bluuebunny/crossref_metadata_2025 huggingface dataset:
Osteoclast-Like Giant-Cell Tumor of the Parotid with Salivary Duct Carcinoma: Case Report and Cytologic, Histologic, and Immunohistochemical Findings
Authors: Kadivar Maryam , Nilipour Yalda , Sadeghipour Alireza
Published: May 2019

Primary giant-cell tumor of the salivary gland is a rare lesion with an incompletely characterized histogenesis. To the best of our knowledge, only 16 cases have been previously documented in the English-language literature. We report a new case, which occurred in a 75-year-old man who presented with a parotid mass and cervical lymphadenopathy. The patient underwent a left total parotidectomy and cervical lymph node dissection. As far as we know, ours is the only reported case of a primary giant-cell tumor of the salivary gland in which the patient presented with lymph node metastasis. Because so little is known about giant-cell tumor of the salivary gland, we use the occasion of this case report to describe the cytologic, histologic, and immunohistochemical characteristics that we observed.
Is IV Access Necessary for Myringotomy with Tubes?
Authors: Allen Arthur H.
Published: May 2019

A retrospective chart review was conducted at a community-based hospital to determine whether intravenous access is necessary during the performance of myringotomy with tube insertion. The study included 50 pediatric patients divided equally into 2 groups: group 1, who did not have intravenous access established before the procedure, and group 2, who did have intravenous access established. To be enrolled, patients in both groups had to be ≤12 years of age, have an American Society of Anesthesiologists physical status classification of P1 or P2, and had to have undergone no adjunctive procedure with the myringotomy. Induction time was significantly shorter in group 1 (average: 6.96 ± 2.72 minutes) than in group 2 (average: 9.80 ± 3.82 minutes; p = 0.004). Operating time and total operating room time were not significantly different between the two groups. Additionally, 24 of 25 patients in group 1 had their pain managed with acetaminophen or no medication at all, while 9 of 25 group 2 patients received acetaminophen and 13 received intravenous pain medication. Interestingly, no patients in group 1 required antiemetics, whereas 4 patients in group 2, who were given intravenous or intramuscular narcotics, received antiemetic medications. These findings indicate that myringotomy with tube insertion can be safely accomplished without establishing intravenous access. Induction times and time under general anesthesia were significantly increased when intravenous access was obtained. The findings also suggest that acetaminophen provides adequate postoperative pain control in this patient population and that the use of intravenous or intramuscular narcotics increases the risk of postoperative nausea.
Nodular Fasciitis of the Nasal Cavity: A Case Report
Authors: Mullin David , Lindsay Fred W. , Keefe Michael A.
Published: May 2019

Nodular fasciitis is an uncommon tumor-like fibroblastic proliferation of the head and neck that is difficult to differentiate from its more malignant counterparts. Despite modern advances, making this distinction is challenging because the clinical presentation is nonspecific and the histologic and radiologic features are variable. Once nodular fasciitis is diagnosed, the primary treatment is conservative resection and observation. We describe a case of nodular fasciitis of the nasal cavity in a 43-year-old woman. To the best of our knowledge, this is only the second reported case of nodular fasciitis arising in the nasal cavity, and the first such case in an adult.
Chondrosarcoma of the Arytenoid Cartilage: A Case Report and Review of the Literature
Authors: Lee Stella , Sparano Anthony , Zhang Paul , Mirza Natasha
Published: May 2019

We report the case of a 56-year-old black woman with a locally aggressive chondrosarcoma at an unusual tumor site: the right arytenoid cartilage. The tumor extended from the superior pole of the right arytenoid cartilage to the soft-tissue areas of the right aiyepiglottic fold, piriform sinus, and interarytenoid area. We undertook a conservative surgical approach by performing an endoscopic transoral CO2 laser resection, a right arytenoidectomy with wide soft-tissue margins, and a tracheotomy in anticipation of postoperative edema. Surgical exploration revealed that the tumor extended into the cricoid cartilage. Histopathology demonstrated a low-grade chondrosarcoma of the conventional variant. Clear margins were obtained by staged procedures. Chondrosarcomas of the larynx typically exhibit low-grade histopathology, and affected patients have a low incidence of metastasis and a good prognosis. Even so, these tumors can present diagnostic and therapeutic challenges. Surgical resection provides adequate airway protection and sound oncologic safety while preserving speech and swallowing, and these should be the surgeon's goals in this setting. Options include open laryngofissure, thyrotomy, organ preservation with partial laryngectomy, and endoscopic laser resection.
Reduction of Snoring with a Plasma-Mediated Radiofrequency-based Ablation (Coblation) Device
Authors: Johnson Jonas T. , Vates Jennifer , Wagner Robin L.
Published: May 2019

