bluuebunny/crossref_metadata_2025 huggingface dataset:
Early-onset Postirradiation Sarcoma of the Head and Neck: Report of Three Cases
Authors: Johns Michael M. , Concus Adriane P. , Beals Ted F. , Teknos Theodoras N.
Published: May 2019

Postirradiation sarcomas of the head and neck are rare. When they do occur, most appear at least 10 years following radiation therapy. We report three cases of early-onset (1, 2, and 7 yr) postirradiation sarcoma. Physicians who care for previously irradiated patients should consider the possibility of a postirradiation sarcoma whenever they see a suspicious lesion, regardless of the amount of time that has passed since radiation therapy was administered. The original pathology should be reexamined to ensure that the original tumor was diagnosed correctly. Electron microscopy can be useful in differentiating sarcomatous-appearing epithelial lesions from true soft-tissue sarcomas, and thus can be helpful in guiding therapy.
Surgery-induced Thyroiditis: Fact or Fiction?
Authors: McDermott Annlouise , Onyeaka Chinyere Vivian Patrick , Macnamara Marcelle
Published: May 2019

Neck surgery carries a risk that the patient will develop postoperative thyroiditis as a result of the surgical procedure. Surgery-induced thyroiditis can manifest in a mild form as serum hyperthyroxinemia or in a more severe form as clinical hyperthyroidism. We describe a case of surgery-induced thyroiditis and review the very limited literature on this subject.
Raynaud's Phenomenon in Radial Forearm Free-Tissue Transfer
Authors: Teknos Theodoros N. , Myers Larry L. , Chepeha Douglas B.
Published: May 2019

During 1998, 69 patients underwent eitherfasciocutaneous or osteofasciocutaneous radial forearm free-tissue transfers at our institution. Three of these patients (4.3%), who had undergone a total of four transfers, had Raynaud's phenomenon. Three of the four transfers survived without perioperative incident. The one flap that failed had been well vascularized until postoperative day 3. Then, coincident with a decrease in ambient room temperature, the patient's extremities and his flap became cyanotic. A salvage procedure was unsuccessful. In this article, we discuss the perioperative course, proposed pathophysiology, and treatment strategies aimed at optimizing hand and flap outcomes in patients with Raynaud's phenomenon.
Temporary balloon occlusion and ethanol injection for preoperative embolization of carotid-body tumor
Authors: Horowitz Michael , Whisnant Richard E. , Jungreis Charles , Snyderman Carl , Levy Elad I. , Kassam Amin
Published: May 2019

We report on the preoperative embolization of a carotid-body paraganglioma by temporary balloon occlusion and ethanol injection. Complete devascularization was achieved without complication. Resection after a short postembolization interval required artery sacrifice. Histologic evaluation revealed that the tumor contained diffuse ethanol-induced microemboli. Compared with unembolized and polyvinyl-alcohol-embolized carotid-body paragangliomas, our technique resulted in no greater adverse effects on the tumor-vessel interface. This procedure is an effective and promising method of preoperative embolization of carotid-body tumors and warrants further experience and study. In this article, we also review the literature on carotid-body tumor embolization and ethanol embolization.
Complete Vascular Ring Detected by Barium Esophagography
Authors: Skinner Liam J. , Ryan Stephanie , Russell John D.
Published: May 2019

The diagnosis of a vascular ring can be made on the basis of characteristic findings on barium esophagography. We report a case of a double aortic arch in a 9-month-old girl that was diagnosed in this manner, and we briefly review the anatomic characteristics of vascular rings.
First Report of a Lipoblastoma of the Parapharyngeal Space
Authors: DePasquale Kalpana , Deschler Daniel G.
Published: May 2019

Lipoblastoma is a rare benign tumor that occurs primarily in children younger than 3 years of age. Fewer than 100 cases have been reported in the literature, and only eight cases have been previously reported in the head and neck; two of them occurred in the parotid region, where the differential diagnosis becomes quite extensive. We report a new case of head and neck lipoblastoma—one that occurred in the parapharyngeal space, a site that has not been previously reported. By doing so, we hope to promote awareness and consideration of lipoblastoma in the differential diagnosis of deep-parotid and para-pharyngeal-space neoplasms.
Biofilm Formation on Tracheostomy Tubes
Authors: Jarrett William A. , Ribes Julie , Manaligod Jose M.
Published: May 2019

An increased awareness of biofilms and their mechanisms has led to a better understanding of bacterial infections that occur following the placement of tracheostomy tubes and other implanted devices and prostheses. One aspect of biofilm formation that is still subject to debate is whether the specific material that is used to manufacture a tube has any bearing in the incidence of infection. We conducted a test of four different tube materials—polyvinyl chloride, silicone, stainless steel, and sterling silver—to ascertain how bacterial biofilms form on tracheostomy tubes and to determine if there is a material-dependent difference in biofilm formation. Scanning electron microscopy demonstrated that Pseudomonas aeruginosa and Staphylococcus epidermidis both formed bacterial biofilms on tracheostomy tubes in vitro. We also found that there was no difference in susceptibility to biofilm formation among the four tube materials tested.
Synchronous Parotid and Nasopharyngeal Warthin's Tumors: First Report of a Case
Authors: Low Wong-Kein , Ng Siok Bian
Published: May 2019

