bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute Respiratory Distress in Pena-Shokeir Syndrome
Authors: Boesen Peter V. , French Christopher E.
Published: May 2019

Pena-Shokeir syndrome is a rare, autosomal-recessive disorder that usually affects newborns. Its etiology is poorly understood. Pena-Shokeir syndrome is defined by camptodactyly, multiple ankyloses, pulmonary hypoplasia, and various facial anomalies. These manifestations are usually severe, and death generally occurs at birth or shortly thereafter. We describe a case of Pena-Shokeir syndrome in a 9-year-old girl of above-normal intelligence who presented with life-threatening airway distress. To the best of our knowledge, she is the oldest living individual with Pena-Shokeir syndrome, and the only such patient whose intelligence was not impaired. We discuss the acute management and subsequent care of this patient, who not only survived, but maintained excellent grades in school.
Primary Columellar Angiosarcoma: A Case Report
Authors: Oliveira Pedro , Correia Ricardo , Castro Eugénia , Almeida Rosete , Silva Agostinho
Published: May 2019

Angiosarcoma of the head and neck, a rare malignancy, is associated with a high degree of invasiveness and poor survival. A high level of suspicion followed by histopathologic and immunohistochemical studies is warranted in order to arrive at a well-timed and accurate diagnosis. We report the case of a 56-year-old man who developed an unusually small neoplasm in the nasal columella. Rapid diagnosis allowed for simple treatment with surgical excision, a rare circumstance because most of these tumors require extensive surgery. Close long-term follow-up of patients with angiosarcoma of the head and neck is vitally important.
Olfactory Neuroblastoma: A Case Report and Review of the Literature
Authors: Ghaffar Shehzad , Salahuddin Iftikhar
Published: May 2019

Malignant tumors of the nasal cavity are rare. We report the case of an elderly woman who consulted us with a 4-year history of progressive nasal obstruction, occasional epistaxis, facial pain, and watering of the eyes. A diagnosis of olfactory neuroblastoma was established by histopathology and confirmed by immunohistochemistry. On staging, the mass was classified as a Kadish stage B tumor. The mass was excised via a lateral rhinotomy approach, and the tumor was peeled away completely from the cribriform plate with endoscopes. The patient underwent postoperative radiation, and she was free of recurrence at follow-up 15 months later.
Descending Necrotizing Mediastinitis: Trends in a Developing Country
Authors: Chaudhary Neena , Agrawal Sanjay , Rai Anil K.
Published: May 2019

Descending necrotizing mediastinitis is believed to be a rare and serious complication of odontogenic and oropharyngeal infections. It is associated with a high (up to 40%) mortality rate, which can be attributed to delays in diagnosis and inadequate surgical drainage. Between May 1999 and September 2002, we treated 7 cases at our institution in New Delhi, indicating that such fulminating infections are not so rare in developing countries. In our 7 cases, a high index of suspicion and early computed tomography helped us make a rapid diagnosis and initiate prompt treatment, which resulted in a favorable outcome in 6 cases (mortality rate: 14.3%).
Pitfalls in Imaging: Differentiating Intravagal and Carotid Body Paragangliomas
Authors: Kerr Julie Thorp , Eusterman Vincent D. , Yoest Stephen M. , Andersen Charles A.
Published: May 2019

We report a case of an intravagal paraganglioma and a case of a carotid body tumor to illustrate a variable presentation of the former in which it mimicked the latter on preoperative imaging. The atypical imaging features of the intravagal paraganglioma included inferior extension to the level of the carotid bifurcation and splaying of the internal and external carotid arteries, features that are similar to those seen in a case of carotid body paraganglioma. Proper differentiation of these lesions permits more appropriate preoperative counseling and surgical preparation. When using magnetic resonance angiography rather than catheter angiography, we advocate the inclusion of gadolinium contrast and three-dimensional time-of-flight techniques to better demonstrate the position of the tumor relative to the carotid bifurcation.
Macroglossia Secondary to Systemic Amyloidosis: Case Report and Literature Review
Authors: Xavier Sandra Doria , Filho Ivo Bussoloti , Müller Helena
Published: May 2019

Amyloidosis is characterized by an abnormal extracellular deposition of amyloid in different tissues and organs, where it usually causes some type of dysfunction. Its cause is unknown. The two main forms of amyloidosis are systemic and localized; the latter is rare. No satisfactory treatment for systemic amyloidosis has been discovered, and mean survival is poor, ranging from 5 to 15 months depending on the presence or absence of multiple myeloma. We report a case of primary systemic amyloidosis in a 71-year-old man. The diagnosis of amyloidosis was established by tongue biopsy, and its systemic nature was identified by analysis of aspirated abdominal fat. At the 1-year follow-up, the patient's clinical condition had not changed, and he was thereafter lost to follow-up.
Comparison of Intranasal Hypertonic Dead Sea Saline Spray and Intranasal Aqueous Triamcinolone Spray in Seasonal Allergic Rhinitis
Authors: Cordray Scott , Harjo Jim B. , Miner Linda
Published: May 2019

