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Objective: To evaluate the effectiveness of unilateral supraglottoplasty in the treatment of children with severe laryngomalacia. Design: Retrospective study. Setting: Pediatric tertiary referral center. Patients: Eighteen children with severe laryngomalacia. Indications for surgical intervention were obstructive apnea, failure to thrive, cyanosis, and/or cor pulmonale. Interventions: Unilateral carbon dioxide laser removal of redundant supraglottic tissue (supraglottoplasty). Outcome Measures: Evaluation of relief of symptoms, need for subsequent contralateral procedure, and incidence of complications. Results: Three patients required treatment of the opposite side at a later date. There were no complications. Obstructive apnea and weight gain improved in all. Conclusions: Unilateral supraglottoplasty can be used to treat severe laryngomalacia in most patients. A small percentage of patients will subsequently require a contralateral procedure. Unilateral supraglottoplasty may have less risk of complications than bilateral supraglottoplasty. (Arch Otolaryngol Head Neck Surg. 1995;121:1351-1354)

• We examined human papillomavirus (HPV) infection in biopsy specimens and cellular scrapes that were taken from respiratory papillomas and six nondiseased sites from the respiratory tract of seven patients. Human papillomavirus was detected by polymerase chain reaction amplification, followed by DNA hybridization with probes for specific HPV types. All papillomas (100.0%, n=5) were positive only for HPV type 6 or 11. In the nondiseased site specimens, 61.3% (19/31) of the specimens were positive, again only for HPV type 6 or 11. Among the nondiseased site specimens from the cervical trachea, intrathoracic trachea, and bronchus, 80% to 100% were HPV positive compared with only 25% to 50% of HPV infection detected in the nasopharynx, posterior tonsillar pillar, and aryepiglottic fold. These results support the tenet that HPV infection is present in clinically normal respiratory tract tissue and that the reservoir site of reinfection is more commonly in the lower airway. However, patients with upper-airway involvement were more likely to be diagnosed as having severe disease. ( Arch Otolaryngol Head Neck Surg. 1993;119:554-557)

Objective To characterize the time demands and practice patterns of pediatric otolaryngologists. Design Prospective survey of members from the American Society of Pediatric Otolaryngology. Results The survey response rate was 54% (n = 136) of practicing members of the American Society of Pediatric Otolaryngology. Respondents described being actively engaged in clinical otolaryngology (99%), hospital or practice administration (71%), private enterprise (17%), research (71%), and teaching (89%) on a weekly basis. Sixty percent considered their time demands to be "too busy"; however, few anticipated changing their activities in 5 years. Among the responding physicians, 90% believed that nonotolaryngology peers within their institutions viewed pediatric otolaryngology favorably whereas only 50% thought that other otolaryngologists held the same opinion. Conclusions Pediatric otolaryngologists participate in many activities beyond clinical medicine. While most considered their time demands to be too busy, few anticipated a change in their activities. This may be reflective of a high level of job satisfaction, financial constraints, or the relative youth of the subspecialty.

The objective benefits of tympanostomy tubes for otitis media are well established, but the subjective impact of surgery on child quality of life (QOL) has not been systematically studied.To determine the subjective impact of tympanostomy tubes on child QOL, and to compare the variability in QOL before surgery with that observed after surgery.Prospective, observational, before-and-after trial.Fourteen referral-based pediatric otolaryngology practices in the United States.Consecutive (64%) and convenience (36%) sample of 248 children (median age, 1.4 years) with otitis media scheduled for bilateral tympanostomy tube placement as an isolated surgical procedure.Tympanostomy tubes were inserted as part of routine clinical care. Validated measures of QOL (OM-6 survey), satisfaction with health care decision (Satisfaction With Decision Scale), and satisfaction with office visit; surveys were completed at baseline (visit 1), at surgery (visit 2), and after surgery (visit 3).Short-term changes in QOL before surgery (visit 1 to visit 2) and after surgery (visit 2 to visit 3).Changes in QOL before surgery were mostly trivial, and were smaller than changes observed after surgery (P.001). Large, moderate, and small improvements in QOL occurred after surgery in 56%, 15%, and 8% of children, respectively. Physical symptoms, caregiver concerns, emotional distress, and hearing loss were most improved, but significant changes were also seen for activity limitations and speech impairment. Trivial changes occurred in 17% of children, and 4% had poorer QOL. Predictors of poorer QOL were otorrhea 3 or more days (10% of variance) and decreased satisfaction with surgical decision (3% of variance). Hearing status, child age, type of otitis media (recurrent vs chronic), and office visit satisfaction were unrelated to outcome.Tympanostomy tubes produce large short-term improvements in QOL for most children. The best outcomes occur when postoperative otorrhea is absent or minimal, and when parents are satisfied with their initial decision to have surgery. Further research is needed to document the long-term impact of tubes on child QOL.

To the Editor. —Dr Frantz and colleagues state that epiglottitis in children is generally confined to the epiglottis. 1 This is not so, according to our experience and that of others. 2-5 Swollen aryepiglottic folds constitute the principal airway obstruction in children who have this diagnosis, often with little actual enlargement of the epiglottis. The hypopharyngeal tissue surrounding the glottis also tends to inflame in children, much as Frantz et al depict in adults. Just as for adults, the more descriptive term for children should be supraglottitis.

We were dismayed in reading in the Clinical Notes section of theArchivesthat Pinczower and coworkers 1 from the University of Washington, Seattle, had suggested that thyroid scanning be performed in all patients with thyroglossal duct cysts. With all due respect, there are several things that we do not agree with in this article. The first is that the conclusion of the article is based on the outcome of two malpractice cases that were decided against physicians for removing the only remaining functioning thyroid tissue. We do not have any details on these particular cases, which were decided against the physicians, and we do not know the circumstances involved. We would disagree that if parents are given informed consent in this instance, that a case should be decided against a physician for that reason alone. Therefore, simply because two adverse cases have been decided, we do not think that