Only a few isolated reports of Warthin's tumor of the nasopharynx have been published in the literature. None of the patients cited in those reports had another Warthin's tumor elsewhere. We describe the case of a patient who had synchronous nasopharyngeal and parotid Warthin's tumors—a case that we believe is the first to be reported in the literature. Our case provided us with a unique opportunity to study and compare the two tumors in a single patient. Their simultaneous presence might have been more than coincidental; it is possible that these two tumors were the result of the influence of one or more unknown systemic factors on trapped salivary elements in the lymphoid stroma.
Direct Application of Dexamethasone for the Treatment of Chronic Eustachian Tube Dysfunction
Authors: Silverstein Herbert , Light Joshua P. , Jackson Lance E. , Rosenberg Seth I. , Thompson Jack H.
Published: May 2019

We undertook a prospective study to determine the safety and effectiveness of the direct administration of a steroid to the eustachian tube via the Silverstein MicroWick in 11 patients with chronic eustachian tube dysfunction, including two who had Samter's triad. All patients had previously been treated with medical therapy and surgical middle ear ventilation without resolution. The MicroWick was placed directly in the eustachian tube orifice through a pressure-equalization tube. Patients received 3 drops of dexamethasone 4 mg/ml three times a day. The drops were discontinued after 4 weeks, and the MicroWick and ventilation tube were removed after 3 months. At study's end, eight patients (72.7%) reported subjective improvement in terms of a reduction in aural pressure and fullness. Audiometric testing demonstrated a 55% reduction in the mean air-bone gap and a 3% increase in the mean speech discrimination score. Bone pure-tone averages remained stable. Tympanometry showed that five patients (45.5%) converted from type B or C tympanograms to type A. Four patients (36.4%) had persistent perforations. Both patients with Samter's triad improved with therapy. These preliminary results suggest that direct dexamethasone administration to the eustachian tube is safe and effective for the treatment of chronic eustachian tube dysfunction. Long-term studies to confirm these findings are under way.
Plasma Cell Granuloma of the Thyroid with Hashimoto's Thyroiditis: Report of a Rare Case
Authors: Mugler Kimberly , Gaido Loretta , Ryder John , Said Sherif
Published: May 2019

As only eight cases have been previously reported in the literature, plasma cell granuloma of the thyroid gland is a rare entity. This condition can be confused with a benign or malignant neoplastic thyroid process. In this article, we describe a new case of plasma cell granuloma of the thyroid gland that occurred in a 46-year-old man who also had Hashimoto's thyroiditis. This case represents only the second documented instance of a plasma cell granuloma of the thyroid occurring in the setting of Hashimoto's thyroiditis. Moreover, it is only the second case of a plasma cell granuloma that has been reported in a male.
Changing Trends in the Surgical Treatment of Ménière's Disease: Results of a 10-year Survey
Authors: Silverstein Herbert , Lewis William B. , Jackson Lance E. , Rosenberg Seth I. , Thompson Jack H. , Hoffmann Karen K.
Published: May 2019

In order to discern trends in surgical procedures used to treat Ménière's disease in the United States during the 1990s, we mailed a questionnaire to 700 members of the American Otological Society and the American Neurotology Society. These physicians were asked about the frequency, results, and complications of surgical procedures for Ménière's disease that they had performed between Jan. 1, 1990, and Dec. 31, 1999. Questionnaires were returned by 137 surgeons (19.6%). Their responses indicated that the number of vestibular neurectomies, labyrinthectomies, and endolymphatic sac surgeries all decreased during 1999. Meanwhile, the use of office-administered intratympanic gentamicin therapy increased rapidly throughout the entire 10-year period, and by 1999 it had become the most frequently used invasive treatment for Ménière's disease. Surgeons now seem to reserve inpatient procedures for cases where intratympanic gentamicin fails to control vertigo.
Endoscopic Management of Inverted Papillomas of the Nose and Paranasal Sinuses
Authors: Baruah Paramita , Deka Ramesh C.
Published: May 2019

We performed endoscopic resection on six patients who had inverted papillomas of the nasal cavity. Disease was completely cleared in four patients after a single procedure, while two others—both of whom had bilateral disease—required repeat surgery. At follow-up, which ranged from 6 months to 5 years, all patients were disease-free. We believe that endoscopic surgery is ideally suited for the treatment of appropriately selected patients who have limited disease and who are likely to adhere conscientiously to a regular follow-up program.
Treatment of Advanced Oropharyngeal Cancers with Chemotherapy and Radiation
Authors: LoTempio Maria M. , Wang Marilene B. , Sadeghi Ahmad
Published: May 2019

We conducted a retrospective chart review of treatment outcomes in 17 adults who had been selected to undergo concomitant chemotherapy and radiation (chemo/XRT) for late-stage oropharyngeal cancers. All patients had been treated at the West Los Angeles VA Medical Center between March 1, 1998, and Sept. 30, 2000. Nine patients had a primary tumor at the base of the tongue, five had a primary tumor in the tonsillar area, and three had a tumor that affected both sites. Of this group, 15 patients completed one to three cycles of chemo/XRT, and the remaining two died during therapy. At the most recent follow-up, 9 of the 17 patients (52.9%) were documented to still be alive; seven patients had earlier died as a result of their primary tumor or a distant metastasis, and one patient had been lost to follow-up after completing treatment. At study's end, the duration of post-treatment survival ranged from 2 to 36 months (mean: 12.5). Based on the results of our small series, we conclude that chemo/XRT is a valid alternative to surgery with postoperative radiation and to radiation alone. Chemo/XRT yields acceptable rates of local control and allows for organ preservation with tolerable side effects.
Subtotal Parathyroidectomy: A Possible Treatment for Calciphylaxis
Authors: Bahar Gideon , Mimouni Daniel , Feinmesser Meora , David Michael , Popovzer Aharon , Feinmesser Raphael
Published: May 2019