Intranasal corticosteroids are well known to be efficacious in the treatment of allergic rhinitis. Nasal irrigation with saline, including hypertonic saline, has long been recommended for the treatment of sinonasal disease, and it has been shown to have a positive effect on the physiology of the nasal mucosa. Until now, no study of the clinical efficacy of intranasal hypertonic Dead Sea saline as a monotherapy for seasonal allergic rhinitis has been reported. We conducted a prospective, randomized, single-blind, placebo-controlled comparison of intranasal hypertonic Dead Sea saline spray and intranasal aqueous triamcinolone spray in 15 patients with seasonal allergic rhinitis. Results were based on a 7-day regimen. Based on Rhinoconjunctivitis Quality of Life Questionnaire scores, clinically and statistically significant (p < 0.0001) improvements were seen in both active-treatment groups; as expected, the corticosteroid spray was the more effective of the two treatments. No significant improvement occurred in the control group. Our preliminary results not only confirm the efficacy of intranasal corticosteroid therapy in moderate-to-severe allergic rhinitis, they also suggest that the Dead Sea saline solution can be an effective alternative in mild-to-moderate allergic rhinitis, particularly with respect to nasal and eye symptoms. The hypertonicity of the Dead Sea solution may have a positive effect on the physiology of the nasal mucosa by improving mucociliary clearance. In addition, the dominant cation in the Dead Sea solution— magnesium— probably exerts anti-inflammatory effects on the nasal mucosa and on the systemic immune response.
Nonsurgical Home Treatment of Middle Ear Effusion and Associated Hearing loss in Children. Part II: Validation Study
Authors: Silman Shlomo , Arick Daniel S. , Emmer Michele B.
Published: May 2019

In this prospective follow-up investigation, we examined the efficacy of a modified Politzer device in the home treatment of persistent middle ear effusion (MEE) and associated hearing loss in children who had previously participated in a similar clinical trial. Our study group was made up of 38 patients who had been either (1) untreated control participants in the previous study whose hearing in one or both ears had not returned to normal within 11 weeks of their initial audiologic pretest (“former control group”; n = 30), or (2) active-treatment participants in the previous study whose hearing sensitivity in at least one ear had not improved to within normal limits after treatment and who elected to undergo a continuation of treatment (“extended-treatment group”; n — 8). Treatment efficacy was determined by comparing differences in pre- and posttreatment air-conduction thresholds and otoscopic findings. Following treatment, the former control group experienced significant improvements in hearing sensitivity at all frequencies; at the posttreatment test, hearing sensitivity was within normal limits in 43 of 60 ears (71.7%), and normal or moderate tympanic membrane mobility was observed in 30 of 34 otoscopically examined ears (88.2%). In the extended-treatment group, hearing sensitivity returned to within normal limits in 9 of 10 impaired ears (90.0%). These findings further substantiate the efficacy of our modified Politzer device in improving middle ear function and hearing sensitivity in children with MEE, and they support the reliability of the findings reported in our previous study. These results also indicate that many patients in whom initial treatment is not successful may benefit from extended treatment.
Poststapedectomy Hearing Gain: Comparison of a Teflon (fluoroplastic ASTM F 754) Prosthesis with a Schuknecht-type Wire/Teflon Prosthesis
Authors: Zepeda-López Emilia Guadalupe , Bello-Mora Antonio , Félix-Trujillo Manuel Martín
Published: May 2019

We conducted a retrospective study to compare poststapedectomy hearing gain in study-eligible patients who had received a Teflon (fluoroplastic ASTM F 754) prosthesis (study group; n = 76) with hearing gain achieved in a matched group (by age, sex, and degree of hypoacusis) of patients who had received a Schuknecht-type wire/Teflon prosthesis (control group; n = 70). All procedures had been performed by the authors at our institution between Jan. 2, 1994, and Dec. 31, 1997. Airway averages at low, medium, and high frequencies were estimated on the basis of pre- and postoperative audiologic evaluations, as were total air-bone gaps at 7 frequencies between 125 and 8,000 Hz. We found that the study group achieved a significantly greater degree of hearing gain at 125 and 250 Hz and significantly better closure of the air-bone gap at 250, 500, 1,000, 2,000, and 4,000 Hz. The hearing outcomes among patients in the study group were excellent.
Rhabdomyosarcoma of the Middle Ear and Mastoid: A Case Report and Review of the Literature
Authors: Abbas Akbar , Awan Sohail
Published: May 2019

We report a case of rhabdomyosarcoma of the middle ear and mastoid in a 3-year-old boy. The patient was treated according to Intergroup Rhabdomyosarcoma Study IV protocol (chemo- and radiotherapy), and he experienced a complete remission. However, 7 months after the completion of treatment, he experienced a recurrence at the primary site that spread to the brain. Despite treatment, the patient died of progressive metastasis to the lung 4 months later.
Bilateral Pleomorphic Adenoma of the Anterior Tongue: A Case Report
Authors: Virk Ramandeep S. , Hundal Harbir
Published: May 2019

We report a case of bilateral pleomorphic adenoma of the anterior two-thirds of the tongue in a 38-year-old man. Both tumors were excised via a transoral route. To the best of our knowledge, this is the first reported case of a bilateral pleomorphic adenoma of the anterior tongue.
Bilateral Peritonsillar Abscess Revisited
Authors: Safdar Adrian , Hughes Joseph P. , Walsh Rory McConn , Walsh Michael
Published: May 2019

Bilateral peritonsillar abscess is uncommon. When it does occur, patients usually present with sore throat; other clinical signs and symptoms may differ from those usually associated with unilateral peritonsillar abscess. We describe 2 cases of bilateral peritonsillar abscess that were successfully treated with needle aspiration of both sides with a 14-gauge intravenous cannula. Needle aspiration is an accepted form of treatment for unilateral peritonsillar abscess, but to the best of our knowledge, its use as a sole treatment modality (with observation under intravenous antibiotic coverage) for bilateral peritonsillar abscess has not been previously reported in the literature. We also believe that the incidence of acute bilateral peritonsillar abscess may be higher than the rates that have been reported in the literature. Finally, we recommend that the threshold for imaging be low for any patient who is suspected of having acute bilateral peritonsillar abscess to avoid any delay in diagnosis and treatment.
Vertigo and Motion Sickness. Part II: Pharmacologic Treatment
Authors: Zajonc Timothy P. , Roland Peter S.
Published: May 2019

