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• We have studied the prevalence of mental disorder in a variety of patients with head and neck cancer in different stages of disease and treatment. Altogether, 59 patients were studied according to a comprehensive psychopathologic rating score and nutritional status. Six patients refused to answer the comprehensive psychopathologic rating score questionnaire. Of the remaining 53 patients, 13 patients were classified as mentally disordered. Five patients were classified as mentally depressed according to a specific comprehensive psychopathologic rating scale depression score. We found that depression was significantly linked to malnutrition. In total, 30% of our patients with cancer with weight loss demonstrated features that were consonant with depression. This suggests that mental depression is associated with physical impoverishment rather than with the malignant condition per se.(Arch Otolaryngol Head Neck Surg 1988;114:1449-1453)

OBJECTIVE: To evaluate the possible causal role of pathologic hemostatic mechanisms in sudden hearing loss. DESIGN: The study was prospective. SETTING: The patients were hospitalized, and all tests were performed at the hospital. PATIENTS: Thirty-two consecutive patients with sudden hearing loss participated, as well as a control group of 28 healthy individuals. The control group was matched with regard to body mass index. MAIN OUTCOME MEASURES: Venous blood analyses were made regarding general blood parameters, as well as specific hemostatic parameters. RESULTS: Twenty-five of the patients had some kind of aberration of specific hemostasis parameters; seven patients had an increase in the activity of the plasminogen activator inhibitor 1 (ie, a glycoprotein associated with diminished fibrinolysis) compared with that in the control group (P<.05). Increased plasminogen activator inhibitor levels were most frequently observed among the patients who were overweight. Seven of the oldest patients had an increase of D-dimers, ie, a degradation product of fibrin, and most of these patients had a history of cardiovascular disease. CONCLUSION: Although isolated aberrations in the hemostatic pathway were observed, we concluded that pathologic hemostasis does not seem to have a decisive importance for the pathogenesis of sudden deafness.(Arch Otolaryngol Head Neck Surg. 1994;120:536-540)

• Using light microscopy, we studied the morphologic events of cholesteatoma progression 8 months after ligation of the ear canal in 14 Mongolian gerbils. Although we observed a wide range of progression, four stages of morphologic development could be clearly distinguished among the 28 specimens: stage I, an orthokeratotic plug in the ear canal without tympanic membrane involvement; stage II, partial retraction of the tympanic membrane; stage III, the interface between cholesteatoma encapsulated within the tympanic membrane and mucosal membranes covering the promontorial wall of the middle-ear cavity was characterized by a buildup of granulation tissue with prominent macrophage infiltration; and stage IV, bone destruction. Chronic inflammation was observed in some but not all stage II to IV cases. Our results indicate that hyperkeratosis is a primary event in cholesteatoma development, that the development of the granulation tissue with activated macrophages may be responsible for the bone destruction, and that acute or chronic inflammation is not a prerequisite for the development of cholesteatoma or the bone resorptive process.(Arch Otolaryngol Head Neck Surg. 1993;119:272-275)

• There is evidence that selenium and zinc are involved in malignant neoplasia. The exact role of these trace elements, however, is not completely understood. For this reason, we studied circulating levels of selenium and zinc in relation to food intake and nutritional status in 14 patients with head and neck cancer. Six patients without cancer served as controls. The patients with cancer were in different stages of disease. They were untreated or in an initial phase of oncologic treatment. Five of these patients were severely cachectic according to weight loss and nutritional status, which included body mass index, anthropometric values, and serum albumin level. These patients also demonstrated decreased circulating levels of selenium and zinc. Plasma glutathione peroxidase (selenium-dependent enzyme) activity, however, was not significantly different when the cachectic patients with cancer were compared with controls. We found that the plasma selenium level was positively correlated to both short-term and long-term selenium intake when all 20 patients were accounted for. However, no significant correlation could be shown between plasma selenium and serum albumin levels. Although only one patient demonstrated a plasma value below the reference value, serum zinc was positively correlated to the serum albumin level. We conclude that plasma selenium concentrations are essentially related to food intake but not necessarily to weight loss. Low circulating levels of zinc are, rather, associated with the catabolic state of the patient with cancer.(Arch Otolaryngol Head Neck Surg. 1989;115:1079-1082)