Calciphylaxis is a rare disorder in patients with chronic renal failure that is characterized by ischemic necrotic skin lesions. The prognosis is grave and mortality is high (80%). The precise mechanism of calciphylaxis is still unknown, but in addition to chronic renal failure, elevated parathyroid hormone levels appear to play a role. The role of parathyroidectomy in treating affected patients is questionable. In this article, we describe the case of a patient with chronic renal failure who developed rapidly progressive subcutaneous calcifications and ulcerations in the lower extremities. These lesions regressed following subtotal parathyroidectomy. We also review the literature on calciphylaxis, with a focus on treatment options.
Black Esophagus
Authors: Pantanowitz Liron , Gelrud Andres , Nasser Imad
Published: May 2019

Black esophagus is a rare, relatively newly described, and usually incidental finding. The differential diagnosis includes several disease states, including ischemia, which has been implicated in acute necrotizing esophagitis. Several theories have been proposed to explain its etiology.
The Effects of Autologous Platelet Gel on Wound Healing
Authors: Henderson Jenifer L. , Cupp Craig L. , Ross E. Victor , Shick Paul C. , Keefe Michael A. , Wester Derin C. , Hannon Timothy , McConnell Devin
Published: May 2019

Laser resurfacing techniques have become a popular means of achieving rejuvenation of damaged skin. Interest is great in attempting to speed re-epithelialization and healing so that patients can return to their normal activities as quickly as possible. Previous studies have demonstrated that wounds heal more quickly when they are covered and kept moist than when they are left open to the air. Until now, no study has been conducted to investigate whether the healing process of a superficial skin burn might be accelerated by the use of an autologous platelet gel as a biologic dressing. Our study of five pigs showed that autologous platelet gel can influence wound healing by stimulating an intense inflammatory process that leads to highly significant increases in the production of extracellular matrices and granulation tissue. The platelet gel accelerated vascular ingrowth, increased fibroblastic proliferation, and accelerated collagen production. However, the gel did not appear to accelerate re-epithelialization. The aggressive production of granulation tissue and the acceleration of collagen production might mean that autologous platelet gel will have a future role in the treatment of burns because the highly vascularized bed it helps create should promote the success of skin grafting in patients with deep partial-thickness and full-thickness burns.
Arteriovenous Malformation of the Maxillary Sinus and Mandible: A Case Report
Authors: Cansiz Harun , Yener Murat , Kalekoglu Nuran , Dalkiliç Osman
Published: May 2019

Vascular tumors are rarely encountered in the paranasal sinuses. When they do arise there, they can be life-threatening because of the risk of bleeding. Embolization alone and in combination with surgical resection has been the mainstay of treatment. We report the case of a prepubertal girl who experienced two recurrences of arteriovenous malformation, one in the maxillary sinus and the other in the mandible. To our knowledge, this is the first report in the literature of recurrences arising in these two locations.
Solitary Malignant Schwannoma of the Nasal Cavity and Paranasal Sinuses: Report of Two Rare Cases
Authors: Mannan A.A.S. Rifat , Singh Manoj Kumar , Bahadur Sudhir , Hatimota Pradeep , Sharma Mehar Chand
Published: May 2019

Malignant schwannomas of the paranasal sinuses are extremely uncommon tumors, as only 18 well-documented cases have been previously published in the English-language literature. We report two new cases of solitary malignant schwannoma—one in a 23-year-old man and the other in a 45-year-old woman. Neither was associated with von Recklinghausen's disease. These tumors involved the maxillary sinus, nasal cavity, and orbit and extended intracranially. Following surgery, both patients experienced recurrences. The male patient developed a slowly enlarging intranasal mass at the same site 8 years following excision of the original tumor and postoperative radiotherapy. Microscopic examination of the recurrent tumor revealed that its features were similar histologically to those of the original. The female patient experienced a recurrence 1 year following her first operation.
Tongue Viability after Bilateral Lingual Artery Ligation and Surgery for Recurrent Tongue-Base Cancer
Authors: Foster Paul K. , Weed Donald T.
Published: May 2019

A 73-year-old man came to us with a second primary tumor of the tongue base. He had undergone a total laryngectomy, neck dissections, and radiation for squamous cell carcinoma of the glottis 25 years earlier. Surgery was performed, including a subtotal tongue-base resection and pectoralis myocutaneous flap reconstruction. Intraoperative findings confirmed tumor involvement of the left lingual artery and hypoglossal nerve, both of which were sacrificed. Dissection revealed an intact but apparently thrombosed right lingual artery, and this was verified by intraoperative Doppler evaluation. Postoperatively, the preserved oral tongue remained well perfused and viable, and tongue mobility was good. In patients who have undergone previous head and neck cancer resections, collateral blood supply to the tongue might develop if the flow of one or both of the lingual arteries is interrupted. This possibility can be fully evaluated by preoperative angiography, which might offer these patients the potential for tongue preservation.
Esophageal Perforation and Neck Abscess from Ingested Foreign Bodies: Treatment and Outcomes
Authors: Lam Henry Chuen Kwong , Woo John Kong Sang , van Hasselt Charles Andrew
Published: May 2019