Vertigo is a sensation of movement when no movement is actually occurring. It is often accompanied by visceral autonomic symptoms including pallor, diaphoresis, nausea, and vomiting. Vertigo is similar to motion sickness in that both may be caused by vestibular stimulation that does not match an internal model of expected environmental stimuli. Indeed, a functioning vestibular system is necessary for the perception of motion sickness. For this reason, many of the same drugs are used to treat both conditions. The investigation of drugs that treat motion sickness helps to discover medications that may treat vertigo caused by disease of the vestibular system. In this article, we discuss the pharmacologic agents that are now available for the treatment of vertigo and those agents that are still under study.
Chondroma of the Nasal Bone: A Case Report
Authors: Sreedharan Suja , Kamath Mulki Pandurang , Hegde Mahesh Chandra , Sundar Seshachalam , Lobo Flora D. , Raju Penumetcha Krishnam
Published: May 2019

Cartilaginous tumors are common in the long bones of the body and relatively rare in the head and neck. When they do occur in the head and neck, the most common site is the midface. Since the first case report by Morgan in 1842, approximately 150 cases of head and neck chondroma have been recorded in the English-language literature. In this article, the authors describe a new case in which a chondroma of the nasal bone caused an external nasal deformity in a 17-year-old boy. The lesion was excised via an external rhinoplasty approach. The authors believe that this is the first reported case of a chondroma arising from the nasal bone. The authors have made an attempt to comprehensively review the literature on this rare and controversial tumor and place special emphasis on its uncertain biologic nature. A detailed discussion of the diagnosis and management of this tumor is also included in this report.
Warthin-like Tumor of the Thyroid Gland: An Uncommon Variant of Papillary Thyroid Cancer
Authors: Kim Harold H. , Myssiorek David , Heller Keith S. , Zahurullah Fazlur , Bhuiya Tawfiqul
Published: May 2019

Several variants of papillary thyroid cancer have been described, including, most recently, Warthin-like tumor of the thyroid gland. To bring attention to this uncommon variant, we review previous reports on this entity and we add 5 new cases to the literature. We retrospectively reviewed the records of all patients who had undergone thyroidectomy at our institution during a 7-year period. Among these cases, we identified 5 patients who had had a Warthin-like tumor of the thyroid. From their charts, we compiled data on age, sex, lymphadenopathy, distant spread, and treatment. Pathologic specimens were reviewed for tumor size, capsular invasion, and vascular invasion. All 5 patients were women (mean age: 51.6 yr). Tumor size ranged from 0.9 to 2.0 cm. Multifocality was seen in 1 of the 5 patients; this patient was also the only one who experienced capsular and vascular invasion. No patient had lymph node spread or distant metastasis. Because the follow-up period among these patients was still short, we were unable to analyze long-term survival data.
A Rare Case of Rhabdomyoma of the Larynx Causing Airway Obstruction
Authors: Jensen Kevin , Swartz Keith
Published: May 2019

Rhabdomyomas are benign tumors of skeletal muscle derivation. Rhabdomyomas of the head and neck are unusual, and laryngeal rhabdomyomas of the adult type are rare. When they do occur, patients may present with symptoms that have progressed slowly over several years. In extraordinary cases, stridor and airway obstruction manifest. We report a case of adult rhabdomyoma of the larynx that features some of its typical and atypical presenting characteristics. This case also exemplifies the favorable prognosis that results following complete yet conservative surgical excision.
Tuberculosis Mimicking Kikuchi's Disease
Authors: Kamath M. Panduranga , Bhojwani Kiran , Naik Ramdas , Kumar Rajiv , Chakravarthy Yeshwanth
Published: May 2019

Kikuchi's disease is an idiopathic self-limiting necrotizing lymphadenitis. Clinically, it mimics tuberculous cervical lymphadenopathy. The disease is diagnosed by histopathologic study. The only specific treatment that has been reported is empiric steroid therapy. We report a case of tuberculosis that was originally thought to be Kikuchi's disease in a 24-year-old man. When the patient's condition worsened during a course of steroid therapy, he underwent surgical exploration, which revealed the presence of tuberculous lymphadenitis. The patient was switched to antituberculosis drug therapy, and his improvement was dramatic.
Acute External Laryngotracheal Trauma: Diagnosis and Management
Authors: Lee Walter T. , Eliashar Ron , Eliachar Isaac
Published: May 2019

Laryngotracheal trauma may result in lifelong complications or even death if diagnosis or treatment is delayed. Emergency room physicians, trauma surgeons, anesthesiologists, and especially otolaryngologists should maintain a high level of awareness of and suspicion for laryngotracheal trauma whenever a patient presents with multiple trauma in general or with cervical trauma in particular. Although there is some controversy regarding care, treatment in experienced hands will usually result in a favorable outcome. In this article, we review and update the diagnosis and management of acute external laryngotracheal trauma.
Outcomes of Primary and Secondary Tracheoesophageal Puncture: A 16-year Retrospective Analysis
Authors: Cheng Elaine , Ho Margie , Ganz Cindy , Shaha Ashok , Boyle Jay O. , Singh Bhuvanesh , Wong Richard J. , Patel Snehal , Shah Jatin , Branski Ryan C. , Kraus Dennis H.
Published: May 2019

