bluuebunny/crossref_metadata_2025 huggingface dataset:
An Assessment of Risk Factors for the Development of a Second Primary Malignancy in the Head and Neck
Authors: Bhattacharyya Neil
Published: May 2019

This retrospective database study of 44,862 patients who had a history of a primary head and neck malignancy was conducted to identify any clinical variables that may predict the occurrence of a second primary head and neck malignancy. During a mean follow-up of 42.2 months, a second head and neck primary developed in 941 of these patients (2.1 %). Statistical analyses revealed that a higher incidence of a second primary was associated with increased age and a location of the first primary in the larynx/hypopharynx, the oropharynx, a major salivary gland, or the nasopharynx. A lower incidence was associated with the presence of cervical nodal disease or treatment of the first primary with radiation therapy. Factors that had no effect on the risk of a second primary included sex, the size of the first primary tumor, a first-primary site in the oral cavity, and treatment of the first primary with cancer-directed surgery. The risk of a second primary head and neck cancer remained constant for at least 10 years.
Respiratory Epithelial Adenomatoid Hamartoma: A Case Report
Authors: Ingram W. Frank , Noone Michael C. , Gillespie M. Boyd
Published: May 2019

Respiratory epithelial adenomatoid (READ) hamartoma is a recently described entity characterized by abnormal glandular formations arising from the epithelium of the nasal cavity. The etiology of the lesion is unclear and may be secondary to either sinonasal inflammation or developmental error. We present a case of a 54-year-old man with a unilateral nasal mass found to be consistent with READ hamartoma upon pathologic review. Although READ hamartomas are thought to be rare, awareness of the lesion is important since it may be confused with sinonasal adenocarcinoma, leading to overly aggressive treatment. Therefore, READ hamartoma should be included in the differential diagnosis of a unilateral nasal mass.
Noise-Induced Perilymph Fistula
Authors: Kung Brian , Sataloff Robert T.
Published: May 2019

Perilymph fistulae are difficult to diagnose because they present with a wide variety of signs and symptoms, they are associated with many etiologies, and they often mimic other conditions. In this article, we describe a case of perilymph fistula that featured one of its more rare causes: acoustic trauma—specifically, damage from a loud blast from the siren of a fire engine. We also review the literature and discuss the difficulties of diagnosis and treatment and the possible mechanisms by which acoustic trauma and other etiologies cause perilymph fistulae.
Low-Grade Mucoepidermoid Carcinoma of the Subglottis Treated with Organ-Preservation Surgery
Authors: Monin Daniel L. , Sparano Anthony , Litzky Leslie A. , Weinstein Gregory S.
Published: May 2019

Mucoepidermoid carcinoma of the subglottis is infrequently reported in the literature. This tumor subtype is more commonly associated with the major and minor salivary glands. Mucoepidermoid carcinoma of the larynx can be difficult to diagnose, and there is no consensus as to appropriate management. We report a case of a low-grade mucoepidermoid carcinoma that was confined to the subglottis and treated with organ-preservation surgery. A conservative surgical approach was taken because of the tumor's low-grade histology and its location and in order to preserve the patient's laryngeal function. At follow-up 15 months postoperatively, the patient remained disease-free, and laryngeal function was intact.
Laryngeal Neurilemmoma: A Case Report
Authors: Newton Jonathan R. , Ruckley Robert W. , Earl Ursula M.
Published: May 2019

Published reports of benign nerve sheath tumors of the larynx are extremely rare. Because these tumors represent a potential threat to the airway, prompt diagnosis and treatment are vital. We report a case of a neurilemmoma that arose from the right arytenoid muscle adjacent to the arytenoid cartilage. The mass was completely excised, and no recurrence was observed during follow-up. We discuss the diagnosis and management of this rare tumor.
Herpes Simplex Virus Infection Presenting as a Piriform Sinus Mass
Authors: Brigandi Laurie A. , Lanfranchi Paul V. , Scheiner Edward D. , Busch Scott L.
Published: May 2019

Evidence is accumulating that herpes simplex virus (HSV) infection is implicated in oncogenesis. HSV antigens have been observed in some oral cancers. We present the case of a 62-year-old man who presented with dysphagia, odynophagia, and dysphonia and who was found on computed tomography (CT) to have a mass in his piriform sinus. We suspected a malignancy, but histopathology of biopsy specimens revealed that the mass exhibited the classic signs of the HSV cytopathic effect, including the presence of intranuclear inclusion bodies, ballooning degeneration of epithelial cells, and a ground-glass appearance of some nuclei. The patient responded well to antiviral therapy, and posttherapy CT revealed that the mass had resolved completely. To the best of our knowledge, this is the first report in the literature of a case of HSV infection presenting as a piriform sinus mass.
Pharmacokinetically Enhanced Amoxicillin/Clavulanate (2,000/125 mg) in Acute Bacterial Rhinosinusitis caused by Streptococcus Pneumoniae, Including Penicillin-Resistant Strains
Authors: Anon Jack B. , Ferguson Berrylin , Twynholm Monique , Wynne Brian , Berkowitz Elchonon , Poole Michael D.
Published: May 2019

