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A muscle-nerve pedicle implantation to the lateral cricoarytenoid muscle as described by Tucker is an alternative to Teflon injection for treating dysphonia due to vocal cord palsy. Improvement in voice was noted in 19 of the 20 (95%) selected patients who were treated by muscle-nerve pedicle reinnervation. These patients have been followed for 6 months to 10 years. Changes in the voice were documented through assessment of high-quality audio tape recordings by three speech pathologists, results of a patient questionnaire, and evaluation by the surgeon. The improvement in voice quality was attributed to reestablishment and maintenance of vocal cord tone and mass, without the vocal cord stiffness usually associated with Teflon injection. The improvements in quality of voice with pedicle implantation are natural and lasting. This technique is proposed as an alternative to Teflon injection in selected cases. [ABSTRACT FROM AUTHOR]

In an effort to develop a simple and accurate method to identify children in whom adenoidectomy might prevent otitis media, the ventilatory function of the Eustachian tube was assessed by a manometric technique. Nasal pressures during swallowing were also determined in some. The study group consisted of 23 children with otitis media in whom tympanostomy tubes had been inserted. All were judged clinically and roentgenographically to have prominent adenoids. Inflation-deflation Eustachian tube ventilation studies were obtained in 36 ears that remained intubated, aerated and dry both before and eight weeks after adenoidectomy. Fifteen of the 36 (42 percent) ears had improvement in Eustachian tube ventilatory function postadenoidectomy which was attributed to relief of extrinsic mechanical obstruction of the tube. In the remaining 21 (58 percent) ears in which Eustachian tube function was not improved, mechanical obstruction was not apparent preoperatively. The effect of nasopharyngeal pressures on a pliant Eustachian tube (Toynbee phenomenon) due to obstruction of the posterior nasal choanae by the adenoid mass was suggested as a possible cause of functional Eustachian tube obstruction. In several instances in which preadenoidectomy mechanical obstruction of the Eustachian tube was not demonstrated, the tube appeared to have been made more pliant by the operation. This increase in compliance of the Eustachian tube was attributed to loss of adenoid support of the tube in the fossa of Rosenmuller. From this study, preliminary recommendations for selection of patients for adenoidectomy are the following: 1. Eustachian tube ventilation function tests in a dry, intubated middle ear; 2. if extrinsic mechanical obstruction of the Eustachian tube is present and chronic inflammation is absent, adenoidectomy will probably improve Eustachian tube function. The surgical technique should include adequate removal of the adenoid tissue in the fossa of Rosenmuller; 3. if the Eustachian tube does not appear to be mechanically obstructed, the adenoids should not be removed unless functional obstruction is suspected due to obstruction of the posterior nasal choanae. Adenoid tissue within the fossa of Rosenmuller should not be removed when such circumstances exist; and 4. in the abscence of obstructive adenoids to the nasal choanae or Eustachian tube, adenoidectomy probably will not improve Eustachian tube function and could make it worse. A more rational and effective approach to adenoidectomy for the prevention of otitis media in children may be possible through this type of preoperative evaluation. [ABSTRACT FROM AUTHOR]

This study was designed to determine whether swallow rehabilitation outcomes were affected by the type of evaluation procedure utilized by the clinician. The two evaluation techniques compared were the bedside examination and videofluoroscopy (the modified barium swallow). Ten institutions participated in this study, enrolling a total of 103 partial laryngectomized patients, 21 in the bedside arm and 82 in the videofluoroscopy arm. Data on recovery of oral intake were collected weekly. All patients received an X-ray study of swallow at 3 months after the operation. Mean time to oral intake of food was significantly lower in patients assessed with bedside examination. Overall swallow measures of transit times and swallow efficiencies after 3 months revealed significantly better function in the videofluoroscopy group. Results are discussed in terms of the visibility of swallow physiology with the two assessment techniques, the accuracy of therapy planning with the bedside examination versus videofluoroscopy and the ability of head and neck cancer patients to tolerate some aspiration without developing aspiration pneumonia. [ABSTRACT FROM AUTHOR]