The current study retrospectively reviewed the cases of 68 patients who had undergone total laryngectomy and tracheoesophageal puncture (TEP) over a 16-year period. Fifty-one patients underwent primary TEP and 17 underwent secondary TEP. Nearly 80% of patients who received TEP at the time of laryngectomy achieved excellent voice quality perceptually. In contrast, only 50% of secondary TEP patients achieved excellent voice ratings. This difference was statistically robust (p = 0.03). Although both surgical and prosthesis-related complications occurred more frequently following primary TEP, statistically significant differences were not achieved. Neither pre- nor postoperative radiotherapy had any effect on voice restoration or complication rates. Based on these data, primary TEP may be preferable for several reasons, including a greater likelihood of successful voice restoration, a shorter duration of postoperative aphonia, and the elimination of the need for a second operation and interim tube feedings.
Management of a Tracheal Tear during Laryngopharyngoesophagectomy with Gastric Pull-up
Authors: Koterski Sandra , Snow Norman , Yao Mike
Published: May 2019

Laceration of the posterior tracheal wall is one of the risks of transhiatal esophagectomy. Various methods of repairing such lacerations have been described; many of these methods involve a thoracotomy, but some do not. We describe a case of a posterior tracheal wall tear that occurred during a laryngopharyngectomy with a gastric pull-up. The tear was repaired with the transposed stomach and did not require a thoracotomy. The transposed stomach was used to patch the tear and block communication between the environment and the mediastinum. Bedside endoscopic examination on postoperative day 5 revealed that the tear had healed. Key management considerations in such a circumstance include having the patient breathe without positive pressure ventilation postoperatively and keeping the tracheal lumen and stoma clear during the healing process in order to prevent the development of positive tracheal pressure. With these safeguards in place, the transposed stomach approach is a safe method of repairing posterior tracheal wall tears.
Use of Negative-Pressure Dressings to Manage a Difficult Surgical Neck Wound
Authors: Shreenivas Satya , Magnuson J. Scott , Rosenthal Eben L.
Published: May 2019

We used negative-pressure dressings to treat a poorly healing cervical rotation flap following radical neck dissection in an elderly man. The wound had failed to heal properly after 2 weeks of conservative management. Following application of the negative-pressure dressings, the wound granulated quickly and healed well by secondary intention.
Malignant Peripheral Nerve Sheath Tumors of the Head and Neck: Two Cases and a Review of the Literature
Authors: Devesa Pablo Martinez , Mitchell Timothy E. , Scott Ian , Moffat David A.
Published: May 2019

Malignant peripheral nerve sheath tumors are uncommon lesions that occasionally affect the head and neck. We describe 2 new cases of head and neck pathology. One tumor involved the parotid gland and resulted in erosion of the temporal bone, and the other affected the lower lip. A rapid diagnosis has significant implications for management because of the tumor's potential for aggressive behavior and its high rate of recurrence. To the best of our knowledge, lip involvement is rare and temporal bone involvement has not been previously described.
Three-Dimensional Computed Tomography and Surgical Treatment for Eagle's Syndrome
Authors: Beder Esen , Ozgursoy Ozan Bagis , Ozgursoy Selmin Karatayli , Anadolu Yucel
Published: May 2019

Eagle's syndrome represents a group of symptoms that includes recurrent throat pain, globus pharyngeus, dysphagia, referred otalgia, and neck pain possibly caused by elongation of the styloid process or ossification of the stylohyoid or stylomandibular ligaments. The medical history and physical and radiologic examinations are the main guides to the precise diagnosis. The radiologic diagnostic modality of choice is three-dimensional computed tomography (3-D CT). We describe a case of bilaterally symptomatic Eagle's syndrome that was diagnosed by 3-D CT of the styloid processes and successfully treated with surgery via a transoral approach.
Fibrous Dysplasia in the Retropharyngeal Area
Authors: Gerceker Muharrem , Ozgursoy Ozan Bagis , Erdem Atilla , Ekinci Cemil
Published: May 2019

More fibro-osseous lesions originate in the bones of the extremities than in the craniomaxillofacial bones, scapula, and ribs, which are rarely involved. Fibro-osseous lesions that decrease the quality of life should be treated surgically. We report the case of a fibro-osseous lesion that caused globus pharyngeus and dysphagia. We discuss the clinical, radiologic, and histopathologic features of this case as well as the removal of this unusual lesion by Doppler ultrasound-guided surgery. To the best of our knowledge, no other case of a fibro-osseous lesion in the retropharyngeal area has been reported in the literature.
Platelet-Rich Plasma in Endoscopic Sinus Surgery
Authors: Rice Dale H.
Published: May 2019

The author designed a study to assess the healing properties of platelet-rich plasma (PRP) after endoscopic sinus surgery in 30 patients with bilateral and symmetrical chronic rhino sinusitis that was refractory to medical management. At the conclusion of each operation, PRP was introduced into the middle meatus of a randomly chosen side, while the other side was treated normally and served as a control. Patients were followed until both sides healed. After 13 operations, follow-up evaluations demonstrated no benefit to the use of PRP, and the study was terminated early. In general, both sides healed quickly and uneventfully as expected. There appears to be no advantage to the use of PRP in endoscopic sinus surgery.
Toxoplasmosis Lymphadenitis Presenting as a Parotid Mass: A Report of 2 Cases
Authors: Shashy Ron G. , Pinheiro Daniel , Olsen Kerry D.
Published: May 2019