Over a 6.5-year period, 5,848 patients who had ingested a foreign body were admitted to the ENT unit at the Prince of Wales Hospital in Hong Kong. Potentially serious complications developed in 12 patients (0.21%). Eight patients had an esophageal perforation; three had clinical evidence that their injury had been caused by the foreign body itself and five were deemed to have been injured iatrogenically during esophagoscopy. One of the latter group eventually developed an abscess. Four patients originally presented with an abscess. Three of these patients and the patient who later developed an abscess were treated with neck exploration and surgical drainage. One of the patients who initially presented with an abscess refused surgical treatment and was treated conservatively. Conservative treatment was also initiated for all patients who had a perforation. Patients on the conservative regimen were administered intravenous broad-spectrum antibiotics and were not permitted to take any food or liquids by mouth; they received their nutrition via either enteral feeding or total parenteral nutrition. Conservative treatment was successful in all seven patients with a perforation and no abscess and in the one patient with an abscess who refused surgery. Moreover, all four patients who underwent surgical treatment recovered. Our experience demonstrates that esophageal perforation related to an ingested foreign body can be safely treated by conservative means if the diagnosis is made before significant contamination occurs. Conversely, abscesses (cervical or mediastinal) related to an ingested foreign body should be explored and surgically drained.
A Comparison of Skin Endpoint Titration and Skin-Prick Testing in the Diagnosis of Allergic Rhinitis
Authors: Gungor Anil , Houser Steven M. , Aquino Benjamin F. , Akbar Imran , Moinuddin Rizwan , Mamikoglu Bulent , Corey Jacquelynne P.
Published: May 2019

Among the many methods of allergy diagnosis are intradermal testing (IDT) and skin-prick testing (SPT). The usefulness of IDT has been called into question by some authors, while others believe that studies demonstrating that SPT was superior might have been subject to bias. We conducted a study to compare the validity of SPT and IDT—specifically, the skin endpoint titration (SET) type of IDT—in diagnosing allergic rhinitis. We performed nasal provocation testing on 62 patients to establish an unbiased screening criterion for study entry. Acoustic rhinometric measurements of the nasal responses revealed that 34 patients tested positive and 28 negative. All patients were subsequently tested by SET and SPT. We found that SPT was more sensitive (85.3 vs 79.4%) and more specific (78.6 vs 67.9%) than SET as a screening procedure. The positive predictive value of SPT was greater than that of SET (82.9 vs 75.0%), as was the negative predictive value (81.5 vs 73.0%). None of these differences was statistically significant; because of the relatively small sample size, our study was powered to show only equivalency. The results of our study suggest that the information obtained by the SET method of IDT is comparable to that obtained by SPT in terms of sensitivity, specificity, and overall performance and that both SET and SPT correlate well with nasal provocation testing for ragweed. Therefore, the decision as to which to use can be based on other factors, such as the practitioner's training, the desire for quantitative results, the desire for rapid results, and the type of treatment (i.e., immunotherapy or pharmacotherapy) that is likely to be chosen on the basis of test results.
Fine-needle Aspiration Cytology in the Management of Salivary Gland Tumors: An Australian Experience
Authors: Stow Nicholas , Veivers David , Poole Alan
Published: May 2019

We conducted a retrospective study of 104 cases of salivary gland tumors that were initially assessed by fine-needle aspiration biopsy (FNAB). Based on subsequent histopathologic analysis of excised specimens, we found that preoperative FNAB was highly sensitive and specific for both benign and malignant tumors—including the most common, pleomorphic adenomas and squamous cell carcinomas, respectively. Despite its possible drawbacks, we conclude that preoperative FNAB is a useful tool in the management of salivary gland tumors.
A Case of a BB-gun Pellet Injury to the Ethmoid Sinus in a Child
Authors: Chhetri Dinesh K. , Shapiro Nina L.
Published: May 2019

Injuries caused by BB and pellet guns remain common among children. These guns fire low-velocity missiles that can cause considerable harm when fired at close range. Most injuries occur in adolescents as a result of accidental or careless shooting. Such injuries to head and neck sites are common, second only to injuries to the extremities. We report the case of a 10-year-old girl who was accidentally shot by a BB gun. The BB pierced the skin of her right cheek, traversed the right maxillary sinus walls, and lodged at the junction of the right ethmoid sinus and septum. Preoperative radiology combined with endoscopic surgery techniques and instrumentation allowed us to precisely locate and remove the steel ball from the paranasal sinus while the patient was under general anesthesia. We review the scope of maxillofacial injuries caused by BB and pellet guns, and we discuss their presentation, diagnosis, and management. Although these guns are easily bought and sold as toys, they are weapons capable of causing significant injury.
Primary Nasal Tuberculosis: A Case Report
Authors: Nayar Ravi C. , Al Kaabi Juma , Ghorpade Kanchanmala
Published: May 2019

During the past 2 decades, tuberculosis—both pulmonary and extrapulmonary—has re-emerged as a major health problem worldwide. Nasal tuberculosis—either primary or secondary to pulmonary tuberculosis or facial lupus—is rare, but it should be considered in the differential diagnosis of nasal granulomas. We describe a case of primary nasal tuberculosis in an adult male who presented with a polypoid lesion in one nasal cavity. The diagnosis was based on histopathology and the patient's successful response to antituberculous drug treatment. Given the rising incidence of tuberculosis, it is prudent that otolaryngologists remain cognizant of this infection as a potential cause of unusual lesions in the head and neck.
Effects of Tisseel Fibrin Glue on the Central Nervous System of Nonhuman Primates
Authors: Kassam Amin , Nemoto Edwin , Balzer Jeffrey , Rao Gutti , Welch William C. , Kuwabara Hiroto , Boada Fernando , Horowitz Michael
Published: May 2019

