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Necrotizing otitis externa during induction therapy for acute lymphoblastic leukemia
Abstracts
Abstracts ELLIOT ABEMAYOR, MD, PHD, EDITOR
MR Findings of Cartilage Invasion by Laryngeal Cancer: Value in Predicting Outcome of Radiation Therapy. JA Castelijns, RP Golding, CV Schaik, et al. Ra-
with a poor prognosis. This paper emphasizes several obvious clinical points: (1) ears should never be blindly instrumented, particularly in immunosuppressed individuals, (2) careful aural hygiene is important in the treatment of necrotizing otitis externa, and (3) intravenous broad-spectrum antibiotics are needed to cover aggressive organisms.
diology 1990; 174:669-673 Invasion of laryngeal cartilage by cancer has an important bearing on how effective radiation therapy will be for primary treatment. There is a higher risk of complications with cartilage invasion as well as a low incidence of success with radiation therapy. Computed tomography may demonstrate submucosal tumor spread, but cannot adequately show evidence of cartilage invasion. More recently, magnetic resonance imaging (MRI) has been shown to demonstrate laryngeal anatomy in great detail and, in particular, image cartilage invasion. The aim of this study was to correlate the MRI findings regarding cartilage invasion with the effectiveness of radiation treatment of early laryngeal carcinomas. Cartilage invasion was found in 16 of 35 patients. Such invasion was found to be present even with small glottic lesions. In 10 of the 16 patients with cartilage invasion, laryngeal cancer recurred. Even with small foci of thyroid cartilage invasion there was an increase in tumor recurrence. This paper suggests that if cartilage invasion is seen by MIU, the preference of treatment of small glottic lesions might be shifted from radiation therapy to partial laryngectomy. Alternatively, one could argue that radiation treatment for small laryngeal tumors should be followed by serial MRIs to note early recurrence. This is an interesting paper that may shift our thinking about the early treatment of laryngeal carcinoma.
Speech Status Following Uvulopalatopharyngoplasty. MB Salas-Provance, 117
DP Kuehn.
Chest 1990; 97:lll-
Uvulopalatopharyngoplasty (UPPP) has been used since the early 1980s to treat heavy snoring and recurrent sleep apnea. The procedure includes removal of a portion of the palate tissue with redundant oropharyngeal mucosa and tonsils. Possible complications following the surgery may include uvelopharyngeal malfunction due to a shortened palate. However, few studies have addressed the effects of such surgery on speech production. The purpose of this study was to evaluate the adequacy of speech following UPPP in 20 patients. Evaluation included measurements of nasal air flow, speech recordings, listener judgments, and questionnaire survey. Listener judgments did not identify a nasal resonance problem in the group of UPPP patients as might be expected based on the amount of tissue removed. It appears that uvelopharyngeal function was adequate for the production of speech following UPPP. However, this study did reveal that phonation and, to a lesser extent, articulation disorders were present in subjects following UPPP. This may not be a result of the procedure itself, as speech problems were also identified in sleep apnea patients who had not undergone surgery. The speech problems may have been related to persistent oropharyngeal dryness with subsequent irritation of the vocal cords. This dryness may be due to an increase in air flow in the oropharynx or removal of nasal turbinates, which is sometimes performed in these patients. This interesting paper examines the outcome of UPPP on speech disorders and suggests that speech may not be greatly affected. Of note is that overaggressive UPPP may result in speech disorders in individuals whose native language uses velac fricatives (such as Greek and Hebrew).
Necrotizing Otitis Externa During Induction Therapy for Acute Lymphoblastic Leukemia. LJ Wolff. Pediatrics 1989; 84:882-885 Children with acute leukemia who are undergoing chemotherapy are highly susceptible to infections. They have a low white blood cell count and show distinct abnormalities in cellular and humoral function. This paper reports the recurrence of necrotizing otitis externa in neuropenic children receiving induction chemotherapy for acute lymphoblastic leukemia. Three children developed necrotizing otitis externa; in two patients, probing of the external canal had preceded the infection. Organisms isolated from these infections included pseudomonas, Staphylococcus aureus, and Streptococcus faecalis. In two patients, necrotizing otitis externa resolved after 2 weeks of intravenous antibiotics and resolution of neutropenia. One patient required prolonged intravenous antibiotics and several surgical procedures for debridement. Although facial nerve palsy was not a problem in these cases, such paralysis has been noted in some children with otitis externa. This is usually an ominous sign and is associated
Primary Facial Nerve Tumors Within the Skull. TT King, AW Morrison.