We evaluated the efficacy of a new pharmacokinetically enhanced formulation of amoxicillin/clavulanate (2,000/125 mg) twice daily for the treatment of acute bacterial rhinosinusitis (ABRS) caused by Streptococcus pneumoniae, particularly penicillin-resistant S pneumoniae (PRSP; penicillin minimum inhibitory concentrations [MICs]: ≥2 μ/ml. A total of 2,482 patients received study medication (safety population). Of these, 2,324 were clinically evaluable (efficacy population), and 1,156 of them had at least one pathogen isolated at screening (bacteriology population). S pneumoniae was isolated from 371 patients in the bacteriology population, including 37 with PRSP. Follow-up in the bacteriology population on days 17 through 28 revealed that amoxicillin/clavulanate therapy was successful in 345 of 371 patients with S pneumoniae infection (93.0%) and in 36 of 37 patients with PRSP infection (97.3%), including 7 of 8 patients (87.5%) whose amoxicillin/clavulanic acid MICs were 4/2 μg/ml or higher. Pharmacokinetically enhanced amoxicillin/clavulanate was generally well tolerated, as only 2.2% of patients withdrew because of adverse events. This agent represents a valuable new therapeutic option for the empiric treatment of ABRS, particularly in areas where antimicrobial-resistant pathogens (including β- lactamase–positive organisms) are prevalent, and for the treatment of patients who are at increased risk of infection with PRSP.
Office-Based Arytenoid Palpation for Diagnosis of Disorders of Bilateral Vocal Fold Immobility
Authors: Krishna Priya , Rosen Clark A.
Published: May 2019

Bilateral vocal fold immobility is an uncommon but serious condition with many causes. Accordingly, accurate diagnosis is essential in order to treat patients promptly and avoid long-term sequelae. Historically, diagnosis has been performed in the operating room with the patient under general anesthesia. We present the case of a patient who was diagnosed with bilateral vocal fold immobility by in-office arytenoid palpation that required only topical anesthesia of the larynx. The patient subsequently underwent appropriate treatment. In our opinion, office-based arytenoid palpation is a simple, safe, and accurate procedure for diagnosing bilateral vocal fold immobility.
Thyroidectomy for Substernal Goiter via a Mediastinoscopic Approach
Authors: Tsai Veling W. , Cameron Robert B. , Wang Marilene B.
Published: May 2019

We report an unusual case in which a patient presented with a large posterior mediastinal goiter that extended to the level of the aorta. The goiter was resected through a standard Kocher neck incision with mediastinoscopic assistance. The large goiter was completely excised without the need for a sternotomy.
Fibrin Glue in Thyroid and Parathyroid Surgery: Is Under-Flap Suction Still Necessary?
Authors: Patel Manish , Garg Rohit , Rice Dale H.
Published: May 2019

The introduction of fibrin sealants has brought into question the necessity of routinely placing suction drains. We conducted a retrospective study to determine whether fibrin sealants are comparable to traditional drains in terms of length of hospital stay and hematoma prevention. We evaluated 124 patients who had undergone thyroidectomy and 47 patients who had undergone parathyroidectomy. Of these, 22 thyroid surgery patients and 10 parathyroid surgery patients had their incisions closed without a drain after the application of fibrin glue. We found that the use of fibrin glue resulted in a statistically significant decrease in the length of hospital stay following both types of surgery (p = 0.033 and p = 0.022, respectively). Two hematomas in the drain group required immediate surgical evacuation; in both of these patients, the suction was clotted and ineffective. One minor hematoma occurred in the fibrin glue group, and it was opened at the bedside 24 hours after surgery. We conclude that fibrin sealants offer a comparative advantage over under-flap suction in both thyroid and parathyroid surgery. Also, fibrin glue is less expensive, and its use obviates the discomfort felt by patients when a drain is removed.
Necrotizing Sialometaplasia: A Potential Diagnostic Pitfall
Authors: KomíAnek Pavel , Blasch Petr
Published: May 2019

Necrotizing sialometaplasia is a benign, spontaneously healing inflammatory condition. It usually affects the hard palate, and it can mimic a malignancy both clinically and histologically. We report a new case of this rare disorder.
Current Technique for Resection of Mediastinal Goiter
Authors: Shemen Larry , Ko Wilson
Published: May 2019

We have developed a combined surgical technique involving traction sutures, the harmonic scalpel, and laryngeal nerve monitoring for the removal of mediastinal goiters. This technique is safe, expeditious, and effective; it minimizes the risk of blood loss or nerve injury; and it obviates the need for sternotomy. During a 4-year period, we performed this operation on 21 patients. We observed only two complications: one patient developed postoperative seroma 1 week after surgery and another experienced vocal fold paralysis after intentional sacrifice of the recurrent laryngeal nerve, which was encompassed by cancer. No other recurrent laryngeal nerve was injured. Operative blood loss was negligible, no systemic infection or permanent hypoparathyroidism was observed, and no patient required a chest tube or chest incision. Almost all patients were discharged home on postoperative day 1.
An Outpatient Medical Treatment Protocol for Peritonsillar Abscess
Authors: Lamkin Roland H. , Portt James
Published: May 2019

Several surgical methods are used to treat peritonsillar abscess, but no protocol for outpatient medical treatment has yet been published. Between February 2002 and February 2005, we treated 98 peritonsillar abscess patients with an outpatient medical regimen that involved hydration, antibiotics, steroids, and good pain control. All patients were Native Americans, who are known to have a particularly high incidence of peritonsillar abscess. The medical regimen was generally successful, as only 4 patients (4.1%) subsequently required post-treatment needle aspiration or incision and drainage. We conclude that the medical protocol described herein provides practitioners with a viable noninvasive alternative for treating peritonsillar abscess.
Liposarcoma of the Tongue: Case Report and Review of the Literature
Authors: Adelson Robert Todd , DeFatta Robert J. , Verret D.J. , Shen Yuenan
Published: May 2019