Toxoplasmosis manifesting as a parotid mass is rare; our review of the literature found only 6 previously reported cases. We report 2 new cases. Both patients presented with a small, mobile left parotid mass, and both were successfully treated with a diagnostic superficial parotidectomy. In both cases, the patient had been regularly exposed to cats and had recently eaten undercooked meat. When evaluating a parotid mass, otolaryngologists should be aware of the infectious causes of parotid swelling and lymphadenopathy and consider the possibility of toxoplasmosis when the history and pathologic findings are not suggestive of more common diseases.
A Case of Papillary Carcinoma Arising in Ectopic Thyroid Tissue within a Branchial Cyst with Neck Node Metastasis
Authors: Mehmood Rao K. , Basha Shaik I. , Ghareeb Essan
Published: May 2019

We describe the interesting case of a young man who presented with a lateral neck node that was diagnosed as a branchial cyst. Histopathology of the excised node revealed that a papillary carcinoma was located within thyroid tissue, which in turn was located within a branchial cyst. A total thyroidectomy with local lymph node clearance was performed. Histology identified a normal thyroid gland, but a papillary carcinoma in one of the excised lymph nodes was consistent with a metastasis. To our knowledge, this is only the second reported case of a thyroid carcinoma arising in ectopic thyroid tissue that metastasized in the neck.
A Case of Skull Base Mucormycosis with Osteomyelitis Secondary to Temporal Bone Squamous Cell Carcinoma
Authors: Safaya Anil , Batra Kadambari , Capoor Malini
Published: May 2019

We describe an unusual case in which a 35-year-old man presented with skull base mucormycosis with osteomyelitis secondary to squamous cell carcinoma of the temporal bone. We also review the literature on the clinical characteristics, diagnosis, and treatment of mucormycosis.
Psychological Characteristics of Patients with Ménière's Disease Compared with Patients with Vertigo, Tinnitus, or Hearing Loss
Authors: Savastano Marina , Marioni Gino , Aita Maria
Published: May 2019

An association between Ménierè's disease and psychological distress is frequently reported. Patients who do not have Ménière's disease but who have similar symptoms also experience various kinds of psychological disturbances. We conducted a study to investigate the relationship between Ménière's disease and personality traits, illness behavior, depression, and anxiety. We compared these factors in 77 patients who had Ménière's disease and 133 controls who did not have the disease but had one of its symptoms—either vertigo, tinnitus, or hearing loss. The mental status of study participants was assessed with standard tests. Patients in both groups had higher than normal levels of anxiety and neuroticism. The only significant difference between the two groups was a higher rate of extroversion in the Ménière's disease group. Minor differences emerged when Ménière's patients with tinnitus or vertigo were compared with similar controls. Relationships between psychological observations and otologic symptomatology or an otologic diagnosis were not specific, which illustrates the need to consider the role of illness behavior and personality as targets for psychological support or therapy associated with ENT treatment.
Embryonal Rhabdomyosarcoma of the Temporal Bone
Authors: Viswanatha Borlingegowda
Published: May 2019

The most common soft-tissue sarcoma in infants and children is rhabdomyosarcoma. The head and neck is the most common site of involvement; temporal bone involvement has been seen in about 7% of reported cases. Multimodality therapy—surgery, multiagent chemotherapy, and radiotherapy—yields sufficiently good results. The author reports a case of embryonal rhabdomyosarcoma of the temporal bone with cranial nerve palsies and extension into the parapharyngeal space in a 4-year-old boy. Despite surgery and chemotherapy, the patient died of his disease within 3 months of presentation.
Auricular Angioleiomyoma: A Case Report and Review of the Literature
Authors: Wirth Garrett A. , Sundine Michael J. , Kong Allen P. , Carpenter Philip M.
Published: May 2019

A 29-year-old woman presented with an unusual lesion on the right auricular antihelix. The mass was purple and painful, and it had been present for 17 years. Preoperatively, the presumptive diagnosis was a venous malformation. The mass was resected, and a staged reconstruction was performed. Microscopic analysis of the specimen revealed that the lesion was an angioleiomyoma. Most cases of angioleiomyoma involve the extremities; few have been described in the head and neck region, and very few of those have been reported on the ear. Among those auricular angioleiomyomas that have been reported, most were distinctly painless. We report a new, atypical case of this unusual tumor.
Multifocal Tuberculosis of the Nose and Lymph Nodes without Pulmonary Involvement: A Case Report
Authors: Kamath M. Panduranga , Bhojwani Kiran M. , Prabhu Shivananda , Naik Ramdas , Ninan Geo P. , Chakravarthy Yeshwanth
Published: May 2019

Tuberculosis of the nose is very rare. When it does occur, it almost always arises secondary to primary pulmonary tuberculosis. Nasal tuberculosis is most common in women older than 20 years. We report the case of a 16-year-old girl who presented with epistaxis, fever, submental swelling, and enlargement of multiple cervical and axillary lymph nodes. The patient was diagnosed with tuberculous granuloma of the nose and tuberculous lymphadenopathy. She was successfully treated with a 6-month regimen of standard antituberculous therapy.
Assessment of Quality of Life among Patients with Sinonasal Disease as Determined by an Internet Survey based on the Rhinosinusitis Disability Index
Authors: Kinney William C. , Benninger Michael S.
Published: May 2019

