Objectives: Determine the safety of ambulatory oropharyngeal surgery in adults with obstructive sleep apnea. Methods: Retrospective cohort study. Relevant data were collected from patients aged 18+ years with obstructive sleep apnea (OSA) receiving head and neck airway surgery between September 1, 2005, and September 15, 2012. Results: Out of 315 patients with complete data, 243 (77.14%) were managed as inpatients and 72 (22.86%) in an ambulatory manner. The mean Apnea/Hypopnea Index (AHI) for the inpatient and ambulatory groups were 35.99 and 18.43, respectively ( P <. 00). The mean body mass index (BMI) for the inpatient and ambulatory groups was 34.12 and 30.79, respectively ( P <. 0002). When calculating the incident risk ratio of changes in AHI or BMI, AHI exhibited a significantly increased contribution. There were no complications in the ambulatory cohort. Conclusions: When evaluating body habitus and polysomnographic data, OSA patients who underwent oropharyngeal procedures and were discharged on the same day were significantly different than those who were admitted to the hospital. It appears from this data that patients with mild‐moderate sleep apnea, even for patients with mild obesity, are safe to have these procedures performed in an ambulatory setting. This data could potentially assist practitioners in determining which procedures could be safely planned for an ambulatory setting and therefore decrease health care expenditures and patient inconvenience while maintaining patient safety. Future studies investigating what, if any, inpatient interventions were provided for those patients that were admitted to the hospital could potentially further expand the group of patient who could be safely managed in an ambulatory setting.

OBJECTIVES/HYPOTHESIS:Preoperative assessment is intended to identify anesthetic risk and a patient's appropriateness to undergo a proposed surgery. The timing of these assessments varies among institutions. In our ambulatory surgery center, preoperative reassessments were initially performed within 30 days of surgery (group A). Recently, this changed to require reassessments within 7 days of surgery (group B). Now, the policy mandates a preoperative reassessment within 24 hours (group C). We evaluate whether there are differences in surgical cancellations based on these new reassessment intervals. STUDY DESIGN:Retrospective operative log and chart review. METHODS:We identified 1,108 cases representative of group A. The rate of surgical cancellations for this group was compared with that of the 3,705 cases in group B and the 1,060 cases in group C. Differences were evaluated with a chi test. RESULTS:Total cancellation rates for groups A, B, and C were 3.0%, 3.3%, and 3.9%, respectively (P = .51). Cancellations secondary to a history and physical examination findings during these preoperative reassessment periods were 0.81%, 0.38%, and 0.66% for groups A, B, and C, respectively (P = .15). CONCLUSIONS:Cancellation rates for patients undergoing ambulatory otolaryngic surgery based on preoperative reassessment intervals of 30 days, 7 days, and 24 hours were similar.

Background The aim of this study was to determine the incidence and perioperative management of patients with cerebrospinal fluid (CSF) fistulas during endoscopic sinus surgery (ESS) in New York State. Methods A questionnaire was mailed to otolaryngologists in New York State who were registered with the American Academy of Otolaryngology, Head and Neck Surgery in November 2005. Questions addressed the incidence and perioperative care of patients with successful closure of unexpected CSF fistula during ESS. Results Twenty-five percent of respondents have experienced at least one episode of unexpected CSF fistula during ESS over the prior 5 years, with a calculated incidence of 0.16%. Surgeons most often (46%) observed patients for 1–2 days. Antibiotics were used in 93% of patients. A lumbar drain was most commonly not used. Repair techniques most often used an intranasal flap or graft (92%). Conclusion The incidence of unexpected CSF fistula during ESS may be lower than previously reported. A majority of surgeons use an intranasal flap or graft in repair with antibiotic use, with no consensus regarding use of lumbar drain or inpatient observation. More study is needed to determine consensus algorithms for management of CSF leaks during ESS.

