Meniere's disease.

Meniere's disease is an idiopathic disorder of the inner ear characterized by the syndrome of endolymphatic hydrops, episodic vertigo, fluctuating hearing loss, tinnitus, and aural fullness. People with this disorder may be severely disabled. Medical therapy exists in the form of diuretics and dietary restriction of salt to minimize the fluid pressure in the labyrinth and cochlea. Treatment of allergies with desensitization and steroids has also shown to be effective in selected patients. Surgical therapies exist in two categories, conservative and ablative. Endolymphatic sac decompression with or without shunt placement remains highly effective and we feel that it should be the first line surgical therapy for patients who fail medical therapy. Ablative therapies include labyrinthectomy (medical or surgical) and vestibular neurectomy. Both of these procedures control the episodic vertigo by destroying vestibular function in the affected ear and should be reserved for patients who have persistent vertigo in spite of more conservative treatments.

PH20: a novel tumor marker for laryngeal cancer.

OBJECTIVE: To determine whether levels of PH-20, a hyaluronidase similar to that found in human sperm, are elevated in laryngeal cancer tissue. DESIGN: In this case-control study. reverse transcription polymerase chain reaction was used to measure levels of PH-20 messenger RNA in tissue taken from laryngectomy specimens. SETTING: A university medical center. PATIENTS: We compared tissue samples taken from 11 patients with laryngeal cancer, and from 2 metastatic lymph nodes, with samples of normal, healthy laryngeal tissue and prostate cancer tissue (positive control). MAIN OUTCOME MEASURE: PH-20 complementary DNA expression as quantified by densitometric analysis. RESULTS: Expression of PH-20 was significantly higher in nonirradiated laryngeal cancer specimens than in normal laryngeal tissue (P<.01). Metastatic lymph nodes also had higher levels of PH-20 expression than did primary laryngeal cancer tissue (P = .11) and normal laryngeal tissue (P<.01). Irradiated laryngeal cancer specimens had PH-20 levels comparable to normal. CONCLUSIONS: We report the first data on PH-20 expression in laryngeal cancer tissue. PH-20 expression is significantly elevated in primary laryngeal cancer tissue and seems to be even higher in metastatic lesions compared with normal laryngeal tissue. PH-20 may be a useful tumor marker and prognostic tool for laryngeal cancer.

Posterior laryngeal cleft.

The posterior laryngeal cleft is a rare congenital anomaly which results from absence of fusion of the posterior cricoid lamina and possibly the tracheoesophageal septum. A high degree of suspicion is required for early diagnosis and repair to prevent significant morbidity and mortality from recurrent aspiration pneumonia. Minor clefts may be repaired endoscopically, whereas severe laryngotracheoesophageal clefts require a multidisciplinary approach with combined extrathoracic and intrathoracic repair. Associated congenital anomalies increase the mortality of the laryngeal clefts and may complicate the timing of surgical repair.

Vocal cord paralysis.

Vocal cord paralysis is a multifacted problem that affects patients of all ages and presents initially to a wide range of healthcare professionals. It can cause laryngeal dysfunction ranging from slight hoarseness to life-threatening airway obstruction. When confronted with a patient with new onset vocal cord paralysis, the physician should determine the etiology of the paralysis. Only after an accurate diagnosis, can restoration of laryngeal function be addressed. Peripheral lesions injuring the vagus nerve or its branches are responsible for 90% of all vocal cord paralysis. Etiologies include neoplasms, surgical iatrogenic injury, and blunt and penetrating trauma in the head, neck, and thorax. Thyroid surgery has historically been accountable for almost a third of reported unilateral vocal cord paralyses. However, recent review has demonstrated a dramatic reduction in this incidence to less than 5%. Numerous treatment options exist for patients with vocal cord paralysis. These treatments can drastically reduce the social and economic disability incurred by these patients.

Pediatric airway foreign bodies.

Foreign body aspiration (FBA) is a leading cause of accidental death in children less than one year old and is the cause of death in 7% of children less than four. Food items, especially peanuts, are the most common items aspirated in infants and toddlers, whereas older children are more likely to aspirate non-food items such as pen caps, pins, and paper clips. A high degree of suspicion is required to diagnose FBA. A history of a witnessed choking episode is most important in early diagnosis. An asymptomatic period is common after aspiration and contributes to a delay in diagnosis of greater than one week in 12% to 26% of patients. This delay in diagnosis causes increased morbidity from bronchial inflammation, obstruction, and pneumonia which is resistant to treatment. Prompt endoscopic removal of the foreign body with an open rigid bronchoscope under general anesthesia is the mainstay of therapy.