Liposarcoma is the most common soft-tissue malignancy in adults, but the appearance of a liposarcoma in the head and neck region is distinctly unusual. Intraoral liposarcomas represent a particularly interesting subset of this tumor in that (1) they are exceedingly rare and (2) affected patients tend to have a better prognosis than do patients with a similar lesion located elsewhere in the head and neck. An understanding of the histologic subtypes and corresponding clinical behavior of liposarcomas will assist physicians in appropriately managing these patients. Most of these tumors can be effectively treated with conservative surgery. We report the rare case of a well-differentiated liposarcoma arising in the tongue of a 55-year-old man. We also discuss the typical pathologic findings in these malignancies and review the diagnosis, associated controversies, management, and prognosis.
Salivary Gland Cystadenocarcinoma of the Mobile Tongue, Low-Grade Papillary Adenocarcinoma Variant: A Case Report
Authors: Grunstein Eli , Kacker Ashutosh
Published: May 2019

Cystadenocarcinoma is a rare malignant neoplasm of the salivary gland. Treatment involves local excision; neck dissection and postoperative radiation therapy are used for clinically positive neck metastases. The prognosis varies according to the clinical stage and grade of the tumor.
Sphenochoanal Polyp Presenting with Concomitant Nasal Polyps
Authors: Tysome James R. , Saleh Hesham A.
Published: May 2019

A sphenochoanal polyp is a rare lesion that originates in the sphenoid sinus. It occurs most often in adolescents and young adults. We present what to the best of our knowledge is the first reported case of a sphenochoanal polyp associated with concomitant nasal polyps. The patient was a 54-year-old man who presented with bilateral nasal obstruction, possible obstructive sleep apnea, and an altered voice, all of which had likely been caused by the presence of a massive left sphenochoanal polyp and bilateral grade III anterior and posterior ethmoid polyps. Because the patient had dilated cardiomyopathy, he was not a good candidate for general anesthesia. Therefore, the polyps were removed endoscopically under local anesthesia. The sphenochoanal polyp measured 7.5 cm in its greatest dimension and weighed 41 g. The patient remained symptom-free at the 1-year follow-up. The presentation of a sphenochoanal polyp is similar to that of the more common antrochoanal polyp, but the two can usually be differentiated on computed tomography. Endoscopic sinus surgery allows for complete removal of the polyp, including its site of origin, which minimizes the risk of recurrence.
Low-Grade Adenocarcinoma of the Nasal Cavity–An Unusual Presentation: Case Report and Review of the Literature
Authors: Baumgartner Brian J. , Ladd Tremaine , Esquivel Carlos
Published: May 2019

Low-grade nasal cavity adenocarcinoma is an unusual neoplasm. When it does occur, it often appears in conjunction with a history of epistaxis and nasal obstruction that spans a period of a few weeks to several months. Most of these tumors arise in patients who are middle-aged or older. We report a case of low-grade nasal cavity adenocarcinoma that was unusual in that it occurred in an adolescent boy and that the presenting symptoms of chronic nasal obstruction and recurrent epistaxis had persisted for 7 years. The occurrence of this uncommon but recognized entity in such a young patient widens the age range of possible patients with this tumor, and a finding of such an extended duration of symptoms should raise clinical suspicion and encourage a thorough investigation in order to make the diagnosis.
Internal Laryngopyocele Presenting as Acute Airway Obstruction
Authors: Fredrickson Kristin L. , D'Angelo Anthony J.
Published: May 2019

A laryngopyocele forms when a laryngocele becomes infected and fills with mucopus. We report a case of an internal laryngopyocele that presented as airway obstruction in a 34-year-old man; such a presenting sign is exceedingly rare. We also review the anatomy, etiology, and clinical course of the different types of laryngoceles.
Acute Prevertebral Calcific Tendinitis: A Nonsurgical Cause of Prevertebral Fluid Collection
Authors: Kupferman Todd A. , Rice Clifford H. , Gage-White Linda
Published: May 2019

Calcific tendinitis of the prevertebral muscles is a rare clinical entity. Its nonspecific presenting symptoms (e.g., retropharyngeal space infection) may mimic an infectious etiology. Treatment is based on the administration of a nonsteroidal anti-inflammatory drug (NSAID) for 2 to 3 weeks and cessation of symptom-provoking activity. Most patients will improve greatly within the first 48 to 72 hours after the initiation of an NSAID, and complete resolution generally occurs within 3 weeks. We describe a new case of prevertebral calcific tendinitis, and we review the literature on this condition.
Cell-Mediated Immunity in Nasopharyngeal Carcinoma and Allergic Rhinitis: A Controlled Study
Authors: Wong Hsien Teik , Shahrizal Tengku A. , Prepageran Narayanan , Lim Wye Keat , Raman Rajagopalan
Published: May 2019