For many years, neurosurgeons and otolaryngologic surgeons have used the fibrin glue product Tisseel to repair skull-base spinal fluid leaks and to help secure repairs following anterior cranial-base surgery. Despite the widespread use, the potential focal cerebral toxicity of this fibrin glue has never been investigated. We studied the safety of Tisseel applied directly to neural tissue (brain parenchyma, cervical cord, and C3-C6 spinal roots) of 6 monkeys (Macaca nemestrina) to determine if any underlying biochemical injury would occur. Another 3 animals that served as controls received saline rather than Tisseel. We found that median nerve electroencephalographic tracings and somatosensory evoked potentials in the experimental and control animals were identical. Likewise, cerebrospinal fluid indicators of neuronal or brain injury, inflammatory responses, and infection were negative in both groups. Finally, there were no significant differences between the two groups with respect to edema volumes and apparent diffusion coefficient values. We conclude that Tisseel does not induce an apparent inflammatory response or abnormal neurophysiologic or histologic response within 5 days of its application when it is applied directly to the brain parenchyma or onto the cervical spinal cord.
Multiple Myeloma in a Patient with Hoarseness, Dysphagia, Aspiration, and Cervical Lymphadenopathy
Authors: Fortson James K. , Nuriddin Ahmad , McCarter Freda , Henderson Vernon J. , Patel Vijaykumar
Published: May 2019

Multiple myeloma, which primarily affects the elderly, is rare in the head and neck. We report the case of a 71-year-old man who came to us with hoarseness, dysphagia, intermittent aspiration, and cervical lymphadenopathy. Our work-up included laboratory tests, radiographic examinations, analysis of bone marrow aspiration, and histopathologic evaluations. Cervical lymph node biopsy confirmed a diagnosis of multiple myeloma. Despite treatment with chemotherapy and radiation, the patient died of his disease 6 months later.
Simultaneous Nonparotid Cranial Mucosa-Associated Lymphoid Tissue Lymphoma and Common Variable Immunodeficiency
Authors: Tcheurekdjian Haig , Jenkins Oliver , Hostoffer Robert
Published: May 2019

Common variable immunodeficiency (CVID) is a condition characterized by low levels of immunoglobulin (Ig) G and either IgA or IgM in the presence of recurrent infections. This disorder is associated with an increased risk of malignancy. Mucosa-associated lymphoid tissue (MALT) lymphoma is a recently recognized form of non-Hodgkin's lymphoma that is not often present in the head. MALT lymphoma in patients with CVID is rare, and until now, it has not been reported in a cranial location outside of the parotid gland. We report the cases of 2 patients who had CVID and cranial MALT lymphoma outside of the parotid gland, and we describe their successful treatment with chemotherapy.
Comparison of Two Face Masks used to Deliver Early Ventilation to Laryngectomized Patients
Authors: Bhalla Rajiv K. , Corrigan Anita , Roland Nicholas J.
Published: May 2019

Emergency airway management of laryngectomized patients is inherently complicated by the altered contours of their necks, by the presence of awkwardly placed tracheostomas, and by stomal strictures. Effective ventilation can also be compromised by the presence of hypertrophic peristomal scar tissue and by tumor recurrence. One common method of airway management involves the use of a pediatric face mask attached to a standard ventilation bag. We conducted a study of 20 laryngectomized patients to determine if they could be adequately ventilated through two commonly used pediatric face masks—the Laerdal mask and the Ambu mask. Ten of these patients had had an end tracheostoma in place for at least 1 year, and the remaining 10 had undergone stoma placement only recently. We found that all 20 patients achieved an adequate peristomal seal when using the Laerdal mask, whereas only 11 adequate seals were achieved with the Ambu mask. Therefore, we recommend that the Laerdal pediatric mask be used for early ventilation in laryngectomized patients.
Crohn's Disease of the Esophagus
Authors: Pantanowitz Liron , Gelrud Andres , Apstein Michael , Nasser Imad
Published: May 2019

Crohn's disease of the esophagus is rare but is being detected more frequently because of the use of upper endoscopy. Clinicopathologic correlation is required to establish the correct diagnosis. We present a case of esophageal Crohn's disease and review the literature to demonstrate that esophageal involvement is usually associated with disease elsewhere in the gut.
Charcot-Leyden Crystals: Pathology and Diagnostic Utility
Authors: Pantanowitz Liron , Balogh Karoly
Published: May 2019

Eosinophilia is associated with several diseases of the upper respiratory tract. The predominance of eosinophils in nasal tissue, secretions, and lavage fluid has been used as an aid in the diagnosis of allergic rhinitis. Charcot-Leyden ctystals, considered to be a morphologic hallmark of eosinophil-related disease, are often also found in inflamed nasal tissue and paranasal sinus contents of patients with allergic rhinitis. These bipyramidal-shaped crystals are composed of the enzyme lysolecithin acylhydrolase, one of several eosinophilic proteins that damage respiratory epithelium and contribute to the pathology of allergy in the upper respiratory tract.
Pleomorphic Adenoma of the Base of the Tongue
Authors: Berry Sandeep , Tay Huey , Puentes Carlos P.
Published: May 2019

