Chondrolipoma of the oropharynx.

We describe the startling case of a man who was able to extend and retract a smooth round mass in and out of his oropharynx at will. On examination under anesthesia, the mass was found to be attached to the posterior tonsillar pillar by a stalk. The lesion was excised, and histopathology determined that it was a chondrolipoma. We believe that this is the first report of a chondrolipoma at this anatomic site.

Nonrecurrent laryngeal nerves: anatomic considerations during thyroid and parathyroid surgery.

PURPOSE: In head and neck surgery, damage to the recurrent laryngeal nerve (RLN) during thyroid surgery is the most common iatrogenic cause of vocal cord paralysis. Identification of the RLNs and meticulous surgical technique can significantly decrease the incidence of this complication. Nonrecurrent RLNs (NRRLNs) are exceedingly rare. Surgeons need to be aware of their position to avoid damage to them. MATERIALS AND METHODS: A retrospective review of 513 RLN exposures over a 7-year period was performed. RESULTS: Two NRRLNs were encountered, for an incidence of 0.39%. CONCLUSION: NRRLNs are rare. Awareness of their existence will prevent the surgeon from accidentally severing one if it is encountered during routine thyroid or parathyroid surgery.

Effects of acute thyroxin depletion on hearing in humans.

OBJECTIVE: To study the physiologic effect of acute thyroid hormone depletion on hearing and the function of outer hair cells. DESIGN: Audiologic and otoacoustic emission testing of subjects undergoing total thyroidectomy before surgery and up to 6 weeks after surgery. Magnitude of thyroxin depletion monitored by serum thyroid-stimulating hormone levels. SETTING: Hearing research laboratory at a state university. SUBJECTS: Ten patients undergoing total thyroidectomy. MAIN OUTCOME MEASURES: Detection of hearing loss on audiogram and decrease or disappearance of otoacoustic emissions as a result of acute thyroxin depletion. RESULTS: No significant changes in the audiogram and otoacoustic emission configurations were detected, although thyroid-stimulating hormone levels became elevated after total thyroidectomy. CONCLUSION: Although thyroid hormone is thought to play a role in the physiology of hearing in humans, no deleterious effects on hearing can be identified up to 6 weeks after thyroxin depletion.

HONC measures in 4- to 6-year-old children. Horii Oral Nasal Coupling Index.

OBJECTIVE: To collect normative data using Horii's Oral Nasal Coupling Index (HONC) from 4- to 6-year-old children without cleft palate to be used in the evaluation of young children with cleft palate. In addition, to determine whether HONC values in children are similar to those of adults and thus show that the HONC ratio successfully normalizes nasal accelerometric signals across age, gender, and vocal intensity. DESIGN: Measurement of accelerometric and acoustic signals from novel nasal and nonnasal utterances, which the children repeated after the experimenter. Measurements also included four sustained [m] productions, which were used to calibrate correction factors used to equate nasal and oral signals during a sustained [m] production. SETTING: Laboratory at a state university. PARTICIPANTS: Ten girls and 10 boys, aged 4 to 6 years, with normal speech, language, and hearing. RESULTS: Differences of 13 dB (HONC) were found to separate nasal from nonnasal sentences. No significant difference in HONC score was found across gender for nasal/nonnasal sentences and [m] productions. The correction factors generated during [m] calibration procedures did not differ between girls and boys. CONCLUSIONS: Horii Oral Nasal Coupling Index differences between nasal and nonnasal utterances appear to be valid and reliable measures in both children and adults for detection of disorders of nasal resonance.

Persistent cerebrospinal fluid otorrhea: a case of Munchausen's syndrome by proxy.

A case is presented of a young child who initially presented with recurrent bacterial meningitis 1 year after significant head trauma and was found to have cerebrospinal fluid (CSF) leakage into the middle ear. Surgical procedures were devised to attempt to stop this abnormal flow, but inexplicably clear otorrhea biochemically identical to CSF persisted for weeks. The child's mother was apparently soaking the surgical dressings with CSF obtained through a lumbar drain and confessed to this activity after she was found to have tampered with an intravenous catheter. This activity resulted in a prolonged hospital stay and several presumably unnecessary procedures. Munchausen's syndrome, typified by intentional mimicry of symptoms of serious illness backed by plausible medical history, is well-described. Rarer is the syndrome by proxy, where parents and/or caregivers, by falsifying histories, fabricating laboratory evidence, or deliberately generating bodily lesions, cause unneeded diagnostic and therapeutic procedures to be performed on their young victims. This form of child abuse is hidden by the perpetrator's apparent concern and involvement in the care of the victim. The literature is reviewed, this form of abuse is discussed, and the role of communication of suspicion between the various health care workers is stressed. The medical and social settings in which this disorder is prevalent are covered. Early detection of this entity is essential in rescuing the victim from life-threatening abuse and in obtaining appropriate therapy for the abuser.

Functional facial nerve weakness after surgery for benign parotid tumors: a multivariate statistical analysis.

A retrospective study was done on 64 patients who underwent superficial or subtotal parotidectomy for a primary benign tumor of the parotid gland. Factors, such as age, sex, smoking, alcohol consumption, type of surgery, duration of surgery, pathology of lesion, and size of lesion, were reviewed in a multivariate statistical analysis to determine if any factor alone or in combination contributed to the development of functional facial nerve weakness postoperatively. Only the age of the patient was found to have a statistically significant causal relation using the Pearson chi-square method (p = 0.015). The marginal mandibular branch was affected in nine of 10 cases. Different surgical approaches cited in the literature are discussed, along with the possible role of ischemic injury to the facial nerve during parotidectomy.

Time series analysis of glottal airflow in normal and pathological phonation.

Time series analysis of glottal airflow was carried out on 26 normal controls and 40 patients with voice disorders, using a modification of Isshiki's original technique which uses a hot-wire flowmeter, taking cycle-by-cycle fluctuations into consideration. The mean flow rate and mean AC/DC were shown to have significant differences among normal and patient groups. The standard deviations of AC/DC and AC/DC perturbation were calculated from the AC/DC value of 50 cycles and shown not to vary significantly among the normal and patient groups. The relationship between AC/DC and perceptual impression of voice was also studied among 20 selected patients with breathy voices. Using Spearman's rank correlation coefficient, this relationship was found to have statistical significance (P < .05).