Richard W. Waguespack

Clinical Value of Laryngeal Videostroboscopy

At the 1991 meeting of the American Laryngological Association in Waikaloa, Hawaii, Robert T. Sataloff, MD, DMA, Joseph R. Spiegel, MD, and Mary J. Hawkshaw, RN, Philadelphia, Pa, discussed their impressions of the clinical value of laryngeal videostroboscopy. Their findings were based on 352 studies conducted in 1989. About 60% of their voice patients, most of whom were professional users, underwent stroboscopy. A modest number, representing 7%, were studied on more than one occasion, usually for conditions such as vocal fold hemorrhage. In 29% of cases, the clinical prestroboscopic diagnosis was confirmed and additional conditions were identified; in 18%, substantial changes in diagnosis were rendered. Thus, nearly half of their laryngeal videostroboscopic studies enhanced the examiners diagnosis. Stroboscopic examination also provided diagnoses that could not be obtained in any other fashion, such as differentiation between intracordal cysts and nodules. Dr Sataloff and coworkers concluded that in about a third of

Alaryngeal Speech and the Pharyngeal Plexus

A discussion of the surgical anatomy of the pharyngeal plexus and its role in the development of postlaryngectomy speech was presented at the 1991 annual meeting of the American Laryngological Association, Waikaloa, Hawaii. Mark I. Singer, MD, San Francisco, Calif, and Curt E. Shinabarger, MD, Indianapolis, Ind, opened their presentation by noting the dependence of successful esophageal and tracheoesophageal speech on effective reduction of pharyngeal constrictor pressure. Traditionally, this has been accomplished with myotomy, which carries with it a clinically significant likelihood of wound breakdown or fistula development. The study population consisted of the following three groups of 10 patients each: myotomy only, cricopharyngeal myotomy with pharyngeal plexus neurectomy, and neurectomy only. After describing the surgical procedure, Dr Singer discussed his findings. Analysis, such as the observation of prolonged swallowing transit times, indicated that the cricopharyngeus is not relaxed by plexus neurectomy alone. The authors postulate that its innervation may

Prophylactic Neck Dissection

Drs Michael Freidman, Mahmood F. Mafee, and Vytenis T. Grybauskas, Chicago, Ill, presented their findings regarding prophylactic neck dissection at the 1989 Triological Society meeting in San Francisco, Calif. The authors note that elective neck dissection has been recommended for patients at high risk for occult metastatic disease. The literature documents a wide range of false-negative results when decision making is based on clinical examination alone. The threshold for recommending prophylactic neck dissection also varies among authors, ranging from approximately 15% to 30%; this is the risk for occult metastatic disease that would justify proceeding with neck dissection. The use of computed tomographic scanning offers the potential advantages of increasing accuracy and of evaluating the contralateral neck, but the disadvantage of being a costly procedure. The authors evaluated 182 patients who had undergone preoperative computed tomographic or magnetic resonance scanning. Of this group, 68 patients underwent neck dissection, having clinically

Voice Analysis of Patients Undergoing Near Total Laryngectomy

At the 1989 Triological Society meeting in San Francisco, Calif, Drs Richard J. Lipton, Thomas McCaffrey, and Kerry D. Olsen, Rochester, Minn, and Bruce Pearson, Jacksonville, Fla, presented their findings regarding electroglottographic voice analysis of patients following near total laryngectomy. The presentation opened with a brief description of the rationale for near total laryngectomy, and the requirements necessary for successful postoperative voice production. Electroglottography was used to analyze the frequency and power spectrum produced by normal male patients, as well as the group under study. A single patient who had successfully undergone tracheoesophageal puncture, as well as a successful esophageal speaker, were included. These patients were evaluated with the electroglottograph for a 16-second time period of contextual speech. This was an attempt to ascertain how these patients functioned in a social setting. Normal male subjects were noted to have a rather narrow frequency band centered around 130 Hz. Those patients

On Becoming a Triological Society Member

At the 1989 Triological Society meeting in San Francisco, Calif, Dr Frank Ritter, Ann Arbor, Mich, outlined the requirements for membership in the Society, and his perceptions regarding strategies that potential candidates might use to successfully attain membership. Dr Ritter (the immediate past Executive Secretary) noted that the requirement that was most likely to deter candidacy was the thesis. He reiterated the basic requirements of being in practice for 3 years beyond the residency and board certification. Attendance at a national or sectional Triologic Society meeting and the candidates need for publications and presentations was noted. Candidacy is extended by nomination only, and requires being proposed and cosponsored by someone in the candidates community. Information about proposed members is circulated several weeks prior to sectional meetings and, if approved at this point, is forwarded to the national level. Thereafter, the candidate is invited to submit a thesis, which is due

Composite Autograft Cartilage Grafts for Tympanoplasty and Mastoid Surgery

At the 1989 Triological Society meeting in San Francisco, Calif, Dr Warren Y. Adkins, Charleston, SC, presented his experience using composite autografts for tympanoplasty and reconstruction of canal wall defects. First, he reviewed his early experience with 40 cases that were presented in 1982; he added to these an additional 62 cases utilizing autograft cartilage to prevent retraction and recurrent cholesteatoma associated with posterior retractions (55 cases) and repeatedly failed tympanoplasty (18 cases). Dr Adkins outlined the technique whereby a groove is created in the ear canal to lock the autograft into position. Perichondrium may help anchor the cartilage in place and, if necessary, acts as graft material should a tympanic membrane or attic defect be present. Only 2 of 62 cases failed, and no recurrent cholesteatoma or retraction pocket developed at the sites. Eustachian tube dysfunction remained a problem in this group, and six patients required intermittent intubation for

Physical Therapy Strategies for Vestibular Rehabilitation

At the 1989 Triological Society meeting in San Francisco, Calif, Donald B. Kamerer and coworkers Joseph M. R. Furman and Barry E. Hirsh, Pittsburgh, Pa, presented their findings regarding long-term management of vestibular disorders with intense physical therapy. A group of 95 patients unresponsive to standard medical and surgical therapy underwent intensive evaluation using a computerized questionnaire and physical therapy examination. They were also evaluated by complete otoneurological and platform testing. Intensive physical therapy, including balancing, eye-hand coordination activities, and teaching of hip and ankle weight-shifting strategies, was incorporated into the treatment protocol. Patients were also taught various walking tasks utilizing nonvisual cues. These therapy methods were individualized based on the initial evaluation and the patients being divided into five diagnostic groups. The two largest groups consisted of patients with peripheral pathologic findings and with nonspecific causes; the other categories were mixed, central, and nonorganic. After several weeks utilizing these