concepts of head and neck
into account that a high percentage of patients with SHL will recover spontaneously, treatment or no treatment. In fact, 43% can expect a return to normal hearing if the diagnosis is
cancer by recognized leaders in their fields. Each chapter is concise. None is by
exhaustive review of rather an attempt to but subject, highlight a controversial point of view or to emphasize an advance in our understanding of head and neck cancer. A certain amount of unevenness in style is inevitable in a book of this type, but compensation is afforded by variety. The book begins with a discussion of radiotherapy and chemotherapy. It then moves to a multidisciplinary ap¬ proach including contributions from dentistry, oral surgery, maxillofacial prosthodontics, and neurosurgery and features an excellent group of chap¬ ters on nutrition and nursing care of head and neck cancer patients. Impor¬ tant contributions of special interest to head and neck surgeons include a discussion of ethmoid and cribiform any
means an
the
plate lesions, pharyngeal repair, salivary gland cancer, rhabdomyosar¬ coma, and flaps used in oral recon¬ struction. William S.
McComb, in
an
opening
states that improved results in the treatment of cancer still depend
chapter,
mostly on early diagnosis, which necessitates a greater educational effort on the part of patients and physicians. He believes that educa¬ tion of the laity through the mass media has progressed as far as possi¬ ble. One could take issue with that point, especially with the dismal response of the public to the Surgeon General's report on cigarette smoking and the intense lobbying and adver¬ tising pressures generated by the to¬ bacco industry; but one must agree that education in the professional field has been inadequate. This book should be of value to all otoiaryngolo¬ gists.
DENNIS A. Denver
GREENE,
MD
BOOKS RECEIVED Atlas of Diseases and
Surgery of the Ear, by Nelson Fernandez-Blasini, MD, Madrid, Editorial Marban, 1975. Le Maxillaire du Nourrisson: Ortho¬ pédie de Ses Anomalies, by J. P. Deffez;
Planté; N. Quérette, Paris, Julien Prélat, 1975. P.
The God of the Deaf Adolescent: An Inside View, by Rev Anthony Russo, CSsR, 278 pp, Paramas, NJ, Paulist
Press, 1975.
established within the first week, if excludes all patients whose loss remained undiagnosed for more than one month (as was done in the previous study).2 I strongly suspect that SHL is much more common than generally believed, that many people recover spontaneously without seeing a physician, and that others recover while under the care of their family physician (who typically assumes that the symptoms are due to a middle ear problem unless vertigo is a strong symptom). This phenomenon leads to some unusual statistics in our series. Patients who were health profession¬ als, having a more immediate access to otoiaryngologists and audiometers, had an overall complete or partial recovery rate of 81%, whereas the incidence was 52% in patients with other occupations, independent of method of treatment. I am also at odds with their criteria for treatment improvement, a 10 dB gain in speech frequency thresholds or a 10% improvement in speech discrim¬ ination scores. There is sufficient test variability in sensorineural hearing losses from day to day to make such slight changes meaningless as bench¬ marks for the successful treatment of SHL. The authors have not established that stellate ganglion block helps the patient with sudden hearing loss. Until such time that the control pa¬ tients are equally matched for time of onset and severity of their losses, I remain unconvinced. F. BLAIR SIMMONS, MD Stanford, Calif one
Stomal Recurrence Following
Laryngectomy
To the Editor.\p=m-\The interesting article Bonneau and Lehman in the Archives (101:408-412, 1975) has prompted me to write. These authors have listed several theories as to the cause of recurrence at the stoma following laryngectomy. I have seen other theories expressed by other writers, but, with one possible exception, I have seen no reference to what looks to me like an obvious reason for this to occur. Carcinomas of the lung exfoliate malignant cells, which are sought in the mucus for diagnostic purposes. Is it not to be expected that a laryngeal cancer also exfoliates malignant cells? Any malignant cells inhaled by the patient, especially when he is struggling with partial obstruction, and any cells that might reach the lower respiratory tract from manipulation of the lesion during removal or by the use of endotracheal tubes or tracheostomy tubes, on getting down into the tracheobronchial tree will be returned in the mucociliary stream. The termination of ciliated epithelium at the stoma would act like an obstruction, and this is where any cells floating in the mucociliary stream would inevi¬ tably lodge. From there, they might get into the lymphatic circulation or be smeared along the tracheostomy tract to grow there as well as at the line of resection of the trachea. A. C. HILDING, MD, PHD Duluth, Minn
by
Stellate
1. Haug 0, Draper L, Haug S: Stellate ganglion blocks for idiopathic sensorineural hearing loss. Arch Otolaryngol 102:5-8, 1976. 2. Simmons FB: Sudden idiopathic sensorineural hearing loss: Some observations. Laryn-
Ganglion Blocks for Idiopathic Sensorineural Hearing
goscope
To the Editor.\p=m-\I wish to call attention an important alternative conclusion about stellate ganglion blocks in the treatment of idiopathic sudden hearing loss (SHL). In their paper recommending this treatment, Haug et al have merely succeeded in demonstrating once again that the earlier the diagnosis is established, the better the prognosis.1 The authors did not take
In Reply.\p=m-\Wecertainly agree with Dr Simmons that many patients with idiopathic sensorineural hearing loss will recover spontaneously, but this recovery rate should apply equally to the group not treated with blocks as well as those treated with blocks. The fact that the health professions he mentioned had a higher recovery
83:1221-1227, 1973.
