bluuebunny/crossref_metadata_2025 huggingface dataset:
Gabapentin for the Treatment of Tinnitus: A Case Report
Authors: Zapp John Joseph
Published: May 2019

The objective of this article is to discuss the clinically effective use of gabapentin in patients with tinnitus. The author describes the case of a man who came to the office complaining of tinnitus of 10 months’ duration. The patient was started on gabapentin and maintained on a regimen of 500 mg/day in divided doses. Subsequently, he reported that he was free of tinnitus approximately 23 days a month and that he experienced a 75% decrease in symptoms during the remaining days. At 2 years’ follow-up, he remains noise- and pain-free on 500 mg/day of gabapentin.
Frontal recess surgery for diving-related frontal pain: Case report
Authors: Jones Stephen E.M. , Yung Matthew , Norris Andrew
Published: May 2019

We report the case of a professional scuba diver who was unable to dive because he began experiencing severe frontal pain on descent. Following endoscopic surgery to open the frontal recess, the man was able to resume diving unrestricted by pain. We discuss the causes and treatment of this complaint, and we suggest that this might be considered a new indication for surgery in a limited number of cases.
Securing cochlear implants to the skull: Two alternate methods
Authors: Djalilian Hamid R. , King Timothy , Faust Russell A. , Smith Sharon , Levine Samuel C.
Published: May 2019

In view of the various problems encountered with the traditional methods of securing cochlear implants—including dural tear and suture dissolution following infection—we devised two alternate methods of performing this procedure. We use a titanium mesh or a Gore-Tex patch secured with two 4-mm screws to fix the receiver to the skull. No patient who has undergone either of these procedures at our institution has experienced any of the complications that are associated with the older silk, nylon, and Dacron sutures. Moreover, our two alternate methods are less technically difficult and can be performed in a shorter period of time.
Incidental Petrous Apex Findings on Magnetic Resonance Imaging
Authors: Leonetti John P. , Shownkeen Harish , Marzo Sam J.
Published: May 2019

We performed a retrospective chart review to categorize a group of petrous apex findings that were noted incidentally on magnetic resonance imaging (MRI) in 88 patients. These patients were among those who had been seen at a tertiary care center between July 1988 and July 1998. These incidental findings, which were unrelated to the presenting clinical manifestations, included asymmetric fatty bone marrow (n = 41), inflammation (19), cholesterol granulomas (14), cholesteatomas (9), and neoplasms (5). Followup imaging and clinical surveillance of these patients has not demonstrated any significant change in the incidentally detected lesions. In all cases, the incidental MRI findings represented benign pathology.
Nasal Glioma: A Case Report
Authors: Chang Ke-Chang , Leu Yi-Shing
Published: May 2019

Nasal gliomas are rare, benign, congenital tumors that are thought to be the result of an abnormality in embryonic development. Three types of clinical presentations have been recognized: extranasal (60%), intranasal (30%), and combined (10%). Clinically, these masses are firm, noncompressible, nonpulsatile, gray or purple lesions that obstruct the nasal cavity intranasally and cause deformity extranasally. Histologically, these tumors are made up of astrocytic neuroglial cells interlaced with fibrous and vascular connective tissue that is covered with skin or nasal respiratory mucosa. The preferred treatment is excision via a frontal craniotomy approach for those patients whose gliomas have an intracranial connection, for those patients who have cerebrospinal fluid rhinorrhea, and for those who have recurrent episodes of meningitis. Otherwise, a transfacial lateral rhinotomy is advised. In this article, we describe a case of a nasal glioma that was removed via a lateral rhinotomy.
Use of the Malleus Handle as a Landmark for Localizing the round Window Membrane
Authors: Silverstein Herbert , Durand Blanca , Jackson Lance E. , Conlon W. Sean , Rosenberg Seth I.
Published: May 2019

Localization of the round window membrane is desirable in order to allow a more direct application of medication to the inner ear. A new procedure has been developed to deliver direct, near-continuous inner ear perfusion to the round window with the Silverstein MicroWick. In this office procedure, the wick is inserted through a tympanostomy tube into the round window niche. Accurate localization of the round window is a necessary component of this procedure. In an effort to ascertain the precise location of the round window, we examined 25 cadaveric human temporal bones and measured the distance from the umbo to the round window in each sample. We found that the round window was an average of 3.44 mm (± 0.68) from the umbo and was situated at an average angle of 113.2° (± 9.8) from the long process of the malleus. Our simple and reliable determination of the relationship between the malleus handle and the round window niche allows for the accurate placement of the Silverstein MicroWick and other devices.
A Rare Case of Renal Cell Carcinoma Metastatic to the Sinonasal Area
Authors: Yee Lynne Lim Hsueh , Keng Christopher Goh Hood
Published: May 2019