We evaluated the effectiveness of using a plasma-mediated radiofrequency-based ablation (Coblation) device to perform volumetric tissue reduction of the soft palate as a means of controlling snoring in 23 patients with loud snoring and mild or no sleep apnea. Tissue reduction was achieved by performing a channeling procedure designed to shrink the tissue surrounding the treatment zone. The soft palate was treated at three separate sites, and each channel was completed in approximately 11 seconds. Data regarding the primary outcome—that is, pre- and postoperative subjective assessments of snoring intensity provided by the patients’ bed partners—were available for comparison for 21 of the 23 patients. Of the 21 patients, treatment was deemed successful in 10 (48%). Postoperatively, the overall mean intensity of snoring on a scale of 0 (no snoring) to 10 (terrible snoring) fell by 4 points (p < 0.05). Likewise, the loudness of snoring was also significantly reduced on objective SNAP recordings; the mean intensity fell from 12 to 8 dB (p < 0.05). Of the 10 successfully treated patients, 2 required only one procedure, 5 were improved after two treatments, and 3 underwent three operations. Seventeen of the 23 patients (74%) reported an improvement in quality of life. Surgical complications were mild to moderate, and pain was easily manageable in most cases. Our findings suggest that this procedure can be an effective treatment for socially unacceptable snoring. We hope that in future studies, investigators will evaluate outcomes over a longer term.
Fibrous Dysplasia of the Temporal Bone Complicated by Cholesteatoma and Thrombophlebitis of the Transverse and Sigmoid Sinuses: A Case Report
Authors: Martinez Rodrigo , Farrior Jay B.
Published: May 2019

Fibrous dysplasia is a benign condition that can affect the skull and facial bones and cause a broad spectrum of otolaryngologic conditions. We present the case of a boy with polyostotic fibrous dysplasia with involvement of the temporal bone that was first diagnosed when he was 9 years old. His condition eventually became complicated by cholesteatoma and thrombophlebitis of the left transverse and sigmoid sinuses, and he died of his disease at the age of 19 years. We discuss these and other complications of fibrous dysplasia of the temporal bone and their management.
Lingual Hematoma and Heparin-induced Thrombocytopenia: A Case Report
Authors: Getnick Geoffrey S. , Lin Samuel J. , Raviv Joseph R. , Walsh William E. , Altman Kenneth W.
Published: May 2019

Lingual hematoma is a rare but potentially fatal cause of upper airway obstruction. Patients receiving anticoagulants such as heparin can suffer from significant complications of these medications. Not only does heparin exert effects directly on the coagulation cascade, but it has the potential to cause thrombocytopenia by stimulating formation of antibodies against platelets. We present the case of a patient being treated with heparin for a deep-vein thrombosis, who subsequently developed heparin-induced thrombocytopenia and lingual hematoma, necessitating tracheotomy.
Congenital Midline Cervical Cleft: A Report of Two Cases
Authors: Franzese Christine , Hayes James D. , Nichols Kristie
Published: May 2019

Congenital midline cervical cleft is an uncommon malformation of the anterior neck. We report the cases of two patients with such an anomaly who had been born within 10 days of each other at a regional hospital in upstate New York. Fewer than 100 cases of congenital midline cervical cleft have been reported in the literature, and to the best of our knowledge, none of the other reported cases occurred so close to each other in terms of time and location. Diagnoses in both cases were established by clinical observation soon after birth. No likely epidemiologic commonalities between the two patients were found. Head and neck surgeons should be familiar with these malformations because early surgical excision is critical. Both of our patients were surgically treated at an early age, one with a Z-plasty and one with a straight closure. In both cases, the patients exhibited good functional and cosmetic results at 5 years of age.
Bilateral First and Second Branchial Cleft Fistulas: A Case Report
Authors: Gupta Ashok K. , Kumar Sudesh , Jain Ajay
Published: May 2019

Branchial cleft anomalies—which include branchial cysts, sinuses, and fistulas—are uncommon developmental defects of the neck. Approximately 2 to 3% of cases are bilateral; bilateral presentations appear to have a familial component. Only 5 cases of bilateral branchial cleft fistulas have been reported in the English-language literature, and only 1 case of simultaneous first and second branchial cleft fistulas has been previously reported. We report what to the best of our knowledge is the second case of bilateral first and second branchial cleft fistulas.
Cervical Lymphadenopathy Secondary to Kikuchi-Fujimoto Disease in a Child: Case Report
Authors: Chase Steven P. , Templer Jerry W. , Miick Ronald , Diaz-Arias Alberto A.
Published: May 2019

While most cases of cervical lymphadenopathy resolve with conservative management, persistent adenopathy can lead to costly investigations and invasive treatments. One cause of persistent adenopathy, as well as a variety of other associated systemic symptoms, is Kikuchi-Fujimoto disease (histiocytic necrotizing lymphadenitis). This rare entity can he diagnosed only by excisional biopsy on the basis of its characteristic histologic appearance. We describe a case of persistent cervical lymphadenopathy secondary to Kikuchi-Fujimoto disease in an 11-year-old girl.
Aggressive Papillary Tumor of the Middle Ear: A True Entity or an Endolymphatic Sac Neoplasm?
Authors: Tysome James R. , Harcourt Jonny , Patel Manish C. , Sandison Ann , Michaels Leslie
Published: May 2019

Aggressive papillary tumors of the middle ear are rare, and their true origin is not clear. We describe the clinical, radiologic, genetic, and histopathologic features of a papillary epithelial tumor filling the middle ear of a 68-year-old woman. Imaging revealed no evidence of petrous temporal bone apex involvement, nor did genetic studies demonstrate the von Hippel-Lindau mutation. A literature search revealed 24 previously reported cases of such a papillary epithelial tumor of the middle ear. All except 2 cases demonstrated apical petrous temporal bone invasion on imaging, and it has been suggested that they arose from a primary endolymphatic sac tumor, which has a similar papillary epithelial histology. Substantial numbers of cases of papillary epithelial tumors involving the middle ear are reported to be associated with von Hippel-Lindau disease, as are known cases of endolymphatic sac tumor. This is the third reported case of papillary epithelial tumor of the middle ear that does not show apical petrous temporal bone invasion on imaging, suggesting that such neoplasms do not always arise from a primary in the endolymphatic sac.
Angiolipoma Presenting as a Nasal Mass: How Rare a Presentation?
Authors: Rao Sridhara Suryanarayan , Panda Naresh K. , Saikia Uma Nahar , Saravanan Karuppiah
Published: May 2019

