlear pathology. A 5-year (1990 to 1994) retrospective study of all patients with ASNHL who were evaluated in a community-based general otolaryngology practice was performed. Demographic, historic, and audiologic data and results from ABRs and radiologic studies were summarized. ASNHL was present in 325 patients. Auditory brain stem response tests were performed in 179 patients (55%), and 92% (164 of 179) were normal. Patients with abnormal or inconclusive auditory brain stem responses and patients with severe SNHL were evaluated with radiologic studies (46 patients). Among the 193 patients who had diagnostic studies, 4 were found to have ANs, for a prevalence of 2.1%. The charge of diagnosis per AN was more than $41,000. In summary, a small percentage of patients with ASNHL have retrocochlear pathology, and the charge of diagnosis per AN can be excessive. A cost-containment approach for the evaluation and management of patients with ASNHL is proposed.

No abstract

An anomalous osseous fusion of the hyoid bone with the thyroid cartilage was encountered during excision of a thyroglossal duct cyst (TGDC) in an otherwise healthy adult. In a review of the English literature, this is the first reported case of complete fusion of the thyrohyoid interval. This unique anatomy will be described, and the embryology and characteristics of TGDCs will be reviewed.

Successful physician-patient encounters satisfy patient and family member needs beyond the effect on the disease process itself. To evaluate that aspect of care in children with chronic and recurrent acute otitis media with effusion, surveys regarding perceptions of health, socioeconomic issues, and other aspects of postoperative status were sent to the parents of 637 children who underwent tympanostomies with tubes in 1994. Three hundred one (47.3%) were returned. Responses included perceptions of improved health (87%), improvement in socioeconomic factors (75%), overall satisfaction with the results of the operation (93%), and willingness to consent to the operation given similar problems in another child (87%). There were no significant differences in responses with regard to patient gender, length of follow-up, or multiple operations. These results suggest that patient and family needs are satisfied by tympanostomies with tubes.