We report a rare case of a hypernephroma that had metastasized to the sinonasal area as a solitary mass. Despite much difficulty, a confirmatory biopsy of the nasal mass was obtained. After radiotherapy had failed to arrest the tumor's growth, the mass was removed via a craniofacial resection. This case illustrates the importance of(1)a high index of suspicion in differentiating this rare tumor from other benign or malignant diseases, (2) awareness of the risk of hemorrhage and the role of preoperative embolization, (3) the need for paraffin histology rather than fine-needle aspiration or frozen section diagnosis, (4) individualizing therapy after due consideration of the characteristics of both the patient and the tumor, and (5) keeping abreast of the most current therapeutic modalities so that patient management can be individualized and optimized. Surgical excision offers the best hope for long-term survival, and it reduces the degree of pain, epistaxis, and disfigurement from the expanding tumor. When such tumors are not resectable, management with radiotherapy, hormonal therapy, immunotherapy, or chemotherapy can be considered.
Detection of Sinus-induced Orbital Mycosis with Standardized Orbital Ultrasonography: A Case Report
Authors: Kaplan Daniel M. , Briscoe Daniel , Niv Alexander , Gatot Albert , Leiberman Alberto , Fliss Dan M.
Published: May 2019

Fungal involvement of the paranasal sinuses is frequently observed in the immunocompromised host, and it can become life-threatening if it is not diagnosed. Although the definitive diagnosis is made by tissue biopsy and culture, imaging is of vital importance in the clinical workup and in planning treatment. We present a case of fulminant ethmoidal sinusitis caused by Aspergillus flavus with orbital involvement in an immunocompromised patient. Standard computed tomography of the paranasal sinuses was complemented by the use of standardized orbital ultrasonography, which was able to identify the intraorbital extension. We discuss the role of standardized orbital ultrasonography as a complementary imaging modality in the diagnosis of fungal sinusitis and in the assessment of local extension. To the best of our knowledge, the role of SOU in diagnosing an orbital extension of a fungal infection of the paranasal sinuses has not been previously discussed in the literature.
Stapes Mobilization in Otosclerosis
Authors: Jaisinghani Vikram J. , Schachern Patricia A. , Paparella Michael M.
Published: May 2019

We performed a retrospective chart study (including surgeon's notes and audiometric results) and an analysis of the archival temporal bones from a patient who had undergone surgery for stapes mobilization in both ears. The stapes footplate was submerged into the vestibule on the right (as a complication of surgery) and absent on the left. One interesting finding was that the patient's hearing had improved on the right despite the presence of the depressed footplate and that the air-bone gap had widened on the left despite the absence of complications on that side.
Localized laryngotracheobronchial amyloidosis: Case report and review of the literature
Authors: Clark J. Madison , Weissler Mark C.
Published: May 2019

Although localized laryngotracheobronchial amyloidosis is rare, the otolaryngologist–head and neck surgeon should be familiar with this condition. Its characteristic appearance can suggest its presence in a patient who has the typical initial symptoms. Biopsies during direct laryngoscopy and bronchoscopy can play both a diagnostic and therapeutic role. After an appropriate examination to rule out systemic involvement, the patient should be managed with conservative surgery, although the use of a CO2 laser might be more efficacious than conventional surgery. With appropriate diagnosis and treatment, patients should expect a favorable prognosis. In this article, we describe a new case of localized laryngotracheobronchial amyloidosis in a 67-year-old woman, and we review the literature on this subject.
Combined Temperature-Controlled Radiofrequency Tongue Reduction and UPPP in Apnea Surgery
Authors: Nelson Lionel M.
Published: May 2019