J Neurosurg
1990; 72:1-8
Tumors arising from the facial nerve proximal to stylomastoid foramen usually arise in the descending or tympanic segment of the nerve and may present with progressive facial palsy. Even more proximal lesions have been described. Some of these lesions may simulate acoustic nerve or other CPA tumors. This paper 126
Abstracts ELLIOT ABEMAYOR, MD, PHD, EDITOR
MR Findings of Cartilage Invasion by Laryngeal Cancer: Value in Predicting Outcome of Radiation Therapy. JA Castelijns, RP Golding, CV Schaik, et al. Ra-
with a poor prognosis. This paper emphasizes several obvious clinical points: (1) ears should never be blindly instrumented, particularly in immunosuppressed individuals, (2) careful aural hygiene is important in the treatment of necrotizing otitis externa, and (3) intravenous broad-spectrum antibiotics are needed to cover aggressive organisms.
diology 1990; 174:669-673 Invasion of laryngeal cartilage by cancer has an important bearing on how effective radiation therapy will be for primary treatment. There is a higher risk of complications with cartilage invasion as well as a low incidence of success with radiation therapy. Computed tomography may demonstrate submucosal tumor spread, but cannot adequately show evidence of cartilage invasion. More recently, magnetic resonance imaging (MRI) has been shown to demonstrate laryngeal anatomy in great detail and, in particular, image cartilage invasion. The aim of this study was to correlate the MRI findings regarding cartilage invasion with the effectiveness of radiation treatment of early laryngeal carcinomas. Cartilage invasion was found in 16 of 35 patients. Such invasion was found to be present even with small glottic lesions. In 10 of the 16 patients with cartilage invasion, laryngeal cancer recurred. Even with small foci of thyroid cartilage invasion there was an increase in tumor recurrence. This paper suggests that if cartilage invasion is seen by MIU, the preference of treatment of small glottic lesions might be shifted from radiation therapy to partial laryngectomy. Alternatively, one could argue that radiation treatment for small laryngeal tumors should be followed by serial MRIs to note early recurrence. This is an interesting paper that may shift our thinking about the early treatment of laryngeal carcinoma.
Speech Status Following Uvulopalatopharyngoplasty. MB Salas-Provance, 117
DP Kuehn.
Chest 1990; 97:lll-
Uvulopalatopharyngoplasty (UPPP) has been used since the early 1980s to treat heavy snoring and recurrent sleep apnea. The procedure includes removal of a portion of the palate tissue with redundant oropharyngeal mucosa and tonsils. Possible complications following the surgery may include uvelopharyngeal malfunction due to a shortened palate. However, few studies have addressed the effects of such surgery on speech production. The purpose of this study was to evaluate the adequacy of speech following UPPP in 20 patients. Evaluation included measurements of nasal air flow, speech recordings, listener judgments, and questionnaire survey. Listener judgments did not identify a nasal resonance problem in the group of UPPP patients as might be expected based on the amount of tissue removed. It appears that uvelopharyngeal function was adequate for the production of speech following UPPP. However, this study did reveal that phonation and, to a lesser extent, articulation disorders were present in subjects following UPPP. This may not be a result of the procedure itself, as speech problems were also identified in sleep apnea patients who had not undergone surgery. The speech problems may have been related to persistent oropharyngeal dryness with subsequent irritation of the vocal cords. This dryness may be due to an increase in air flow in the oropharynx or removal of nasal turbinates, which is sometimes performed in these patients. This interesting paper examines the outcome of UPPP on speech disorders and suggests that speech may not be greatly affected. Of note is that overaggressive UPPP may result in speech disorders in individuals whose native language uses velac fricatives (such as Greek and Hebrew).
Necrotizing Otitis Externa During Induction Therapy for Acute Lymphoblastic Leukemia. LJ Wolff. Pediatrics 1989; 84:882-885 Children with acute leukemia who are undergoing chemotherapy are highly susceptible to infections. They have a low white blood cell count and show distinct abnormalities in cellular and humoral function. This paper reports the recurrence of necrotizing otitis externa in neuropenic children receiving induction chemotherapy for acute lymphoblastic leukemia. Three children developed necrotizing otitis externa; in two patients, probing of the external canal had preceded the infection. Organisms isolated from these infections included pseudomonas, Staphylococcus aureus, and Streptococcus faecalis. In two patients, necrotizing otitis externa resolved after 2 weeks of intravenous antibiotics and resolution of neutropenia. One patient required prolonged intravenous antibiotics and several surgical procedures for debridement. Although facial nerve palsy was not a problem in these cases, such paralysis has been noted in some children with otitis externa. This is usually an ominous sign and is associated
Primary Facial Nerve Tumors Within the Skull. TT King, AW Morrison.
J Neurosurg
1990; 72:1-8
Tumors arising from the facial nerve proximal to stylomastoid foramen usually arise in the descending or tympanic segment of the nerve and may present with progressive facial palsy. Even more proximal lesions have been described. Some of these lesions may simulate acoustic nerve or other CPA tumors. This paper 126