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Objective: To identify objective parameters that could serve as valid indicators of vocal function in evaluating patients treated at multiple centers for head and neck cancer. Design: Objective measures of voice were validated against functional outcome measures of voice and communication. Setting: A multidisciplinary university-based ambulatory head and neck cancer clinic. Subjects: Fifteen patients at varying posttreatment intervals after chemoradiation therapy for head and neck cancer and 5 volunteers with no cancer but with a history of heavy smoking and drinking. Main Outcome Measures: Acoustic and aerodynamic parameters were measured in patients with head and neck cancer after treatment with combined chemotherapy and irradiation and in control subjects. Communicative function was assessed by perceptual assessment of recorded voice samples, by a clinician-based communication score, and by patient self-rating of voice and communication. Results: Both perceptual analyis and communication score were concordant with patient self-rating of voice and communication ability. Acoustic measures were abnormal in patients, and jitter scores correlated with listener ratings of perceived voice quality. However, acoustic measures did not relate to communication function, as assessed by either the patient or the clinician. Laryngeal resistance demonstrated a significant correlation with both patient and observer assessments of voice quality and communication function. Laryngeal resistance was on average twice as high in patients who complained of voice fatigue, but this difference was not statistically significant. Conclusions: Laryngeal resistance, determined during standardized phonation, is a reliable objective parameter of vocal function after chemoradiation therapy for head and neck cancer. A standardized clinician-based communication scale holds promise as a useful tool. Acoustic measures reflect the sound of the voice but not the ability to communicate effectively. Arch Otolaryngol Head Neck Surg. 1996;122:858-864

Congenital dacryocystoceles presenting with intranasal extension may precipitate respiratory distress in neonates. Twenty-one children have been described as having congenital dacryocystoceles with intranasal extension, and, of these, 14 had respiratory distress. We present a series of patients with congenital dacryocystoceles who presented with ranging degrees of respiratory distress. Magnetic resonance imaging and computed tomographic scans confirmed the diagnosis. In all cases, the endonasal portion of the cyst was marsupialized endoscopically with complete resolution of symptoms. Pertinent embryology, anatomy, clinical presentation, and treatment are discussed.

The objectives of this study were to determine the effects of botulinum toxin injection on measures of depression, anxiety, and somatic complaints in patients diagnosed as having spasmodic dysphonia. Patients were asked to complete preinjection questionnaires with self-ratings of depression, state and trait anxiety, and somatic complaints. Approximately 1 week and 2 months following injection, patients were again asked to complete the questionnaires. The spasmodic dysphonic subjects exhibited significantly elevated mean levels of depression and anxiety. These levels were significantly reduced approximately 1 week after injection. Two months later, depression and anxiety measures did not change significantly from their 1-week postinjection values. The results suggest that patients with spasmodic dysphonia who demonstrate significantly elevated measures of depression and anxiety show a reduction in those measures following treatment with botulinum toxin.

• A prospective clinical study was performed on 62 patients with peritonsillar abscesses at Ben Taub General Hospital, Houston. The abscesses were treated with either incision and drainage or needle aspiration alone. The recovery period was similar in both groups, but two of the 41 patients initially treated with aspiration had an immediate recurrence. These were successfully treated with subsequent incision and drainage. The advantages of needle aspiration alone as the primary drainage procedure outweigh the acceptably low failure rate, making it the initial procedure of choice. (Arch Otolaryngol Head Neck Surg1987;113:984-986)

• Serious injury to the optic nerve is an uncommon, usually permanent, complication of orbital fractures. Occasionally it is due to reversible changes, such as edema, contusion, or compression of the optic nerve. The early management of visual loss due to orbital fracture is controversial. Some authors advocate emergency optic nerve decompression; others recommend steroid therapy alone. We present a case of nearly complete unilateral loss of vision after a lateral orbital fracture with compression of the optic nerve by bony fragments. Computed tomographic scanning of the orbit helped us to pinpoint the cause of visual compromise and also served as a guide in planning surgery. Large dosages of steroids, combined with early reduction of the fracture, resulted in substantial recovery of vision. This case illustrates the importance of precisely determining the nature of the injury and the cause of visual compromise. A protocol for management of these injuries is presented. ( Arch Otolaryngol Head Neck Surg 1987;113:81-83)