We conducted a survey to measure patient quality of life with the Rhinosinusitis Disability Index adapted for the Internet. Our target population was patients who were seeking information on sinonasal disease on the World Wide Web. Usable responses were obtained from 896 patients with self-diagnosed sinonasal disease. According to the survey responses, patients with chronic rhinosinusitis were significantly more bothered by their condition than were patients with allergic rhinitis. Also, women were significantly more impaired by recurrent acute sinusitis and chronic rhinosinusitis than were men. Our findings are consistent with the results of previous surveys conducted by means other than the Internet. This project represents the first quality-of-life survey of an unsolicited group of individuals with sinonasal disease. We believe that use of the Internet will allow researchers to obtain larger patient populations than is now typical with traditional means of survey dissemination.
Comparison of Helicobacter Pylori Colonization on the Tonsillar Surface versus Tonsillar Core Tissue as determined by the CLO test
Authors: Khademi Bijan , Niknejad Nika , Gandomi Behrooz , Yeganeh Firoozeh
Published: May 2019

We conducted a prospective study to determine the correlation between the presence or absence of Helicobacter pylori on the tonsillar surface and in the tonsillar core as determined by the Campylobacter- like organism (CLO) rapid urease enzyme test. Our study population was made up of 55 patients who underwent adenoidectomy, tonsillectomy, or both from December 2002 through April 2003 at Khalili Hospital in Shiraz, Iran. Of these 55 patients, 45 (82%) were positive and 10 (18%) were negative for H pylori colonization as determined by CLO testing. Analysis of samples obtained from individual patients revealed differences in H pylori colonization between tonsillar surface samples and the core tissue samples. Of 106 tonsils obtained from 53 patients who underwent adenotonsillectomy or tonsillectomy, H pylori was found on 56 tonsillar surface samples (53%) and 24 tonsillar core samples (23%); only 13 tonsils (12%) contained H pylori both on the surface and in the core. We conclude that a surface swab is neither specific nor sensitive as an indicator of the presence or absence of H pylori colonization in tonsillar core tissue.
Cavernous Hemangioma of the Maxillary Sinus with Bone Erosion
Authors: Mussak Erich , Lin Jerry , Prasad Mukesh
Published: May 2019

We report a case of cavernous hemangioma originating in the maxillary sinus. This is an unusual location for hemangioma, and this case also had a rare presentation involving bone erosion. The substantial bone destruction and resultant widening of the right ostiomeatal complex made it difficult to differentiate this cavernous hemangioma from malignant epithelial tumors.
Two Cases of Neurilemmoma of the Tongue
Authors: Batra Kadambari , Rai Anil Kumar , Chaudhary Neena , Topno Sameer
Published: May 2019

Neurilemmomas of the tongue are uncommon. When they do occur, treatment is simple. However, diagnosis is invariably delayed because of the vagueness of symptoms. We encountered 2 cases of this unusual tumor within weeks of each other. In 1 of these cases, the definitive diagnosis was delayed because of the atypical clinical picture—that is, an abscess in the tongue that had caused respiratory distress. We describe our management of these 2 cases, and we discuss what has been published in the literature regarding the presentation, diagnosis, histopathology, treatment, and prognosis for patients with glossal neurilemmoma.
Endotracheal Intubation with Flexible Fiberoptic Bronchoscopy in Patients with Abnormal Anatomic Conditions of the Head and Neck
Authors: Elizondo Eduardo , Navarro Francisco , Pérez-Romo Alfredo , Ortega Conceptión , Muñoz Heberto , Cicero Raúl
Published: May 2019

We performed a retrospective chart review to evaluate the indications for endotracheal intubation via flexible fiberoptic bronchoscopy in patients who were scheduled for surgery or who were hospitalized in the intensive care unit of our 1,100-bed, tertiary care university hospital. We reviewed 9,201 clinical records of anesthetic procedures during which endotracheal intubation had been performed from January to December 2002. We identified 66 patients who had been intubated with flexible fiberoptic bronchoscopy. On preanesthetic examination, 61 of these patients had been found to be poor candidates for conventional laryngoscopic intubation—51 because of abnormal head and neck anatomy and 10 because of reduced visual access to the airway (Mallampati class IV). The remaining 5 patients were intubated via flexible fiberoptic bronchoscopy after conventional intubation had failed during emergency surgery. Our study emphasizes (1) the importance of the preanesthetic examination of surgical patients, to identify those in whom conventional intubation would likely be problematic, and (2) the need to have fiberoptic bronchoscopes and an anesthesiologist or bronchoscopist skilled in their use available in operating suites and intensive care units.
Laryngeal Metastasis from a Rectal Carcinoma
Authors: Ramanathan Yogeetha , Rajagopalan Raman , Rahman Nazarina Abdul
Published: May 2019

Metastases to the larynx from distant primaries are rare. We report a case of a laryngeal metastasis from a rectal carcinoma.
Solitary Neurofibroma of the Palatine Tonsil: A Case Report
Authors: Madhumita Kumar , Nambiar Ajit , Prathapan Parameswaran
Published: May 2019

We present a rare case of a benign tumor of the tonsil in a 49-year-old woman. The tumor was excised in its entirety, and the patient's postoperative course was uneventful. No evidence of recurrence was detected during follow-up. Although some sporadic cases of tonsillar schwannoma have been reported, to the best of our knowledge this is only the second case of a solitary neurofibroma of the palatine tonsil to be reported in the English-language literature.
Isolated Lingual Mucormycosis in an Infant with down Syndrome
Authors: Shetty Subhaschandra , Kini Usha , Joy Rajeev
Published: May 2019