trephine during ESS. 2. To compare different populations and genders. METHODS: One hundred and sixty-eight random CT scans of paranasal sinuses from patients seen in the Hospital de Clı́nicas de Porto Alegre (Brazil) and at UPMC-Shadyside Hospital of Pittsburgh (USA) were reviewed. Scans were analyzed in the axial plane. RESULTS: Of the total of 168 patients, 87 were male (51.7%) and 81 were female (48.3%). Using both frontal sinuses from each patient, this yielded a total of 336 measurements for each point. When data from the American and Brazilian subjects were analyzed collectively, males had a significantly larger frontal sinus than females at all measurement points (p 0.001). The frontal sinus depth of the Brazilian patients (males and females grouped) was significantly larger than the American subjects at 5mm [p 0.001; mean (M) 12.22, standard deviation (SD) 4.35 vs. M10.34, SD 5.29] and at 10mm (p 0.05 M11.78, SD4.65 vs. M10.52, SD5.71). At 15mm there was no statistically significant difference. CONCLUSIONS: Provided that the intersinus septum is in the midline and the frontal sinus is well developed laterally, the sinus can usually be trephinated at 5mm, 10mm, or 15mm from the midline. All patients who had a frontal sinus with less than 7mm of depth at the trephine site were female. Because some frontal sinus trephine sets extend beyond 7mm, care should be taken to review the axial CT scans or image guidance data, particularly in women, if this procedure is contemplated.

Otolaryngology–Head and Neck SurgeryVolume 134, Issue 2 p. 348-350 Case Report Supraglottic Myxedema Presenting as Acute Upper Airway Obstruction Dr. Rami K. Batniji MD, Corresponding Author Dr. Rami K. Batniji MD [email protected] Division of Otolaryngology–Head and Neck Surgery, Albany Medical Center Albany, Albany, New YorkReprint requests: Rami K. Batniji, MD, Division of Otolaryngology–Head and Neck Surgery, Albany Medical Center, 47 New Scotland Ave, MC-41, Albany, NY 12208. E-mail address: [email protected].Search for more papers by this authorDr. Henry F. Butehorn III MD, Dr. Henry F. Butehorn III MD Division of Otolaryngology–Head and Neck Surgery, Albany Medical Center Albany, Albany, New YorkSearch for more papers by this authorDr. John J. Cevera MD, Dr. John J. Cevera MD Capital Region Otolaryngology–Head and Neck Group, Albany, New YorkSearch for more papers by this authorDr. John P. Gavin MD, Dr. John P. Gavin MD Division of Otolaryngology–Head and Neck Surgery, Albany Medical Center Albany, Albany, New YorkSearch for more papers by this authorDr. Peter E. Seymour MD, Dr. Peter E. Seymour MD Division of Otolaryngology–Head and Neck Surgery, Albany Medical Center Albany, Albany, New YorkSearch for more papers by this authorDr. Steven M. Parnes MD, Dr. Steven M. Parnes MD Division of Otolaryngology–Head and Neck Surgery, Albany Medical Center Albany, Albany, New YorkSearch for more papers by this author Dr. Rami K. Batniji MD, Corresponding Author Dr. Rami K. Batniji MD [email protected] Division of Otolaryngology–Head and Neck Surgery, Albany Medical Center Albany, Albany, New YorkReprint requests: Rami K. Batniji, MD, Division of Otolaryngology–Head and Neck Surgery, Albany Medical Center, 47 New Scotland Ave, MC-41, Albany, NY 12208. E-mail address: [email protected].Search for more papers by this authorDr. Henry F. Butehorn III MD, Dr. Henry F. Butehorn III MD Division of Otolaryngology–Head and Neck Surgery, Albany Medical Center Albany, Albany, New YorkSearch for more papers by this authorDr. John J. Cevera MD, Dr. John J. Cevera MD Capital Region Otolaryngology–Head and Neck Group, Albany, New YorkSearch for more papers by this authorDr. John P. Gavin MD, Dr. John P. Gavin MD Division of Otolaryngology–Head and Neck Surgery, Albany Medical Center Albany, Albany, New YorkSearch for more papers by this authorDr. Peter E. Seymour MD, Dr. Peter E. Seymour MD Division of Otolaryngology–Head and Neck Surgery, Albany Medical Center Albany, Albany, New YorkSearch for more papers by this authorDr. Steven M. Parnes MD, Dr. Steven M. Parnes MD Division of Otolaryngology–Head and Neck Surgery, Albany Medical Center Albany, Albany, New YorkSearch for more papers by this author First published: 17 May 2016 https://doi.org/10.1016/j.otohns.2005.03.069Citations: 1 Presented as a poster at the Meeting of the Western Section of The Triological Society, Indian Wells, CA, Feb 1, 2003. Read the full textAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1Gupta OP, Bhatia PL, Agarwal MK, et al. Nasal, pharyngeal, and laryngeal manifestations of hypothyroidism. ENT J 1977; 56: 10–22 2Bicknell PG. Mild hypothyroidism and its effects on the larynx. J Laryngol Otol 1973; 87: 123–7 3Parving HH, Mansen JM, Nielson SL, et al. Mechanisms of edema formation in myxedema-increased protein extavasation and relative slow lymphatic drainage. New Engl J Med 1979; 301: 460–6 4Altman KW, Haines GK, Vakkalanka SK, et al. Identification of thyroid hormone receptors in the human larynx. Laryngoscope 2003; 113: 1931–4 5Stahl N, Leiberman A. Acute upper airway obstruction due to myxedema and upper airway abnormalities. J Laryngol Otol 1988; 102: 733–4 Volume134, Issue2February 2006Pages 348-350 ReferencesRelatedInformation