We conducted a prospective study of 60 patients in a tertiary care referral center to ascertain the status of cell-mediated immunity as determined by delayed hypersensitivity reactions in patients with nasopharyngeal carcinoma (NPC) or allergic rhinitis. Delayed hypersensitivity as detected by Mantoux testing is generally accepted as a reflection of the level of cell-mediated immunoactivity—the less hypersensitivity reaction that occurs, the lower the level of immunoactivity is, and vice versa. Our study population was made up of three groups: 20 newly diagnosed patients with NPC (pretreatment), 20 age- and sex-matched patients with allergic rhinitis, and 20 matched controls without either disease. A negative Mantoux test (0- to 5-mm induration) was seen in 13 patients with NPC (65.0%), in 17 patients with allergic rhinitis (85.0%), and in 16 controls (80.0%); none of these differences was statistically significant. However, it is interesting that while the NPC group had the lowest percentage of negative Mantoux results overall, it had the highest percentage of patients who had no reaction at all (i.e., 0-mm induration); a complete absence of any reaction was seen in 7 of the 13 Mantoux-negative NPC patients (53.8%), compared with 2 of the 17 Mantoux-negative allergic rhinitis patients (11.8%) and 3 of the 16 Mantoux-negative controls (18.8%). An absence of a reaction generally indicates a very limited degree of cell-mediated immunoactivity. Therefore, we conclude that patients with NPC appear to have significantly less cell-mediated immunity than do patients with allergic rhinitis and normal controls; no statistically significant difference was noted between the latter two groups.
Hypothyroidism following Hemithyroidectomy for Benign Nontoxic Thyroid Disease
Authors: Seiberling Kristin A. , Dutra Jose C. , Bajaramovic Sanija
Published: May 2019

Hypothyroidism following hemithyroidectomy for benign nontoxic thyroid disease is an underappreciated phenomenon. Up until recently, it was common practice for physicians to place post-hemithyroidectomy patients on thyroid suppression therapy during the immediate postoperative period. That practice began to fall out of favor as a result of two developments: (1) the publication of data that put into question the efficacy of levothyroxine therapy for preventing recurrent disease or thyroid growth and (2) a heightened awareness of the morbidity associated with levothyroxine. We conducted a retrospective chart-review study of 58 patients with benign nontoxic thyroid disease who had undergone hemithyroidectomy from 1994 through 2003 at one institution. Of these 58 patients, 14 (24.1%) had become hypothyroid after surgery, including 7 who had been so diagnosed 1 month postoperatively and 6 at 2 months. The remaining 44 patients were euthyroid. The mean preoperative serum thyroid-stimulating hormone (TSH) levels in the hypothyroid and the euthyroid groups were 2.39 and 1.07 μIU/ml, respectively—a statistically significant difference (p < 0.0001). A tissue diagnosis consistent with chronic inflammation (lymphocytic thyroiditis or Hashimoto's thyroiditis) was found in 50.0% of the hypothyroid patients, compared with only 6.8% of the euthyroid patients—again, a significant difference (p < 0.001). No significant difference was seen between the two groups with respect to age, sex, or the weight of the resected gland. We conclude that hypothyroidism after hemithyroidectomy is not an uncommon occurrence. Apparent risk factors include a high mean preoperative serum TSH level and tissue pathology consistent with chronic inflammation. It may be wise to follow patients with these identifiable risk factors more closely during the postoperative period; monitoring should include scheduled serial serum TSH draws.
An Aggressive Psammomatoid Ossifying Fibroma of the Sinonasal Tract: Report of a Case
Authors: Khademi Bijan , Niknejad Nika , Mahmoudi Jalal
Published: May 2019

Aggressive psammomatoid ossifying fibromas (APOFs) represent a subgroup of related fibro-osseous lesions that appears to be unique to the nasal cavity, paranasal sinuses, and orbit. These rare lesions are characterized by distinctive histomorphologic features and a tendency to affect younger patients. Histologically they are benign, but clinically they are locally aggressive. We report the case of a 15-year-old boy who had a large APOF in the left ethmoid and sphenoid sinuses. The location of this tumor made this case unusual.
The Prevalence and Effect of Asthma on Adults with Chronic Rhinosinusitis
Authors: Seybt Melanie W. , McMains Kevin C. , Kountakis Stilianos E.
Published: May 2019

We conducted a retrospective review of 145 consecutively presenting adults treated for chronic rhinosinusitis (CRS) in a tertiary care institution. Our goals were to determine (1) the prevalence of asthma in these patients, (2) the prevalence of specific CRS symptoms in both asthmatic and nonasthmatic patients, and (3) the frequency of surgical treatment for CRS in patients with and without asthma. We found that asthma was present in 23.4% of CRS patients, a much higher rate than the 5% prevalence of asthma in the general adult population. Patients with asthma had a significantly higher prevalence of nasal polyps (47 vs. 22%; p = 0.004), olfactory dysfunction (26 vs. 6%; p = 0.001), and nasal congestion (85 vs. 60%; p = 0.027) than did those without asthma. Patients without asthma had a significantly higher prevalence of headache (72 vs. 53%; p = 0.037) and rhinorrhea (58 vs. 38%; p = 0.047). The prevalence of postnasal drip and environmental allergies in the two groups was similar. Although the difference between the proportions of patients with and without asthma who required primary sinus surgery was not statistically significant (76 vs. 64%; p = 0.175), patients with asthma did require significantly more revision sinus procedures overall (mean: 2.9 vs. 1.5; p = 0.003).
Use of the Laryngeal Mask Airway in Preventing Airway Fires during Adenoidectomies in Children: A Study of 25 Patients
Authors: Militana Charles J. , Ditkoff Michael K. , Mattucci Kenneth F.
Published: May 2019

