Rhinosporidiosis: three domestic cases.

Three cases of rhinosporidiosis in Americans who had not traveled abroad are reported. We believe this is the largest cluster of indigenous cases reported in the United States. The three patients had lived in rural northeast Georgia all of their lives. One had a polypoid conjunctival lesion, and the two others had nasal polyps. In each case, the diagnosis was made by demonstrating morphologically distinctive fungal elements in histopathologic sections. Clinically, rhinosporidiosis had not been suspected.

Otolaryngology--head and neck surgery: retrospective and prospective view.

By way of summation, I would point out that otolaryngology--head and neck surgery has been the focal point of interesting, stimulating, and exciting changes in the past decade. From a position in the late 1940s and early 1950s of being considered prematurely moribund, the specialty has had a dramatic revival and has risen like the phoenix from the ashes to take its rightful position as one of the dynamic specialties of our era. It can be proud of its demanding training programs, its enlightened and modern certifying process, its lead in continuing education, its venerable societies, and its Academy, now fully representative of all our colleagues. The residencies that once had to search for young men to fill vacancies now have a choice of the finest minds coming out of our medical schools, and the future of the specialty looks bright indeed. We are privileged to be part of this group of enthusiastic, capable, and well trained young men who will, I am sure, carry the specialty on to heights of which we can only now catch a faint glimpse. To have spent one's life in this work is a gratifying experience. To be permitted to view even dimly the heights to which it can ascend assures one that "the best race hasn't been run." How great to be a part of this cohort and to hope "our reach will always exceed our grasp." If we always remember the words on Trudeau's statue, "To cure sometimes, to relieve often, to comfort always," we will always merit the esteem of our colleagues and patients.

Entomophthorales infection of the maxillofacial region.

Phycomycosis infections caused by the fungi Rhizopus and Mucor are commonly termed mucormycosis. Mucormycosis infections exhibit a rapidly progressive course characterized by angioinvasion and necrosis. The rhinocerebral form has been described thoroughly in the literature. However, there exists another order of Phycomycetes, the Entomophthorales, which rarely cause clinical disease. Their infection is indolent and is associated with granulomatous inflammation and a protracted clinical course. Presented here is a rare case of suspected Canidiobolus coronato infection occurring in the maxillofacial region of a previously healthy male. The authors believe this to be the first reported case occurring in the United States. Because of the poorly documented natural history of this infection and the patient's relative intolerance to parenteral antifungal therapy, a multidisciplinary therapeutic approach was designed. It consisted of long-term, low-dosage amphotericin-B, hyperbaric oxygen and sequential surgical debridements. This unusual disease entity must now be considered in the differential diagnosis of granulomatous disorders of the head and neck.

Intractable hiccups. (singultus).

Intractable hiccups (singultus) is an uncommon disorder with various etiologies. The majority of reported studies of intractable hiccups has claimed ipsilateral spasm of the hemidiaphragm based solely on clinical or radiographic evidence. A case of intractable hiccups is presented. Documentation of normal phrenic nerve latencies with bilateral synchronous firing of anterior scalene, intercostal muscles and bilateral hemidiaphragm involvement is presented. This combination of muscle group involvement supports the concept of a "supraspinal hiccup center." A systematic trial of chemotherapeutic agents described as effective against hiccups was employed. Relief lasting for three to four week periods has been obtained by the intravenous administration of a specially prepared sterile solution of methylphenidate. The nerve pathways pertinent to hiccup are discussed. The etiology of intractable hiccups and the various treatment modalities are presented.

Otolaryngology manpower revisited.

In the December issue of the Archives, Nickerson et al published an article on the manpower resources of otolaryngology based on a report released in 1975. The conclusion reached by Nickerson and co-workers was that otolaryngology had a manpower pool too big for present and near future needs. This article was followed by a press release by the American Medical Association that endorsed the statements of the Archives article and in which Nickerson et al were quoted that no more otolaryngologists were needed from the training programs for some years. These statements were in sharp disagreement with the findings of the manpower studies carried out by another group in 1973-1975. Because the two surveys employed different statistical approaches, this article has been written to present the methods employed and to discuss the merits of the conclusions reached in each.

Ossicular discontinuity.

Because of the numerous and varied surgical approaches to ear pathology devised and expanded in the past two decades, we are destined to be confronted with increasingly frequent cases of ossicular defects behind an intact eardrum. Using a technique which is the converse of the established "patch" test a simple office procedure is described which may help establish the diagnosis of ossicular discontinuity in the adult with an intact eardrum. An audiogram is obtained and then a myringotomy performed with insertion of a large ventilation tube. A second audiogram is then done. A rise in the air conduction level, in the absence of fluid, is suggestive of ossicular discontinuity.

Maintenance of conization of the drumhead in tympanoplasty.

Temporal fascia placed medially to the tympanic remnants with the malleus handle exteriorized has been used successfully in over 1,200 tympanoplasties with adequate conization of the drumhead produced in most cases.