bluuebunny/crossref_metadata_2025 huggingface dataset:
Vibrant Soundbridge Implantable Hearing Device: Critical Review and Single-Surgeon Short- and Long-Term Results
Authors: Luetje Charles M. , Brown Sandra A. , Cullen Robert D.
Published: January 2019

We conducted a retrospective descriptive study of a series of 31 consecutively presenting patients who had been implanted with the Vibrant Soundbridge middle ear hearing device. All implantations had been performed by the senior author. Three of these patients had undergone bilateral implantation, and 4 others had undergone subsequent explantation and reimplantation in response to known or suspected device failure, giving us a total of 34 ears and 38 implants. Our goal was to ascertain short- and long-term outcomes as measured by conventional audiometry (pure-tone average at 1 to 6 kHz) and long-term benefit as defined by the use or nonuse of the device. We found that at the initial activation session 2 months postoperatively, the average hearing thresholds were within 3 dB of the preoperative thresholds in all 34 ears and all 38 implants. The mean short-term gain at activation in the 38 implants was 28.1 dB. Nineteen patients (20 ears) were available for long-term evaluation, with the length of follow-up ranging from less than 1 year to 11 years (mean: 7.3). Of these 20 ears, 9 demonstrated further gain (mean: 10.8 dB) despite any natural hearing deterioration; of the remaining 11 ears, gain was unchanged in 2, diminished in 7 (mean: −3.6 dB), and gain data were unavailable in 2. In the final analysis, there were 20 user ears and 10 nonuser ears; 4 ears were lost to all follow-up. We conclude that direct-drive hearing with the Vibrant Soundbridge middle ear hearing device is beneficial and provides sustained audiometric gain. Factors that have a significant impact on patient use or nonuse include difficulty in obtaining audiologic support and the direct and indirect costs of the device. Without audiologic or financial support, some patients may choose to become nonusers and to either switch to conventional hearing aid amplification or become apathetic about hearing improvement.
Taste Impairment following Tonsillectomy and Adenoidectomy: An Unusual Complication
Authors: Randall David A.
Published: January 2019

Tonsillectomy and adenoidectomy is a relatively safe procedure, but it is nevertheless associated with certain complications. Some of these include throat pain, otalgia, dehydration, hemorrhage, nasopharyngeal stenosis, velopharyngeal insufficiency, burns, soft-tissue injury, dentomandibular trauma, atlantoaxial subluxation, and respiratory compromise. One unusual complication is altered taste. To the best of the author's knowledge, only 29 cases of altered taste associated with palatine tonsillectomy have been previously reported in the literature since 1966. In this article, the author reports a new case and discusses the features of this unlikely complication.
Hypopharyngeal Diverticulum Formation following Anterior Discectomy and Fusion: Case Series
Authors: Allis Terah J. , Grant Nazaneen N. , Davidson Bruce J.
Published: January 2019

Pharyngoesophageal diverticulum is a rare complication following anterior cervical discectomy and fusion (ACDF). Dysphagia is a well-documented complication associated with ACDF. It may result postoperatively from a variety of etiologies, including hardware displacement, pharyngeal edema, or vocal fold paresis. One rare cause of persistent dysphagia is the formation of a hypopharyngeal diverticulum, reported in the literature in 9 previous cases. Such diverticula after ACDF surgery may have pathogenesis that is distinct from that of typical Zenker diverticula. We report 3 new cases of hypopharyngeal diverticula in patients who underwent revision ACDFs. Variables assessed included age, sex, level of fusion, ACDF-related complications, and diverticulum management. Two patients underwent successful open surgical diverticulectomy and cricopharyngeal myotomy. In the third case, the patient had a small diverticulum close to the surgical hardware and minimal symptoms and was managed conservatively. Our cases, combined with the 9 previous cases, demonstrate commonalities, particularly with regard to the risk of revision spinal surgery and infection and subsequent hypopharyngeal diverticula development. Hypopharyngeal diverticulum can occur as a complication of ACDF and should be considered in patients with persistent dysphagia after surgery. In this patient population, open resection and cricopharyngeal myotomy are recommended.
Submandibular Gland Hemangioma: Clinicopathologic Features and a Review of the Literature
Authors: Kumar Sudesh , Gupta Ashok K. , Bakshi Jayamanti
Published: January 2019

We conducted a retrospective study to determine the incidence and characteristics of submandibular gland hemangioma at our institution. We reviewed the records of all patients who had undergone submandibular gland excision from January 1998 through December 2006. We found a total of 230 such cases. Of these, submandibular gland hemangioma was found in 4 patients (1.7%)–3 women and 1 man, aged 20 to 47 years (mean 34.8). Their duration of symptoms had ranged from 26 to 78 months (mean: 49.3). These symptoms had included submandibular swelling, pain or discomfort, and features of sialadenitis. Computed tomographic angiography had revealed that the hemangiomas were supplied by the facial and lingual arteries. Two of the 4 patients had undergone preoperative vascular embolization, but it had failed to significantly reduce the amount of intraoperative blood loss. Final histopathologic examination had revealed that all 4 lesions were cavernous hemangiomas and that they had replaced the normal glandular structure. No recurrence was seen during a follow-up that ranged from 47 to 72 months (mean: 56.3).
Efficacy of Gabapentin on Subjective Idiopathic Tinnitus: A Randomized, Double-Blind, Placebo-Controlled Trial
Authors: Dehkordi Mahboobeh Adami , Abolbashari Samaneh , Taheri Reza , Einolghozati Sasan
Published: January 2019