We report the results of our study of 25 children who underwent adenoidectomy under general anesthesia with a laryngeal mask airway to determine their risk of fire in the oropharynx. We explain the distinct advantage that such an anesthetic technique has with respect to minimizing the conditions that may contribute to an airway fire. We also discuss additional advantages of using a laryngeal mask airway during adenoidectomies.
Management of a Maxillary Sinus Foreign Body (Dental Bur)
Authors: Smith Joseph L. , Emko Precha
Published: May 2019

Metal foreign bodies are occasionally found in the paranasal sinuses. Often they result from the escape of material through an oroantral fistula or from trauma. Rarely, they occur as a complication of a dental procedure. A literature review revealed only four other reports of iatrogenic dental bur lodgment in the maxillary sinus, all of which are in the dental literature. Otolaryngologists, who might be required to deal with this complication, must be knowledgeable about its management. In this article we describe a patient who was referred to our otolaryngology department for management of a retained dental bur in the maxillary sinus. We also review two treatment options—an endoscopic and an open surgical approach—for the removal of sinus foreign bodies.
A Sinonasal Inverted Papilloma of Mixed Histology: Implications for Management of All Sinonasal Papillomas
Authors: Steiger Jacob D. , Chiu Alexander G.
Published: May 2019

Sinonasal papillomas are classically categorized by their histology. Inverted, cylindrical, and fungiform are the three subtypes used to describe these lesions, and their medical and surgical management is often based on the specific subtype. We describe a case of a sinonasal papilloma with all three subtypes represented within the same surgical specimen. To our knowledge, this represents the first such case in the literature and has implications for the management of all sinonasal papillomas.
Unilateral Tonsillar Lymphoepithelioma with Ipsilateral Parapharyngeal Space Involvement: A Case Report
Authors: Lee Scott L. , Lee Ching Y. , Batniji Rami K. , Silver Steven
Published: May 2019

We report a case of unilateral tonsillar lymphoepithelioma with extension into the ipsilateral parapharyngeal space, and we review the clinical, histologic, and radiographic findings of the case. The patient presented with a tonsillar mass that was confirmed on biopsy to be lymphoepithelioma. Computed tomography demonstrated ipsilateral parapharyngeal space involvement. Association with Epstein-Barr virus was not assessed since it does not affect the treatment modality. We also review the literature and discuss the diagnosis and current treatment options.
Unilateral Inferior Turbinate Agenesis: A Case Report
Authors: Çaylakli Fatma , Yilmaz Ismail , Hürcan Cem , Özer Cem , Özlüoğlu Levent
Published: May 2019

Many common anatomic variations in the nasal cavity have been observed, including paradoxical turbinates and pneumatization of the inferior, middle, and superior turbinates. We describe a case of a rare anomaly—unilateral inferior turbinate agenesis—in a 65-year-old man who had presented with epistaxis. During evaluation, anterior rhinoscopic examination revealed the absence of the right inferior turbinate; this finding was confirmed on computed tomography. The patient had never undergone nasal or sinus surgery, and he denied ever having expelled anything of significance from his nasal cavity. This case merits attention because of the rarity of reports on turbinate agenesis.
Successful Treatment of Invasive Aspergillus Sinusitis with Caspofungin and Voriconazole
Authors: Chirch Lisa , Roche Patricia , Fuhrer Jack
Published: May 2019

Chronic invasive Aspergillus sinusitis is a rare and potentially devastating infection. Management typically requires extensive surgical debridement followed by long-term antifungal therapy, primarily with intravenous amphotericin B. We describe the case of an elderly woman who had been diagnosed with extensive Aspergillus sinusitis that had invaded critical structures. The extensiveness of the infection and the patient's frailty and unwillingness to undergo a disfiguring procedure precluded surgery, and her medical condition was too fragile to withstand amphotericin B therapy. Therefore, we decided to treat her with a combination of caspofungin and voriconazole, two relatively nontoxic antifungal agents that have different mechanisms of action. After administration of this novel regimen, the infection resolved rapidly.
Bilateral Multinodular Oncocytomas of the Parotid Arising in a background of Bilateral Oncocytic Nodular Hyperplasia
Authors: Hyde Jason , Takashima Masayoshi , Dodson Brennan , Said Sherif
Published: May 2019

Oncocytic tumors of the major salivary glands are rare, accounting for less than 1% of all salivary gland tumors. When they do occur, these neoplasms typically present as solitary nodules that affect only one major salivary gland, usually the parotid. Multiple bilateral multinodular tumors are rare. We report the case of a 53-year-old woman with a case of synchronous multiple bilateral multinodular oncocytomas that arose in a background of bilateral oncocytic nodular hyperplasia in the parotid glands. The patient underwent superficial parotid resections, and at the 4-year follow-up, she exhibited no evidence of recurrence.
The Etiology of Recurrent Chordoma Presenting as a Neck Mass: Metastasis vs. Surgical Pathway Seeding
Authors: Boyette Jennings R. , Seibert John W. , Fan Chun-Yang , Stack Brendan C.
Published: May 2019