We describe a rare case of pleomorphic adenoma involving the base of the tongue and adjacent valleculae. We also discuss the incidence, diagnosis, and treatment of these cases.
Arterial Pulse as a Rare Artifact Observed on Electronystagmography
Authors: Mitsuhashi Miyuki , Tsunoda Atsunobu , Komatsuzaki Atsushi
Published: May 2019

We report a rare artifact observed during electronystagmography (ENG) in a 54-year-old woman. Rhythmic waves were seen on ENG even though no corresponding movements of the eyes or eyelids were detected, even by infrared camera monitoring. The rhythmic waves corresponded to the patient's pulse and occurred after the appearance of each QRS complex on electrocardiography (ECG). The waves were believed to have been generated by the pulse of the artery near the electrodes, which represented contamination of plethysmography at the temple. To the best of our knowledge, such an artifact has not been previously reported in the literature. When rhythmic waves unrelated to eye movements are recorded during ENG, an artifact of cardiovascular origin should be ruled out, and ECG and direct observation of the eyes are necessary.
Partial Tetrasomy of Chromosome 22: Genetic and Surgical Implications for Otolaryngologists
Authors: Godinho Ricardo N. , Keogh Ivan J. , Morales Gustavo M. , Calixto Nassin , Gonçalves Tânia M.L.
Published: May 2019

Partial tetrasomy of chromosome 22 is a rare multiple congenital anomaly syndrome that is more commonly known as cat-eye syndrome (CES). It is caused by the duplication of a 2-million base region of chromosome 22 (22 pter → q 11·2). The phenotype is extremely variable, and its clinical characteristics include a combination of craniofacial, cardiac, renal, gastrointestinal, and genitourinary defects. We describe a rare occurrence of CES in a Brazilian family. Three siblings were affected—monozygotic twin boys and their younger brother. All 3 were born to healthy nonconsanguineous parents. On examination, all 3 were found to have strabismus, primary telecanthus, bilateral coloboma iridis, and low-set ears with posterior rotation of the pinnae. Partial tetrasomy of chromosome 22 was confirmed by fluorescent in situ hybridization. To our knowledge, this is the first report of such an occurrence in one family. We discuss the genotype and phenotype of CES, with particular reference to inheritance patterns and craniofacial defects.
Bilateral Asymmetric Mucoceles of the Paranasal Sinuses: A First Case Report
Authors: Varghese Lalee , John Mary , Kurien Mary
Published: May 2019

Bilateral paranasal sinus mucoceles are rare. To date, only 5 cases have been reported in the English-language literature. All were bilaterally symmetrical. We present a patient with bilateral asymmetric mucoceles. This patient had a symptomatic mucocele of the right ethmoid sinus with orbital extension and an asymptomatic mucocele involving the left maxillary sinus with retroorbital extension. The latter was an incidental finding on radiologic evaluation. This is the first case report of bilateral mucoceles with asymmetric involvement of the paranasal sinuses.
Bacteriology in Patients with Chronic Sinusitis who have been Medically and Surgically Treated
Authors: Yildirim Altan , Oh Charles , Erdem Hakan , Kunt Tanfer
Published: May 2019

Chronic sinusitis is a disease that afflicts a significant percentage of the population and causes considerable long-term morbidity. The common use of multiple broad-spectrum oral antibiotics and endoscopic sinus surgery to treat this condition may alter the pathogenes that promote persistence of chronic sinusitis. Forty-eight culture-positive patients with chronic sinusitis who had been medically treated for at least 3 months and had undergone sinus surgery were bacteriologically evaluated. Swab specimens of the middle meatus and sphenoethmoid recess were aseptically obtained endoscopically and cultured for aerobes. Coagulase-negative staphylococci were the most common isolates (45.8%), followed by Streptococcus pneumoniae (16.7%), Enterobacteriaceae (16.7%), Staphylococcus aureus (10.4%), and Pseudomonas aeruginosa (10.4%). Coagulase-negative staphylococci were the most frequently isolated organisms in our study, as in many other studies. Despite the significant predominance of these organisms, they have always been assumed to be contaminants, and their presence in culture has been discounted. Coagulase-negative S aureus may be a pathogen in the chronic sinusitis process, and sensitivities of this isolate should be obtained for evaluation and possible treatment of the disease.
Amyloid Tumor of the Larynx associated with Plasma Cell Infiltration: Differential Diagnosis
Authors: Benning Susanne , Technau-Ihling Katja , Fisch Paul , Fradis Milo , Schipper Joerg , Maier Wolfgang
Published: May 2019

Localized amyloidosis of the larynx is uncommon, accounting for fewer than 1 % of all benign laryngeal tumors. We report 2 cases of laryngeal amyloidosis in which dense plasma cell infiltrates were found in the vicinity of the amyloid deposits; in view of this finding, we suspected a hematologic disease—plasmacytoma in particular. However, molecular genetic analysis did not demonstrate any light-chain restriction, indicating that the plasma cells were of polyclonal origin and therefore consistent with chronic inflammation. We also discuss the available literature with respect to diagnostic and therapeutic procedures inpatients with amyloidosis of the upper airway.
Summary of the Findings of a Joint Consensus Panel on the Use of Potentially Ototoxic Ototopicals
Authors: Roland Peter S.
Published: May 2019

