Mucociliary Function of the Eustachian Tube To the Editor.\p=m-\DrElliott Blumberg first reported using saccharin placed into the conjunctiva as a means of measuring patency of the nasal lacrimal duct. Following Andersen's description of using saccharin to test nasal cilia, several reports showing usefulness of this test have appeared. As was anticipated, patients with chronic sinusitis, atrophic rhinitis, or chlorine gas toxic reactions all had slow nasal mucociliary flow. What was not anticipated was the finding that serous otitis media and Eustachian tube malfunction appeared on the concave side of the deviated septum, where mucociliary flow was slowest. Another finding was that slow nasal mucociliary flow correlated well with serous otitis and Eustachian tube dysfunction. Restoration of nasal mucociliary flow and use of the saccharin test as a guide to therapy proved to be advantageous in treating middle ear
blockage.
Elbr\l=o/\ndand Larsen's study1 of Eustachian tube function, which was carried out by placing saccharin directly into the middle ear and timing how long it took to taste the saccharin, adds an interesting modali¬ ty for correlating mucociliary flow, both from the middle ear to the naso¬ pharynx, as well as direct nasal
testing. As
more
nasal saccharin tests
are
done, I expect greater correlation
to
be found between poor middle ear function and poor nasal mucociliary flow function tests. This is particularly true following various toxic inhalations. Since it has been shown that first the defense mechanism of mucociliary flow fails, and then disease and toxins and carci-
nogens enter the body, the importance of this test as an early indication of toxicity to industrial toxins cannot be
overemphasized.
MURRAY GROSSAN, MD Los Angeles
1. Elbrpnd 0, Larsen E: Mucociliary function of the Eustachian tube: Assessment by saccharin test in patients with dry perforations of the tympanic membrane. Arch Otolaryngol 102:539541, 1976.
Total Removal of
Angiofibroma
To the Editor.\p=m-\Irecently read an article entitled "Intracranial and Extracranial Nasopharyngeal Angiofibroma" by Gill et al.1 The authors may be interested in knowing that total removal of angiofibroma with intracranial extension was first successfully done and described by Lt Col E. A. Krekorian, MC, USA (ear, nose, and throat), and Col L. G. Kempe (neurosurgery) using a combined craniofacial approach in 1969.2 Since publication of the first article, Lt Col Krekorian has added two cases with similar findings. This added material was presented at the Midwestern Section of the Triologic at Minneapolis, Minn, in January 1976 and has been accepted for publication in the
Laryngoscope.
JOAN T. ZAJTCHUK, MD Denver
1. Gill G, Rice DH, Ritter FN, et al: Intracranial and extracranial nasopharyngeal angiofibroma: A surgical approach. Arch Otolaryngol 102:371-373, 1976. 2. Krekorian EA, Kempe LG: The combined otolaryngology-neurosurgery approach to extensive benign tumors. Laryngoscope 79:2086-2103, 1969.
In Reply.\p=m-\Ihave just read with great interest Drs Krekorian and Kempe's
article. My Medline search included only those articles with "angiofibro-
ma" contained within the title. I appreciate your making me aware of this article, which I shall include in my bibliographies in the future, with due credit to those involved in this generally untried procedure. Gus GILL, MD Ann Arbor, Mich
Computerized Tomography of the Head
To the Editor.\p=m-\Messina'sarticle
on
computerized tomography (CT) of the head, which appeared in the September issue of the Archives
(102:566-567, 1976) was interesting, but I must disagree with some of his comments
and conclusions regarding the use of this examination in diagnosis of acoustic neuromas or cerebellopontine angle lesions. First, at the present state of CT, accurate assessment of the size of the bony internal auditory canal is difficult and misleading. Second, in the past several years, I've seen a number of patients with small acoustic neuromas who have had normal results of CT. In this regard, the size of the lesion is of utmost importance. If there is a tumor greater than 1 to 1.5 cm, then most likely CT will demonstrate it. If the lesion is smaller than this, however, one may well not see an abnormal CT scan. His article is misleading in its implication that if there is a negative CT scan, then there is no tumor. It's exceedingly important that this point be clarified in order that some of our colleagues are not led astray. B. HILL BRITTON, MD Los Angeles
Downloaded From: http://archotol.jamanetwork.com/ by a University of Pennsylvania User on 06/18/2015
blockage.