Tinnitus can cause extreme morbidity. Despite many attempts to find a treatment for idiopathic cases, they remain difficult to manage. Because nerve injury is one of the suspected etiologies of tinnitus and because gabapentin has been found to be effective in treating nerve injuries, some authors have attempted to determine if gabapentin has a role in treating tinnitus. Although gabapentin was found to be ineffective for tinnitus in these previous studies, to the best of our knowledge no studies have been performed that took into consideration the presence of various accompanying factors and concomitant diseases that might influence its effect. We conducted a prospective, randomized, double-blind, placebo-controlled clinical trial of gabapentin for idiopathic tinnitus. We treated 40 patients with gabapentin and measured its effectiveness by comparing differences between pre- and post-treatment Tinnitus Severity Index (TSI) values and tinnitus loudness scores. We also compared these outcomes with those of a group of 40 matched placebo controls. At study's end, we found no significant differences between the gabapentin and control groups in mean decreases in TSI value and loudness score (p = 0.85 and p = 0.12, respectively). However, we did find that patients with hypertension, diabetes, and/or dyslipidemia showed a better response to gabapentin than did those with tinnitus alone (p = 0.01). We conclude that although there was no statistically significant difference between gabapentin and placebo in treating isolated tinnitus or tinnitus overall, patients with concomitant hypertension, diabetes, and/or dyslipidemia may benefit from gabapentin.
A Comparison of Techniques for Evaluating IgE-Mediated Allergies
Authors: Boyles John H.
Published: January 2019

Skin prick testing remains the most popular way to confirm an IgE-mediated allergic response. This study was performed to compare the accuracy and sensitivity of two skin testing modalities (serial endpoint titration and skin prick testing with 2 different in vitro assays.) In 52 atopic patients serial endpoint titration showed a higher degree of sensitivity in evaluating skin response in less sensitive reactors. At higher degrees of reactivity in individual patients there was good correlation between the 3 modalities. Identifying patients who are less sensitive reactors is important, so that they can be started on immunotherapy. In fact, an informal survey of low-reacting patients treated with immunotherapy showed a high degree of success.
Salivary Gland Cancer in Patients Younger than 30 Years
Authors: Rutt Amy L. , Hawkshaw Mary J. , Lurie Deborah , Sataloff Robert T.
Published: January 2019

Previous research has shown that salivary gland tumors are rare in the young population. A clinical diagnosis has to be made very carefully because the proportion of malignancies is higher in children than in adults. We present a review of cases of malignant salivary gland carcinoma (SGC) in patients younger than 30 years of age. Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) 17 Registry. A total of 763 patients younger than 30 years with carcinoma of a major salivary gland from 1973 to 2004 were identified within the SEER database. The most common salivary gland cancer was mucoepidermoid parotid gland carcinoma. The incidence of all major salivary gland carcinomas increased with increasing patient age. The 5-year relative survival rate for salivary gland carcinomas in our population was calculated according to the Kaplan-Meier analysis in each age group. Relative 5-year survival was 100% in the 1 patient younger than 1 year, 50.0% in the 1-to 4-year-old group; 87.2% among the 5- to 9-year-olds; 97.0% among the 10- to 14-year-olds; 95.0% among the 15- to 19-year-olds; 95.1% among the 20- to 24-year-olds; and 93.6% in the 25- to 29-year-old group. We found that SGC affects patients of all ages, even children in the first year of life. It is essential for physicians to detect salivary gland neoplasms promptly and to evaluate them thoroughly when they are found in children.
Pharyngeal wall Differences between Normal Younger and Older Adults
Authors: Aminpour Shervin , Leonard Rebecca , Fuller Scott C. , Belafsky Peter C.
Published: January 2019

Previous research has demonstrated differences in pharyngeal size and constriction between normal younger and older adults. The distance between the larynx and the hyoid bone at rest is greater in older persons, as is the anteroposterior width of the pharynx when it is maximally expanded during swallow. In addition, pharyngeal clearing during swallow is reduced with aging. These observations suggest that the aging pharynx undergoes structural changes consistent with atrophy. The purpose of this investigation was to compare pharyngeal wall thickness at rest and when maximally constricted during swallow in younger and older adults. Videofluoroscopic swallow studies were performed on 178 normal adults. Measures of posterior pharyngeal wall thickness were determined at rest and during maximum constriction of the pharynx during a 20-ml bolus swallow. Data were subjected to analysis of variance and Student t test procedures to determine sex and age differences. We found no statistically significant differences between the men and women in either age group, and so we then pooled our data across sex. Mean pharyngeal wall thickness at rest was 0.39 cm (±0.09) in the younger group and 0.30 cm (±0.08) in the older group (p < 0.01). Pharyngeal wall thickness measured at the same point during maximum constriction was 1.08 cm (±0.34) in the younger group and 0.92 cm (±0.36) in the older adults (p < 0.01). Our data suggest that the posterior pharyngeal wall is thinner and does not constrict to the same extent in older subjects compared with younger individuals. These findings contribute to our understanding of differences in pharyngeal strength, swallowing efficiency, and safety associated with aging.
Rectal Adenocarcinoma Metastatic to the Larynx
Authors: Ta Joseph Q. , Kim John Y.
Published: January 2019