Postoperative speech function may be influenced by a number of treatment variables. The objective of this study was to examine the relationships among various treatment factors to determine the impact of these measures on speech function. Speech function was tested prospectively in 142 patients with surgically treated oral and oropharyngeal cancer 3 months after treatment. Each patient's speech was recorded during a 6- to 7-minute conversation and while performing a standard articulation test, producing speech outcome measures of percent correct consonant phonemes and percent conversational understandability. Correlational analyses were used to determine the relationships among the speech outcome measures and 14 treatment parameters. Speech function was mildly to moderately negatively correlated with most surgical resection variables, indicating that larger amounts of tissue resected were associated with worse speech function. Overall measures of conversational understandability and percent correct consonant phonemes were related to extent of oral tongue resection, floor of mouth resection, soft palate resection, and total volume of tissue resected. These relationships varied depending on the method of surgical closure. Method of surgical reconstruction had a profound impact on postoperative speech function 3 months after treatment and was an important factor in determining how oral tongue resection influenced articulation and intelligibility. The combination of closure type, percent oral tongue resected, and percent soft palate resected had the strongest relationship with overall speech function for patients with surgically treated oral and oropharyngeal cancer 3 months after treatment. [ABSTRACT FROM AUTHOR]

Background: Postoperative swallowing function may be influenced by a number of treatment variables; this study examines the relationship of various treatment factors to measures of swallow function., Methods: Swallowing was examined with the modified barium swallow procedure in 144 patients surgically treated for oral or oropharyngeal cancer 3 months after healing. Univariate and multivariate correlations were used to examine the relationship between swallowing function and treatment., Results: Percent tongue base resected and total volume resected were most often correlated with swallowing function in the univariate analyses. Multivariate analyses identified the following combinations with the strongest correlations: (1) percent tongue base resected and closure type for liquids; (2) percent tongue base resected and unreconstructed mandible for pastes; (3) total volume resected, percent lateral floor of mouth resected, and postoperative radiotherapy dose for masticated boluses., Conclusions: Total volume resected and percent tongue base resected had a profound impact on postoperative swallowing function. Combinations of percent tongue base resected with other surgical variables had the strongest relationships with overall swallowing function., (Copyright 2004 Wiley Periodicals, Inc.)

Background: Few objective data characterizing the pretreatment swallow function of patients with head and neck cancer are available., Methods: Pretreatment swallowing function in 352 patients with various lesions was evaluated with videofluoroscopy and compared with control subjects., Results: Patients had significantly longer oral and pharyngeal transit times, greater amounts of oral and pharyngeal residue, shorter cricopharyngeal opening durations, and lower swallow efficiencies. Swallow function worsened significantly with increased tumor stage, and patients with oral or pharyngeal lesions had worse swallow function than patients with laryngeal lesions. Frequency of complaint of swallow difficulty before treatment was 59%. Patients with lower stage tumors had fewer complaints of swallowing, as did patients with oral cavity lesions., Conclusions: Despite demonstrating significant differences from control subjects, patients had highly functional swallows before treatment. The tendency for patients not to perceive a swallowing problem is consistent with the highly functional nature of their pretreatment swallow.

The relation between functional outcome and dropout from a 12-month follow-up period was examined in a longitudinal study whose objective was to define and quantify the functional effects of oral surgical resection and reconstruction on speech and swallowing in patients with head and neck cancer. In a group of 150 patients recruited to a surgical study in the Cancer Control Science Program in Head and Neck Cancer Rehabilitation, dropout from all causes and dropout from specific causes (medical, patient, and administrative specific) were assessed in relation to longitudinal speech and swallow function. In univariate analysis, better speech articulation was associated with decreased risk of dropout from all causes and from medical-specific causes. Better swallow performance was associated with decreased risk of medical-specific dropout. Multivariate analysis revealed the following: (1) only articulation function was associated with dropout from all causes; (2) the association of speech articulation function with medical dropout was diminished after adjusting for advanced age and surgical resection variables; (3) the association of speech articulation function became significant for patient-specific dropout after adjusting for advanced age and surgical resection variables and indicated that better function decreased the risk of this type of dropout; and (4) swallowing function was not related to dropout. Patients treated for oral or oropharyngeal cancer who have poorer speech outcomes are more likely to drop out from a longitudinal study. Basing study results on only patients who complete a longitudinal study will understate the level of dysfunction experienced.