In 2003, Dr. Roland was appointed chairman of the Consensus Panel on Role of Potentially Ototoxic Antibiotics for Topical Middle Ear Use by the president of the American Academy of Otolaryngology-Head and Neck Surgery (AAO- HNS), John S. John on, MD. Other members of the committee were Peter C. Weber; MD, and Fred Owens, MD, appointed by the leadership of the AAO-HNS; Rick Friedman, MD, PhD, and Spiros Manolidis, MD, appointed by the American Neurotology Society; Leonard Rybak, MD, PhD, and Greg Matz, MD, appointed by the American Otological Society; and Janet Casey, MD, appointed by the American Academy of Pediatrics. Maureen Hannley, PhD, served as a scientific advisor, and Michael G. Stewart, MD, MPH, served as an advisor in evidence-based medicine. What follows is a brief summary of their findings.
CSF Otorrhea Complicating Temporal Bone Osteoradionecrosis in a Patient with Nasopharyngeal Carcinoma
Authors: Lim Bernard Y.K. , Pang Kenny Peter , Low Wong Kein , Tan How Ming
Published: May 2019

A 44-year-old Chinese man with a history of nasopharyngeal carcinoma that was treated with radiotherapy presented with fluid in the middle ear. We performed a myringotomy and subsequently made a diagnosis of cerebrospinal fluid (CSF) leakage secondary to osteoradionecrosis of the temporal bone. To the best of our knowledge, this is only the second reported case of an otogenic CSF leak resulting from osteoradionecrosis of the temporal bone. This case highlights the controversial role of myringotomy in the management of CSF otorrhea.
The Effect of Silver Nitrate on Nasal Septal Cartilage
Authors: Lloyd Simon , Almeyda John , Di Cuffa Riccardo , Shah Ketan
Published: May 2019

Epistaxis from the anterior septum is frequently treated with a topical application of silver nitrate, which cauterizes the bleeding vessel. However, this treatment causes a septal perforation in a small percentage of patients. We report our study of the histologic effect of topical silver nitrate on samples of septal tissue obtained from 11 patients. We found that 30 seconds of exposure allowed silver nitrate to penetrate to a depth of approximately 1 mm. Longer exposure (45 and 60 sec) resulted in no significant additional penetration. Similarly, the amount of silver nitrate deposition into the chondrocytic lacunae did not vary significantly with the length of exposure. On the other hand, the depth of deposition into the extracellular matrix was positively associated with the duration of exposure. We found no direct evidence that silver nitrate exerted any damaging effect on septal cartilage. Instead, the development of septal perforations in patients who receive topical silver nitrate may be attributable to necrosis of the septal cartilage following damage to the overlying perichondrium, from which it derives its blood supply.
Falling Sensation in Patients who Undergo the Epley Maneuver: A Retrospective Study
Authors: Uneri Alev
Published: May 2019

The author conducted a retrospective study to determine the prevalence of a falling sensation in patients who underwent the Epley canalith repositioning maneuver for the treatment of benign paroxysmal positional vertigo. The author studied a total of 436 maneuvers performed on 412 patients and observed 58 episodes (13%) of a strong falling sensation, some very severe. In almost every case, the sensation occurred when the patient was moved to the final (sitting) position; in 1 case, the sensation occurred nearly 30 minutes later. The author recommends that physicians who perform the Epley maneuver warn patients of the risk of a falling sensation, take steps to prevent its consequences, and monitor their patients for at least 30 minutes after the completion of the procedure.
Sinonasal Hemangiopericytomas: Clinicopathologic and Imaging Findings
Authors: Palacios Enrique , Restrepo Santiago , Mastrogiovanni Luciano , Lorusso Giovanni D. , Rojas Rafael
Published: May 2019

Hemangiopericytomas are rare soft-tissue neoplastic lesions that can arise in any part of the body. They are mesenchymal tumors that account for 3 to 5% of all soft-tissue sarcomas and 1% of all vascular tumors. They originate in extravascular cells (pericytes). Some 15 to 30% of all hemangiopericytomas occur in the head and neck; of these, approximately 5% occur in the sinonasal area. We describe our brief retrospective review of 7 histologically proven cases of sinonasal hemangiopericytoma, and we discuss the imaging characteristics and clinical and pathologic findings in these patients.
The use of Combined PET/CT for Localizing Recurrent Head and Neck Cancer: The Pittsburgh Experience
Authors: Zimmer Lee A. , Snyderman Carl , Fukui Melanie B. , Blodgett Todd , McCook Barry , Townsend David W. , Meltzer Carolyn C.
Published: May 2019

We performed a retrospective study of 47 patients to ascertain the ability of combined positron-emission tomography and computed tomography (PET/CT) to localize recurrent head and neck cancer. When clinically warranted, biopsies were performed in an attempt to obtain pathologic confirmation of the PET/CT findings. Of the 47 patients, 33 exhibited PET/CT findings consistent with recurrent cancer. Of the 33 patients, 25 underwent either biopsy or surgical excision of disease in an attempt to obtain a pathologic confirmation. Biopsy analysis confirmed the PET/CT findings in 22 of these patients; in the remaining 3 patients, pathologic findings were inconsistent with the PET/CT diagnosis. Based on the subset of 25 patients who underwent pathologic testing, the sensitivity of combined PET/CT was 95% and the specificity was 60%. We conclude that combined PET/CT imaging is a valuable tool for localizing tumor recurrence in patients with head and neck cancer.
Surgical-Handling Properties of the Titanium Prosthesis in Ossiculoplasty
Authors: Maassen Marcus M. , Löwenheim Hubert , Pfister Markus , Herberhold Stephan , Jorge Jesus Rodriguez , Baumann Ingo , Nüsser Andreas , Zimmermann Rainer , Brosch Sibylle , Zenner Hans P.
Published: May 2019