Malignancies metastatic to the larynx are rare, accounting for fewer than 1% of all laryngeal cancers with metastatic sources; the most common of these metastases are cutaneous melanomas and renal cell carcinomas. Only 13 cases of colon cancer and 2 cases of rectal adenocarcinoma metastatic to the larynx have been previously reported in the literature. We report a new case of rectal adenocarcinoma metastatic to the larynx that resulted in subglottic stenosis in a 60-year-old man. We also review the literature, and we discuss the presentations of and treatments for this rare entity.
Idiopathic Acquired Ectopic Auricular Ossification: A Case Report and Review of the Literature
Authors: Chang Ki-Hong , Kim Dong-Kee , Kim Ji-Hong , Park Yong-Soo
Published: January 2019

A petrified auricle is a rare condition in which the structure becomes partially or completely rigid. It arises as a consequence of calcification or ossification of the auricular cartilage. An ossified auricle is much more rare than a calcified cartilage, and it can be diagnosed only by histology. To the best of our knowledge, only 18 cases of ossification of the auricle have been previously reported in the literature. We report a new case of auricular ossification in a 72-year-old woman who had taken calcium for the previous 8 years. We also review the relevant literature.
Syndromes after Resection of Cervical Schwannoma
Authors: Boros Michael J. , Wysong Stephen T.
Published: January 2019

Cervical schwannomas are rare, as fewer than 250 cases have been reported in the literature. The preferred method of removing a schwannoma is enucleation. Complications of schwannoma excision include Horner syndrome, first-bite syndrome, and Pourfour du Petit syndrome. These complications are usually transient and in most cases do not require treatment. Pourfour du Petit syndrome, which is the converse of Horner syndrome, occurs with stimulation of the sympathetic cervical chain. We report a case of cervical schwannoma in a 44-year-old woman who developed signs suggestive of both Horner syndrome and Pourfour du Petit syndrome following excision of the lesion. We discuss the diagnostic workup, surgical treatment, and likely sequelae of this pathology.
Chronic Rhinitis: A Manifestation of Leprosy
Authors: Camacho Ivan D. , Burdick Anne , Benjamin Latanya , Casiano Roy
Published: January 2019

Leprosy, or Hansen disease, is an infection that affects the mucous membranes of the respiratory tract and may manifest with nasal symptoms of chronic rhinitis, including nasal congestion, rhinorrhea, and intermittent epistaxis. We present a case of a woman diagnosed with leprosy as an incidental finding from a biopsy obtained during endoscopic sinus surgery for the management of chronic rhinitis. The diagnosis of leprosy should be considered in patients with nasal symptoms and presumptive chronic rhinitis who do not respond adequately to standard therapies.
Effectiveness of a Nasal Saline Gel in the Treatment of Recurrent Anterior Epistaxis in Anticoagulated Patients
Authors: Massick Doug , Hurtuk Agnes
Published: January 2019

We believe that the use of cauterization in patients with anterior epistaxis in the absence of acute bleeding should be discouraged because it does not address the underlying cause and because it may even worsen the condition by extending the degree of mucosal disruption. This is especially true in patients who are receiving anticoagulation therapy. Therefore, we conducted a study to determine if the use of a nasal saline gel as monotherapy would be an effective alternative to invasive measures in treating recurrent epistaxis in anticoagulated patients. Our study group consisted of 74 patients—43 men and 31 women (mean age: 64.4 yr)—who had been seen in our department over an 18-month period and whose bleeding had originated in the anterior portion of the nasal vault. Most patients had been experiencing epistaxis for at least 6 months. Patients were given the saline nasal gel and taught to gently apply it to the mucosa of the anterior nasal vault with a cotton-tipped applicator at the first sign of recurrent bleeding. Patients were then followed up periodically over the next 3 months. Among the 74 patients, 69 (93.2%) had experienced a cessation of their epistaxis at 3 months. The results of our study suggest that this simple, painless technique has considerable value as a treatment option in this cohort of patients.
Subacute Airway Obstruction Caused by a Suprastomal Tracheal Granuloma following Tracheotomy in an Adult
Authors: Kelly Elizabeth A. , Badi Arunkumar N. , Blumin Joel H. , Poetker David M.
Published: January 2019

We report a case of a post-tracheotomy suprastomal granuloma in the early postoperative phase that caused subacute airway obstruction in a 28-year-old woman. The patient had undergone the tracheotomy during the surgical treatment of a submental abscess. During recovery, several capping trials had failed. Therefore, direct laryngoscopy was performed on postoperative day 11, and it revealed that the airway was being obstructed by a tracheal granuloma. The granuloma was managed with a partial resection and corticosteroids. The patient was successfully decannulated with no recurrence of the granuloma. To the best of our knowledge, airway obstruction secondary to a tracheal granuloma has not been previously reported as an early complication of a traditional surgical tracheotomy in an adult. In this report, we discuss the presenting features of this case and we propose several possible etiologies.
Clinical Improvement after Escalation for Sublingual Immunotherapy (SLIT)
Authors: Woody Jamie , Wise Sarah K. , Koepp Sarah , Schlosser Rodney J.
Published: January 2019

Sublingual immunotherapy (SLIT) permits rapid antigen escalation with an improved safety profile over that of subcutaneous immunotherapy. Outcomes for SLIT in terms of the timing of clinical improvement were investigated in a retrospective review of patients undergoing SLIT who completed quality of life (QOL) and medication-use questionnaires at baseline and immediately after antigen escalation was performed. A subset of patients (n = 24) also completed maintenance-phase questionnaires. Paired post-escalation data (mean 5.5 weeks; N = 38) demonstrated improvement (p < 0.05) in overall QOL scores and in 6 of 14 symptom domains. Maintenance phase data (n = 24) revealed significant improvements in total QOL scores and in 5 symptom domains. A significant reduction in nasal steroid use was also demonstrated during the maintenance phase of treatment (p < 0.05). Significant improvement is seen immediately post-escalation in SLIT patients. This improved QOL appears to be maintained, and perhaps even increases, during the maintenance phase, with decreased nasal steroid use.
Maxillary Sinus Nonodontogenic Myxoma Extending into the Sphenoid Sinus and Pterygopalatine Fossa: Case Report
Authors: Yilmaz Süleyman , Edizer Deniz Tuna , Yağiz Cengiz , Sar Mehmet , Cansiz Harun
Published: January 2019