The extent and nature of dropout was assessed in a longitudinal study whose objective was to define and quantify the functional effects of oral surgical resection and reconstruction on speech and swallowing function in patients with head and neck cancer. Of 150 patients who were enrolled to be followed up with speech and swallow assessments for 1 year after surgery, 113 (75%) dropped out and 37 (25%) returned to complete the study at the final 12-month evaluation point. In general, those completing the study had a smaller resection than the patients who dropped out before the 12-month evaluation. Fifty percent of the dropout was accounted for by medical reasons, 23% by administrative reasons, and 27% by patient-specific reasons (i.e., reasons known only to the patient). Analysis of the dropout categories revealed that higher cancer stage, larger volume of resection, and having a flap surgical closure versus a primary closure or skin graft increased a patient's chance of dropping out. A larger volume of resection was also related to an increased chance of being a patient-specific dropout. Patients who reported no or low alcohol usage had a greater chance of completing follow-up than being a patient-specific dropout.

The harmonica is arguably the most widely played instrument in the world, yet there is a surprising paucity of published studies of its acoustics or physical dynamics. The typical diatonic harmonica and the physical forces involved in its natural function are described, and simple observations of the harp's functions are reported. The speaking of the reeds, naturally, when producing a bend, and when speaking as an overblow or overdraw is discussed and investigated by simple stopping of the reeds, by videostroboscopic analysis, and by recording vibration of the reeds with displacement gauges. The reeds of the ten hole harmonica can be made to vibrate at varying frequencies depending on the size and shape of the player's vocal tract. Three different modes of speaking from each hole and its pair of reeds are revealed and studied: first, naturally in a closing mode, either blown or drawn; second, as a bend, either blown or drawn, with pitch in the interval between the two notes in the hole; and third, as an overblow or overdraw in an opening mode with a pitch outside the interval between the two natural notes of the hole. This dynamic interaction allows the player to speak with the instrument perhaps as with no other.

Background: The purpose of this study was to determine whether the speech and swallowing function of surgically treated oral cancer patients improves between 1 month and 1 year after surgery., Methods: Speech and swallowing performances were assessed for 28 men and 10 women preoperatively and at 1, 3, 6, and 12 months postoperatively following a standardized protocol. Speech tasks included an audio recording of a brief conversation and of a standard articulation test; swallowing function was examined using videofluoroscopy. Data were also collected on the number and duration of speech/swallowing therapy sessions, as well as the amount and duration of radiotherapy., Results: Statistical analyses revealed that the speech and swallowing function of surgically treated oral and oropharyngeal cancer patients did not improve progressively between 1 and 12 months postsurgery; the level of functioning that these patients demonstrated at the 1- and 3-month posthealing evaluations was characteristic of their status at 1 year after surgery., Conclusion: The lack of improvement between 1 and 12 months postsurgery may be related to the relatively small amount of therapy that these patients received during that period. Several outcome variables worsened significantly at the 6-month evaluation; the reversal of function at the 6-month evaluation point could be the effect of postoperative radiotherapy, because irradiated and nonirradiated patients differed in their pattern of recovery on oropharyngeal swallow efficiency and several speech variables.

Speech and swallowing function was examined in 11 patients who underwent surgical resection of greater than 1 cm of tongue base, tonsil, and faucial arch with mandible resected on the side of the tumor and reconstruction by primary closure. Preoperatively and 1 and 3 months post-healing, high fidelity audio recordings were made of a 6- to 7-minute conversational speech sample, the sentence version of The Fisher Logemann Test of Articulation Competence was administered, and videofluoroscopic assessment of oropharyngeal swallow was conducted. All subjects exhibited changes in speech and swallowing function postoperatively, with little improvement during the study. Patients exhibited greatest difficulty on stop and fricative consonants and bolus propulsion. Comparison with patients who received anterior tongue and floor of mouth resections and distal flap reconstruction revealed consistently better speech performance by the tonsil/base of tongue patients, although the same phonemes were affected. Swallow function was equally affected in the two groups. Results are discussed in terms of locus of surgical resection, nature of reconstruction, and need for swallowing therapy.