• Twenty-eight consecutive patients with acute unilateral facial palsy were examined with special reference to clinical signs of central nervous system involvement. The clinical investigation in the acute stage of the disease showed that only seven patients had solitary facial nerve dysfunction, while the remaining patients had evidence of more widespread disease involvement. The most frequent finding was a trigeminal dysfunction of the paretic side, as shown by paresthesia and sensibility disturbance corresponding to the sensoritrigeminal area, as well as a dysfunction of the trigeminal component of the corneal reflex of the paretic side. Three patients showed migrating symptoms that were suggestive of a brain-stem disorder. In addition, four patients had an optic neuropathy, while an abnormal brain-stem audiometry response was demonstrated in five patients. The outcome of acute facial palsy one to two years after onset, however, could not be predicted from the clinical central nervous system signs. The degree of the palsy in the acute stage of the disease still seemed to be one of the most important prognostic factors. It is concluded that acute facial palsy is not a single entity, but rather a feature of different neurologic conditions.(Arch Otolaryngol Head Neck Surg 1987;113:516-520)

• The possible association of some viral infections with the onset of Bell's palsy was examined in a study of 142 patients. The number of probable recent viral infections, as judged by increase in antibody titers or presence of IgM antibodies, did not differ statistically from that found in a sex- and age-matched control group. However, a higher prevalence of herpes simplex virus (HSV) antibodies was found in the patient group with both a complement-fixation (CF) test and a radioimmunoassay (RIA). Moreover, titers of HSV CF antibodies and antibodies against HSV envelope antigens (RIA) were higher in the patient group. The possibility of reactivated HSV infection and transient demyelination of the facial nerve being causatively associated with Bell's palsy is discussed.(Arch Otolaryngol 107:79-81, 1981)

• The present study evaluates the energy and skeletal muscle metabolism in malnourished patients, with and without cancer, in response to nutrition. The energy balance was positive in all patients receiving nutritional support. This led to an increase in body weight and body potassium levels. Glucose turnover increased in all patients. In patients with cancer, elevated glucose turnover reflected increased utilization of glucose preferentially for synthetic pathways rather than for oxidation. Protein synthesis and RNA content in skeletal muscles increased during nutrition. Nutritional support improved energy balance and protein synthesis capacity in skeletal muscles in patients with cancer to the same extent as in malnourished patients without cancer. Malignant cachexia seems to be a consequence of a relative lack of energy and not of impaired energy utilization in host tissues, at least early in the disease.(Arch Otolaryngol 1982;108:697-699)

• A case of mucosal melanoma involved the bronchus, maxillary sinus, and small intestine. Treatment with a combination of autologous tumor cells, BCG vaccine, and cytarabine was given, and the immunological system was investigated regularly. After each treatment episode, there was a transient improvement of the cell-mediated immunity to melanoma antigens. The cutaneous delayed hypersensitivity reaction to PPD was converted to a permanently positive one. In the final stage of the disease, the number of T cells was decreased. Difficulty occurred in interpreting the immunological findings according to the clinical condition.(Arch Otolaryngol 105:48-50, 1979)

• The influence of a paper prosthesis on healing in acute traumatic tympanic membrane perforations was studied in 60 patients randomly selected for a treatment group or a control group. The majority (42 [70%]) were seen within two days. All patients were treated with oral antibiotics for ten days. The overall healing rate two months after the trauma was 94% (37 of 39 patients). No significant difference between the study group and the control patients was observed. Intermittent secretion was seen in six patients but did not influence the outcome. The perforations occurred in patients with normally sized mastoid air cell systems as seen on roentgenograms. We conclude that acute traumatic tympanic membrane perforations do not need to be treated routinely with paper patching.(Arch Otolaryngol Head Neck Surg 1987;113:1285-1287)

In Reply.—We regret that our article, which was a summary of recent and unpublished work from our laboratory, did not give the complete information under the "Patients" section that our control group was matched according to physical activity, age, and malnutrition. Therefore, we hereby want to add the information that our patients with and without cancer had lost similar amounts of weight and that the groups had a comparable degree of malnutrition assessed by conventional means, eg, body weight, actual to ideal weight, triceps skinfold, midarm circumference, serum albumin concentration, and total body potassium. However, it may well be that the patients with cancer were slightly more protein malnourished and their conditions were evaluated from lower serum albumin concentrations. The patients with cancer who received enteral nutrition were also essentially comparable with the patients with cancer receiving parenteral nutrition. However, the groups were too small to allow meaningful comparison between the