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Controversy exists concerning indications for primary hyperparathyroidism surgery, tests to localize parathyroid tumors, pathologic criteria for adenoma and hyperplasia, and unilateral versus bilateral surgery for hyperparathyroidism. Seventy cases were reviewed. Results of localization tests, sites of aberrant tumors, symptoms, complications, and ratio of adenoma to hyperplasia will be presented. The foreseeable trends are continued improvement in localization techniques, earlier intervention in the disease spectrum, unilateral exploration for adenoma and bilateral surgery for hyperplasia, and acceptance of primary nodular hyperplasia and normal size with hypercellularity as pathologic entities in primary parathyroid hyperplasia.

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Audiometric and tympanometric tests were used to identify patients with myasthenia gravis, a disease characterized by skeletal muscle weakness. Middle ear muscle reflexes in untreated myasthenics were found to be typically depressed or absent. Hearing was abnormally sensitive for some frequencies and middle ear pressures were often negative. Following drug administration, patients who were responding well to medication had more sensitive reflex thresholds, less sensitive hearing, and were able to equalize middle ear pressures. Tympanometric measurements have proved to be of value in the diagnosis of myasthenia and in monitoring the effects of therapy.

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Juvenile fibromatosis is a benign lesion with locally aggressive characteristics. Wide surgical excision is the treatment of choice. Radiation therapy can be used for inoperable cases or as adjunctive therapy. Steroid therapy has not been used extensively and deserves further evaluation. In the head and neck area, juvenile fibromatosis must be very carefully diagnosed and treated due to the serious consequences that result from inadequate control.

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Acute epiglottitis is a disease with significant mortality. The patient, usually an otherwise healthy pre-school child, develops a sore throat and muffled voice from swollen supraglottic structures, and may progress rapidly to respiratory arrest. Early diagnosis and airway maintenance can prevent these fatalities. Whether to secure an airway by tracheostomy or endotracheal intubation is the subject of much discussion. Nineteen series totalling 738 cases of epiglottitis plus 11 new cases are reviewed. These patients were treated as follows: Tracheostomy = 348 (3 deaths - 0.86%); Endotracheal intubation = 216 (2 deaths - 0.92%); medical management with no artificial airway = 214 (13 deaths - 6.1%). The difference in morbidity and mortality between tracheostomy or nasotracheal intubation is so slight that the choice should be determined by local factors. Medical management with no artificial airway should not be used in children.

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Round Window Membrane Rupture is a surgically correctable cause of sudden hearing loss and vertigo. Reported is a 19-year-old male who had proven round window membrane rupture secondary to barotrauma. Surgical exploration revealed an abnormally large round window niche and membrane, possibly predisposing him to this injury. Diagnostic and therapeutic modalities of this entity are presented.

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As a diagnostic tool, a new horizon in otolaryngology has become apparent in the past several years. It is known as xeroradiography and is a convenient technique requiring minimal patient cooperation and enjoying excellent acceptability for both patients and physicians. Speed, efficiency and consistently high image quality make xeroradiography suitable for otolaryngologic applications in the office, as well as in operating and emergency rooms. All tissue densities are represented in a single image, eliminating the need for taking two films of different densities, while radiation exposure in the same. Now popular for use in mammography, the technique is especially useful for detailed studies of the areas of interest to otolaryngologists. Certain inherent disadvantages in the technique are mentioned and guidelines are given to make these disadvantages an acceptable trade-off in actual application.

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This paper discusses the hospitalization of aviators at the Naval Regional Medical Center, San Diego, Ca. The areas covered include cancer, trauma, cardiac cases, alcoholics, and the effect of hospitalization on the flying status of aviators. The variety of diagnoses accumulated in 2 years was suprising. Further follow-up of cardiac cases must be pursued, especially post-coronary artery bypass. Alcoholism as a diagnosis in hospitalized patients may be a larger problem than elicited in this series. Hopefully this paper will not be just a statistical study. We should think of prevention and care to decrease the number of aviators who have their wings clipped due to medical problems.

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Myasthenia gravis can be a difficult diagnostic and therapeutic problem. Our study on six patients consisted of pure-tone audiograms, tympanometry, and acoustic reflex tests. Positive findings in the myasthenia gravis patients prior to medication included hyperacusis and increase in the intensity of sound required to elicit an acoustic reflex. Following medication, the hyperacusis lessened and the intensity of sound required to elicit the acoustic reflex decreased. During follow-up of two of the patients we encountered cholinergic (overdosage) crisis in one patient and myasthenic (underdosage) crisis in the other patient. Muscle weakness can be a common factor in both conditions. The acoustic reflex test can differentiate between the two types of crises. We believe audiotympanometric tests can aid in diagnosis and treatment of myasthenia gravis patients.

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In two asymptomatic patients, routine preoperative radiographs revealed three pennies in the esophagus in one patient and a spring from a toy in another patient. In contrast two symptomatic patients, one with a flip-top cap from a beer can in the esophagus and the other with a piece of photographic film in the larynx, had negative findings on their radiographs. Salient points of the cases are that diagnosis can be delayed by inadequate history, misinterpretation of signs and symptoms, and unexpected radiographic findings. Special attention should be focused on the flip-top cap ingestion case. Sixty-five percent of 677 people polled have placed flip-top caps into full cans. Fifty-two people almost swallowed a flip-top cap. Otolaryngologists should be alerted about the radiolucency of this metallic foreign body, and the general population should be discouraged from this dangerous practice.

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