This article describes a technique of making custom flexible and combined flexible/rigid tracheostoma vents. The combined flexible rigid tracheostoma vent provides a flexible material that is nonirritating in the peristomial region and maintains a patent tracheostoma by the rigidity of the hard acrylic resin section. The flexible tracheostoma vent can be easily inserted and is more comfortable than the rigid commercially available tracheostomy tube. The use of microwave-cured materials permits fabrication during a single visit. The steps involved in the fabrication of the tracheostoma vents are simple and require no elaborate laboratory equipment.

Fiberoptic nasoendoscopy was used to evaluate the activity in the lateral and posterior pharyngeal walls of five adults with cleft palate, each of whom had worn a prosthetic speech appliance for more than 20 years. Activity during speech was greatest in the area of the levator veli palatini muscle and Passavant's ridge, while no gross activity was observed in the area of the auditory tube superiorly. Activity was variable within and between subjects. Apparent medial movement of the auditory tube seemed to be secondary to the influence of the levator muscle on the pharyngeal wall soft tissues.

In an attempt to determine the effect of an upper respiratory tract infection on the ventilatory function of the Eustachian tube, 20 children who had recurrent acute or chronic middle ear effusions were studied. Baseline Eustachian tube function testing was obtained when there were no signs or symptoms of upper respiratory infection. These tests were repeated at six-week intervals and whenever an upper respiratory tract infection supervened.

In an effort to establish the diagnostic value of otoscopy, tympanometry, and the middle ear (ME) muscle reflex in the identification of otitis media with effusion (OME), the diagnostic findings by these three methods were compared with the findings at myringotomy in 333 children (500 ears). The study showed that even experienced clinicians had some difficulty in identifying those ears with effusion (sensitivity) and had even greater difficulty in making a diagnosis of those ears without an effusion (specificity). However, tympanometry, employing patterns that have been validated with myringotomy findings, was found to be more accurate. On the other hand, assessment of the ME muscle reflex as a diagnostic method was unacceptable due to an extremely low specificity (52%). An algorithm derived from the combination of the three methods had highest sensitivity (97%) and specificity (90%).

Tympanometric evaluation using an otoadmittance meter and X-Y plotter was performed on 129 ears of 70 children with history of recurrent acute otitis media, or evidence otoscopically of persistent middle ear effusion, or both. Myringotomy, performed immediately following the tympanometric procedure, confirmed the presence or absence of effusion. Following myringotomy, tympanometric patterns, as shown by susceptance and conductance tracings at 220 and 660 Hz, were identified and middle ear pressures and otoadmittance peak values were determined. These findings were compared and criteria were developed which best determined the presence or absence of effusion. The results revealed the following: 1) High negative middle ear pressure is not necessarily a reliable indicator of middle ear effusion. 2) Tympanometry can be used reliably as an indicator of effusion. A combination of pattern classification and susceptance criteria enabled correct prediction of effusion in 93% of these children. One pattern at B660 was found to be pathognomonic of effusion. 3) In general, otoadmittance at 660 Hz appears to be a better indicator of effusion than 220 Hz.

Past studies of the efficacy of adenoidectomy in the management of children with otitis media have been inconclusive due to significant limitations in experimental design. At the Children's Hospital of Pittsburgh, the effect of adenoidectomy on the outcome of otitis media is currently being studied in a prospective manner. An attempt is being made to document and to control those factors cited as lacking in the previous studies. This report describes the techniques for assessment of nasal and Eustachian tube function and for the completeness of adenoidectomy.

Several concepts related to the pathogenesis of middle ear effusions are postulated. The mechanisms proposed are based on an understanding of fluid mechanics. A flask with a long, narrow neck is presented as a model of the Eustachian tube-middle ear-mastoid system. Fluid flow into and out of the flask is dependent upon the pressure gradient, compliance of the narrow neck and whether or not the bulbous portion is intact. It is suggested that locking of the tube may be dependent upon the speed of the application of the negative pressure and the compliance. Eustachian tube opening appears to be related not only to active muscle forces but may also be dependent upon the presence of a pressure gradient which passively assists tubal function. It is proposed that middle ear effusions result from reflux, aspiration or insufflation of nasopharyngeal secretions (acute otitis media), or from persistent functional or mechanical Eustachian tube obstruction (secretory otitis media) or both.