Loss to
Downloaded From: http://archotol.jamanetwork.com/ by a New York University User on 06/21/2015
into account that a high percentage of patients with SHL will recover spontaneously, treatment or no treatment. In fact, 43% can expect a return to normal hearing if the diagnosis is
cancer by recognized leaders in their fields. Each chapter is concise. None is by
exhaustive review of rather an attempt to but subject, highlight a controversial point of view or to emphasize an advance in our understanding of head and neck cancer. A certain amount of unevenness in style is inevitable in a book of this type, but compensation is afforded by variety. The book begins with a discussion of radiotherapy and chemotherapy. It then moves to a multidisciplinary ap¬ proach including contributions from dentistry, oral surgery, maxillofacial prosthodontics, and neurosurgery and features an excellent group of chap¬ ters on nutrition and nursing care of head and neck cancer patients. Impor¬ tant contributions of special interest to head and neck surgeons include a discussion of ethmoid and cribiform any
means an
the
plate lesions, pharyngeal repair, salivary gland cancer, rhabdomyosar¬ coma, and flaps used in oral recon¬ struction. William S.
McComb, in
an
opening
states that improved results in the treatment of cancer still depend
chapter,
mostly on early diagnosis, which necessitates a greater educational effort on the part of patients and physicians. He believes that educa¬ tion of the laity through the mass media has progressed as far as possi¬ ble. One could take issue with that point, especially with the dismal response of the public to the Surgeon General's report on cigarette smoking and the intense lobbying and adver¬ tising pressures generated by the to¬ bacco industry; but one must agree that education in the professional field has been inadequate. This book should be of value to all otoiaryngolo¬ gists.
DENNIS A. Denver
GREENE,
MD
BOOKS RECEIVED Atlas of Diseases and
Surgery of the Ear, by Nelson Fernandez-Blasini, MD, Madrid, Editorial Marban, 1975. Le Maxillaire du Nourrisson: Ortho¬ pédie de Ses Anomalies, by J. P. Deffez;
Planté; N. Quérette, Paris, Julien Prélat, 1975. P.
The God of the Deaf Adolescent: An Inside View, by Rev Anthony Russo, CSsR, 278 pp, Paramas, NJ, Paulist
Press, 1975.
established within the first week, if excludes all patients whose loss remained undiagnosed for more than one month (as was done in the previous study).2 I strongly suspect that SHL is much more common than generally believed, that many people recover spontaneously without seeing a physician, and that others recover while under the care of their family physician (who typically assumes that the symptoms are due to a middle ear problem unless vertigo is a strong symptom). This phenomenon leads to some unusual statistics in our series. Patients who were health profession¬ als, having a more immediate access to otoiaryngologists and audiometers, had an overall complete or partial recovery rate of 81%, whereas the incidence was 52% in patients with other occupations, independent of method of treatment. I am also at odds with their criteria for treatment improvement, a 10 dB gain in speech frequency thresholds or a 10% improvement in speech discrim¬ ination scores. There is sufficient test variability in sensorineural hearing losses from day to day to make such slight changes meaningless as bench¬ marks for the successful treatment of SHL. The authors have not established that stellate ganglion block helps the patient with sudden hearing loss. Until such time that the control pa¬ tients are equally matched for time of onset and severity of their losses, I remain unconvinced. F. BLAIR SIMMONS, MD Stanford, Calif one
Stomal Recurrence Following
Laryngectomy
To the Editor.\p=m-\The interesting article Bonneau and Lehman in the Archives (101:408-412, 1975) has prompted me to write. These authors have listed several theories as to the cause of recurrence at the stoma following laryngectomy. I have seen other theories expressed by other writers, but, with one possible exception, I have seen no reference to what looks to me like an obvious reason for this to occur. Carcinomas of the lung exfoliate malignant cells, which are sought in the mucus for diagnostic purposes. Is it not to be expected that a laryngeal cancer also exfoliates malignant cells? Any malignant cells inhaled by the patient, especially when he is struggling with partial obstruction, and any cells that might reach the lower respiratory tract from manipulation of the lesion during removal or by the use of endotracheal tubes or tracheostomy tubes, on getting down into the tracheobronchial tree will be returned in the mucociliary stream. The termination of ciliated epithelium at the stoma would act like an obstruction, and this is where any cells floating in the mucociliary stream would inevi¬ tably lodge. From there, they might get into the lymphatic circulation or be smeared along the tracheostomy tract to grow there as well as at the line of resection of the trachea. A. C. HILDING, MD, PHD Duluth, Minn
by
Stellate
1. Haug 0, Draper L, Haug S: Stellate ganglion blocks for idiopathic sensorineural hearing loss. Arch Otolaryngol 102:5-8, 1976. 2. Simmons FB: Sudden idiopathic sensorineural hearing loss: Some observations. Laryn-
Ganglion Blocks for Idiopathic Sensorineural Hearing
goscope
To the Editor.\p=m-\I wish to call attention an important alternative conclusion about stellate ganglion blocks in the treatment of idiopathic sudden hearing loss (SHL). In their paper recommending this treatment, Haug et al have merely succeeded in demonstrating once again that the earlier the diagnosis is established, the better the prognosis.1 The authors did not take
In Reply.\p=m-\Wecertainly agree with Dr Simmons that many patients with idiopathic sensorineural hearing loss will recover spontaneously, but this recovery rate should apply equally to the group not treated with blocks as well as those treated with blocks. The fact that the health professions he mentioned had a higher recovery
83:1221-1227, 1973.
Loss to
Downloaded From: http://archotol.jamanetwork.com/ by a New York University User on 06/21/2015