Myxomas are benign mesenchymal tumors of uncertain etiology. They can arise from odontogenic tissue, as well as from the sinonasal tract and from the facial and temporal bones, apparently from nonodontogenic mesenchyme. Although histologically benign, myxomas are locally invasive. Histopathology demonstrates a characteristically hypocellular lesion with loose stellate cells. We describe the case of a 48-year-old woman with a nonodontogenic maxillary sinus myxoma that invaded the sphenoid sinus and pterygopalatine fossa. We removed the mass via a combined endoscopic and gingivobuccal approach. The rarity of a nonodontogenic sinonasal myxoma extending into the sphenoid sinus and pterygopalatine fossa is the basis for our presentation of this case.
Intratympanic Steroid Use for Hearing Salvage in Vogt-Koyanagi-Harada Syndrome
Authors: Pelosi Stanley , Chandrasekhar Sujana S.
Published: January 2019

We discuss the rare case of a 68-year-old woman with Vogt-Koyanagi-Harada (VKH) syndrome and sensorineural hearing loss (SNHL) who was successfully treated with intratympanic corticosteroid injections. The patient had presented with bilaterally asymmetric (i.e., moderate and moderate to severe) SNHL, tinnitus, vertigo, and vitiligo. She received two intratympanic injections in her worse-hearing ear over the course of 1 month. Subsequent audiometry showed an immediate 5- to 10-dB improvement in her hearing across multiple frequencies, as well as a long-term improvement to near-normal thresholds. The hearing thresholds in her untreated ear remained stable. To the best of our knowledge, this is the first report of a patient with VKH syndrome who was successfully treated with intratympanic steroid application.
Dynasplint for the Management of Trismus after Treatment of Upper Aerodigestive Tract Cancer: A Retrospective Study
Authors: Barañano Christopher F. , Rosenthal Eben L. , Morgan Bruce A. , McColloch Nancy L. , Magnuson J. Scott
Published: January 2019

In order to evaluate the Dynasplint Trismus System (DTS) for the relief of trismus secondary to the treatment of head and neck cancer, we conducted a retrospective chart review of patients who had undergone DTS therapy during a 1-year period. Our inclusion criteria were cancer of the upper aerodigestive tract; treatment with radiation, chemotherapy, and/or surgery; and a maximal incisal opening (MIO) of less than 30 mm. MIO and the rate of improvement of trismus (“gain”) were measured at selected intervals. Twenty-six patients met our study criteria; their pretherapy mean MIO was 19.3 mm. At the time of their most recent measurement, the mean MIO had increased to 25.5 mm—a measured gain of 32%. Although the initial rate of gain was 0.36 mm/day during the first 6 weeks, improvement leveled off over time, and the overall rate of gain was 0.16 mm/day. We conclude that the DTS is effective in increasing the mandibular range of motion at a rate of change that is maximized during initial treatment.
Tooth in the Nose: Unusual Presentation of a Misdiagnosed Maxillary Ossifying Fibroma
Authors: Ozgursoy Ozan Bagis , Kankaya Duygu , Balcioglu Mustafa , Ungor Cem , Kucuk Babur
Published: January 2019

Fibro-osseous lesions involving the paranasal sinuses are uncommon, and making a determination of their histologic type is challenging. Correlating clinical and surgical findings with radiologic and histologic characteristics is essential for making a definitive diagnosis. We describe a case of misdiagnosed maxillary ossifying fibroma presenting as a solitary mass that completely filled and enlarged the left maxillary sinus. Another interesting finding was the presence of a molar tooth embedded in the tumor. We briefly comment on the genesis, natural course, and differential diagnosis of this lesion.
A case of Congenital Fistula from An Accessory Parotid Gland: Diagnosis and Treatment
Authors: Pinto Fabio Roberto
Published: January 2019

The author reports a case of congenital fistula from an accessory parotid gland and describes its diagnosis and treatment. The patient was referred to the author's clinic for evaluation of a continuous serous discharge from a small orifice in the left cheek near the angle of the mouth. A left preauricular appendix was also noted. Fistulography detected an aberrant duct leading to an accessory parotid gland. The main parotid gland and its duct were normal. The anomalous duct was dissected in continuity with a small ellipse of skin and sutured to the buccal mucosa. The patient's recovery was uneventful. The author also discusses the embryologic origin of this rare anomaly.
Multicentric Giant Cell Tumor: Metachronous Central and Peripheral Involvement
Authors: Alireza Karimi Yazdi , Sazgar Amir A. , Kouhi Ali
Published: January 2019

Giant cell tumors are rare in the head and neck region. The most frequently involved sites of giant cell lesions in the head and neck are the maxilla and mandible, whereas the sphenoid and temporal bones are rarely involved. This tumor is usually located in the long bones of limbs. Reparative granuloma and brown tumor of hyperparathyroidism must be included in the differential diagnosis. Here we report the clinical and radiologic findings of a multicentric giant cell tumor with skull base involvement in a female patient. This case report demonstrates the similar pathophysiology of peripheral and central giant cell tumors.
Suprahyoid Pharyngotomy for excision of Laryngeal Venous Malformation
Authors: Menon Unnikrishnan K. , Deepthi N.V. , Menon Indudharan R.
Published: January 2019

