Otosurgical model in the guinea pig (Cavia porcellus).

The guinea pig is a useful model for otologic research. Common problems encountered in working with individual animals include preexisting chronic middle ear disease, anesthetic deaths, and a lack of knowledge of the surgical anatomy and landmarks of the middle and inner ear. The methods detailed in this article will benefit those interested in a reliable, inexpensive, otosurgical animal model.

Acute suppurative thyroiditis in children.

The ability of the thyroid gland to withstand infection is a well known phenomenon. In this regard, inflammatory disease of the thyroid gland in children is an uncommon occurrence. The frequency with which this proceeds to abscess formation is rare. Review of the literature of the past 25 years reveals only 21 reported cases of acute suppurative thyroiditis in children, only one of which has been reported in the otolaryngologic literature. We report two cases of thyroid abscess in children initially presented as painful swellings in the lower neck. An overview of the management of these patients is detailed, including a discussion of the appropriate utilization of diagnostic studies. Demonstration of an internal fistula originating from the pyriform sinus underscores the need to consider a fourth branchial arch remnant as a possible source of infection. The importance of obtaining appropriate bacterial, fungal, and acid-fast cultures is stressed, as is the role of antibiotic therapy and definitive surgery once the diagnosis of thyroid abscess is made.

The Frey syndrome: a simple, effective treatment.

The benign but socially embarrassing problem of gustatory sweating and flushing (Frey syndrome) has been studied in the past in search of a simple but effective treatment. Twenty-two patients participated in clinical trials of glycopyrrolate on an investigational basis, 17 of which have been followed up for four to five years. Double-blind comparisons of the efficacy and side effects of topical scopolamine (solution and cream) and glycopyrrolate (roll-on lotion, solution, and cream) are also presented. The use of 1% glycopyrrolate roll-on lotion and cream were associated with an average of three days of complete control of gustatory sweating and a remarkably low incidence of side effects.

Medullary carcinoma of the thyroid masquerading as idiopathic vocal cord paralysis.

The following conclusions may be drawn as a result of our study: 1. Serum calcitonin by radioimmunoassay proved to be the only valid preoperative indicator in a case of medullary carcinoma of the thyroid occurring with vocal cord paralysis. This test should be considered in all cases of idiopathic recurrent laryngeal nerve paralysis, especially when obscure thyroid pathology is suspected. 2. Provocative calcitonin testing, such as a calcium infusion test, may help verify presence or absence of disease in equivocal cases of calcitonin assay. 3. Vocal cord paralysis may be the first sign of intrathroid malignancy. 4. In the furture, serum calcitonin assay (drawn posttreatment) may be a valuable prognostic indicator and may guide the need for additional treatment.

The Frey syndrome: a review and double blind evaluation of the topical use of a new anticholinergic agent.

The symptom complex of localized facial gustatory sweating and flushing during mastication (The Frey syndrome) is a common sequela of parotidectomy with facial nerve dissection. A thorough review of the literature concerning the Frey syndrome is reported. The procedure of tympanic neurectomy has received special emphasis with a review of 73 cases of tympanic neurectomy. The treatment modalities available, if tympanic neurectomy fails, are discussed. Important guidelines for the safe use of topical therapy to control gustatory sweating are presented as an alternative to surgical therapy. The author studied 129 post parotidectomy patients in whom 60% noted symptomatic gustatory sweating, and approximately one-fourth fo these symptomatic patients requested topical anticholinergic therapy, with one patient electing tympanic neurectomy. The only form of medical treatment presently available utilizes the topical application of scopolamine, a drug having potentially significant central nervous system side effects if systemically absorbed. In an effort to find an effective drug for topical application with a more favorable therapeutic index than scopolamine, glycopyrrolate was investigated. Glycopyrrolate was compared in varying concentrations to topical scopolamine in a personally conducted double blind clinical trial involving 16 patients. Initial results of this investigation suggest that topical glycopyrrolate in concentrations 0f 0.5% and 1.0% provide complete effective control of gustatory sweating for at least several days duration after a single application. There have been no significant side effects with the use of topical glycopyrrolate to date. Commercial topical antiperspirants were also investigated and found to be of limited benefit.

Fatal mediastinitis after a dental infection.

The pertinent features of life-threatening complications of dental infections have been briefly reviewed with particular emphasis on the alterations of the clinical features of these conditions induced by antibiotic therapy. The clinician who deals with dental infections must exercise a high index of suspicion to consistently abort the development of these complications, especially when treating debilitated patients or individuals with compromised immune functions.

Parapharyngeal neurilemmoma of the hypoglossal nerve.

Although neurilemmomas are uncommon cervical neoplasms, they account for a significant percentage of parapharyngeal space tumors. These neoplasms may originate from any nerve traversing this space, but the vast majority arise from the vagus nerve and sympathetic chain. Satisfactory treatment of neurilemmomas consists of total excision which is best accomplished via an external approach. Immediate nerve grafting is advocated when a segment of cranial nerve must be sacrificed in order to achieve complete tumor removal. A case of a parapharyngeal neurilemmoma arising from the hypoglossal which required treatment in this manner is presented. Electromyographic studies performed 15 months postoperatively demonstrate reinervation of the lingual musculature via the nerve graft.