Angiolipomas are benign adipose tumors. There are two types: infiltrating and noninfiltrating. An angiolipoma presenting as a nasal mass is rare. To our knowledge, this is only the second documented case of angiolipoma presenting in the nasal dorsum. Total surgical excision by an external rhinoplasty technique with close follow-up is advised. Recurrence is not common.
Superior Turbinate Pneumatization in Patients with Chronic Rhinosinusitis: Prevalence on Paranasal Sinus CT
Authors: Kanowitz Seth J. , Nusbaum Annette O. , Jacobs Joseph B. , Lebowitz Richard A.
Published: May 2019

With the availability of high-resolution computed tomography (CT), a great deal of attention has been paid to the anatomy of the paranasal sinuses. But while investigators have focused on the osteomeatal complex and its relation to chronic rhinosinusitis, there has been little discussion of the superior turbinate. Although a few anatomic studies have tried to quantify pneumatization of the superior turbinate, the prevalence of this finding on radiography is not well addressed in the literature. We prospectively studied 100 consecutively presenting patients who underwent coronal CT of the paranasal sinuses (200 sides) for the evaluation of symptoms of chronic rhinosinusitis at an academic tertiary referral center to determine the prevalence of pneumatization of the superior turbinate. We found evidence of pneumatization in 44 of the 200 sides, for a prevalence of 22%. In all, pneumatized superior turbinates were found in 27 patients (27%)—bilaterally in 17 (17%) and unilaterally in 10 (10%).
Squamous Cell Carcinoma of the Buccal Mucosa: A Retrospective Analysis of 22 Cases
Authors: Lin Doris , Bucci M. Kara , Eisele David W. , Wang Steven J.
Published: May 2019

We examined our institutions experience with 22 cases of previously untreated buccal squamous cell carcinoma via a retrospective chart review. Eleven of these patients had been treated with a combination of surgical excision and postoperative radiation therapy, 8 patients with surgical excision alone, and 3 patients with radiation therapy alone. The overall 3-year locoregional recurrence rate was 32% (n = 7). The 3-year survival rates were 82% after surgery plus radiation (9 of 11 patients), 63 % after surgery alone (5 of 8), and 33% after radiation alone (1 of 3). Three-year T-category-specific survival rates were 100% for category T1 tumors (3 of 3 patients), 73% for T2 (8 of 11), 50% for T3 (3 of 6), and 50% for T4 (1 of 2). Although the small size of our study precluded any statistically significant conclusions, we believe that locoregional control and survival rates may be greater with surgical excision plus postoperative radiation than with treatment with either modality alone.
A Hemangioma on the Floor of the Mouth Presenting as a Ranula
Authors: Skoulakis Charalampos E. , Khaldi Lubna , Serletis Demetre , Semertzidis Themistoklis
Published: May 2019

A painless, bluish, submucosal swelling on one side of the floor of the mouth usually indicates the presence of a ranula. Rarely, such a swelling may be caused by an inflammatory disease process in a salivary gland, a neoplasm in the sublingual salivary gland, a lymphatic nodular swelling, or embryologic cysts. We report a patient with swelling in the floor of her mouth that was clinically diagnosed as a ranula. Suspicion arose during surgery that it was a vascular tumor and, on histologic testing, the swelling was confirmed to be a hemangioma. To our knowledge, this is the first report in the literature of a hemangioma presenting as ranula.
Pharmacodynamic Effect of Iopanoic Acid on Free T3 and T4 Levels in Amiodarone-induced Thyrotoxicosis
Authors: Matrka Laura , Steward David , Falciglia Mercedes , Nikiforov Yuri
Published: May 2019

We describe the effects of iopanoic acid on daily levels of free triiodothyronine (FT3) and free thyroxine (FT4) in a patient with progressive type II amiodarone-induced thyrotoxicosis (AIT) who was undergoing thyroidectomy. The patient was a 59-year-old man who was undergoing amiodarone therapy while awaiting cardiac transplantation; the use of beta blockers and corticosteroids to control the AIT was contraindicated in this patient. Prior to thyroidectomy, the patient was started on iopanoic acid at 1.0 g twice a day; in response to gastrointestinal side effects, the dosage was subsequently reduced to 0.5 g twice a day. The patient responded to iopanoic acid with a rapid decrease in his FT3 level and slight increase in his FT4 level. This control of thyrotoxicosis allowed for an uneventful thyroidectomy, which was later followed by successful cardiac transplantation. Based on our findings in this single case, we believe that iopanoic can be used to rapidly lower FT3 levels and to treat symptoms of thyrotoxicosis in a preoperative setting. We also discuss the different pharmacodynamic effects that iopanoic acid has on FT3 and FT4 levels.
Depressed Anterior Table Fracture: A Minimally Invasive Method of Reduction
Authors: Hewitt Derek K. , Scheidt Troy D. , Calhoun Karen H.
Published: May 2019