The objective of this study was to investigate the effects on outcomes and morbidity of combining temperature-controlled radiofrequency (TCRF) tongue reduction with uvulopalatopharyngoplasty (UPPP) as an initial site-directed approach to the surgical treatment of obstructive sleep apnea syndrome (OSAS). This investigation was a prospective, nonrandomized, open-enrollment study of 20 consecutive eligible patients with OSAS. Seven patients had a single-level velopharyngeal obstruction (Fujita type I or IIa), and they were assigned to undergo UPPP only (group 1). Thirteen patients had a multilevel velopharyngeal and retroglossal obstruction (Fujita type IIb), and they were assigned to undergo TCRF tongue reduction in addition to UPPP (group 2). Patients who had only a retroglossal obstruction (Fujita type III) were not included in this study. Following their initial operation, nine patients in group 2 underwent two subsequent in-office TCRF tongue treatments under local anesthesia. Three patients in group 2 were lost to followup, and one patient underwent only one TCRF procedure at the initial operation; data on the latter patient are included in some of the outcomes measures reported here where indicated, but no data are reported on the three who were lost to followup. The primary post-treatment outcomes measures were the results of comparative polysomnography and clinician and patient evaluations regarding morbidity and symptom improvement. Analysis of these data showed that there was no difference between the two groups in terms of postoperative pain or dysphagia following the initial operative session. The degree of symptom improvement in the two groups was similar. Overall success rates—as measured by the apnea/hypopnea index (group 1: 57.1% success; group 2: 50.0%) and by the apnea index (group 1: 71.4% success; group 2: 70.0%)—were statistically comparable, given the small size of the sample (figures are based on 10 patients in group 2). The author concludes that combining TCRT tongue reduction with UPPP in patients with multilevel obstruction improves response rates to a degree that is comparable to that seen with UPPP alone in patients with single-level velopharyngeal obstruction. Moreover, the combination treatment does not increase the risk of additional pain, morbidity, and complications compared with UPPP alone.
Sudden Hypoacusis Treated with Hyperbaric Oxygen Therapy: A Controlled Study
Authors: Fattori Bruno , Berrettini Stefano , Casani Augusto , Nacci Andrea , De Vito Andrea , De Iaco Giuseppe
Published: May 2019

The term sudden hypoacusis describes a hearing loss of rapid onset and unknown origin that can progress to severe deafness. Of the many therapeutic protocols that have been proposed for treating sudden hypoacusis, hyperbaric oxygen therapy (HOT) plays a leading role. We studied 50 patients who had been referred to our ENT unit within 48 hours of the onset of sudden hypoacusis. We randomly assigned 30 of these patients to undergo once-daily administration of HOT for 10 days; the other 20 patients were treated for 10 days with an intravenous vasodilator. Response to therapy in all patients was evaluated by calculating the mean hearing threshold at frequencies between 500 and 4, 000 Hz and by assessing liminal tonal audiometry results recorded at baseline and 10 days after the cessation of treatment. These results, plus the findings of other audiologic and otoneurologic examinations, revealed that the patients in the HOT group experienced a significantly greater response to treatment than did those in the vasodilator group, regardless of age and sex variables. Significantly more patients in the HOT group experienced a good or significant response. In both groups, patients with pantonal hypoacusis responded significantly better than did those with a milder condition. Based on our findings, coupled with the fact that oxygen therapy is well tolerated and produces no side effects, we conclude that HOT should be considered the preferred treatment for patients with sudden hypoacusis.
Post-Tonsillectomy Hemorrhage: Results of a 3-Month Follow-Up
Authors: Windfuhr Jochen P. , Ulbrich Thomas
Published: May 2019

Episodes of post-tonsillectomy hemorrhage are unpredictable and potentially life-threatening. Primary post-tonsillectomy hemorrhage (<24 hr postoperatively) is generally considered to be more common and more serious than secondary hemorrhage (>24 hr). Therefore, recent studies have focused on the control of primary hemorrhage in order to determine the appropriate length of postoperative observation. The issue of follow-up is becoming more important in light of the increasing popularity of outpatient tonsillectomy. We undertook a prospective study to evaluate the incidence of post-tonsillectomy hemorrhage over the short and long term (3 mo). We studied 602 patients, aged 23 months to 89 years (mean: 20.6 yr), who had undergone inpatient tonsillectomy in 1999 and who had been hospitalized for at least 5 days. Our goal was to ascertain the number of episodes of postoperative hemorrhage that required surgical treatment under general anesthesia. We were able to contact 601 of these patients (or their parents) by telephone 3 months postoperatively to inquire about any instances of delayed secondary bleeding. In all, 16 patients (2.7%) had experienced post-tonsillectomy bleeding that required surgically achieved hemostasis under general anesthesia. Of this group, 11 patients (68.8%) had experienced primary hemorrhage and were treated immediately, and five (31.3%) experienced secondary hemorrhage. One patient in the latter group experienced excessive bleeding 38 days postoperatively, which we believe is the latest episode of secondary bleeding reported to date. Based on the findings of this study, we believe that a postoperative follow-up period of 10 days is sufficient to identify all but the most rare cases of post-tonsillectomy hemorrhage.
Is Imaging Necessary in the Evaluation of the Patient with an Isolated Complaint of Anosmia?
Authors: Busaba Nicolas Y.
Published: May 2019

