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• Congenital central alveolar hypoventilation (Ondine's curse) is a rare disorder with absence of automatic control of ventilation but preservation of voluntary breathing. Phrenic pacing, used to treat this condition, is usually not successful without a tracheotomy. We performed fiberoptic videoendoscopy on an affected infant airway. During wakefulness and ventilation by a negative pressure ventilator, the airway was normal, but with sleep onset, passive inspiration produced phasic epiglottic collapse. This case demonstrates the importance of central control in maintaining upper airway patency. ( Arch Otolaryngol Head Neck Surg. 1992;118:310-312)

At the annual meeting of the American Laryngological Association in San Francisco, Calif, Drs Cynthia Anonsen and Lauren Lalakea, Stanford (Calif) University, and Dr Maureen Hannley, Washington, DC, presented their work in evaluating far-field brain-stem recordings in response to electrical stimulation of the superior laryngeal nerve in cats. In the first part of the study, nasopharyngeal and posterior cervical electrodes were used for recording, and animals were anesthetized and paralyzed. Six positive and five negative reproducible waves were observed, which corresponded closely to those previously reported by investigators in Japan. Anonsen and coworkers also looked at the effects of stimulus intensity and repetition rate on this response. In contrast to the auditory brain-stem response, the laryngeal brain-stem response does not appear to change as a function of these parameters. This study also explored the possibility of obtaining brain-stem recordings without paralysis. By

• A number of different therapies have been used in the management of spasmodic dysphonia. None are curative, and the results of the most widely used surgical procedure (resection of the recurrent laryngeal nerve) are not universally good, with a high recurrence rate in some series. Furthermore, the procedure is not reversible. Using a special electromyographic hypodermic needle, we injected botulinum A toxin into one of the vocal folds of two patients with severe spasmodic dysphonia. Both had significant improvement without any complications. Although the resultant paresis is not permanent, the injection can be repeated as needed as an outpatient procedure. ( Arch Otolaryngol Head Neck Surg 1987;113:603-605)

• Disruption of the thoracic aorta is usually fatal without prompt surgical attention. Left recurrent laryngeal nerve paralysis has been reported in approximately 10% of patients who survive long enough to develop a pseudoaneurysm, but the time of onset has rarely been specified. In this study, 50 cases of thoracic aortic trauma were reviewed to determine the incidence and timing of laryngeal paralysis, compared with 50 cases of atherosclerotic aneurysms matched for location. Four patients in the traumatic group were hoarse, and the onset was immediate in 3. Six in the atherosclerotic group became hoarse. Results indicate that laryngeal paralysis following severe trauma can be a very early sign of aortic injury and requires prompt and thorough investigation. ( Arch Otolaryngol Head Neck Surg. 1989;115:1100-1102)

• A case of a highly destructive, cytologically nondysplastic squamous epithelial lesion of the middle ear is presented. The cranial nerve involvement and bone destruction are more extensive than has been seen in cholesteatoma. Cultures are negative forPseudomonas, and the patient does not have the reported diathesis for malignant otitis externa. The gross and microscopic features are those of verrucous carcinoma. To our knowledge, the middle ear has not been previously reported as a site of involvement by verrucous carcinoma. (Arch Otolaryngol107:63-65, 1981)

At the annual meeting of the Triological Society in Palm Beach, Fla, Terrence K. Trapp, MD, and coauthors, Los Angeles, reported the use of a new needle to perform magnetic resonance—guided aspiration cytology in three patients with head and neck lesions. The new needle is constructed of c-276 stainless steel, which has a very high nickel content and low ferromagnetic properties. This results in minimal image artifact. A new technique of needle placement was also developed, which takes advantage of the multiplanar imaging capability of magnetic resonance imaging. Oblique images, parallel and perpendicular to the plane of the needle, provide precise localization of the needle tip. The authors state that this technology may be very useful in the evaluation of lesions that would be otherwise inaccessible to biopsy.

Dr Roger Crumley, San Francisco, at the annual meeting of the Triological Society in Palm Beach, Fla, presented an update on his results with nerve transfer in the treatment of vocal cord paralysis. His technique involves anastomosis of the nerve to the sternohyoid muscle to the recurrent laryngeal nerve, distal to the site of injury. Gelfoam injection is performed to provide vocal improvement during the time required for reinnervation. Results were presented for five patients, documented by sonography and, in some cases, videolaryngostroboscopy. The goal of the procedure is not normal movement but resting tone in the vocalis muscle, which permits more normal vibration of the vocal fold. Dr Crumley feels that the results of this procedure are much more reliable than those of polytef (Teflon) injection. Complications of polytef injection that he cited included granuloma formation and migration of the polytef. Dr Crumley states that there are few perfect

Dr K. Thomas Robbins, and coauthors, Houston, at the annual meeting of the Triological Society in Palm Beach, Fla, recently reviewed the treatment of 150 patients with T1N0 or T2N0 cancer of the tongue at M. D. Anderson Hospital, Houston. The best disease-free survival at five years (86%) was achieved in 26 patients who had partial glossectomy with elective supraomohyoid neck dissection. In contrast, 77 patients treated with partial glossectomy alone had a five-year disease-free survival of only 69%. Overall, five-year survival was not significantly different at 91% and 90%, respectively. Radiation therapy had the poorest results, with five-year survival rates of 69% disease free and 78% overall. The authors concluded that even small tongue cancers warrant aggressive management, and that initial surgery is more effective than radiation therapy. Supraomohyoid neck dissection adds very little morbidity to the initial surgery and provides effective control of the primary echelon lymph nodes.