Mucormycosis is characterized by severe infection with rapid progression and a high mortality rate. In immunocompromised hosts, the most common type is the rhinocerebral form of mucormycosis. Invasive mucormycosis affecting only the tongue is extremely rare. We report one such case that occurred in an immunocompromised 4-month-old girl with Down syndrome who had been hospitalized for acute gastroenteritis. The infant had metabolic acidosis secondary to diarrhea. It was suspected that the infection had been contracted through the use of a wooden tongue depressor during oral examination. We present this case report in the hope that it will discourage clinicians from using wooden tongue depressors in vulnerable infants. We also wish to emphasize that mucormycosis should be considered in all patients—regardless of age—who present with localized bluish-black discolored mucosa of the oral mucosa and/or tongue.
Pearls on the Presentation and Diagnosis of Otosclerosis
Authors: Lippy William H. , Berenholz Leonard P.
Published: May 2019

Since the 1960s, our group has performed more than 18,000 primary and revision stapedectomies for the treatment of otosclerosis. All of the patient histories, surgical findings, and hearing results pertinent to these cases have been entered into a database at our clinic. The suggestions and conclusions that we offer in this and in future installmentsof Clinical Nuggets are based on, and thus validated by, the experience that has been documented in our database. We begin with some pearls on the presentation and diagnosis of otosclerosis. In future installments, we will provide some tips on the physical examination and on primary and revision stapedectomy. Ourgoal is to give you a clear picture of what works and what doesn't.
Neuroendocrine Carcinoma of the Jugular Foramen
Authors: Leonetti John P. , Shirazi Mobeen A. , Marzo Sam , Anderson Douglas
Published: May 2019

We describe what might have been the first reported case of a neuroendocrine carcinoma of the jugular foramen. A 50-year-old woman presented with progressive left-sided sensorineural hearing loss, vertigo, pulsatile tinnitus, headaches, and ataxia. Magnetic resonance imaging revealed a 4-cm left-sided jugular foramen tumor. The patient underwent near-total resection of the tumor. Despite lower cranial nerve preservation, postoperative paralysis of cranial nerves IX and X occurred, and vocal fold medialization was performed 5 days later. The final pathologic diagnosis was neuroendocrine carcinoma. The patient was treated with concurrent chemotherapy and intensity-modulated radiation therapy. This article will discuss the pathologic features and the management of jugular foramen tumors, along with the differential diagnosis of these rare tumors.
Effect of Cochlear Implantation on Nasality in Children
Authors: Nguyen Lily H.P. , Allegro Jennifer , Low Aaron , Papsin Blake , Campisi Paolo
Published: May 2019

Hypernasality is a commonly perceived characteristic of speech in deaf adults and children, but the mechanism of this abnormal nasal resonance is poorly understood. The impact of cochlear implantation on nasalance measures in children with severe auditory deprivation has not been previously reported. We conducted a study of nasality in 6 deaf children who had undergone cochlear implantation. Voice recordings were obtained before surgery and 6 months after activation of the implants. The MacKay-Kummer SNAP Test—which consists of a syllable-repetition subtest and a picture-cued subtest—was used to obtain nasalance scores for oral (bilabial, alveolar, velar, and sibilant) and nasal phonemes. Before cochlear implantation, mean nasalance scores were significantly higher than normal during the production of oral phonemes for both subtests (p ≤ 0.05). Six months after activation, the nasalance measures for all components of the syllable-repetition subtest had been restored to within 1 standard deviation of normal. For all oral phonemes of the picture-cued subtest, the elevated nasalance scores were consistently lower after cochlear implant activation, although the difference was statistically significant only for velar tasks. Nasalance scores for nasal phonemes were within 1 standard deviation of normal both before and after implant activation. Our study showed that cochlear implantation partially corrects elevated nasalance measures. Disturbances in nasal resonance may be caused in part by the inability of deaf speakers to monitor velopharyngeal valving with auditory feedback. The trend toward improved nasalance scores after implantation highlights the role of auditory feedback in monitoring velopharyngeal function. Visual biofeedback may be required to further normalize hypernasal speech in profoundly deaf children.
Rhinolithiasis with a Nasal Polyp: A Case Report
Authors: Ozcan Ibrahim , Ozcan K. Murat , Ensari Serdar , Dere Huseyin
Published: May 2019

Rhinoliths are uncommon mineralized masses that form as a result of calcification of an endogenous or exogenous nidus. The most common manifestations of rhinolithiasis are unilateral nasal discharge, nasal obstruction, and facial pain. The diagnosis is made by nasal endoscopy and computed tomography. The differential diagnosis includes chronic inflammation, osteomyelitis, benign tumors (e.g., calcified nasal polyps, ossifying fibromas, osteomas, and chondromas), and malignant tumors (e.g., osteosarcomas, chondrosarcomas, and squamous cell carcinomas). Rhinoliths may cause rhinosinusitis, erosion of the nasal septum and medial wall of the maxillary sinus, and perforations of the palate. To the best of our knowledge, the occurrence of a nasal polyp associated with rhinolithiasis has not been previously reported in the English-language literature. In this article, we describe such a case.
Retropharyngeal Hematoma as a Complication of Anticoagulation Therapy
Authors: Akoğlu Ertap , Seyfeli Ergün , Akoğlu Sebahat , Karazincir Sinem , Okuyucu Şemsettin , Dağli Ali Şafak
Published: May 2019