Otolaryngology–Head and Neck SurgeryVolume 129, Issue 2 p. P115-P115 Tuesday, September 23, 2003, Room OCCC 106 Session Category: Session C: Rhinology, Laryngology, and Upper Aerodigestive Tract 9:00 am The Effect of Montelukast on Nasal Polyposis Jacquelynne Corey MD, Jacquelynne Corey MDSearch for more papers by this authorBoyd Gillespie MD, Boyd Gillespie MDSearch for more papers by this authorAlbert Merati (moderators) MD, Albert Merati (moderators) MDSearch for more papers by this authorSiobhan Kuhar (presenter) MD PhD, Siobhan Kuhar (presenter) MD PhD Albany, NYSearch for more papers by this authorHannah Vargas MD, Hannah Vargas MD Albany, NYSearch for more papers by this authorSteven M Parnes MD, Steven M Parnes MD Albany, NYSearch for more papers by this author Jacquelynne Corey MD, Jacquelynne Corey MDSearch for more papers by this authorBoyd Gillespie MD, Boyd Gillespie MDSearch for more papers by this authorAlbert Merati (moderators) MD, Albert Merati (moderators) MDSearch for more papers by this authorSiobhan Kuhar (presenter) MD PhD, Siobhan Kuhar (presenter) MD PhD Albany, NYSearch for more papers by this authorHannah Vargas MD, Hannah Vargas MD Albany, NYSearch for more papers by this authorSteven M Parnes MD, Steven M Parnes MD Albany, NYSearch for more papers by this author First published: 17 May 2016 https://doi.org/10.1016/S0194-59980300992-6Read the full textAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume129, Issue2August 2003Pages P115-P115 RelatedInformation

Leukotrienes are inflammatory mediators that are known as the slow-reacting substance of anaphylaxis produced by a number of cell types including mast cells, eosinophils, basophils, macrophages, and monocytes. Synthesis of these mediators results from the cleavage of arachidonic acid in cell membranes, and they exert their biologic effects by binding and activating specific adaptors. This occurs in a series of events that lead to contraction of the human airway smooth muscle, chemotaxis, and increased vascular permeability. These effects have led to their important role in the diseases of asthma, allergic rhinitis, and possible paranasal sinusitis with the formation of nasal polyps. Because these agents lead to the production of symptoms in patients that are asthmatic, the use of leukotriene enzyme inhibitors, particularly montelukast, and zafirlukasts seem appropriate. These classes of drugs can block the binding of leukotrienes to CysLT(1) receptors. Zileuton is a 5-lipoxygenase inhibitor that prevents the formation of leukotrienes and can also result in the prevention of leukotriene activity. Demonstrated efficacy in these patients in a number of studies has also suggested their role in inhibiting nasal symptoms in asthmatic patients. In addition, it has been suggested by serendipitous observations that many of the aspirin-intolerant patients have nasal polyps and that treatment with the leukotriene inhibitors has resulted in improvement and resolution of the polyps. Therefore, these agents may also play a role in patients afflicted with chronic sinusitis with concomitant nasal polyposis. These papers are discussed in detail because this form of therapy may represent a novel way to treat patients with this malady in addition to or in lieu of surgical treatment and steroid therapy.

