James H. Kelly

Speech and Survival

Abstract In Stage T3 carcinoma of the larynx (carcinoma restricted to the vocal cords, causing complete immobility of the cords but not extending to adjacent structures), laryngectomy leads to a three-year survival rate of approximately 60 per cent and the loss of normal speech. Radiation therapy, on the other hand, leads to a lower survival (30 to 40 per cent at three years) but preserves normal or nearly normal speech. We investigated attitudes toward the quantity and quality of life in 37 healthy volunteers, interviewing 12 firefighters and 25 middle and upper management executives to determine their preferences for longevity and voice preservation. We used the principles of expected utility theory to develop a method for sharpening decisions involving tradeoffs between quantity and quality of life. Our analysis indicates that to maintain their voices, approximately 20 per cent of volunteers would choose radiation instead of surgery. These results suggest that treatment choices should be made on the ba...

Management of nasal septal abscess

Nasal septal abscesses are uncommon. Sixteen cases from the Massachusetts Eye and Ear Infirmary were reviewed retrospectively and are presented. The diagnosis, bacteriology, and pathophysiology are discussed. Immediate therapy is indicated to avoid cosmetic deformity or intracranial infection. Treatment is based on diagnostic needle aspiration, antibiotic coverage and surgical drainage.

Upper Airway Obstruction Associated with Regional Enteritis

Two patients are presented with upper airway obstruction associated with regional enteritis (Crohns disease). Two mechanisms for this obstruction are proposed. The first is involvement of the cricoarytenoid joint with the inflammatory process and the second is extensive edema of the upper airway due to submucosal involvement with the disease process. We were unable to find any previous reports of upper airway obstruction associated with regional enteritis. The data from these patients suggests that Crohns disease should be included in the differential diagnosis of chronic persistent laryngeal edema.

Laryngopyocele as a cause of airway obstruction

Symptomatic laryngoceles are unusual lesions. Laryngopyoceles are even more unusual, with a total of 32 cases reported in the world literature. Two cases of laryngopyocele presenting as airway obstruction are described along with a review of the anatomy, etiology, clinical course, and management of this lesion. An argument is made supporting the resection of the symptomatic laryngocele to prevent the rapid respiratory obstruction that may occur in the presence of a laryngopyocele.

Myology of the pharyngoesophageal segment : Gross anatomic and histologic characteristics

Although numerous studies have been performed on the function and dysfunction of the pharyngoesophageal segment, few studies have investigated features of the musculature in this area. Thus, the purpose of this study was to systematically examine the structure (gross anatomy and histology) in this area and to relate these findings to the functions of the pharyngoesophageal segment.

An unusual foreign body of the tongue masquerading as malignancy.

Foreign bodies within the tongue are a rare finding. The history is often not helpful as it is usually remote. Presented is a case of an unusual foreign body in the tongue which masqueraded as a malignancy. The differential diagnosis of an asymptomatic tongue swelling or tongue pain should include foreign body.

The effects of anesthesia on middle-ear effusions

Surgeons occasionally note a discrepancy between preoperative assessment of middle‐ear effusion and operative observation during the placement of ventilating tubes in childrens ears. This study was designed to determine whether this variance is secondary to the effects of inhalation anesthesia or misinterpretation of the preoperative exam. Observations were recorded by three distinctly different methods of measurement: the surgeon, the MD‐2 Impedance Analyzer, and the Acoustic Otoscope® immediately before and after induction of anesthesia. These results were then analyzed and compared with the operative findings. Anesthetic induction was shown to cause alteration in the presence of middle‐ear fluid in less than 10% of cases.

Alternatives to anterior-posterior packs for epistaxis

This paper describes two alternatives to a conventional anterior-posterior pack for control of posterior epistaxis. Both methods involve occluding the posterior choana with finger-cot packs introduced through the anterior nares. These have proved effective in controlling bleeding with significant reduced morbidity.

Chicken bone in the larynx

A 24-year-old male developed a sudden onset of dyspnea while eating chicken. He coughed up several fragments of meat which relieved the dyspnea but the sensation of a foreign body in his throat remained. Several hours later, he again experienced dyspnea and coughing and expelled another piece of chicken. The following day, he presented himself to the emergency ward complaining of a foreign body sensation at the level of the larynx.