EPITOMES

sensori-neural or cochlear on the basis of the pure The Significance of Post-irradiation

tone audiogram. This, however, does not describe
the site of lesion other than to exclude middle or
outer ear involvement. Retrocochlear lesions may
occur at any point beyond the cochlea on the
auditory pathways such as the 8th nerve, brain
stem or auditory cortex. Various audiometric tests
have been designed to differentiate between these
pathologic conditions. Each presents a specific
listening task which increases in difficulty. Otol-
ogists and audiologists have been encouraged by
finding that there is a high correlation between
these clinical tests results and the medical-surgi-
cal findings. SEYMOUR J. BROCKMAN, MD
REFERENCES
Smith BB, Resnick DM: An auditory test for assessing brain
stem integrity. Preliminary report. Laryngoscope 82:414-424, Mar
1972
Berlin C: Dichotic speech perception. An interpretation of right
ear advantage and temporal offset effects. J Acoust Soc Am 53,
Mar 1973
Jerger J: Clinical experience with impedance audiometry. Arch
Otolaryngol 92:311-324, 1970
A Protocol for Evaluating Dizziness
A PROTOCOL has been established for the evalua-
tion of a dizzy patient when there is any suggestion
that the dizziness may be related to the inner ear.
This protocol includes hearing tests, vestibular
tests and x-rays of the inner ear. If these tests fail
to show an otologic reason for the dizziness, then
it is suggested that the patient have a five-hour
glucose tolerance test, thyroid studies, FTA/Abs
studies and, in some cases, an allergic evaluation.
These studies will often give a clue to a treatable
cause of dizziness. WILLIAM F. HOUSE, MD
REFERENCES
Sheehy JL: The neuro-otologic evaluation. Arch Otolaryngol 88:
592-597, 1968
Powers HP, House WF: The dizzy patient-allergic aspect.
Laryngoscope 79:1330-1339, 1969
Edema of the Larynx
VARIABLE DEGREES of laryngeal edema often ac-
company curative dose, full course radiation ther-
apy for cancer of the larynx. This edema usually
subsides within a month or two. However, persis-
tence of significant edema of the larynx beyond
six months after completion of radiation therapy
makes careful inspection and evaluation of the
larynx difficult. A thorough search for tumor in
such cases appears warranted. In 11 of our 14
most recent cases of "persistent edema," residual
or recurrence eventually was proved to be present.
The edema is believed to be secondary to in-
creased vascular permeability and obstruction of
the small veins and lymph channels from hyaline
degeneration of their walls. These radiation
changes facilitate the obstruction to the passage
of tumor cells through the lymphatic channels.
Less likely factors that may be responsible for
"persistent postradiation edema" are previous
laryngeal operation, infection, and perichondritis.
Keeping the delayed development of edematous
larynx under observation until tumor manifesta-
tions are clinically apparent diminishes the chance
for curative operation. Diligence is called for
when confronted with the diagnostic dilemma of
"delayed edema." When evaluating such a pa-
tient, repeated biopsy, then exploration via laryn-
gofissure are indicated in order to confirm the
high diagnostic probability of residual or recurrent
carcinoma.
PAUL H. WARD, MD
REFERENCES
Calcaterra TC, Stern F, Ward PH: Dilemma of delayed radia-
tion injury of the larynx. Ann Otol Rhinol Laryngol 81:501-507,
Aug 1972
Manara G: Histological changes of the human larynx irradiated
with various technical therapeutic methods. Arch Ital Otol 79:
596-635, 1968

ADVISORY PANEL TO THE SECTION ON OTOLARYNGOLOGY

HERBERT DEDO, MD, Chairman, San Francisco
RICHARD GOODE, MD
CMA Section on Otolaryngology
Chairman
Stanford University
WILLIAM SIMPSON, MD
CMA Section on Otolaryngology
Secretary
Los Angeles
MANSFIELD SMITH, MD
CMA Section on Otolaryngology
Assistant Secretary
San Jose
ROBERT ROWE, MD
Loma Linda University
F. BLAIR SIMMONS, MD FRANCIS A. Sooy, MD
Stanford University University of California, San Francisco
LESLIE BERNSTEIN, MD
ALDEN H. MILLER, MD
University of California, Davis University of Southern California
HOWARD HOUSE, MD Los Angeles
Los Angeles
SEYMOUR BROCKMAN, MD
ROBERT I. KOHUT, MD CMA Scientific Board
University of California, Irvine
California College of Medicine DALE TIPTON, MD
San Francisco
PAUL H. WARD, MD
University of California, Los Angeles MAURICE SCHIFF, MD
La Jolla
ALAN NAHUM, MD
University of California, San Diego

66 JANUARY 1974 * 120 * 1