We report an uncommon case of symptomatic venous malformation of the larynx in a 22-year-old man, and the successful surgical management thereof. A detailed radiologic investigation of the lesion was done, followed by surgical excision via a suprahyoid pharyngotomy using cold instruments. Long-term follow-up was maintained, and the patient had subjective and objective resolution of his symptoms and signs at 3 years postoperatively. We conclude that radiology can reveal hitherto unsuspected extensions of vascular malformations in the neck and that surgical excision is a viable mode of treatment in upper aerodigestive venous malformations.
Outcomes of Endoscopic Sphenopalatine Artery Ligation for Epistaxis: A Five-Year Series from a Single Institution
Authors: Howe David J. , Skinner Derek W.
Published: January 2019

Epistaxis is a common emergency seen by the otolaryngologist. A minority of cases require surgical intervention. Multiple surgical procedures have been tried in the past, including endoscopic ligation of the sphenopalatine artery (ELSPA), which is considered an effective surgical modality in the management of epistaxis. This study examines the outcome of 33 ELSPA procedures over a 5-year period. Three of 4 cases that were not controlled with ELSPA were successfully managed with subsequent anterior ethmoidal ligation. Failed ELSPA procedures may represent an incorrect choice of procedure rather than a failure of the procedure. High-resolution computed tomography can identify the position of the anterior ethmoidal artery; it may be possible to infer vulnerability to hemorrhage from this artery and hence target procedure selection.
A Case of Extranasopharyngeal angiofibroma of the Ethmoid Sinus: A Distinct Clinical Entity at an Unusual Site
Authors: Lerra Sandeep , Nazir Tanvir , Khan Nazir , Qadri Mir Sajjad , Dar Nisar H.
Published: January 2019

Angiofibromas of the head and neck usually arise from the nasopharynx in adolescent boys. The term extranasopharyngeal angiofibroma (ENA) has been applied to vascular fibrous nodules that arise outside the nasopharynx. Because the clinical characteristics of ENA are not consistent with those of juvenile nasopharyngeal angiofibroma (JNA), diagnosis of the former can be challenging. Biopsy is ill advised in a patient with an ENA because it might result in brisk bleeding. A high index of suspicion and a methodical evaluation are essential in establishing the proper diagnosis and treatment. We report the rare case of a 16-year-old girl who presented with a pinkish lobulated mass in her left nostril that had arisen from the anterior ethmoid sinus. The mass was removed via a lateral rhinotomy approach. Postoperative histopathologic analysis identified it as an angiofibroma. To best of our knowledge, only 9 cases of ENA arising from the ethmoid sinus have been previously reported in the English-language literature.
Pertussis Presenting as Hoarseness in An Adult
Authors: Tornabene Stephen V. , Crose Joshua , Cruz Raul M.
Published: January 2019

Pertussis is a rare condition in adults. This report describes a 65-year-old man presenting to the otolaryngology service with hoarseness secondary to pertussis. He had a history of worsening cough and hoarseness occurring over several weeks. Laryngoscopy showed significant erythema at the medial edges of the vocal folds. Stroboscopy demonstrated bilateral decreased amplitude and decreased mucosal wave of the vocal folds. Polymerase chain reaction testing of the sputum revealed Bordetella pertussis. The patient was started on azithromycin, and he reported gradual resolution of the chest and laryngeal symptoms over the next few months. Pertussis, or whooping cough, is not common in the United States because of childhood vaccination protocols. Nevertheless, otolaryngologists need to be aware of this condition as a possible cause of hoarseness.
Ectodermal Dysplasia: Otolaryngologic evaluation of 23 Cases
Authors: Yildirim Muzeyyen , Yorgancilar Ediz , Gun Ramazan , Topcu Ismail
Published: January 2019

The aim of this prospective study was to improve the quality of life of and reduce morbidity for patients with ectodermal dysplasia by assessing their actual and potential ENT pathologies, and offering methods of prevention and treatment. The study was conducted between 2006 and 2008 and included 23 patients diagnosed with ectodermal dysplasia. The major symptoms of ectodermal dysplasia were evaluated. Patient histories were obtained in all cases, and a complete head and neck examination was carried out. Of the 23 patients (11 males and 12 females, aged 5 to 45 years) diagnosed with ectodermal dysplasia, 22 had hypohidrotic ectodermal dysplasia and 1 had ectrodactyly-ectodermal dysplasia-clefting syndrome. In all patients diagnosed with hypohidrotic ectodermal dysplasia, the salivary glands were examined by ultrasonography and, when necessary, by scintigraphy. Hearing defects inpatients with otologic problems were determined by audiometric examination: 39.1% of the patients had hearingloss, 43.5% had otitis media, and 39.1% had impacted cerumen. The most common rhinologic findings were saddle nose deformity in 56.5%, nasal obstruction and nasal dryness (52.2% each), and chronic rhinitis/rhinosinusitis (34.8%). The most common oral and oropharyngeal findings were difficulty chewing in 82.6% and dry mouth in 78.3%. All 23 patients had required dental work. Because this disorder affects several aspects of the body, its treatment requires a multidisciplinary approach, with the otolaryngologist being a vital part of the management team.
The burden of Hearing Loss in Kaduna, Nigeria: A 4-Year Study at the National Ear Care Centre
Authors: Kodiya Aliyu M. , Afolabi Olushola A. , Ahmad Babagana M.
Published: January 2019