Elbr\l=o/\ndand Larsen's study1 of Eustachian tube function, which was carried out by placing saccharin directly into the middle ear and timing how long it took to taste the saccharin, adds an interesting modali¬ ty for correlating mucociliary flow, both from the middle ear to the naso¬ pharynx, as well as direct nasal
testing. As
more
nasal saccharin tests
are
done, I expect greater correlation
to
be found between poor middle ear function and poor nasal mucociliary flow function tests. This is particularly true following various toxic inhalations. Since it has been shown that first the defense mechanism of mucociliary flow fails, and then disease and toxins and carci-
nogens enter the body, the importance of this test as an early indication of toxicity to industrial toxins cannot be
overemphasized.
MURRAY GROSSAN, MD Los Angeles
1. Elbrpnd 0, Larsen E: Mucociliary function of the Eustachian tube: Assessment by saccharin test in patients with dry perforations of the tympanic membrane. Arch Otolaryngol 102:539541, 1976.
Total Removal of
Angiofibroma
To the Editor.\p=m-\Irecently read an article entitled "Intracranial and Extracranial Nasopharyngeal Angiofibroma" by Gill et al.1 The authors may be interested in knowing that total removal of angiofibroma with intracranial extension was first successfully done and described by Lt Col E. A. Krekorian, MC, USA (ear, nose, and throat), and Col L. G. Kempe (neurosurgery) using a combined craniofacial approach in 1969.2 Since publication of the first article, Lt Col Krekorian has added two cases with similar findings. This added material was presented at the Midwestern Section of the Triologic at Minneapolis, Minn, in January 1976 and has been accepted for publication in the
Laryngoscope.
JOAN T. ZAJTCHUK, MD Denver
1. Gill G, Rice DH, Ritter FN, et al: Intracranial and extracranial nasopharyngeal angiofibroma: A surgical approach. Arch Otolaryngol 102:371-373, 1976. 2. Krekorian EA, Kempe LG: The combined otolaryngology-neurosurgery approach to extensive benign tumors. Laryngoscope 79:2086-2103, 1969.
In Reply.\p=m-\Ihave just read with great interest Drs Krekorian and Kempe's
article. My Medline search included only those articles with "angiofibro-
ma" contained within the title. I appreciate your making me aware of this article, which I shall include in my bibliographies in the future, with due credit to those involved in this generally untried procedure. Gus GILL, MD Ann Arbor, Mich
Computerized Tomography of the Head
To the Editor.\p=m-\Messina'sarticle
on
computerized tomography (CT) of the head, which appeared in the September issue of the Archives
(102:566-567, 1976) was interesting, but I must disagree with some of his comments
and conclusions regarding the use of this examination in diagnosis of acoustic neuromas or cerebellopontine angle lesions. First, at the present state of CT, accurate assessment of the size of the bony internal auditory canal is difficult and misleading. Second, in the past several years, I've seen a number of patients with small acoustic neuromas who have had normal results of CT. In this regard, the size of the lesion is of utmost importance. If there is a tumor greater than 1 to 1.5 cm, then most likely CT will demonstrate it. If the lesion is smaller than this, however, one may well not see an abnormal CT scan. His article is misleading in its implication that if there is a negative CT scan, then there is no tumor. It's exceedingly important that this point be clarified in order that some of our colleagues are not led astray. B. HILL BRITTON, MD Los Angeles
Downloaded From: http://archotol.jamanetwork.com/ by a University of Pennsylvania User on 06/18/2015