Reports in the literature of retropharyngeal hematoma as a complication of anticoagulation therapy are rare. When this complication does occur, it can become life-threatening if the airway is compromised. However, no consensus exists as to which approach—intubation, tracheotomy, or conservative therapy—is best for managing the airway in these cases. We report a case of retropharyngeal hematoma that occurred as a sequela to a trivial blunt trauma in a 48-year-old man who had been undergoing anticoagulation therapy with warfarin. The hematoma had caused airway obstruction, and the patient was hospitalized. He was treated conservatively, and the hematoma slowly resolved over the course of 2 weeks. On the basis of our experience and the findings of our literature review, we suggest that conservative management can be initiated for small nonexpanding hematomas that do not seriously compromise the airway. Securing the airway with intubation or tracheotomy should be reserved for patients who are in serious respiratory distress; the choice between intubation and tracheotomy should be made on an individual basis.
How to Eliminate Air-bone Gaps Audiometrically: Use Too Much Masking
Authors: Miller Maurice H.
Published: May 2019

The excessive, indiscriminate use of masking during measurements of pure-tone bone-conduction thresholds can reduce or eliminate air-bone gaps. This may result in an abnormal, audiometrically induced bone-conduction threshold shift and suggest to the otologist the need for auditory brainstem response testing and/or magnetic resonance imaging. A case is presented in which the inappropriate use of the masking plateau method resulted in a reduction of the air-bone gap in an ear with a mild conductive hearing loss. The audiometric Weber test should be used in these cases, and nonmasked bone thresholds should be used to determine the actual level of the cochlear reserve.
Sinonasal Neuroendocrine Carcinoma: A Case Report
Authors: Mendis Dulani , Malik Nasser
Published: May 2019

Neuroendocrine carcinoma (NEC) is rare. We report a case of probable sinonasal NEC in a 73-year-old man who had presented with a history of right nasal obstruction, nasal discharge, and recurrent epistaxis. On examination, a red, friable, gelatinous, polypoid mass with a tendency to bleed was seen in the right nasal cavity. Computed tomography revealed that the lesion was confined to the right nasal cavity; coincidental or reactive opacification was seen in the adjacent sinuses. The final histologic evaluation of the excised biopsy specimens yielded a diagnosis of an invasive, poorly differentiated NEC, probably a large-cell variant, with the differential diagnosis lying at a point somewhere between poorly differentiated large-cell NEC and high-grade olfactory neuroblastoma. The patient underwent a right lateral rhinotomy and medial maxillectomy followed by adjuvant radiotherapy. At 20 months of follow-up, he exhibited no sign of recurrence.
Epidermoid Carcinoma Involving the Parotid Gland and Orbital Region: Case Report of a Rare Entity
Authors: Aslan Sundus , Yavuz Haluk , Altan-Yaycioglu Rana , Bolat Filiz , Ozgirgin Nuri
Published: May 2019

Epidermoid carcinoma (also known as squamous cell carcinoma) of the parotid gland is more prevalent among the elderly, as are other head and neck tumors. In most cases it is observed either as a nodal metastasis of a primary tumor that drains into the parotid area or as a direct extension of a tumor that has originated in the upper dermis. Primary epidermoid carcinomas arising directly from the parotid gland are extremely rare. Similarly, secondary invasion of the orbital region by a neighboring tumor is more common than primary epidermoid carcinoma of the orbit, which is also rare. In this article, we discuss the diagnosis and treatment of a rare case of epidermoid carcinoma simultaneously invading the parotid gland and the orbit.
Gentamicin Injections for Ménière Disease: Comparison of Subjective and Objective end Points
Authors: Steenerson Ronald Leif , Hardin Robin B. , Cronin Gaye W.
Published: May 2019

This retrospective study reports the overall efficacy and comparative results of intratympanic gentamicin injections for disabling vertigo episodes. All patients received weekly injections for diagnosed Ménière disease. In Group 1 (81 patients), treatment end points were determined by subjective complaints of imbalance, with resolution of vertigo. In Group 2 (23 patients), treatment end points were determined when 2 or more values of nystagmus were demonstrated. (Group 2 patients were assessed before initiation of therapy for head-shaking, head-thrust, and spontaneous nystagmus using infrared video goggles.) After the final injection, all patients had audiograms and balance and oculomotor retraining. Gentamicin therapy was determined to be successful based on 3-month post-therapy findings of vertigo resolution, stable hearing, normalized nystagmus, and functional balance.
The Safety of Outpatient UPPP for Obstructive Sleep Apnea: A Retrospective Review of 40 Cases
Authors: Strocker Ali M. , Cohen Alen N. , Wang Marilene B.
Published: May 2019

We retrospectively reviewed the outcomes of 40 patients who had undergone outpatient uvulopalatopharyngoplasty (UPPP) for the treatment of moderate to severe obstructive sleep apnea (OSA) in order to determine the safety of the procedure in an outpatient setting. Postoperatively, 36 of the 40 patients (90%) were discharged home the day of surgery without morbidity; 3 other patients stayed overnight for nonmedical reasons, and 1 patient who was already an inpatient remained hospitalized for unrelated medical issues. No postoperative complications occurred, and all patients reported a resolution of OSA symptoms and improvement in sleep. Based on a combination of our data and those of previous studies, we conclude that patients with significant OSA can safely undergo UPPP as an outpatient procedure. We recommend that guidelines regarding the perioperative care of patients with OSA be adjusted to include consideration of treatment in an outpatient setting.