One-third of frontal sinus fractures are isolated to the anterior table. Traditional approaches to the reduction of an isolated anterior table fracture include the coronal incision, the bilateral brow incision, an endoscopic brow lift with an incision either directly over the fracture or in the brow, and delayed repair with a camouflaging implant. We describe a case involving a 14-year-old boy with a depressed anterior table fracture that we successfully treated using a minimally invasive technique requiring only one 2-cm incision.
Cervical Esophagotomy for an Impacted Denture: A Case Report
Authors: Imam Sardar Zakariya , Ikram Mubasher , Fatimi Saulat , Iqbal Moghira
Published: May 2019

We present the case of a 46-year-old woman with an impacted denture and an impending esophageal perforation. Her family physician initially missed the diagnosis but during a subsequent visit reviewed her x-ray and was able to see the shadow of the denture's wire attachment in her esophagus. The patient was then referred to a tertiary care hospital, where esophagoscopy confirmed the location of the denture, but the surgeon there was unable to remove it. Eighteen days after she had swallowed her denture, she was referred to our hospital. Attempts at removal via rigid esophagoscopy were unsuccessful, but the denture was successfully removed via a cervical esophagotomy. A Gastrograffin swallow performed 1 week postsurgically showed no extravasation of the contrast medium, and subsequent follow-ups were unremarkable. We conclude that cervical esophagotomy is a safe method for removing foreign bodies impacted in the cervical esophagus when they cannot be removed endoscopically.
Idiopathic Internal Carotid Artery Aneurysm Rupture in an Infant: A Case Report
Authors: Roebuck Jeremy C. , Pereira Kevin D.
Published: May 2019

We report a case of idiopathic rupture of an internal carotid artery (ICA) aneurysm in an infant, a finding that we believe has not been previously reported in the literature. The more common causes of isolated injury to the ICA are deep neck space infections and penetrating intraoral trauma. Pseudoaneurysms of the artery are well known to result in delayed hemorrhage. In most cases, the outcome is unfavorable because of the large amount of blood loss. Our case involved a previously healthy 11-month-old girl who presented with massive epistaxis secondary to a ruptured left ICA aneurysm. The patient had no history of any antecedent trauma or infection. She was successfully managed by ligation of the involved ICA in the neck.
Neuroendocrine Adenoma of the Middle Ear (NAME)
Authors: Leong Karen , Haber Marian M. , Divi Venu , Sataloff Robert T.
Published: May 2019

Neuroendocrine adenoma of the middle ear (NAME) is a rare tumor. We report a case of NAME, the clinical and pathologic findings of which illustrate the biologic behavior of adenomatous tumors of the middle ear and their relationship with rare carcinoid tumors of the middle ear. A 29-year-old man presented with a history of recurrent otitis media, right conductive hearing loss, and aural fullness. The tumor was removed in its entirety. Otolaryngologists should be familiar with this unusual but important entity.
Possible Risk Factors for respiratory Complications after Thyroidectomy: An Observational Study
Authors: Rahman Ganiyu A.
Published: May 2019

It is widely accepted that thyroid surgery is not without morbidity. One well known postoperative complication is respiratory distress. The aim of this prospective observational study was to determine the incidence of post-thyroidectomy respiratory complications and to identify possible predictive factors. The study population was made up of 262 patients who had undergone thyroidectomy for goiter at the University of Ilorin Teaching Hospital in Nigeria from January 1989 through December 2003. Information was collected on 8 possible predictive factors for respiratory complications: (1) the duration of the goiter, (2) the preoperative status of the recurrent laryngeal nerve, (3) the presence or absence of tracheal narrowing or deviation, (4) the presence or absence of retrosternal extension, (5) the ease or difficulty of endotracheal intubation, (6) the presence or absence of thyroid cancer, (7) the presence or absence of giant goiter, and (8) whether or not the goiter represented a recurrence. Respiratory complications occurred in 20 of the 262 patients (7.6%). Of these 20 patients, 16 (80%) had a goiter of at least 5 years’ duration, 12 (60%)) had a giant goiter, 5 (25%) had tracheal narrowing, 4 (20%) had a malignant goiter, 3 (15%) had palsy of the recurrent laryngeal nerve preoperatively, and 2 patients each (10%) had retrosternal extension, a difficult intubation, or a recurrent goiter. Twelve patients (60%) had at least 4 of the 8 possible risk factors, and 6 others (30%) had 3 factors. Postoperative tracheotomy was necessary for 4 patients. No deaths occurred. While the findings of this observational study can only suggest the possibility of causation, preoperative factors such as long-standing goiter and giant goiter should be taken into consideration in postoperative management and the prevention of respiratory complications. In addition, the presence of at least 4 of the 8 factors studied should likewise alert the management team.
Synovial Chondromatosis of the Middle Ear: A Case Report
Authors: Saggese Domenico , Fernandez Ignacio Javier , Salfi Nunzio C.M. , Ceroni Alberto Rinaldi
Published: May 2019

Synovial chondromatosis is a rare pathology of unknown etiology characterized by multinodular cartilaginous proliferation in the synovium. When it does occur, it usually develops in the large synovial joints (e.g., the knee, hip, elbow, and shoulder). Only rarely does it occur in the head and neck (most often in the temporomandibular joint). We report a case of synovial chondromatosis of the middle ear (i.e., the incudomalleolar joint) in a 64-year-old woman, and we describe the clinical, radiologic, and intraoperative findings in this case. To the best of our knowledge, this is the first reported case of synovial chondromatosis in the middle ear.
Osseous Metaplasia of the Maxillary Sinus with Formation of a Well-Developed Haversian System and Bone Marrow
Authors: Maitra Suchir , Gupta Deepak , Radojkovic Miladvic , Sood Salil
Published: May 2019