In an attempt to determine the effect of a decongestant with or without an antihistamine on the ventilatory function of the eustachian tube (ET), two separate studies were conducted in 50 children who had had chronic or recurrent otitis media with effusion (OME) and in whom tympanostomy tubes had been inserted previously. The first was a double-blind study that compared the effect of an oral decongestant, pseudoephedrine hydrochloride, with that of a placebo in 22 children who developed an upper respiratory infection (URI) during an observation period. Certain measures of ET function were significantly elevated above baseline values during the URI, which was attributed to intrinsic mechanical obstruction of the ET. It was found that the oral decongestants tended to alter these parameters of ET function in the direction of the baseline (preURI) values. Even though the effect was statistically significant, the favorable changes in measurements of tubal function were only partial and were more prominent on the second day of the trial after the subjects had received four doses of the decongestant. However, the administration of nasal spray of 1% ephedrine appeared to have no apparent effect on ET function in these children. The second study was a double-blind crossover design. In this study of 28 children who did not have a URI, the effect of a decongestant-antihistamine combination (pseudoephedrine hydrochloride and chlorpheniramine maleate) was compared with that of a placebo. When the subjects were given the decongestant-antihistamine medication, there were favorable changes in certain ET function measures which were not observed when they received the placebo. Again, the response differences between the two groups were statistically significant. Even though these two studies indicated that an oral decongestant appeared to affect favorably the ET function of children who had a URI, and that the combination of an oral decongestant and antihistamine had a similar effect on tubal function in children without a URI, an evaluation of the efficacy of these commonly employed medications must await the results of controlled clinical trials in children with OME.

The authors report on a special section of a Children's Museum which is designed to involve the child and parent in actively learning about vocal function. This approach is recommended as an excellent way to promote interest in healthy vocal function.

Forty-eight subjects with repaired palatal clefts were divided into three major groups on the basis of speech symptoms and were examined for velopharyngeal valving integrity by means of the R-D nasal manometer, pressure-flow techniques, the Hunter oral manometer, and videofluoroscopy. Videofluoroscopy appeared to provide data that most nearly agreed with predictions of valving made from speech. The Hunter oral manometer was the least useful of the four techniques.

A double-blind, randomized clinical trial comparing cefaclor with amoxycillin in the treatment of acute otitis media with effusion (OME) in infants and children is being conducted at Children's Hospital of Pittsburgh. Although the randomization code has not yet been broken, the results of treating the first 55 children are reported, since they appear to be of interest. Of the 62 ears with acute OME on which an initial tympanocentesis was performed, 41 positive cultures were isolated from the middle ear aspirates. Of the 10 ears from which Haemophilus influenzae was isolated, one had a type b strain, and of the remaining unencapsulated strains, one was resistant to both penicillin G and ampicillin. In the one ear from which Staphylococcus aureus was isolated, the organism was found to be resistant to ampicillin. However, all of the organisms were sensitive in vitro to cefaclor. In 88% of all subjects observed for the first 2 weeks, the initial symptomatic response was excellent. Six children had persistent signs and symptoms of acute OME and received a second tympanocentesis; however, none of the effusions from the repeat aspiration revealed an organism. An effusion was still present in 97% of the ears after 3 days, in 69% after 2 weeks, and in 48% 6 weeks after initiation of the study. Tympanocentesis did not appear to affect either the initial clinical response or the persistence of effusion. There were no adverse reactions to either drug in this study. Because an apparent increase in the incidence of ampicillin-resistant strains of H. influenzae is being reported, and because of the presence of ampicillin-resistant S. aureus in some ears with acute OME, a new antimicrobial effective against all the common pathogens causing acute middle ear disease would be desirable. In this respect, the preliminary findings of treatment with cefaclor from this study appear promising.

An algorithm for identification of hearing loss and middle ear effusion based on otologic history, audiometry and tympanometry was designed and tested on 771 first grade school children. Each ear was profiled as being normal, at risk, or in need of otologic referral based on test-retest screening. In addition, each child was categorized on the basis of the worse ear. Results showed 57 percent of the children as being normal; otologic referral was indicated in 14 percent. The remaining children (29 percent) were at risk or at high risk. The combination of medical history, audiometry and tympanometry constitutes an excellent case finding procedure for screening the otologic status of young school children. Through the utilization of specific criteria, optimal referrals can be made, thereby providing better health care.