Hearing loss among people in developing countries has been recognized as a major source of disability. Many of its causes are preventable, and others are curable. We reviewed the records of 5,485 patients who had presented during a 4-year period to the National Ear Care Centre in Kaduna, Nigeria. Of these, we identified 1,435 patients—812 males and 623 females, aged 9 months to 90 years (mean: 29.2 yr)—who had been diagnosed with hearing loss (26.2%). In addition to demographic data, we compiled information on each patient's type and degree of hearing loss, the affected side, and the predisposing factors. Sex and age cross-tabulations revealed that the greatest proportion of hearing loss according to sex occurred between the ages of 11 and 20 years for males and 21 and 30 years for females. The most common type of hearing loss was sensorineural, which was seen in 78.9% of patients; conductive hearing loss was seen in 17.7% and mixed in 3.4%. More than three-quarters of hearing losses were either moderate, moderately severe, or severe. Bilateral losses were far more common than unilateral losses; among the latter, the left side was affected slightly more often than the right. Predisposing factors were not documented in the vast majority of cases (87.6%), but when they were, the most common were chronic suppurative otitis media, meningitis, febrile convulsion, measles, and trauma. We present these findings to highlight the burden of hearing loss in our part of the world.
Congenital Os Vomer Agenesis: Case Report and Literature Review
Authors: Yorgancilar Ediz , Yildirim Muzeyyen , Gun Ramazan , Meric Faruk , Topcu Ismail
Published: January 2019

Defects of the nasal septum occur as a result of a variety of causes, including tuberculosis, irritation, neoplasia, trauma, infection, and chronic inflammatory diseases. Congenital os vomer agenesis as a cause is very rare. We report the case of a 28-year-old man with a defect in the posteroinferior part of the nasal septum that was discovered incidentally during a routine endoscopic examination. The patient was diagnosed with congenital os vomer agenesis, and the diagnosis was confirmed by computed tomography. We discuss the features of this case and review the literature on this rare anomaly.
Germ Cell Tumor Metastatic to the Oral Cavity
Authors: Lee Luis , Oppenheimer Randy , Jayaram Lakshmi
Published: January 2019

Neoplasms metastatic to the oral cavity are rare, accounting for less than 1% of all malignancies found there. When they do occur, they are usually found in the soft tissue or mandible. Metastatic malignancies involving the gingival, alveolar, or buccal mucosa are very rare. We present a case of what appeared to be a benign epulis in a 25-year-old man. Biopsy revealed that the lesion represented metastatic testicular cancer.
Topical Measles-Mumps-Rubella Vaccine in the treatment of Recurrent Respiratory Papillomatosis: Results of a Preliminary Randomized, Controlled Trial
Authors: Lei Jin , Yu Wang , Yuexin Lin , Qi Chen , Xiumin Sun , Tianyu Zhang
Published: January 2019

We conducted a study to test the hypothesis that the measles-mumps-rubella (MMR) vaccine can either prevent further recurrences of recurrent respiratory papillomatosis (RRP) or prolong its remission. Our study population was made up of 26 children with RRP. All patients underwent surgical excision of their lesions. After the lesions were removed, half of these patients were prospectively randomized to receive a topical coating of the MMR vaccine on the site of their excised lesion (intervention group); the other half were treated with excision alone (control group). The patients in the intervention group experienced a longer period of recurrence-free remission than did those in the control group (median: 160 and 133 days, respectively), but the difference was not statistically significant. Therefore, it appears that topical MMR vaccine as an adjunct to routine surgical management may not be beneficial in preventing or slowing the return of RRP. However, we believe that further studies with larger patient populations are warranted.
Myxoid Malignant Fibrous Histiocytoma Presenting as a Midline Nasal Mass
Authors: DeRosa Jaimie , Smit Jeffrey R.
Published: January 2019

Myxoid malignant fibrous histiocytoma is a rare type of pediatric non-rhabdomyosarcoma soft-tissue sarcoma. The case of a 5-year-old girl is presented, highlighting the potential for multiple pitfalls and aberrant differential diagnoses that need to be identified for successful treatment of pediatric myxofibrosarcomas. An awareness of these tumors and a call for standardized postsurgical treatment protocols is necessary in order to successfully treat children with this disease.
Lateral Ectopic Thyroid: A Case Diagnosed Preoperatively
Authors: Prado Héctor , Prado Alejandro , Castillo Bertha
Published: January 2019

Ectopic thyroid is an uncommon condition defined as the presence of thyroid tissue at a site other than the pretracheal area. When the process of embryologic migration is disturbed, aberrant thyroid tissue may appear. In most cases, ectopic thyroid is located along the embryologic descent path of migration as either a lingual thyroid or a thyroglossal duct cyst. In rare cases, aberrant migration can result in lateral ectopic thyroid tissue. Approximately 1 to 3% of all ectopic thyroids are located in the lateral neck. Ectopic tissue frequently represents the only presence of thyroid tissue; a second site of orthotopic or ectopic thyroid tissue is found in other cases. The presentation of ectopic thyroid as a lateral mass should be differentiated from metastatic thyroid cancer; other differential diagnoses include a submandibular tumor, branchial cleft cyst, carotid body tumor, and lymphadenopathy of various etiologies. In addition to the history and physical examination, the workup for a patient with a submandibular mass suspicious for ectopic thyroid should include (1) technetium-99m or iodine-131 scintigraphy, (2) ultrasonography and either computed tomography or magnetic resonance imaging, (3) fine-needle aspiration biopsy, and (4) thyroid function testing. No treatment is required for asymptomatic patients with normal thyroid function and cytology, but hypothyroid patients should be placed on thyroid hormone replacement therapy. Most cases are diagnosed postoperatively. Surgical treatment of ectopic thyroid should be considered when a malignancy is suspected or diagnosed, when the patient is symptomatic, or when thyroid suppression therapy fails.
Intracranial Sarcoid Granuloma as An extension of Severe Sinonasal Sarcoidosis
Authors: Wold Stephen M. , Sinacori John T.
Published: January 2019

