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A case of mixed type adenoma of the middle ear and mastoid is presented in which CT showed complete opacification of the middle ear and mastoid air cells with bulging of the tympanic membrane but without ossicular or bony destruction.

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The CT and MR appearance of a case of low-grade adenocarcinoma of probable endolymphatic sac origin is presented. The tumor destroyed a large part of the posterior temporal bone and showed prominent extension into the posterior cranial fossa.

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Injection of Teflon paste is a commonly accepted procedure to improve the caliber of voice in unilateral vocal cord paralysis. There are several drawbacks to Teflon injection, among them respiratory obstruction (from overinjected Teflon) and unsatisfactory voice quality (Teflon causes stiffness of the vocal folds). This paper is a preliminary report on lipoinjection instead of Teflon injection into a paralyzed vocal fold. Fat appears to impart a soft bulkiness to the injected cord, while allowing it to retain its vibratory qualities. It is autologous material and can be retrieved if excessively overinjected. The fate of autologous fat injected into a paralyzed vocal cord remains unknown. Most of the literature on lipoinjection concerns repairs of depressed scars or breast augmentation. Our longest follow-up has been 12 months. Three patients have had this procedure, and the results appear to be very encouraging.

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The hypoglossal nerve is frequently involved in head and neck afflictions as a result of its long course. Hypoglossal nerve paralysis, rarely occurs as the initial presenting symptom. Clinical situations, where the hypoglossal nerve paralysis was an early symptom, are discussed. The anatomy of the nerve from the brain stem to the tongue is elaborated upon.

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Laryngeal Teflon paste implants are routinely used to lessen the manifestations of unilateral vocal cord paralysis. Although the Teflon paste is not visible on plain radiography, it is detected on CT as a high density area. Computed tomography may be useful as a baseline study to determine the amount and location of the Teflon paste and also to detect complications such as acute edema, migration of paste, or chronic granuloma formation.

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Congenital bronchoesophageal fistulas usually present in infants and may occur with or without esophageal atresia. Twenty cases of congenital bronchoesophageal fistula in adults have been reported in the English literature. Another case of this rare developmental anomaly is presented here. The radiographic, endoscopic, surgical, and pathologic findings are discussed with a review of the literature.

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Epithelial-myoepithelial carcinomas are a rare form of salivary gland carcinoma. They are found predominantly in the parotid glands and rarely occur in the upper airway and in minor salivary glands. These neoplasms are found predominantly in women in the seventh and eighth decades of life and account for less than 1% of all salivary gland ductal carcinomas. These tumors may demonstrate infiltrative and destructive patterns, with a tendency to metastasize. It is recommended that they be approached and treated along the same avenues as any other malignant lesions of the head and neck.

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Three cases of antral sinusitis that presented in an unusual fashion are reported. In each case, the inflamed, swollen sinus mucosa became redundant and prolapsed into the nasal cavity through a widened sinus ostium, mimicking the findings of an antrochoanal polyp. The cases represent the first report in the radiographic literature of this unusual manifestation of maxillary sinusitis.

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Brainstem auditory evoked potentials (BAEP) were studied in 93 newborns (49 preterm and 44 fullterm) admitted to the neonatal intensive care unit. One group of 42 infants (28-42 wk CA) were considered at low risk for perinatal complications and served to establish the normal ranges of the BAEP parameters (wave I peak latency and wave I-V interwave interval). Two groups of high risk infants were studied during or shortly following clinically significant hyperbilirubinemia (31 infants) or hypoxemia (20 infants). Though statistically significant BAEP abnormalities were found in the high risk infants, these consisted predominantly of wave I latency prolongations in hypoxemic infants (p less than 0.05) indicating dysfunction in peripheral auditory processes. No significant increases in the wave I-V interval (central conduction time) were found in the high risk infants to suggest central auditory dysfunction in the brainstem. These findings are discussed in relation to previous studies of hyperbilirubinemic and hypoxemic infants.

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A one stage reconstruction of the tympanic membrane and the ossicular chain using a composite graft of tragal perichondrium with cartilage is described (Type III tympanoplasty). The long-term results in 18 operated cases reveals closure of the air-bone gap to within 0 to 10 dB in 72% of the cases. The above procedure used autologous graft material, does not disturb the remaining middle ear structures, can be performed under local anesthesia, and in most cases is done on an outpatient basis.

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We have recently examined three young patients with congenital unilateral profound sensorineural hearing loss. On computed tomography the only abnormality discovered was a remarkably enlarged vestibular aqueduct on the abnormal side. The vestibular aqueduct syndrome is an important cause of congenital hearing loss. Although this finding has been well illustrated with conventional multidirectional tomography, there has been little emphasis on the computed tomographic appearance.

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Granular cell tumors are rare neoplasms that arise in different regions of the body. Their cell of origin is still debated among many pathologists, but recent authors consider them to be neurogenic. These tumors are believed to be benign; however, local recurrences after excision and multifocality arouse suspicions for malignancy. In the head and neck, granular cell tumors occur most frequently in the tongue. In the laryngotracheobronchial tree, most tumors reported have been in the larynx and the next most in the bronchi. Only six cases of true tracheal occurrences have been reported previously; two additional cases are reported in this paper. The literature of the cell of origin of these tumors is reviewed, the different theories are presented, and diagnosis, treatment, and follow-up are discussed.

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