Osteogenesis in the maxillary sinus is a lesser known entity in otolaryngology, although it is put to good therapeutic use by maxillofacial surgeons. We present a case of postoperative osseous metaplasia in the maxillary sinus that led to the formation of mature bone with a well-developed haversian system and bone marrow. Such a finding has not been previously reported as a complication of endoscopic sinus surgery. This case highlights the importance of keeping in mind the possibility of osteogenesis within the maxillary sinus in patients who experience a recurrence of symptoms following sinus surgery.
Revision Stapedectomy
Authors: Lippy William H. , Berenholz Leonard P.
Published: May 2019

This is the fifth installment in a series of CLINICAL NUGGETS on stapedectomy and revision stapedectomy. These installments are based on our experience with more than 17,000 cases, including 2,000 revisions performed at the authors' practice.
Ecthyma Gangrenosum Mimicking Acute Invasive Fungal Sinusitis in an Immunocompromised Patient
Authors: Hekiert Adrianna M. , Cohen Michael B. , Montone Kathleen T. , Palmer James N. , Govindaraj Satish
Published: May 2019

Ecthyma gangrenosum is a rare necrotizing cutaneous infection usually caused by Pseudomonas aeruginosa. We report a case of ecthyma gangrenosum presenting as a sinonasal eschar and mimicking acute invasive fungal sinusitis in an immunocompromised 39-year-old man with a hematologic malignancy To the best of our knowledge, this represents the first case of ecthyma gangrenosum affecting the sinonasal mucosa to he reported in the literature.
Audiological Management and Performance of Adult Cochlear-Implant Patients
Authors: Tyler Richard S. , Lowder Mary W.
Published: May 2019

We review the signal-processing strategies of three of the most common cochlear implants in use today, the single-channel House, the multichannel Nucleus, and the Ineraid devices. The results of 65 postlinguistically-deafened patients tested at The University of Iowa are reviewed. The tests include everyday sound, accent, word and sentence recognition, as well as noise/voice differentiation. For all tests, patients with the Nucleus and Ineraid cochlear implants outperformed those with the House implant. In general, selection criteria should focus on comparing the performance of Patients who have already received an implant. Prelinguistically-deafened adults are typically not good cochlear-impact candidates. Cochlear-implant teams should be aware of the enormous time commitment for testing and rehabilitation of these patients, and be prepared to handle frequent implant breakdowns. Nevertheless, cochlear-implant patients have been helped significantly be these devices.
Actinomycosis of the Larynx
Authors: Nelson Erik G. , Tybor Allen G.
Published: May 2019

Actinomycosis of the larynx is rare. Only seven cases have been reported in the literature. We report a case of actinomycosis of the larynx in a 63-year-old male following radiation therapy for laryngeal carcinoma. The diagnosis of actinomycosis can be made with a biopsy. It is important to distinguish infection from radionecrosis and recurrent carcinoma. Treatment consists of airway control and a prolonged course of antibiotics.
Transcanal Tympanoplasty: Dura versus Temporalis Fascia
Authors: Zakzouk Siraj , Attallah Mohammad
Published: May 2019

The surgical approaches to repairing tympanic membrane perforations and control of middle ear disease have been well documented in the literature. One is the transcanal approach. The experience with this approach in controlling middle ear disease in 242 cases using both homologous dura and autologous temporalis fascia will be discussed. The results of graft taking and closure of air-bone gap to within 10 dB were slightly better using temporalis fascia compared with dura graft (86.7%) and (78.1%), respectively. Complications in the form of graft failure and high frequency sensory neural hearing loss (S.N.H.L.) were found to be greater in revision cases and in cases using dura. Most of our patients had wide external auditory canals, making this approach easy. Post-operative recovery is quick and morbidity is of short duration with no cosmetic derangements. This is important, as the cost-effectiveness is increased by reducing the time in the hospital and allowing more cases to be operated.
Laser Surgery of the Larynx: The Case for Caution
Authors: Sataloff Robert Thayer , Spiegel Joseph R. , Hawkshaw Mary , Jones Alyson
Published: May 2019

Laser surgery has been advocated for treatment of many laryngeal lesions. Although the CO2 laser has many advantages, its safe use requires special education of the surgeon and operating room team, and considerable surgical skill. Several dangers inherent in laser use for laryngeal surgery must be considered. These include vocal fold scarring secondary to thermal injury, loss of histopathologically important tissue through vaporization, airway fire and others. Laser-related complications must be considered whenever use of this instrument is contemplated.
Etiology and Treatment of Fluid Retention (Hydrops) in Ménière's Syndrome
Authors: Proctor Conrad A. , Proctor Todd B. , Proctor Bruce
Published: May 2019

For years low sodium diets have been recommended in the treatment of Ménière's syndrome. Elevated levels of insulin play an important role in sodium retention in renal tubules. Insulin production is stimulated by high carbohydrate diets. Adrenaline, cortisone, and glucagon levels may he increased by stress or food or inhalant allergies, further elevating insulin levels. The end result of prolonged hyperinsulinemia includes vasoconstriction and eventually arterial smooth muscle hypertrophy. Individual susceptibility to Ménière's syndrome may occur as a reult of inflammatory changes in the endolymphatic sac or cochlear aqueduct secondary to primary or latent viral infections, thus predisposing to fluid retention. Long term medical treatment of Ménière's should be directed towards preventing sodium retention through sodium restriciton and carbohydrate management. Other factors including stress and allergy should also be considered.
Uvulopalatopharyngoplasty: Strategies for Success and Safety
Authors: Fairbanks David N. F.
Published: May 2019

