The Usefulness of the RPR-Reply

Abstract

issue of JAMA, a question regarding management of Frey's syndrome was posed.1 Additional means for treatment of the symptomatic patient include topical scopolamine cream (0.1%), commercial antiperspirants, and tympanic neurectomy.2 Antiperspirants are of only occasional value, and scopolamine cream usually affords but temporary relief because the sweat glands become refractory. Tympanic neurectomy is indicated when the gustatory sweating is severe enough to embarrass the patient.Tympanic neurectomy involves elevation of the tympanic membrane (eardrum), in order to expose the mucosa of the middle ear. Along the medial surface of the middle ear are found the autonomic secretomotor nerve fibers that normally regulate salivary secretion of the parotid gland and are responsible for gustatory sweating following parotidectomy. These fibers are disrupted, and the tympanic membrane is returned to its original position. Abolition of symptoms is usually immediate and complete following surgery. Complications are uncommon in skilled hands.