McDonald, Thomas J.

A decrease in cerebrospinal fluid pressure may result in an endolymphatic hydrops through a patent cochlear aqueduct or through the fundus of the internal auditory canal. This hydrops typically leads to low-frequency sensorineural hearing loss. We describe the case of a man who presented with a subjective and objective hearing loss in addition to a headache 4 days after he had undergone a dural puncture. We treated him with a standard epidural blood patch. Immediately after treatment, his hearing improved and his headache resolved.

Congenital choanal atresia is rare. Previous literature has dealt with the diagnosis and management of these patients, but there are no reports that accurately describe the nature of the deformity. This is a presentation of two patients with tomographic demonstration of the abnormality which confirms the surgical descriptions of previous authors. These abnormalities are (1) narrowing of the entire nasal chamber, (2) primary bony obstruction with an area of membranous obstruction, and (3) gross deformity of the vomer.

Malignant pyoderma is a rare inflammatory pyoderma of unknown cause with characteristic destructive and necrotizing ulcers limited to the face, neck, and upper trunk. The typical lesions are small, purulent, periauricular ulcers. Enlargement and coalescence result in extensive lesions that may ultimately destroy portions of the external ear. The histopathologic findings are acute and chronic inflammation with necrosis. Treatment consists of long‐term systemic corticosteroids. We present two new cases and alert otolaryngologists to the seriousness of this disease.

Amyotrophic lateral sclerosis is a progressive degenerative neuromuscular disease of insidious onset. It involves upper and lower motor neurons and causes both spastic and atrophic muscular symptoms. More than one fourth of patients have complaints relating to the head and neck (bulbar palsy); thus, the otolaryngologist may be the first physician to see them. Predominant symptoms are slurred speech, hoarseness, dysphagia, and dyspnea. Muscular weakness, atrophy, and fasciculation are noted on examination. The course is relentless, and only 20% of patients survive five years after diagnosis.

This review of 29 patients with relapsing polychondritis seen at the Mayo Clinic between 1962 and 1976 emphasizes the head and neck manifestations of the disease and the role of the otolaryngologist in its diagnosis and treatment. The major clinical features included inflammation of the pinna, eye involvement, nasal cartilage involvement, laryngotracheal involvement, arthropathy, hearing loss, costal chondritis, and fever. The erythrocyte sedimentation rate was often elevated, and mild anemia was not uncommon.

Frontal sinus mucocele was our preoperative diagnosis in a patient who had frontal swelling and downward displacement of the eye. Supporting this were typical roentgenogram changes, a long history of asthma, pansinusitis, and previous multiple‐polypectomy surgery. Frontal sinus exploration revealed a locally eroding lesion.It was composed of spindled cells and lipid‐laden histiocyctes with a pattern of fibrous xanthoma and was treated conservatively. It should not be confused with true malignancies such as fibrous histiocytoma having a similar histopathologic appearance and requiring more aggressive surgical treatment.

Twenty‐one cases of histologically confirmed dermoid cysts of the nose are reviewed. The sites involved were the dorsum (18), septum (5), glabella (2), nasal tip (2), and columella (1), with several patients having multiple sites of involvement. Bony or cartilaginous destruction occurred in 14 patients (67%). A sinus tract was evident in ten patients (48%). Complete excision of these lesions is necessary for prevention of recurrence. The differential diagnosis includes hemangiomas, gliomas, encephaloceles, epidermoid cysts, neurofibromas, and lipomas.

Review of 112 patients with Wegener's granulomatosis showed that 21 (19%) had ear involvement. Conductive deafness, which was present in all 21 patients, was due to serous middle ear fluid, suppurative otitis media with thickening of the tympanic membrane, perforation of the tympanic membrane, or granulation tissue in the middle ear space. Nine patients also had sensorineural hearing loss. Sensorineural hearing loss was improved in five of the nine patients after control of the disease with prednisone and cyclophosphamide.