An elusive nasopharyngeal hamartoma in a neonate.

A rare, elusive, mobile, pedunculated nasopharyngeal tumor in a neonate is described. The child was only intermittently symptomatic and the diagnosis was not made until 1 month of age.

Esophageal reflux and dysmotility as the basis for persistent cervical symptoms.

To examine a possible esophageal basis for cervical symptoms, we studied 63 patients with persistent cervical complaints, 36 patients with gastroesophageal reflux but no cervical symptoms, and ten normal subjects. Patients were evaluated for a history of pyrosis and regurgitation and underwent otolaryngologic examination, barium esophagram, upper endoscopy, esophageal biopsy, standard esophageal manometrics, acid reflux testing, and Bernstein examination, as well as tests of esophageal dysmotility and acid clearance time before and after bethanechol (50 micrograms/kg, two doses). Standard diagnostic examinations usually were normal in patients with cervical symptoms. Pyrosis, regurgitation, and a positive Bernstein examination were uncommon in patients with cervical symptoms. This occurred despite frequent acid reflux (68%) and poor acid clearance (79%). Esophageal dysmotility also was common (63%). Patients with reflux but no cervical symptoms and normal subjects had a normal acid clearance time, and dysmotility was unusual (8%). We conclude that patients with cervical symptoms have diminished esophageal sensitivity despite frequent and long acid exposure. The pathophysiologic significance of this observation is discussed.

Halitosis.

Halitosis, or bad breath, is a universally experienced condition that is usually resolved by common practices of oral hygiene. Medical or dental evaluation is sought by many patients with halitosis of elusive etiology. The physician knowledgeable in the many causes of halitosis can appropriately diagnose and manage these cases.

The patient requiring mechanical ventilatory support: use of the cuffed tracheostomy "talk" tube to establish phonation.

Many patients requiring mechanical ventilatory support via a cuffed tracheostomy tube possess a normal larynx and intact linguistic and cognitive abilities yet are unable to communicate normally because of the interruption of airflow through the intact larynx. The usual alternative means of communication such as writing, gesturing, or the use of an electrolarynx have obvious limitations and are often impossible when there is neurologic motor impairment. Frustration, depression, and compromised medical care are frequent side effects of the patient's inability to communicate. An adapted speaking-aid tracheostomy tube has been available since 1975 for the patient requiring mechanical ventilatory support. However, acceptance and satisfaction with this aid to phonation have not been uniform and there have been few claims of consistent acquisition of phonation. Reasons for success or failure have been unclear. We wish to report experience with the single-cuffed tracheostomy "talk" tube in 19 patients, 14 of whom acquired satisfactory functional laryngeal phonation. Indications for its use, technical aspects of the tube, solutions of common problems, and potential reasons for failure are discussed.

Multiple simultaneous paragangliomas of the head and neck in association with multiple retroperitoneal pheochromocytomas.

A patient in whom multiple, familial, catecholamine-secreting head and neck paragangliomas and retroperitoneal pheochromocytomas were identified is reported. There were at least nine primary and possibly five recurrent neoplasms, the most reported in a single patient. In patients with family history of pheochromocytoma or paraganglioma or with multiple tumors, careful laboratory and angiographic studies are indicated to discover additional lesions.

The management of persistent congenital occlusion of the nasolacrimal duct: after unsuccessful probing.

Persistence of congenital occlusion of the nasolacrimal duct in spite of apparently successful probings is usually due to separation of the nasal mucosa in the region of the exit of this duct and failure to rupture the membrane that causes the occlusion. Cutting of this membrane through a nasal speculum is a simple method that often leads to a permanent cure.