Imaging studies are often obtained during the evaluation of the patient with an olfactory deficit. The purpose of this article is to describe an investigation that was conducted to assess the effectiveness of imaging studies in determining the etiology of olfactory loss in the patient with an isolated complaint of anosmia and no relevant findings on physical examination, including nasal endoscopy. The author conducted a retrospective review of the records of 20 women and eight men, aged 22 to 71 years (mean: 45), whose duration of anosmia had ranged from 1 month to 2 years (median: 3 mo). Twenty of these patients had undergone contrast-enhanced magnetic resonance imaging of the paranasal sinuses and brain, and the other eight had undergone enhanced computed tomography. The author found that these imaging studies did not add to the information obtained by the clinical history and endoscopic nasal examination and were thus not useful in determining the cause of anosmia. Based on these findings, the author does not recommend that imaging studies be included as part of the evaluation of these patients.
Sentinel Lymph Node Biopsy in SCC of the Head and Neck: A Major Advance in Staging the NO Neck
Authors: Wiseman Sam M. , Loree Thorn R. , Hicks Wesley L. , Rigual Nestor R.
Published: May 2019

The management of the NO neck in patients with head and neck cancer is controversial. Neck dissection provides important staging information that guides patient treatment. We examined the feasibility of using a dye technique for staging patients by sentinel lymph node biopsy (SLNBX). We studied seven patients with previously untreated early-stage squamous cell carcinoma of the oral cavity and NO necks. Each patient underwent SLNBX guided by an intraoperative injection of 1% isosulfan blue dye. An open biopsy of the sentinel node was followed by neck dissection. We identified the sentinel node in four of the seven patients (57%). The sentinel node accurately predicted the pathologic status of the neck in three of these four patients (75%). In one of the three patients, the sentinel node was one of four histopathologically positive nodes, whereas in two others, the neck was free of disease. One patient had a histopathologically negative sentinel node and tumor metastasis present in the neck. Of the four patients in whom a sentinel node was identified, the negative predictive value for the absence of cervical metastases was 67%. Based on our findings and those of other authors, we conclude that the use of blue dye in lymphatic mapping for SLNBX in head and neck cancer patients is technically feasible but of limited clinical utility. Our literature review also suggests that performing SLNBX with a radiotracer technique or a combination of a radiotracer and blue dye is a promising method of staging the NO neck in head and neck cancer patients and warrants further clinical study.
Bilateral Lemierre's Syndrome: A Case Report and Literature Review
Authors: Moore Brian A. , Dekle Catherine , Werkhaven Jay
Published: May 2019

Lemierre's syndrome is characterized by thrombosis of the internal jugular vein that develops following an oropharyngeal infection. Sepsis and septic metastases frequently ensue and affect the lungs, the musculoskeletal system, and occasionally the liver. Most cases are caused by infection with Fusobacterium necrophorum. This infection responds to antibiotic therapy with beta-lactamase-resistant compounds that exert good anaerobic coverage. Anticoagulation and surgical intervention can be helpful in advanced cases. Fewer than 160 cases of classic Lemierre's syndrome have been described; approximately one-third of these reported cases have occurred since 1988. We describe a new case of Lemierre's syndrome that occurred in an otherwise healthy 27-year-old man. Thrombosis of both internal jugular veins extended through the subclavian system and into both upper extremities. The patient was treated with intravenous antibiotics and heparin during 14 days of hospitalization. He was discharged on oral clindamycin and warfarin sodium, and after 6 months he was able to return to full activity. To our knowledge, this is the first reported case of Lemierre's syndrome in which internal jugular vein thrombosis occurred bilaterally. By reporting this previously undescribed manifestation of Lemierre's syndrome, we hope to increase practitioner awareness of this disease entity.
Cicatricial Pemphigoid: Report of Five Cases
Authors: Miziara Ivan Dieb , Sperandio Fabiana , Bohadana Saramira C. , Braga Natasha , Romano Fabrizio Ricci , Miniti Aroldo
Published: May 2019

