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