Chordomas are rare tumors of notochordal origin that arise along the vertebral axis. These slowly growing yet highly destructive tumors are associated with an alarming rate of recurrence, although surgical resection followed by proton, proton/photon, or conventional radiotherapy has been somewhat successful in terms of recurrence-free survival. Still, recurrent disease as a result of metastasis or surgical pathway seeding does occur. We retrospectively reviewed the case of a 64-year-old woman who presented with a left neck mass at level II. She had a history of recurrent chordomas involving the occipital portion of the clivus that had been treated with multiple resections and proton-beam irradiations over a period of several years. The new mass was found to have infiltrated the superior end of the sternocleidomastoid muscle. Neck dissection was performed. Pathology revealed no lymphoid tissue in the main specimen and no evidence of chordoma in any of the lymph nodes. We believe that this latest clival chordoma might have occurred as a result of surgical pathway seeding during a previous operation anterior to the sternocleidomastoid muscle, although metastasis cannot be ruled out. We also review the literature on clival and skull base chordomas as it relates to recurrence, metastasis, and seeding.
Dentigerous Cyst of the Maxilla with Impacted Tooth Displaced into Orbital Rim and Floor
Authors: Litvin Morton , Caprice Domenic , Infranco Leonard
Published: May 2019

We report a case of dentigerous cyst of the maxilla and maxillary sinus that caused the ectopic displacement of an unerupted tooth into the orbital rim and floor. After an incisional biopsy, marsupialization of the lesion promoted its involution and stimulated osteogenesis. This in turn simplified the surgical enucleation of the specimen and removal of the unerupted tooth without the excessive loss of the bony contours of the maxilla.
Complex Odontoma of the Nasal Cavity: A Case Report
Authors: Soltan Michelle , Kacker Ashutosh
Published: May 2019

We describe the case of a 76-year-old man who presented with symptoms of chronic nasal obstruction and recurrent sinusitis of many years’ duration. The patient's history and radiographic findings established a diagnosis of a complex odontoma of the nasal cavity. The mass was surgically excised, and the diagnosis was confirmed by histopathology. The occurrence of an odontoma in the nasal cavity is extremely rare.
Pleomorphic Adenoma of the Trachea
Authors: Rodriguez Michael J. , Thomas Giovana R. , Farooq Uzma
Published: May 2019

Primary pleomorphic adenoma of the trachea is rare, as only 33 cases have been previously reported worldwide since 1922. We describe a new case of primary tracheal pleomorphic adenoma that was discovered incidentally in a 78-year-old man. The tumor was excised, and the patient recovered without complication. Salivary gland tumors of the trachea should be considered in the differential diagnosis of tracheal lesions; the diagnosis is confirmed by pathologic evaluation. Patients are adequately treated with sleeve resection and primary anastomosis whenever possible.
An Unusual Case of Adult Airway Obstruction from a Lymphovenous Malformation
Authors: Harsha Wayne J. , Crawford James V. , Sorensen Douglas M.
Published: May 2019

Lymphatic, venous, and mixed lymphovenous malformations are low-flow lesions that are present at birth and grow proportionately with the patient. We describe an unusual presentation of a lymphovenous malformation in an adult. A 19-year-old man presented to the emergency department with complaints of recent upper respiratory tract symptoms, increasing left-sided sore throat, voice change, odynophagia, dysphagia, and occasional subjective fevers and blood-tinged sputum. Examination revealed the presence of a left peritonsillar bulge consistent with a peritonsillar abscess; however, findings on needle aspiration were negative. The patient was admitted for intravenous steroid and antibiotic therapy. Within 24 hours, his airway became compromised, and he underwent an awake tracheotomy and biopsy, which showed alymphovenous malformation. Magnetic resonance imaging the following day revealed a large, poorly circumscribed, heterogeneous left parapharyngeal mass consistent with a vascular malformation. With continuation of the steroids and antibiotics, the lesion regressed, and the patient was subsequently decannulated. At the 1-year follow-up, he exhibited no clinical symptoms, and he was in good health off steroids.
Near-complete Tracheal Ring Deformity: A Case Report
Authors: Somers Melissa L. , Suskind Dana L.
Published: May 2019

Long-segment near-complete tracheal ring deformity is a rare condition with few documented cases. We present the case of a 7-week-old male with total anomalous pulmonary venous return and long-segment near-complete tracheal rings. We discuss the presentation, evaluation, and management of near-complete and complete tracheal rings.
Intratracheal Ectopic Thyroid Tissue Presenting with Protracted Airway Obstruction: A Case Report
Authors: Khan Mo , Michaelson Peter G. , Hinni Michael L.
Published: May 2019

Intratracheal ectopic thyroid tissue is a rare finding, with few cases reported in the literature. Ectopic thyroid tissue results when the thyroid gland fails to descend to its final position during early development. These lesions present in various locations, and the clinician should be aware of their existence and presenting signs and symptoms.
Resveratrol Protects Auditory Hair Cells from Gentamicin Toxicity
Authors: Bonabi Sharouz , Caelers Antje , Monge Arianne , Huber Alex , Bodmer Daniel
Published: May 2019

Resveratrol is a naturally occurring polyphenol that is synthesized by a variety of plant species. It is abundant in grapes and grape products (e.g., red wine). Resveratrol has demonstrated reactive oxygen species (ROS) scavenger activity, and it has been linked to nuclear factor-kappa B (NF-κB) activity. We recently demonstrated that NF-κB is important to the survival of immature mammalian hair cells. Therefore, we undertook an in vitro experiment to determine if resveratrol is able to exert some protective influence against gentamicin-induced damage to and death of auditory hair cells. To accomplish this, we dissected the organ of Corti (OC) from newborn Sprague-Dawley rats and cultured the OCs in medium overnight for recovery. We treated two groups of OC explants with different concentrations of resveratrol plus gentamicin for 24 hours; for comparison and control purposes, we also treated a group of explants with gentamicin only and we left a group untreated. We found that resveratrol in both concentrations had a moderate but statistically significant protective effect against gentamicin-induced toxicity in vitro.
An Alternative Treatment for Facial Nerve Tumors: Short-Term Results of Radiotherapy
Authors: Hillman Todd A. , Chen Douglas A. , Fuhrer Russell
Published: May 2019