Management of snoring and/or obstructive sleep apnea patients may include uvulopalatopharyngoplasty, a surgical operation that occasionally generates complications. The most serious are perioperative airway problems and palatal dysfunction. Strategies to minimize risks and maximize efficacy are discussed.
Staging in Cholesteatoma Surgery
Authors: Deguine Christian
Published: May 2019

The closed technique is the treatment of choice for middle ear cholesteatoma in the opinion of the author. Several interventions may be required. At the onset, the purpose of the systematic second stage procedure was to verify the absence of any residual cholesteatoma. Experience has shown that the interest of this second intervention lies equally in the opportunity to observe the evolution of the otitis disease process, and the tubal status and in the possibility of restoring transmission under optimal conditions, thanks in particular to the utilization of thick silastic sheeting.

This technique necessitates, however, a long-term follow-up. On occasion, a third intervention may be required. Despite the iterative nature of this surgery, it should be considered as a form of a logical progression offering the best chances of a successful anatomic and functional outcome for the patient.
Electrocautery versus Epinephrine-Injection Tonsillectomy
Authors: Trent Christopher S.
Published: May 2019

This prospective, single-blinded study on tonsillectomy was done to compare the Bovie electrocautery dissection technique with the epinephrine-and-lidocaine injection technique and to document which technique is safer, faster, and less morbid. Twenty-nine patients who were scheduled for tonsillectomy at two Northern California Region Kaiser Permanente Medical Centers were enrolled in the study. Each patient served as his or her own control, and tonsillectomy technique was randomized on the basis of even or odd numbers of the last digit of the medical record number. The time of injection of epinephrine and time of dissection for each tonsil was recorded. Blood loss was quantified for each dissection, and pain was assessed by asking the patient which side hurt more.

I found no statistically significant difference in operating time, intraoperative blood loss, or postoperative hemorrhage between these two methods. The electrocautery, or Bovie, technique produced more clinically significant eschar and delayed healing than the epinephrine-injection technique did. The Bovie technique produced more inadvertent burns to surrounding tissue than the epinephrine-injection technique did, but the epinephrine caused transient tachycardia in 14% of the study participants. The present study showed no difference between the two techniques in postoperative pain experienced by study participants, but other recent studies have shown that patients experience more pain when the Bovie technique is used. Study data do not support the superiority of Bovie tonsillectomy. I recommend epinephrine-injection tonsillectomy as a safe and expedient operation.
Undifferentiated Carcinoma of the Nose and Paranasal Sinuses
Authors: Gallo Oreste , Graziani Paola , Fini-Storchi Omero
Published: May 2019

Among twenty-six “undifferentiated” tumors of the nasal cavity and paranasal sinuses treated from 1970 to 1990 at the Institute of Otolaryngology of Florence University, 13 were ultimately diagnosed as true undifferentiated sinusonasal carcinoma (SNUC) by conventional light microscopy and use of monoclonal antibodies to epithelial membrane antigen and cytokeratins. SNUC patients, who ranged in age from 20 to 82 years, often had multiple sinonasal symptoms due to very large tumors (nine of 13 tumors were staged as T3–T4) with short average delay of 4 months between onset of symptoms and diagnosis. Both data suggest the high growth capacity and aggressiveness of such a tumor. In our series, follow-up evidenced an overall crude 5-year survival rate of 15.5%. Worse prognostic factors are neck metastases and orbital invasion, according to the behavior of more common carcinomas of the nose and paranasal sinuses. We also found a better prognosis for SNUC primarily arisen in the nasal cavity than in paranasal sinuses (crude 5-year survival rate of 66% vs. 10%, respectively).

The histopathological and clinical analysis of our series shows that SNUC is a highly aggressive, uncommon tumor of the nose paranasal sinuses, which should be recognized in advance for a more aggressive treatment by combined multiple therapy.
Pediatric Actinomycosis of the Head and Neck
Authors: Stewart Michael G. , Sulek Marcelle
Published: May 2019

Actinomycosis is a rare soft tissue infection caused by a gram-positive, anaerobic bacteria. It is seen only approximately once a year in major medical centers, and is rarer still in the pediatric population. About 50% of all cases of actinomycosis involve the head and neck. The organism is very difficult to isolate in culture and the differential diagnosis is extensive, prompting one reviewer to name actinomycosis the “masquerader” of the head and neck. We review three cases of actinomycosis over the past ten years (1981–1990) at Texas Children's Hospital, Houston, Texas.
Fatal Mediastinal Abscess from Upper Respiratory Infection
Authors: Isaacs Larry M. , Kotton Bernard , Peralta Modesto M. , Shekar Raja , Meden Glenn , Brown Leon A. , Raaf John H.
Published: May 2019

Suppurative mediastinitis following neck infection is an uncommon entity that carries a 40% mortality. It is most commonly associated with esophageal perforation or odontogenic abscess. The rapidity of spread has been attributed to dependent drainage from the neck into the mediastinum, negative intrathoracic pressure, and synergistic necrotizing bacterial growth. Cultures obtained usually grow streptococci and/or Bacteroides.

