A comparison of postoperative bleeding incidence between general and local anesthesia tonsillectomies.

Postoperative bleeding after tonsillectomy is a problem that has earned the respect and cautious attention of the most experienced surgeons. The incidence of postoperative hemorrhage after tonsillectomy, as well as many factors affecting this incidence, has been extensively investigated. A possible factor that has not been well studied as a possible influence in postoperative tonsillectomy bleeding is the choice of anesthetic. A study was completed comparing the incidence of postoperative tonsillectomy bleeding between patients operated on using general anesthetic and local anesthetic. One hundred ninety-two patients consecutively undergoing tonsillectomy at Naval Hospital, Oakland, California, were included in the study. Three of 150 patients (3%) having general anesthesia and 13 of 87 patients (15%) having local anesthesia experienced postoperative bleeding. Possible factors influencing this difference in postoperative bleeding incidence are discussed. The possibility is suggested that surgeons (and previous reports) may underestimate the rates of postoperative bleeding as a result of patients being treated by other than the operating physician.

Cervical osteomyelitis. An unusual complication of tonsillectomy.

Tonsillectomy is one of the most common operations performed by the otolaryngologist. Deep-neck infections are among the possible complications associated with this procedure. We encountered a case of osteomyelitis of the cervical spine occurring subsequent to an otherwise uncomplicated tonsillectomy. Although never previously reported with tonsillectomy to our knowledge, cervical osteomyelitis has been associated with other procedures and infections of the head, neck, and maxillofacial regions. Mechanisms that might explain this occurrence include direct extension via fascial planes, direct venous and lymphatic spread, and hematogenous dissemination from the contaminated surgical site. Treatment consisted of drainage and débridement of the infection, cervical immobilization, and long-term antibiotic administration. Healing was complete and cervical mobility and stability were normal at three months. Early recognition of this unusual complication of tonsillectomy is imperative to avoid potential neurologic sequelae.

Polymorphous low-grade adenocarcinoma of the tongue.

Primary adenocarcinoma of the oral cavity is an infrequently encountered problem. Adenocarcinomas are distinctive lesions which can be subclassified according to their tissue growth patterns or histomorphology. The polymorphous low-grade adenocarcinoma of the oral cavity is usually of minor salivary gland origin. We present an unusual case of polymorphous low-grade adenocarcinoma of the tongue and add this case to the existing two previous reports in the literature. A review of the current literature concerning this tumor is included. Treatment presently consists of complete local excision followed by radiation therapy.

Spontaneous thrombosis of the internal jugular vein.

The internal jugular vein is an uncommon site of deep venous thrombosis. Infection, prolonged central venous catheterization, and trauma are the usual causes of this condition. We present an unusual case of spontaneous thrombosis of the internal jugular vein. The evaluation of this case included a search for possible anatomic, hematologic, and oncologic conditions which could predispose to hypercoagulability and thrombosis. Anticoagulation therapy resulted in complete resolution of thrombosis and subsequent recanalization of the internal jugular vein.

Electrodermal audiometry: renewed acquaintance with an old friend.

Reasonable requirements for any test of nonorganic hearing impairment are that the procedure should result in both identification of a nonorganic problem and an accurate determination of true organic thresholds. In our clinical experience, no hearing test meets the determination of threshold requirement as accurately and as efficiently as electrodermal audiometry (EDR). The purpose of this presentation is to offer a brief review of our recent clinical experience with EDR audiometry, including representative case histories.

Inner ear lidocaine concentrations following iontophoresis.

This study has established the feasibility of measuring perilymph lidocaine levels after iontophoresis for local tympanic anesthesia in the rabbit model. A subsequent study may now be performed to produce a valid, dose-response curve correlating perilymph lidocaine levels and cochlear responses. In this manner the effects of and safety of lidocaine iontophoresis for tympanic anesthesia can be determined with certainty. After intravenous sedation, eight rabbits underwent iontophoresis followed by diagnostic vestibulotomies. Perilymph samples were taken and analyzed for lidocaine levels. Significant amounts of perilymph lidocaine were found in both the intact and perforated tympanic membrane groups. In the perforated tympanic membrane group, the perilymph lidocaine level was eight times that of the intact tympanic membrane group. Future studies to determine the dose-response relationship of perilymph lidocaine to cochlear responses are now possible. Thus, the safety of lidocaine iontophoresis and the degree of inner ear toxicity of lidocaine can be established quantitatively.

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.