A review of medical records of patients undergoing radiotherapy for facial nerve tumors was undertaken to determine subsequent facial nerve results, hearing results, and tumor control. Two patients with facial nerve tumors received this treatment. Facial nerve function remains excellent in one patient and significantly improved in the other. Neither tumor demonstrated growth. Current philosophies of facial nerve schwannoma management attempt to balance tumor control with facial nerve function. Radiotherapy for these tumors appears to preserve short-term facial function and may be a viable alternative to surgical management.
Nonseptic Lateral Sinus Thrombosis: The Role of the Otolaryngologist
Authors: Viswanatha Borlingegowda
Published: May 2019

Nonseptic lateral sinus thrombosis differs from septic lateral sinus thrombosis in that it is not associated with ear or sinus infection. Mastoid changes are frequently detected on computed tomography or magnetic resonance imaging in cases of nonseptic lateral sinus thrombosis. An otolaryngologic evaluation is usually required to exclude coexisting mastoiditis.
Dexamethasone Inner Ear Perfusion for Subclinical Endolymphatic Hydrops
Authors: Silverstein Herbert , Farrugia Mathew , Van Ess Mark
Published: May 2019

We suggest that the term subclinical cochlear hydrops be used to describe patients presenting with aural fullness, stuffiness, or ear pressure when all other diagnoses have been excluded. We reviewed the charts of 20 patients who had presented with a chief complaint of aural fullness, stuffiness, or pressure and who underwent perfusion of the inner ear for 1 month with dexamethasone 4 or 10mg/ml. The symptoms improved in 13 (68.4%) of 19 patients after treatment. None of these patients reported a worsening of symptoms, and no patient had worse hearing after perfusion. Complications were infrequent, and patients tolerated the treatment well. Perfusion of the inner ear appears to be a safe procedure with little risk.
Otolaryngologic Symptoms in Persons Exposed to World Trade Center Dust and Particle Pollutants: A Case for Caution in Declaring a Diagnosis of Wtc Syndrome
Authors: Chandran Swapna K. , Hawkshaw Mary J. , Sataloff Robert T.
Published: May 2019

Since the Sept. 11, 2001, attack on the World Trade Center (WTC), the health status of survivors, rescue and cleanup workers, and residents of Lower Manhattan has been monitored. Exposure to dust and particulate matter resulted in numerous complaints of both upper and lower aerodigestive tract irritation. The symptoms, diagnoses, and management of affected persons have previously been described in the literature. However, evidence establishing causation is scarce, especially with regard to the purported long-term effects of such exposure. Many persons who were exposed to the Ground Zero site have otolaryngologic conditions that are common in persons who were not so exposed. Therefore, otolaryngologists involved in the care of such patients should be cautious about assigning a diagnosis of “WTC syndrome” without a comprehensive examination to look for other possible etiologies. A diagnosis of a treatable, potentially serious health problem should not be missed simply because a patient who was exposed to WTC irritants was presumed to have WTC syndrome. In this review, we discuss the reported otolaryngologic manifestations of exposure to the WTC site, and we describe the specific cases of 2 workers there who continue to have otolaryngologic complaints. Considerable research is needed to establish the existence and nature of any long-term sequelae of exposure to WTC fallout.
Pleomorphic Adenoma: A Preliminary Histopathologic Comparison between Tumors Occurring in the Deep and Superficial Lobes of the Parotid Gland
Authors: Fliss D. M. , Rival R. , Gullane P. , Mock D. , Freeman J. L.
Published: May 2019

Twenty-four cases of pleomorphic adenoma of the parotid gland were retrospectively reviewed. The histopathological features of capsular thickness, penetration and completeness, tumoral cell population and mitotic activity were analyzed in twelve superficial lobe and twelve deep lobe tumors. The capsules were found to be significantly thicker and less likely to be penetrated by tumor in the deep lobe group. No significant differences in completeness of encapsulation, cell population or mitotic activity were found between the two groups. This may explain the clinical suggestion that the less aggressive surgical approach which is often performed does not compromise the prognosis for recurrence in the deep lobe lesions.
Malignant Thyroid Lymphoma Presenting as Acute Airway Obstruction
Authors: Kennedy Kevin S. , Wilson Joseph F.
Published: May 2019

Malignant thyroid lymphoma is an uncommon form of thyroid cancer which most commonly presents in elderly women. Most patients demonstrate a rapidly enlarging mass and may show tracheal deviation on chest roentgenogram. Radioisotopic scanning of the thyroid often demonstrates a “cold” or “cool” process of decreased uptake in the affected area. There is often an underlying lymphocytic thyroiditis process noted. Unfavorable prognosis is related to extracapsular extension, blood vessel wall infiltration, diffuse architectural pattern, and cervical lymph node involvement. We present two unusual cases of thyroid lymphoma presenting with acute airway obstruction and review the literature concerning this subject. One case presented a clinical and radiographic appearance similar to a prevertebral space abscess.
A Prospective Study of Ocular Abnormalities in Hearing Impaired and Deaf Students
Authors: Leguire L.E. , Fillman Robyn D. , Fishman Deborah R. , Bremer Don L. , Rogers Gary L.
Published: May 2019