Despite the wide variety of ossiculoplasty techniques that are available, success rates are limited. Current use indicates that surgeons prefer ceramic, autograft bone, and plastic pore prostheses. During the past decade, titanium prostheses have been used with great promise. Although their use is not widespread, satisfaction rates are high. An earlier study of ossiculoplasty showed that titanium prostheses were effective in reducing conductive hearing loss. To date, the surgical-handling attributes of titanium middle ear prostheses have not been assessed. We report the results of our survey of 32 otologic surgeons who used the open Tubingen titanium prosthesis for primary and revision ossiculoplasty during tympanoplasty in 400 patients at 12 academic and nonacademic otolaryngology clinics, most of them in Germany. Because the audiometric efficacy of titanium prostheses has been previously reported, our primary outcomes measures included ease of use with respect to the amount of time required to prepare the implants for placement and the surgeons ‘overall impression of the intraoperative handling characteristics of the implants, taking into consideration factors such as positioning, length adjustment, visibility, and the stability of the coupling. Surgeons also compared the properties of the titanium implant with those of gold, ceramic, and autograft implants that they had used in the past. Based on the results of 383 of the 400 ossiculoplasties, our survey revealed that the titanium implant was significantly superior to the others in all measured respects.
Pediatric Allergic Rhinitis: Factors Affecting Treatment Choice
Authors: Gelfand Erwin W.
Published: May 2019

Allergic rhinitis is the most prevalent chronic allergic disease in children. Although it is not life-threatening, it can have a significantly detrimental effect on a child's quality of life, and it may exacerbate a number of common comorbidities, including asthma and sinusitis. The Allergic Rhinitis and its Impact on Asthma guidelines, an evidence-based algorithm for the treatment of allergic rhinitis, advocate the use of antihistamines for the treatment of the broad spectrum of the disease. However, first-generation antihistamines are associated with a number of adverse events, including central nervous system impairment and anticholinergic and cardiovascular effects. Moreover, these agents have not been rigorously tested in the pediatric population. Nevertheless, first-generation antihistamines remain the most frequently prescribed agents in this class of drugs. This is despite the fact that the second-generation antihistamines are largely free of the undesirable side effects associated with their predecessors and the fact that they have been shown to be effective in relieving allergic rhinitis symptoms in children in a number of large-scale clinical trials. Therefore, when selecting an antihistamine for a child, it would be prudent to consider the full range of antihistamines and to base the selection of a particular drug on its efficacy, onset and duration of action, and safety profile.
Tympanostomy Tube Obstruction Related to Ototopical Drug Therapy
Authors: Bassim Marc K. , Drake Amelia F.
Published: May 2019

Obstruction of tympanostomy tubes is a potentially significant complication, sometimes requiring replacement of the nonfunctioning tube. Early blockage can occur secondary to bleeding during the tube placement procedure. Delayed obstruction is usually caused by inspissated secretions or epithelial casts. We briefly report our treatment of 9 cases of delayed ventilation tube obstruction that were associated with the use of an ototopical antibiotic/steroid suspension.
Total Necrosis of the Intranasal Structures and Soft Palate as a Result of Nasal Inhalation of Crushed Oxycontin
Authors: Greene David
Published: May 2019

Nasal inhalation of substances such as cocaine has long been linked to septal necrosis and more recently to palatal perforation. This report describes the case of a 3 7-year-old man who was addicted to crushed OxyContin (sustained-release oxycodone HCl) tablets and who presented with total necrosis of the septum, sinuses, and soft palate. To the best of the author's knowledge, this is the first reported case of nasal and palatal necrosis linked to nasal inhalation of crushed OxyContin, which is a relatively new form of drug abuse. The pathophysiology of drug-induced sinonasal disease and a review of the literature are also presented.
Vertigo and Motion Sickness. Part I: Vestibular Anatomy and Physiology
Authors: Zajonc Timothy P. , Roland Peter S.
Published: May 2019

Control of the symptoms of vertigo and motion sickness requires consideration of the neurophysiology of areas both intrinsic and extrinsic to the vestibular system proper. We review the essential anatomy and physiology of the vestibular system and the associated vomiting reflex.
Spontaneous Transtemporal CSF Leakage: A Study of 51 Cases
Authors: Leonetti John P. , Marzo Sam , Anderson Douglas , Origitano Thomas , Vukas Daniel D.
Published: May 2019

We conducted a retrospective study of 51 cases of spontaneous transtemporal cerebrospinal fluid (CSF) leakage in 48 adults who had presented to our tertiary care academic referral center between July 1, 1988, and June 30, 2002. All patients had undergone high-resolution temporal bone computed tomography, and 26 patients had undergone magnetic resonance imaging. All patients were treated with a middle fossa craniotomy to repair the CSF fistulae. During a mean follow-up of 4.9 years, 46 of the 48 patients (95.8%) had experienced a complete cessation of CSF leakage (49 of 51 cases [96.1%]). The 2 patients whose leakage recurred were successfully managed with a subtotal petrosectomy with occlusion of the eustachian tube and obliteration of the middle ear and mastoid. No patient developed meningitis.
Spontaneous Retropharyngeal and Cervical Emphysema: A Rare Singer's Injury
Authors: Shine Neville P. , Lacy Peter , Conlon Brendan , McShane Donald
Published: May 2019

Spontaneous retropharyngeal and cervical emphysema is rare. We describe a case that was unusual in its etiology: the result of singing. Although this condition is usually benign, hospital admission for close observation and supportive therapy is prudent.