Sarcoidosis is a chronic, multisystem, granulomatous disease of unknown etiology. It manifests with a wide range of symptoms and clinical findings, including some that occur in the head and neck. Sinonasal sarcoidosis, in particular, frequently demonstrates a rather recalcitrant course and a potential for severe complications if left untreated. We present the case of a 46-year-old woman with extensive sinonasal sarcoidosis that progressed to involve the skull base and olfactory tract and ultimately led to the formation of a granuloma within the frontal lobe that required craniotomy and excision. Although surgery is not considered the primary treatment modality for sarcoidosis, it may have a role in managing this highly variable disease in certain patients.
Case Report: Metastatic Small-Cell Lung carcinoma of the External Auditory Canal
Authors: Hain Moshe , Feldberg Edit , Halperin Doron
Published: January 2019

We report the case of a 73-year-old man who developed metastatic small-cell lung cancer to the bony external auditory canal (EAC). The patient had only recently been diagnosed with his primary carcinoma. The metastasis presented as a bulky, fleshy, bleeding mass in the right EAC. Biopsy of the metastasis revealed that its histologic characteristics were identical to those of the primary. This case is of interest because this was a unique type of metastasis to the EAC. Although there are reports in the literature of lung cancer and even small-cell cancer metastasizing to the temporal bone, we could find no previously published report of a small-cell lung carcinoma metastasizing to the EAC.
Bipolar Radiofrequency-Induced Interstitial Thermoablation for Oral Cavity Vascular Malformations: Preliminary Results in a series of 5 Children
Authors: Civelek Şenol , Sayín İbrahim , Ercan İbrahim , Çakír Burak Ömür , Turgut Suat
Published: January 2019

We report our assessment of the effectiveness of bipolar radiofrequency-induced interstitial thermoablation (BRIT) for the treatment of certain oral cavity vascular malformations in 5 children. Two of these patients had lymphangiomatous macroglossia (LM), 1 had lymphangioma circumscriptum (LC), and 2 had a venous malformation (VM). Each patient underwent BRIT at least twice; treatment was delivered at 4- to 8-week intervals according to each patient's circumstances. The 2 patients with LM required three treatment sessions; although their tongue volume decreased after each session, both still required a partial glossectomy to achieve a satisfactory reduction in volume. The patient with LC underwent two BRIT treatments, which reduced the size of the lesion by half; the remainder was excised. The 2 patients with a VM (1 buccal and 1 lingual) responded well to BRIT, and their malformations almost completely disappeared. Our early results with BRIT suggest that it is an effective treatment for oral cavity vascular malformations—more so for patients with venous rather than lymphangiomatous lesions.
Mucoepidermoid carcinoma of the Larynx with Transglottic Involvement in a Child: A Case Report
Authors: Bhagat Sanjeev , Varshney Saurabh , Singh Rakesh K. , Bist Sampan
Published: January 2019

Mucoepidermoid carcinoma (MEC) of the larynx is one of the rarest tumors in the pediatric age group. Our review of the English-language literature found only 1 previously reported case of a laryngeal MEC in a child. We present what to the best of our knowledge is the first case of a pediatric MEC of the larynx with transglottic involvement. Our patient was a 12-year-old girl who presented with long-standing hoarseness and recent dysphagia, breathing difficulty, and pain radiating to the left ear. Investigation revealed the presence of an endophytic mass in the larynx. Histopathologic examination of biopsy tissue identified the mass as a low-grade MEC. The patient was scheduled to undergo a total laryngectomy 1 week later, but she did not report for surgery. Three weeks later, she presented to the emergency department in a semiconscious state and in respiratory distress. Despite all resuscitative measures, she died.
Intraparotid Arterial Aneurysm Treated with Embolization Followed by Surgical Resection
Authors: Ganc Daniel T. , Prestigiacomo Charles , Baredes Soly
Published: January 2019

We describe the case of a 41-year-old woman who presented to a local facial plastic surgeon for evaluation of a cosmetic defect of the cheek of 1 month's duration. When imaging revealed the presence of a vascular mass, the patient was referred to us. Further imaging identified the mass as an intraparotid external carotid artery aneurysm. The decision was then made to treat the patient with embolization of the lesion followed by surgical resection the next day. During the resection, the lateral-most aspect of the aneurysm was found to be adherent to and splaying the facial nerve. The embolized mass and the surrounding fascial layer were removed, and the branches of the facial nerve were retracted superiorly and inferiorly. Dissection proceeded around the aneurysm in this plane. Blood loss during the procedure was minimal. On postoperative day 1, the patient exhibited minimal lower facial asymmetry. In this case, performing embolization prior to surgical resection appeared to be a prudent and efficacious strategy. The preoperative embolization greatly reduced the risk of damage to the facial nerve.
An Unusual cause of Vertigo, Tinnitus, and Hyperacusis: Vogt-Koyanagi-Harada Syndrome
Authors: Gaudreau LT Philip , Moy LCDR Justin , Lindsay Fred
Published: January 2019