In a prospective study of 505 hearing impaired and deaf students conducted at Children's Hospital Eye Clinic, 48.7% were found to have significant ocular abnormalities. The prevalence of myopia, astigmatism, and pathological intraocular changes was found to be significantly increased over the general population. In addition, the prevalence of ocular abnormalities generally increased with the severity of the hearing loss. Of importance was the high prevalence of rubella-consistent abnormalities in the hearing impaired and deaf student populations. Rubella syndrome may be responsible for a major portion of high refractive errors and ocular pathological changes. It is recommended that ENT specialists and pediatricians be aware of the nearly 50% chance of ocular abnormality in hearing impaired and deaf students, and that ophthalmologic examination may be valuable for identification or confirmation of the etiology of hearing impairment.
Clinical Correlates of Sudden Auditory-Vestibular Loss in a Cochlear Implant Patient
Authors: Luetje Charles M. , Mediavilla Sarah Jo , Geier Lisa L.
Published: May 2019

The precise electrophysiologic mechanism for sudden sensorineural auditory-vestibular loss has yet to be defined. No human models exist for this idiopathic phenomenon. A 67-year-old cochlear implant (CI) patient experienced what could be termed a “typical” acute sudden auditory-vestibular loss. Vestibular and CI electrical psychophysical changes were monitored over a 22-month period. Once the acute vestibular problems diminished, CI electrical parameters returned to near pre-episode levels. Some improvement occurred in rotational chair phase lag and asymmetry. While improving, platform posturography continued to show difficulty performing sensory organization tests V and VI. These clinical findings may imply that ganglion cell and neuronal population are responsible for the auditory findings in sudden auditory-vestibular loss. Secondly, a CI patient may serve as an ideal human model for further study of this phenomenon, should it occur.
Solitary Extramedullary Plasmacytoma of the Oropharynx: A Rare Location
Authors: Segas John , Skoulakis Haralambos , Katrinakis George , Tzardis Maria
Published: May 2019

We describe a case of solitary extramedullary plasmacytoma of the oropharynx growing on the left posterior tonsillar pillar. The clinical picture was difficulty in swallowing caused from the partial obstruction of the area and bleeding from the ulcerated tumor. Lambda light chains were identified on immunohistochemical staining but they were not detected in either serum or urine (non-secreting tumor). Excisional biopsy followed by radiation therapy were used for treatment. Long-term follow up for several years is necessary in order to rule out evolution to multiple myeloma.
Parotid Cancer: Treatment and Results
Authors: Roberson David W. , Chu Felix W. K. , Yarington C. Thomas
Published: May 2019

The records of 74 consecutive patients with primary parotid malignancy were reviewed. The age and sex incidence was comparable to that described in previous studies; we observed a high incidence of adenocarcinoma not reported by other investigators. Stage at the time of examination and histologic grade of tumor were independent statistically significant predictors of clinical outcome. Long survival with low grade disease and late recurrence were common. Radiation therapy has been shown to increase survival in a number of studies; however, it had no demonstrable benefit in our series. Parotid cancer should be managed aggressively and early surgery is indicated for all parotid neoplasms. Neck dissection is indicated for clinically positive nodes and high grade cancers; radiation therapy is indicated for high grade cancers and residual disease.
Intracranial Placement of a Nasogastric Tube after Complex Craniofacial Trauma
Authors: Sacks Alan David
Published: May 2019

The complication of intracranial placement of a nasogastric tube in patients with complex facial and skull base fractures is rarely seen.

A case report of a patient with complex craniofacial injury after trauma in whom a computerized tomogram scan showed passage of a nasogastric tube via a fracture of the anterior cranial fossa floor into the skull vault is presented. This case stresses the caution to be exercised in the emergency room resusitation of patients with craniofacial injury requiring nasogastric tube placement.
Sound Evaluation of Partially Implantable Piezoelectric Middle Ear Implant: Comparative Study of Frequency Responses
Authors: Kodera Kazuoki , Suzuki Jun-Ichi , Nagai Kyoko , Yabe Takao
Published: May 2019

Two comparative studies were performed in six subjects using partially implantable middle ear implants (MEI). The sound quality was evaluated by speech discrimination tests and sound evaluation tests. In the first experiment, the performance of the output transducer of the MEI and an ear phone of a conventional hearing aid was compared. The MEI showed better results than the hearing aid in both the speech discrimination tests and sound quality rating. In the second experiment, four kinds of frequency responses for the external component of the MEI were compared. Sound quality evaluation in a wide frequency response with a peak at 4000 Hz were superior to those with the frequency response of the present MEI model. In conclusion, improvement of the external component in the frequency response can provide better performance of the MEI.
Multichannel Cochlear Implantation with Percutaneous Pedestal
Authors: Parkin James L. , Parkin Matthew J.
Published: May 2019

In a prospective study by Cohen et al,3 the superiority of multi channel cochlear implant patient performance over single-channel cochlear implant performance was demonstrated. The Ineraid system described in this paper includes a percutaneous pedestal which has had a satisfactory patient experience. Only one pedestal removal has been necessary because of specific pedestal problems. Other less serious pedestal problems decrease in frequency with increasing time post-implantation.

The auditory performance indicates significant commu nication skills improvement in patients with multichannel cochlear implants.