A. G. D. Maran

Gastroesophageal Reflux and Posterior Laryngitis

Esophageal acid exposure was assessed by 23-hour ambulatory pH monitoring and compared with a biopsy of the posterior larynx and proximal esophagus in 97 patients with hoarseness, burning pharyngeal discomfort, or globus sensation. Patient results were compared with normal acid exposure times obtained in 54 control subjects. In 24 patients there were laryngeal abnormalities but both esophageal biopsy results and acid exposure times were normal. Laryngeal disease was found in association with prolonged acid exposure time or esophagitis in only 17 of the 97 patients (17.5%) studied. Recent reports appear to have overestimated the importance of acid reflux as a cause of posterior laryngitis.

Radical neck dissection: a 19-year experience

A series of 394 radical neck dissections performed over the 17 year period 1969-1986 is presented. The shortest period of follow-up is two years. Of the major complications reviewed, wound breakdown was associated with T stage, prior radiotherapy and incision used but not with age or N stage. Cervical recurrence was associated with N stage, prior radiotherapy and surgical incision and inversely associated with age. Wound breakdown and recurrence were lowest in parotid primary tumours. Carotid artery rupture occurred in 17 patients (4.3 per cent), was fatal in all cases and was strongly associated with wound breakdown and previous radiotherapy. The importance of the choice of incision, clearance of the posterior belly of the digastric muscle and carotid artery protection are discussed.

Swallowing Performance in Patients with Vocal Fold Motion Impairment

Twenty-seven patients with vocal fold motion impairment underwent detailed pharyngoesophagel manometry with a strain gauge assembly linked to a computer recorder. Nine were known to have lesions of the central vagal trunk or nucleus, 9 had recurrent laryngeal nerve (RLN) palsy, and the remainder were idiopathic. The site of the lesion was a more important determinant of subjective swallowing performance than the position of the involved cord at laryngoscopy. Patients with cental lesions had lower tonic and contraction upper esophageal sphincter (UES) pressures than 25 age-matched controls, suggesting that high cervical branches of the lower cranial nerves are important in UES excitatory innervation. RLN palsy patients showed significantly increased pharyngeal contraction amplitude and reduced pharyngoesophageal wave durations. The results suggest that the dysphagia associated with vocal fold motion impairment is not simply due to the disruption of laryngeal deglutitive kinetics, but to independent effects on pharyngeal function.

Parotid Salivary Secretory Pattern in Bulimia Nervosa

Parotid gland enlargement occurs in about 25% of patients with the binge eating syndrome of bulimia nervosa. The parotid salivary secretory patterns in 28 bulimics were determined in order to investigate the functional abnormality in the glands. Bulimia patients had a reduced resting flow rate. Bulimics who developed sialadenosis (4 patients) had reduced resting and stimulated flow rates. The salivary amylase activity was increased in both the resting and stimulated states in bulimics and the sialadenosis group. The resting total protein levels were greater in the bulimics. The electrolyte and immunoglobulin levels were within normal limits. The possibility of protein and enzymatic secretory disturbances due to autonomic nerve disorders as an explanation for the development of sialadenosis in bulimia nervosa is discussed.

Fine needle aspiration biopsy and the otolaryngologist.

A survey of the diagnostic value of fine needle aspiration cytology in ENT practice was carried out over a 3-year period. The 119 aspirates were taken from a variety of head and neck sites and examined by an experienced cytopathologist. Cytology was accurate in 111 (93 per cent), with two false negative aspirates (1.7 per cent) and no false positive results. There were no complications and the technique was found to be a rapid, safe and cost-effective diagnostic tool.

Treatment of Vocal Cord Carcinoma by Vertical Hemilaryngectomy

While evaluating a patient and confirming the diagnosis of carcinoma, the physician is obligated to assess the total patient to ascertain that he can withstand the impending treatment. Following any form of partial laryngectomy, there is the possibility of aspiration which may result in injury to the cardiac and pulmonary systems, and therefore, these two organ systems must be evaluated before treatment. Particularly important is the ability of the lungs to withstand small amounts of aspiration until adequate deglutition can be reestablished. We regard no specific age with good cardiac and pulmonary function, and therefore, pay little attention to a patient’s age as long as the heart and lungs are healthy. The criterion for hemilaryngectomy in our clinic (during the years studied) is the presence of a malignant neoplasm (usually squanious

Nasal Histamine and Heparin in Chronic Rhinitis

Histamine and heparin, both free and cellular, were assayed in the nasal mucosa of 11 atopic and 15 nonatopic patients undergoing turbinectomy for chronic rhinitis. There was no significant difference between the free and cellular histamine levels of the atopic and nonatopic patients. There was also no significant difference between the free heparin levels of atopic and nonatopic patients. Mean cellular heparin was, however, significantly greater in the nonatopic group. This finding, together with the results of mast cell counting, suggests either that in atopic patients heparin stores are already depleted prior to turbinectomy, or that in nonatopic individuals nasal mast cells contain an excess of heparin in nonreleasable stores.