Objective assessment of snoring before and after laser-assisted uvulopalatoplasty.

Laser-assisted uvulopalatoplasty (LAUP) is an outpatient staged surgical procedure for the treatment of snoring. Each patient undergoes a series of procedures with the end point being patient and bed partner satisfaction in most cases. The purpose of this study was to objectively evaluate the frequency, pattern, and volume of snoring in patients prior to and following each LAUP procedure. A sonographic device, SNAP, which records oronasal respiration, was used to assess patients at home. A digital analysis of the frequency, pattern, and volume was then performed. Twenty-seven patients have been completely evaluated with this recording device. The findings demonstrate that the LAUP procedure alters the snoring sound. The maximum, average, and velum-like respiratory noise loudness all showed a statistically significant decrease when comparing the preoperative snoring to the final recording after treatment was completed. In addition, the fundamental frequency of the snoring increased significantly after each LAUP procedure. No change was seen in the snoring index following treatment. These objective results correlated well with the subjective responses of the patients and their bed partners. These findings are consistent with the hypothesis that the LAUP procedure alters snoring in a favorable manner by both objective data and subjective accounts.

Subcutaneous blastomycosis: diagnosis by fine-needle aspiration cytology.

Blastomycosis is a rare disease. Fine-needle aspiration of nodules and neck masses is generally well accepted for head and neck cancer. This method has recently been used to make a rapid diagnosis of blastomycosis so that therapy could be instituted before the usual 4 to 6 week delay that is necessary for fungal cultures to mature. We believe this technique is reliable, provided the services of an experienced cytopathologist are available. The current treatment for blastomycosis is amphotericin B or ketoconazole, though newer antifungal agents hold promise for the treatment of this disease in the future.

The safety and effectiveness of an implanted electromagnetic hearing device.

The records of 184 patients implanted with the XOMED Audiant Bone Conductor (XOMED Inc, Jacksonville, Fla) prior to March 1988 were reviewed retrospectively to determine the safety of this device. Complications were few and minor in nature. Effectiveness was judged from the audiometric data obtained from the 96 patients in the hearing part of this study, all of whom had improved hearing with the device. The mean preoperative pure-tone air-conduction three-frequency average threshold +/- SD in the implanted ear was 55.8 +/- 10.7-dB hearing level; postoperative average aided warble-tone threshold was 19.9 +/- 8.5-dB hearing level. The average improvement in threshold was 36.0 +/- 13.3 dB. Ninety-three percent of patients achieved socially adequate hearing, ie, mean aided sound-field thresholds of at least 30-dB hearing level, and 81% had thresholds of at least 25-dB hearing level. We conclude that the XOMED Audiant Bone Conductor is a safe and effective device for the surgical correction of conductive hearing loss.

Tumor of the tongue containing heterotopic brain tissue.

A polypoid tumor containing astrocytic glia and ependyma was excised from the base of the tongue of a 3-month-old infant. Neuroid elements were identified immunocytochemically and by means of electron microscopy. We attribute this rare anomaly to displacement of brain tissue in early embryogenesis before closure of the palate.

Aneurysmal bone cyst associated with a dentigerous cyst: report of case.

An aneurysmal bone cyst associated with a dentigerous cyst filled the entire maxillary right sinus and corresponding eroding portions. The report discusses the unusual presence of a dentigerous cyst, documentation of an aneurysmal bone cyst associated with a primary lesion, and offers suggestions as to the common pathogenesis of the two lesions.

Congenital laryngeal atresia.

Laryngeal atresia is a rare congenital anomaly requiring immediate tracheotomy as a lifesaving measure. A case of subglottic laryngeal atresia is reported and correlated with laryngeal embryogenesis. Three types of laryngeal atresia are described. Although tracheoesophageal fistula is commonly associated with laryngeal atresia, one must be careful not to confuse a pharyngotracheal duct with a tracheoesophageal fistula. A disproportionate number of reported TE fistulas associated with laryngeal atresia may result if an accurate distinction between pharyngotracheal duct and TE fistula is not made.

Creation of the phonatory neoglottis. Preliminary experience with ten cases.

Voice rehabilitation in the laryngectomy patient has been a major goal of reconstructive laryngeal surgery. A series of ten patients underwent laryngectomy and creation of a phonatory neoglottis as outlined by Staffieri. Speech and swallowing were evaluated postoperatively. Functional speech was achieved in 9 out of 10 patients. Swallowing difficulties did not present a serious problem. Voice production utilizing the neoglottic technique was found to be superior to esophageal speech. From this preliminary series, the phonatory shunt operation of Staffieri appears to offer much potential and deserves further study.

Mucoepidermoid carcinoma of the larynx.

Mucoepidermoid carcinoma of the larynx is an uncommon tumor that occurs almost exclusively in men. Primary vocal cord involvement is rare. We report a case of mucoepidermoid carcinoma of the vocal cord in a woman. Special histologic studies may be necessary to arrive at an accurate diagnosis of this neoplasm. Appropriate surgical intervention and close follow-up offer the patient the best chance for cure.

Synovial sarcoma of the laryngopharynx.

Synovial sarcoma of the laryngopharynx is an extremely rare neoplasm. To date, only two such cases have been reported. We describe two additional patients in whom this lesion occurred as a primary neoplasm of the laryngopharynx. Hoarseness, upper respiratory distress, and dysphagia characterize the original complaints in laryngopharyngeal synovial sarcoma. The difficulties that may be encountered in histologic diagnosis are emphasized. Our findings suggest that an aggressive surgical approach is indicated. Adjuvant therapy with irradiation and the chemotherapeutic agent, doxorubicin (Adriamycin), may contribute to better survival rates.