We report the case of a 34-year-old woman with an upper respiratory infection who subsequently was found to have a para-/retropharyngeal and mediastinal abscess. Septic shock, respiratory failure, and death ensued, despite aggressive treatment with broad-spectrum antibiotics (for both aerobes and anaerobes), surgical drainage of the neck and mediastinum, and cardiorespiratory support.

The danger of a rapid downhill clinical course with mortality due to suppurative mediastinitis makes early diagnosis of critical importance. All clinicians evaluating a “sore throat” should consider neck edema or gas on neck radiograms as evidence of cervical abscess, and subsequent widening of the mediastinum on chest x-ray as an ominous sign suggesting mediastinal abscess.
The Facial Nerve: How to Find It
Authors: Pulec Jack L.
Published: May 2019

Iatrogenic facial paralysis is one of the most serious and most dreaded complications of temporal bone surgery. The risk of this complication as well as the duration of surgery can be reduced if the otologic surgeon can promptly identify the facial nerve at any stage of an operation. This is especially important in cases of anatomic variation and pathology which obscures or distorts normal anatomy. Twelve different surgical techniques will be described which allow the surgeon to safely expose and identify the facial nerve throughout its course through the temporal bone at any stage of an operation.
Mycobacterial Cervical Adenitis in Children: Medical and Surgical Management
Authors: Hawkins Donald B. , Shindo Maisie L. , Kahlstrom Emily J. , MacLaughlin Eithne F.
Published: May 2019

This is a review of the treatment results of cervicofacial mycobacterial adenitis in 85 children and adolescents. Twenty-three patients were treated with only anti-tuberculous medications (Group A). Thirteen underwent surgical procedures at the time of presentation for drainage of abscess or diagnostic biopsy, followed by treatment with anti-tuberculous medications (Group B). Forty-nine were initially treated with anti-tuberculous medications, with or without needle aspirations, and subsequently required surgery for one of the following reasons: 1) drainage and/or excision of abscess (Group C); 2) diagnostic biopsy (Group D); and 3) excision of persistent, enlarging, or recurrent nodes, or of draining fistulas (Group E). Four patients who were initially treated with surgery required a second procedure for persistent or recurrent disease. The cure rate for patients treated only with medications (Group A) was 95%. The cure rate for patients in the surgical groups after the initial procedures were 50% for Group B, and 100% for Groups C, D, and E. The overall cure rate was 92% for surgical treatment groups B-E and 93% for all 5 treatment groups. The clinical features of the disease, treatment outcome, and guidelines for management are discussed.
The Enlarged Vestibular Aqueduct Syndrome (EVA Syndrome)
Authors: Belenky Walter M. , Madgy David N. , Leider Jeffrey S. , Becker Christie J. , Hotaling Andrew J.
Published: May 2019

The presentation to the Department of Pediatric Otolaryngology at the Children's Hospital of Michigan of a series of patients with sensorineural hearing loss and enlargement of the vestibular aqueduct prompted exploratory tympanotomy in three patients (two unilateral and one bilateral), for a total of four ears. These explorations were prompted by progression and/or fluctuation of hearing levels. The discovery of abnormal round windows in all four ears with a post-traumatic fistula present in one ear suggested the presence of a new association. A previously undescribed association of an enlarged vestibular aqueduct, sensorineural hearing loss and round window abnormality with potential fistula formation was identified.

A review of the anatomy and physiology, literature review, and a prospective analysis with discussion of eight patients with enlarged vestibular aqueduct syndrome evaluated and treated at Children's Hospital of Michigan, is presented. We conclude that all children with sensorineural hearing loss should undergo extensive evaluation to determine etiology, including radiographic studies of the temporal bone. Further, the presence of an enlarged vestibular aqueduct should prompt the otolaryngologist to consider the presence of a round window abnormality and the potential for predisposition to perilymph fistula.
Bondy's Modified Radical Mastoidectomy Revisited
Authors: Pappas Dennis G.
Published: May 2019

The original criteria for modifying a radical mastoidectomy were: (I) an intact pars tensa and a defective pars flaccid a with cholesteatoma; (2) normal or near normal hearing; and (3) an intact, functional ossicular chain. We propose a fourth criterion: that the cholesteatoma site be delineated lateral to the body of the incus. Control of the disease process is easily assured if the lesion is in that area. Our recommended fourth criterion is based on the results of a five-year study of fifty-two cases that met the original criteria. The cholesteatoma reoccurred in the middle ear in only one case. In six cases, periodic care is necessary because of retraction to the grafted attic area. The procedure and technique used in these patients and the excellent results are discussed in this article.
Squamous Epithelium in the Middle Ear and Sinus
Authors: Tutkun Alper , Batman Caglar , Üneri Cüneyt , Sehitoglu Mehmet Ali
Published: May 2019

This study has been performed between December 1990—March 1991 in the Microsurgery laboratory of the Marmara University Hospital. Twelve healthy albino guinea pigs were used as a study group while the control group consists of three animals. The potentials for cholesteatoma formation of the squamous epithelium, namely the squamous epithelium of the posterior superior part of the external ear canal skin and normal skin, were investigated. Among 24 subjects who were implanted by canal skin, cholesteatoma was fanned in 21 of them. Likewise, 19 of 24 animals implanted by normal skin came out with cholesteatoma formation. Between these two types of epithelium, there is no statistical difference in cholesteatoma formation (p >0.5).
A Contactless Electromagnetic Implantable Middle Ear Device for Sensorineural Hearing Loss
Authors: Maniglia Anthony J. , Ko Wen H. , Rosenbaum Mary , Zhu Wei-Lin , Werning John , Belser Robert , Drago Paul , Falk Ted , Frenz William
Published: May 2019