We describe the case of a 36-year-old woman with a history of vitiligo who presented with an insidious onset of neurologic, vestibular, ocular, and auditory symptoms. She had recently noted the onset of vertigo, tinnitus, and hypersensitivity to sound. Findings on audiometry were within normal limits, although the patient reported some auditory discomfort during the testing. The patient had a history of bilateral uveitis and peripheralneurologic symptoms. She was diagnosed with Vogt-Koyanagi-Harada (VKH) syndrome and started on corticosteroid therapy. Her neurologic, vestibular, ocular, and auditory symptoms resolved. VKH syndrome is an uncommon cause of vertigo and hearing loss, but it should be considered in the differential diagnosis of patients with autoimmunity-related inner ear symptoms.
Nasopharyngeal metastasis of Follicular carcinoma of the Thyroid with Extensive Clear Cell Change: A Case Report
Authors: Patel Trupti Shreyans , Desai Swapan L. , Trivedi Priti P. , Shah Manoj J.
Published: January 2019

Thyroid carcinoma metastatic to the maxillofacial area is extremely rare. Other carcinomas can metastasize to this area, but very few cases of follicular thyroid carcinoma metastasizing to the nasopharynx have been reported. Carcinoma from the kidney, liver, large bowel, prostate, and thyroid are known to have the potential for clear cell differentiation, and all of them can metastasize to the sinonasal area. Histochemical and immunohistochemical evaluations, along with clinical details, are useful in distinguishing metastases of these clear cell tumors from primary sinonasal tumors. In this article we describe a rare case of metastatic thyroid carcinoma with clear cell change mimicking metastatic renal cell carcinoma in the nasopharynx.
A Prospective Study of Parents’ Compliance with Their Child's Prescribed Analgesia following Tonsillectomy
Authors: Lennon Paul , Amin Mohamed , Colreavy Michael P.
Published: January 2019

We conducted a prospective study to assess how well parents ensured that their children received their prescribed analgesia following tonsillectomy. Our study was based on 69 cases of tonsillectomy that were carried out at our tertiary pediatric care center. Postoperatively, all patients were prescribed paracetamol (acetaminophen) on the basis of their weight; the standard pediatric dosage of this agent at the time of our study was 60 mg/kg/day. The parents were telephoned 2 weeks postoperatively to assess their compliance with this regimen. Of the original 69 patients who had been recruited, 66 completed the study—35 girls and 31 boys, aged 2 to 15 years (mean: 7.0; median 5.5). According to the parents, only 15 children (22.7%) received our recommended 60-mg/kg/day dosage and were thus determined to be fully compliant. Overall, parents reported a wide variation in the amount of drug administered, ranging from 12.5 to 111.0 mg/kg/ day (mean: 44.8), indicating that parents often underdose their children. We recommend that more emphasis be placed on weight-directed, parent-provided analgesia during the post-tonsillectomy period.
Craniofacial and Shoulder Asymmetry and its Relationship to Temporomandibular Disorder: A Study of 183 Patients
Authors: Cox Kent W. , Klein Rob
Published: January 2019

We conducted a prospective study to ascertain the prevalence of features of craniofacial and shoulder asymmetry and to determine if they are related to temporomandibular disorder (TMD). Our study population was made up of 183 patients—105 females and 78 males, aged 8 to 92 years (mean: 53.5; median: 60) who presented to a private otolaryngologic practice in a rural retirement community in Arizona. These patients completed a questionnaire to determine their self-assessment of the their body asymmetry. Next, all patients underwent a nurse evaluation for the presence or absence of asymmetry, which was based on the relative position of the ears, lateral canthi, hemimandibles, and shoulders. All patients were then evaluated independently by a physician for the presence or absence of TMD. The most important finding of this study was that asymmetry as determined by the nurse evaluation was associated with a relative risk of TMD of 5.89 (p = 0.0001); the perception of asymmetry on the patient self-assessments was associated with a relative risk of only 1.86 (p = 0.0026). We conclude that the recognition and diagnosis of TMD is significantly enhanced by a brief evaluation by a health professional who has been trained in recognizing the signs of facial and shoulder asymmetry.
A Study of Persistent Unilateral Middle Ear Effusion Caused by Occult Skull Base Lesions
Authors: Leonetti John P.
Published: January 2019

Te goal of this article is to review a series of patients with persistent unilateral middle ear effusion (MEE) and to suggest a more contemporary diagnostic algorithm. The author conducted a retrospective chart review of adults with persistent unilateral MEE and normal findings on physical and nasopharyngoscopic examinations whose MEE was eventually found to be caused by a variety of occult skull base lesions. The study population was made up of 79 patients–52 women and 27 men, aged 21 to 83 (mean: 54.8) at presentation–who had been referred to an academic tertiary care medical center between July 1, 1988, and June 30, 2008. Follow-up ranged from 9 months to 19.5 years (mean: 8.7 yr). Of this group, 50 patients (63.3%) had a malignant tumor, 26 (32.9%) had a benign tumor, and 3 (3.8%) had an internal carotid artery aneurysm. Eustachian tube occlusion had been caused by diffuse invasion in 33 patients (41.8%), by intracranial pathology in 24 (30.4%), and by extracranial-infratemporal lesions in 22 (27.8%). Nasopharyngoscopy cannot identify a variety of rare skull base lesions that cause eustachian tube compression or tissue invasion that ultimately leads to MEE. Therefore, patients with unexplained persistent unilateral MEE should undergo coronal magnetic resonance imaging or computed tomography to look for any intra- or extracranial lesions before undergoing ventilation tube placement.