Perennial rhinitis with an allergic component (PRAC) in association with chronic mouthbreathing has been thought to cause skeletal open-bite facial type and narrow transverse facial dimensions. The object of this study was to supply data for this theory and to determine if allergy management would alter the course of facial growth. When a group of children, aged 5 to 10 years, with PRAC was compared with a matched control sample, a significantly larger palatomandibular angle and lower anterior facial height were found for the PRAC group. Transverse cephalometric measurements showed significantly narrower bilateral orbital breadth, bizygomatic, and binasal dimensions (narrower face) of the PRAC patients compared with the control sample. A pilot study of twelve PRAC patients who received 2 1/2 years of allergy management revealed no significant dento-facial dimensional change. This study suggests that PRAC with chronic mouthbreathing can alter the development of the midface. Whether allergy therapy can prevent or change this is as yet uncertain.

A comparatively high prevalence of acute and chronic otitis media (OM) has been reported for the native American Indian population. The present study reports data on the function of the eustachian tube (ET) in 25 White Mountain Apache Indians ranging in age from 3 to 36 years. All study subjects had a history of OM and reported to the reservation clinic with tympanic membrane perforations and a dry middle ear (ME). The results of inflation-deflation tests on these subjects indicated that the Indians had lower forced opening pressures than had been measured in a group of Caucasians with perforations secondary to chronic OM. Of the 23 subjects studied, 67% equilibrated applied positive ME pressures and 38% equilibrate negative pressures by swallowing. During forced response testing, the passive resistance of the ET was found to be lower and the active resistance equivalent to that of a group of Caucasians with traumatic perforations and otherwise negative otologic histories. While the ET was predilated in these subjects by constant airflow, active swallowing further dilated the tube in 67% of the subjects, constricted the tube in 25%, and had no effect in 8%. This study indicated that the ET of the American Indian was functionally different from that of Caucasians previously studied and was characterized by comparatively abnormal, low passive tubal resistance which may be considered to facilitate ventilatory function and to impair protective function. The difference may account for the high prevalence of OM with perforation and the low incidence of cholesteatoma in this population.

A knowledge of normal articulation is needed before the prosthodontist can assess the compensatory articulation used by glossectomy patients. The amount and portion of tongue resected is directly correlated with speech intelligibility. The loss of the tip of the tongue is more critical to intelligibility than a hemiglossectomy. Partial glossectomy speakers can often use the residual tongue stump to perform adaptive movements that approximate normal movements and should be treated as an articulation problem. The compensatory articulation used by the total glossectomy patient was reviewed. The prosthodontic management of patients with partial tongue resection often includes lowering the palatal vault, while the management of the total glossectomy patient usually requires a mandibular tongue prosthesis. These prostheses can be refined with the use of multiview videofluoroscopy, videotaping, and spectrographic analysis.

A major goal of any surgical program for patients with tumors is to cure their cancer. Patients requiring total glossectomy usually are seen initially with far-advanced disease, often after failure of other treatment modalities. As a result, they may be suffering from constant pain as well impairment of speech and deglutition. The prognosis is poor, and palliative surgery with good rehabilitation of the speaking and swallowing mechanisms becomes a reasonable, albeit limited, objective. Our series does show that properly selected patients can be successfully rehabilitated after total glossectomy with out laryngectomy. This successful rehabilitation begins with good patient selection and preoperative preparation. Postoperative rehabilitation requires the interplay of a highly motivated patient and a well-coordinated health care team. The physician, nurse, speech pathologist, dietitian, and social worker all have important roles in ensuring the patient's return to a good quality of life. The surgeon will direct the efforts of the team. To the nurse and the speech pathologist falls much of the bedside job of instructing and motivating the patient. Because such effective rehabilitation has been demonstrated by the success of our patients, we advocate preserving the larynx whenever possible in the patient who must undergo total glossectomy.