Following basic science experiments, improvement of precision micromechanics and electronics design, and development of different prototypes, a contactless electromagnetic hearing device has been successfully implanted in cats (acute experiments). Chronic animal experiments using the cat as well as the rabbit are ongoing to test the components of the device. A highly efficient air core coil is used to vibrate a neodymium-iron-boron magnet cemented to the body of the incus. The parts of the system, including implanted electronics (hybrid circuit, solid state), are laser welded and hermetically sealed. The system allows for the generation of enough force which vibrates the magnet implanted on the incus. It would be suitable for the treatment of moderate to severe sensorineural hearing loss.
Implantation of Electromagnetic Ossicular Replacement Device
Authors: Tos Mirko , Salomon Gerhard , Bonding Per
Published: May 2019

Semi-implantable hearing aids consisting of permanent middle ear implanted magnet, either partial ossicular replacement prostheses (PORP's) or total ossicular replacement prostheses (TORP's) driven by an electromagnet placed in the ear canal have been tested on six patients undergoing surgery for chronic otitis.

The surgical and audiological problems are described. The audiological results were excellent in all six cases. A functional gain of 40-70 dB can be obtained for entire frequency range of the audiogram.
Bilateral Digital Hearing Aids for Binaural Hearing
Authors: Kimberley Barry P. , Dymond Rob , Gamer Abram
Published: May 2019

The rehabilitation of binaural hearing performance in hearing impaired listeners has received relatively little attention to date. Both localization ability and speech-understanding-in noise are affected in the impaired listener. When localization performance is tested in impaired ears with conventional hearing aid fittings it is found to be worse than the unaided condition. Advances in electronic design now permit speculation about the implementation of complex digital filters within the confines of an in-the-ear hearing aid. We have begun exploring strategies to enhance the localization performance of impaired listeners with bilateral digital signal processing. We are examining three strategies in bilateral hearing aid design to improve localization performance in hearing impaired listeners, namely 1) more accurate fitting of individual ear losses, 2) equalization of the effect of the hearing aid itself on the acoustics within the ear canal, and 3) binaural fitting strategies which in effect modify individual ear fittings to enhance localization performance. The results of early psychophysical testing suggests that localization performance can be improved with these strategies.
Exploring the Maze of Adverse Reactions to Foods
Authors: King Hueston C.
Published: May 2019

Nowhere in medicine is a test or battery of tests more needed than in the diagnosis of adverse reactions to foods. Such tests are not at present a reality. Research produces tests that individually appear to show validity, but when challenged with the entire range ofpossible adverse reactions and their results, the tests fall short. Considering the range of mechanisms involved in adverse reactions to foods, this is to be expected.

There is a tendency to discount positive test results when they fail to cover all of the parameters desired. The inherent weakness in any test is that all available formats explore a single or limited reaction route. The reality is the presence of multiple routes, multiple target organ s, and multiple external variable s not subject to programming into a single test. Considering the range of possibil ities, it is amazing that any existing tests show any clinical validity at all. We as scientists should not denigrate any study that shows a significant degree of reliability, even within a limited range. This simply halts progress. An encouraging study should be used as a stepping stone to a more comprehensive format for evaluating the overall range of adverse reactions and providing us with at least some inroads in coping with this most difficult problem. To quote Sir Peter Medawer on receiving the Nobel Prize in Science: “Nothing must be said or written that diminishes the likelihood that someone else will get at the truth.”
Intraductal Tetracycline Therapy for the Treatment of Chronic Recurrent Parotitis
Authors: Bowling Lcdr David M. , Rauch Steven D. , Goodman Max L.
Published: May 2019

Chronic recurrent parotitis (CRP) is recurrent parotid inflammation with non-obstructive sialectasis. Therapies which produce acinar atrophy or remove the acini are effective in treating CRP. Parotidectomy, tympanic neurectomy, duct ligation, and radiation therapy have either a low success rate or a high risk of morbidity. Intraductal antibiotic instillation has been proposed as a possible method of treatment. We hypothesized that the cytotoxic effects of tetracycline could produce acinar atrophy. A double-blind experiment of intraductal tetracycline instillation was performed in ten rabbits. Acinar atrophy and acute inflammation were found in 40% of the tetracycline treated glands; controls had a complete absence of these histologic changes. These results support the use of tetracycline instillation to produce acinar atrophy and therefore, intraductal tetracycline may be an effective, low-risk therapy for CRP. The clinical features of CRP will be reviewed and therapeutic implications discussed.
Hypnosis as an Aid for Tinnitus Patients
Authors: Kaye Janet M. , Marlowe Frank I. , Ramchandani Dilip , Berman Steve , Schindler Barbara , Loscalzo Grace
Published: May 2019

This study was undertaken to evaluate hypnosis versus stress management as therapeutic modalities in the treatment of tinnitus. Participants were recruited from the local tinnitus association and the Otolaryngology Division of the Department of Surgery. The instruments were the following standardized tests (NIMH Diagnostic Int. Schedule; SCL 90R, Beck Depression Inventory) in addition to a tinnitus questionnaire. Improvement was shown on 5 separate scales, some alleviated by both types of treatment and others singularly by hypnosis or stress management. The data reinforce the use of behavioral techniques and suggest that different techniques may be more appropriate for specific symptoms.