Leukotrienes have been known in the field of immunology since the 1930s. At that time they were referred to as the slow reacting substance of anaphylaxis. They were not, however, characterized until the 1980s, when they were noted to be formed during the breakdown of arachidonic acid by the enzyme 5-lipoxygenase. The leukotrienes consist of leukotriene (LT) A4, LTB4, LTC4, LTD4 and LTE4, so named because the molecule was originally isolated from leukocytes and therefore its carbon backbone contains three double bonds in series, which constitutes a trion. This structural information provided the key to the oxidative pathway of lipometabolism, known as the 5-lipoxygenase. Leukotrienes are classified as inflammatory mediators, and therefore they are produced by a number of cell types, particularly mast cells, eosinophils, basophils, macrophages and monocytes. With the identification of asthma, allergic rhinitis and paranasal sinusitis associated with inflammatory pathways, the leukotrienes have been implicated in the pathogenesis of these conditions and have become targets for therapeutic modulation. Leukotriene synthesis inhibitors have been used successfully in the treatment of patients with asthma where they have demonstrated the ability to induce bronchial dilatation, provide protection against broncho-provocation tests and significantly diminish symptoms. When it was serendipitously noted that patients who had concomitant nasal pathology also showed improvement, leukotriene synthesis inhibitors were used as adjuvant therapy in the management of patients with rhinitis, sinusitis and nasal polyposis. Preliminary studies have demonstrated improvements in nasal airflow and reduced recurrence of nasal polyps as noted by endoscopy and imaging studies. Leukotriene synthesis inhibitors therefore appear to be a novel treatment modality for patients with rhinitis, sinusitis and nasal polyps when used as adjunctive therapy.

Posttransplant lymphoproliferative disorder (PTLD) is a serious complication of organ transplantation. Although the precise etiology is unknown, the Epstein-Barr virus and immunosuppressive agents appear to be risk factors. The presentation PTLD is diverse, including many patients with symptoms of the head and neck, which may make diagnosis difficult. We present a patient who had undergone renal transplantation referred for recurrent sinusitis. She was found to have PTLD of the nasopharynx. Three cases of head and neck PTLD treated at our institution are described. Although PTLD is uncommon in the general community, the incidence has continued to increase as more patients undergo transplants and clinical presentations of PTLD should be familiar to the otolaryngologist.

OBJECTIVE:To characterize the clinicopathologic features of head and neck follicular dendritic cell (FDC) tumor and report the experience of this entity at our institution.STUDY DESIGN:Two case presentations are compared with a retrospective analysis of all published head and neck cases.SETTING:A tertiary academic medical center.RESULTS:Thirty four cases of FDC tumor of the head and neck cases have been published. Twenty five occurred in the cervical lymph nodes, 4 in the tonsils, 2 in the palate, 1 in the pharynx, 1 in the parapharyngeal region, and 1 in the thyroid gland. Patient ages ranged from 13 to 73 years (mean, 38), and there was a roughly equal number of men and women. Patients were treated with surgery (17), surgery and chemotherapy (8), and surgery and radiation (9). After the primary treatment, 12 patients had no evidence of disease, whereas 5 were incurable. Ten tumors recurred locally and 3 distally. Of these 13 patients who suffered recurrences, 4 had no evidence of disease after secondary treatment, 6 were alive with disease, and one was lost to follow up. Two patients died after recurrence. We add 2 unique cases to the 9 previously reported extranodal cases, 1 in the tonsil and 1 in the parotid gland.CONCLUSION:FDC tumor is a rare malignant neoplasm that can present in the head and neck region in both lymph nodes and extranodal sites. Because of their rarity, these tumors are probably underrecognized by both clinicians and pathologists. Distinct light microscopic, immunohistochemical, and ultrastructural features do exist, however, and are reviewed. Surgery has been the mainstay of treatment and should include diligent control of surgical margins. The role of adjuvant therapy remains controversial. Although originally considered to be a low-grade malignancy, our review suggests both high recurrence rates and metastatic potential. We believe that FDC tumor should be viewed and treated as a moderately aggressive head and neck tumor.

Leukotrienes are slow-reacting inflammatory mediators that appear during anaphylaxis. They are produced by a number of cell types, including mast cells, eosinophils, basophils, macrophages, and monocytes. Synthesis of these mediators results from the cleavage of arachidonic acid in cell membranes, thereby binding and activating specific adaptors. This occurs in a series of events that lead to contraction of the human airway smooth muscle, chemotaxis, and increased vascular permeability. These effects occur in asthma, allergic rhinitis, and possibly paranasal sinusitis with the formation of nasal polyps. Since these agents lead to the production of symptoms in patients who are asthmatic, the use of leukotriene enzyme inhibitors, particularly montelukasts and zafirlukasts, seems appropriate.