A prospective study was carried out which tested three hypotheses: 1) certain tumors of the head and neck that originate in sites other than the nasopharynx may cause middle ear effusion; 2) middle ear effusion is a predictable sequela of radical maxillectomy as well as total or partial resection of the soft palate; and 3) middle ear effusions that follow surgery to remove head and neck lesions are due to disturbances in palatal function, specifically to tensor veli palatini muscle dysfunction. Our results indicate that one fourth of all subjects had some evidence of middle ear abnormality prior to entering into treatment although they were asymptomatic. The treatment process influenced the function of the middle ear, as 79% of the subjects experienced middle ear-eustachian tube dysfunction following treatment, and 23% were found to have developed a perforation of the tympanic membrane or required myringotomy and tube insertion to relieve middle ear effusion. The results of these studies indicate that surgery that is adequate to remove cancer of the maxilla, tonsil, or palate in most cases interferes with the function of the tensor veli palatini muscle, resulting in functional eustachian tube obstruction. The need for attention to and the treatment of middle ear effusion in such patients is emphasized in light of other sensory deficits in this patient population.

In 120 ears of 67 children with a history of recurrent acute otitis media or otoscopic evidence of persistent middle ear effusion, or both, tympanograms were obtained using an otoadmittance meter and an electro-acoustic impedance bridge. Myringotomy was performed immediately following the tympanometric evaluation confirming the presence or absence of middle ear effusion. The comparison of myringotomy findings with a tympanometric pattern classification revealed 85.8% overall correct association with the presence or absence of a middle ear effusion for both instruments. In 83.3% of the cases, there was agreement in the classification of the tympanogram between the otoadmittance meter and the electro-acoustic bridge.

Patients with oral carcinomas often have resection of the tongue, the floor of the mouth, or the bone of the mandible. Postoperatively, these patients encounter chewing, swallowing, and speech problems. Oral rehabilitation through prosthetic management can aid in alleviating these problems. Designs of the prosthesis vary according to patient needs. A "snap-on" tongue prosthesis or palatal augmentation prosthesis can be constructed. Total glossectomy patients require prosthetic intervention on a mandibular framework. Partial glossectomy patients require prosthetic augmentation on a maxillary framework. Through prosthetic management of this type, articulation and resonance are improved, food is more easily directed into the esophagus, tissues are protected and socialization is enhanced through improved appearance.

The ventilatory function of the Eustachian tube was assessed in a group of infants and children with cleft palate, some of whom had received palatal repair. Those whose palates had been repaired were better able, in general, to equilibrate applied positive middle ear pressures than were those with open clefts. In many of the patients whose palates had been repaired, the results of Eustachian tube function studies were similar to those in normal subjects. Differences in Eustachian tube ventilatory function are assumed to be related to differences in tubal compliance. Excessive compliance probably results in, or exaggerates, functional Eustachian tube obstruction. Improvement in tubal function following palate repair is probably related to factors resulting in greater tubal stiffness.

A group of 12 children with acquired cholesteatoma had the ventilatory function of the Eustachian tube assessed by the inflation-deflation technique. All had varying degrees of functional rather than mechanical obstruction of the Eustachian tube. In these children, the pathogenesis of acquired cholesteatoma appeared to be the result of the following sequence of events: functional Eustachian tube obstruction, high negative middle ear pressure, atelectasis of the tympanic membrane-middle ear, a retraction pocket in either the posterosuperior or attic portion of the tympanic membrane, and adhesive otitis media. Tympanoplasty in these children was not successful. It is suggested that when the middle ear-mastoidectomy cavity is allowed to remain open, then the bony portion of the Eustachian tube should be surgically closed to prevent postoperative reflux of nasopharyngeal secretions.

Telescopic oral endoscopy is an effective aid in the construction and modification of a speech aid prosthesis. The method is noninvasive and easy to perform, permits the prosthodontist to achieve the goal of functional effectiveness in prosthesis construction while keeping the weight and size of the pharyngeal extension at a minimum, decreases the number and length of patient visits required for modification, and when coupled to a fiberoptic teaching arm or a video camera and recording system, it becomes an excellent aid in teaching, patient education and orientation, and record keeping.

Eustachian tube function was evaluated in 27 children (32 ears) with tympanostomy tubes at 6-week intervals for 12 to 30 months. Using a modified inflation-deflation test of passive and active ventilatory function, it was found that the ears had persistent functional obstruction. Most ears exhibited no significant change in tubal function throughout the observation period. There was no difference in the ventilatory function when the nasal airway was congested (other than due to purulent upper respiratory tract infection) and not congested. However, significant seasonal effects on Eustachian tube ventilatory function were recorded: function was poorer in the winter than in the summer. No relationship was found between Eustachian tube ventilatory function and the age of the child.