Recently, leukotrienes have been implicated in the mediation of bronchoconstriction and inflammatory changes in asthma. Leukotriene levels have also been shown to be elevated in patients with asthma as well as in those with sinonasal polyposis and sinusitis. The leukotriene synthesis inhibitor zileuton and the leukotriene receptor antagonist zafirlukast have been shown to produce subjective and objective improvements in patients with mild to moderate asthma. Given these findings, we evaluated the efficacy of these two medications in controlling sinonasal polyposis and their associated symptoms. We treated 40 patients diagnosed with sinonasal polyposis and sinusitis with either zileuton or zafirlukast. No other change was made in their standard therapy. Outcome measures included subjective interviews and questionnaire responses, as well as office endoscopic examinations and chart reviews. At study's end, 36 patients were available for evaluation. Twenty-six had taken zafirlukast, five had taken zileuton, and five others had switched from zafirlukast to zileuton. Overall, 26 patients (72%) experienced subjective improvement in their symptomatology after starting their medication. Statistically significant improvement was noted with respect to headache, facial pain and pressure, ear discomfort, dentalgia, purulent nasal discharge, postnasal drip, nasal congestion and obstruction, olfaction, and fever. An objective alleviation, or at least stabilization, of sinonasal polyposis was seen in 50% of the patients. Four patients (11%) discontinued their medication because of side effects. We conclude that antileukotrienes might play a significant role in controlling polyposis and symptoms secondary to sinonasal disease, and they might be a viable alternative to long-term oral steroid therapy and repeated surgical debridement.

OBJECTIVE To report our experience in treating 4 cases of recurrent siacloceles with botulinum toxin type A after partoid surgery. DESIGN This is a prospective, nonrandomized, nonblinded pilot study describing a new use for botulinum toxin type A. SETTING Tertiary academic medical center. PATIENTS Four patients (2 men and 2 women) with persistent postparotidectomy sialoceles who had undergone various treatment failures were included. The diagnosis was made by fine-needle aspiration of the mass based on well-recognized cytologic features of the entity, as well as an elevated amylase level and no evidence of tumor or infection. INTERVENTIONS Sialoceles were aspirated before local injection of botulinum toxin type A (30-50 U) subcutaneously. MAIN OUTCOME MEASURES The patients were followed up 1 week after receiving botulinum toxin type A injection and then at monthly intervals. They were extensively questioned and examined for any evidence of side effects or recurrence. RESULTS All patients had total resolution of sialocele or external salivary fistula within 1 month of treatment. None of the patients to date have demonstrated recurrences at 7 through 13 months, and there were no complications, particularly facial nerve weakness. CONCLUSION Our findings suggested that botulinum toxin type A offers a highly effective, safe, and noninvasive method of treatment in postparotidectomy sialocele.

Complete and acute unilateral deafferentation of the auditory periphery (auditory and vestibular afferents) can induce changes in the central nervous system that may result in unique forms of tinnitus. These tinnitus perceptions can be controlled (turned on and off) or modulated (changed in pitch or loudness) by performing certain overt behaviors in other sensory/motor systems. Clinical reports from our laboratory and several other independent sources indicate that static change in eye gaze, from a neutral head-referenced position, is one such behavior that can evoke, modulate and/or suppress these phantom auditory events. This report deals with a new clinical entity and a form of tinnitus that can be evoked directly by cutaneous stimulation of the upper hand and fingertip regions. In 2 adults, cutaneous-evoked tinnitus was reported following neurosurgery for space-occupying lesions at the base of the skull and posterior craniofossa, where hearing and vestibular functions were lost completely and acutely in one ear (unilateral deafferentation) and facial nerve paralysis (unilateral deefferentation) was present either immediately following neurosurgery or had occurred as a delayed-onset event. Herein, we focus on the phenomenology of this discovery, provide perceptual correlates using contemporary psychophysical methods and document in one individual cutaneous-evoked tinnitus-related neural activity using functional magnetic resonance imaging. In a companion paper, neuroanatomical and physiological interactions between auditory and somatosensory systems, possible mechanistic accounts and relevant functional neuroimaging studies are reviewed.

Cutaneous-evoked tinnitus is a clinical entity that has not been reported previously in the neurootological literature. Herein, a neuroscience framework that encompasses several distinct areas of research is used to conceptualize and help understand this phenomenon. We review normal neuroanatomical and physiological interactions between auditory and somatosensory systems in mammals. Also considered are mechanistic accounts of lesion-induced changes in the CNS following deafferentation/deefferentation of peripheral sensory or motor structures that may have a relationship to this phenomenon, as well as the role of functional imaging modalities in studying various phantom perceptions.

Asbestos is a considerable health hazard, and evidence from recent cohort and case-control epidemiologic studies continues to demonstrate the increased risk for pulmonary disease in occupations that handle asbestos. Laryngeal cancer has been noted in some studies, but the level of risk for this condition is lower than that for pulmonary tumors. The mechanism for carcinogenesis probably operates at the gene level but may also be mediated through various other avenues. Asbestos and cigarette smoke clearly have a synergistic effect; therefore, surveillance programs seem to be most appropriate in persons who smoke and have occupations with high levels of exposure to asbestos. The evidence at this time neither supports chemopreventive programs nor mandates head and neck surveillance programs in this population of workers, however.

The current management in tinnitus of sensorineural origin is reviewed. Epidemiological data demonstrates that 90% of patients with hearing loss experience some tinnitus. Approximately 1% of the population suffer from a chronic tinnitus that causes severe distress and requires some type of management intervention. Present non-surgical therapies include masking techniques, psychological counseling, and biofeedback. There are also a number of drugs that have been applied, the most common being antidepressants. These have had the most success in managing patients with tinnitus, although it is currently felt that antidepressants treat underlying psychological problems rather than directly affect the tinnitus. The other large class of drugs include benzodiazopans, in addition to a new synthetic analog of a natural prostaglandin E1, misoprostol. Despite the many drugs now available,none has been approved by the United States Food and Drug Administration for the treatment of tinnitus. Many surgical therapies have been advocated but are directed towards the treatment of concurrent vertigo or for tumors of the cerebellopontine angle, with tinnitus sometimes being relieved by the operation. Specific surgical procedures such as cochlear resection and microvascular decompressions lack clear-cut efficacy. Despite author bias and a myriad of treatment modalities at present, there is still no specific therapy that definitively relieves tinnitus clinically.

Sudden hearing loss (SHL) is a controversial topic for which no definitive practical guidelines exist. Studies employing vasodilators, plasma expanders, anticoagulants, and carbogen inhalations have shown no improvement over the rate of spontaneous recovery. At present, there is insufficient evidence to support medical treatment for SHL, except steroid therapy in selected patients. Distortion product otoacoustic emissions (DPOAEs) are sensitive to cochlear disorders and are absent in ischemic injury to the cochlea, but can persist in cochlear neuritis. In a prospective study of 10 patients who presented to Albany Medical Center from 1995 to 1996, three patients with intact DPOAEs at presentation had an average improvement of 33 dB in the pure‐tone average (PTA) of 0.5, 1.0, and 2.0 kHz with steroid therapy, whereas five of seven patients with absent DPOAEs had no improvement in hearing despite steroid therapy in six patients. The presence of DPOAEs may be a useful prognostic factor that positively correlates with recovery from SHL.

Many surgeons find that patients have increased morbidity after supraglottic laryngectomy if postoperative irradiation is given, but this remains poorly documented. Twenty-nine patients undergoing supraglottic laryngectomy were retrospectively reviewed. Seventeen received postoperative radiotherapy, and 12 did not. The mean follow-up was 64 months. When compared to patients treated with supraglottic laryngectomy alone, irradiated patients had a significantly higher incidence of lifelong gastrostomy dependency (35% versus 0%; p = .03) and acute upper airway obstruction (29% versus 0%; p = .05). There was a trend toward greater tracheotomy dependency (24% versus 0%), aspiration pneumonia (35% versus 9%), and delayed independent swallowing (34.8 weeks versus 7.8 weeks) in the patients treated with combined therapy, but this difference was not significant. A morbidity index score was developed to evaluate the overall lifelong morbidity of these patients, and this was found to be significantly higher in patients treated with surgery and radiotherapy (2.29 versus 0.83; p = .04). Overall survival was equal in both groups. We have shown that radiotherapy increases the morbidity of supraglottic laryngectomy. This should be considered when planning treatment for patients with supraglottic carcinoma.