Cicatricial pemphigoid is a chronic, systemic, autoimmune disease characterized by progressive bullous skin and mucous membrane lesions that tend toward scarring and involution. Manifestations of cicatricial pemphigoid include oral mucosal bullous lesions in 85 to 90% of patients, ocular mucosal lesions in 66%, nasal mucosal lesions in 15 to 23%, and laryngeal involvement in 8 to 21 %. We report five cases of cicatricial pemphigoid in which all patients had ENT manifestations—specifically, oral and nasal mucosal involvement. Three of these patients also had laryngeal lesions; one of the three had a large laryngeal ulceration and bullae that caused a laryngeal stenosis and necessitated a tracheostomy. In addition to the five case reports, we also review the literature and discuss the pathogenesis, diagnosis, and treatment of this uncommon disease.
A Rare Case of Mucoepidermoid Carcinoma of the Nasal Cavity
Authors: Thomas Giovana R. , Regalado Jacinto J. , McClinton Mark
Published: May 2019

Mucoepidermoid carcinoma of the nasal cavity is rare. We report the case of a 57-year-old man who was evaluated for a rapidly enlarging subcutaneous mass on the nasal bridge. The tumor was diagnosed as a mucoepidermoid carcinoma. The patient underwent extensive surgical resection andpostoperative radiotherapy, but 5 months later he required orbital exenteration for persistent disease. Despite these radical measures, the patient died with persistent disease 9 months following the initial evaluation. The aggressive behavior of this tumor highlights the need for physicians to be aware of the differential diagnosis, symptoms, and signs of neoplasms that originate in the nasal cavity so that prompt treatment can be instituted.
Cocaine-Induced Oronasal Fistulas with External Nasal Erosion but without Palate Involvement
Authors: Vilela Ronald J. , Langford Carol , McCullagh Linda , Kass Erik S.
Published: May 2019

The effects of chronic cocaine abuse have been widely described in the literature. Common complications include nasal septal perforation, saddle-nose deformity, and palatal perforation. Erosion of the external structures of the face has not been as extensively described, nor have oronasal fistulas that involve structures other than the hard or soft palate. In this article, we present the first reported case of cocaine-induced external nasal erosion that included multiple oronasal fistulas in the anterior gingival sulcus but did not involve the hard or soft palate. We stress the importance of a thorough history in such patients and consideration of all possible diagnoses, including drug abuse.
Schwannoma of the Epiglottis: First Report of a Case
Authors: Martin Paul A. , Church Christopher A. , Chonkich George
Published: May 2019

Schwannomas of the larynx are rare. Most of the few such reports in the literature have described schwannomas that occurred in the aryepiglottic fold or the true vocal folds. In this article, we report what we believe is the first case of a schwannoma arising from the epiglottis.
Comparison of Bipolar Scissors and Bipolar Forceps in Tonsillectomy
Authors: Patel Nitesh , Kirkland Paul , Tandon Pavan , Hung Terry , Knight Jeff
Published: May 2019

Bipolar diathermy scissors tonsillectomy is a relatively new surgical technique. We conducted a prospective study of 90 patients to compare this technique with bipolar forceps tonsillectomy. We found that the use of the bipolar scissors required significantly less operating time (mean: 3.03 min less) and allowed patients to resume eating solid food more rapidly (mean: 40.35 min earlier). Bipolar scissors tonsillectomy was safe, and there were no intraoperative complications or primary hemorrhages. A postoperative follow-up telephone survey revealed that patients who underwent scissors tonsillectomy experienced no more morbidity than did the forceps group during the first 2 weeks after surgery. We conclude that bipolar scissors tonsillectomy is a safe and rapid technique that can be used successfully as an outpatient procedure.
A Rare Case of a Foreign Body Migration from the Upper Digestive Tract to the Subcutaneous Neck
Authors: Pang Kenny Peter , Pang Yoke Teen
Published: May 2019

Ingested foreign bodies are not unusual in Singapore. The most common of these objects are fish bones, which typically become lodged in the tonsils or in the base of the tongue. We report a rare case of an ingested fish bone that migrated from the upper digestive tract and into the soft tissues of the neck just below the skin.
Orbital Infection as a Complication of Sinusitis: Are Diagnostic and Treatment Trends Changing?
Authors: Younis Ramzi T. , Lazar Rande H. , Bustillo Andres , Anand Vinod K.
Published: May 2019

Orbital infection has long been the most common complication of sinusitis. In light of our increased knowledge of sinusitis, improved diagnostic tools, and new pharmacologic and surgical treatments, we investigated whether trends in diagnosis and treatment are changing. We reviewed the charts of all 43 patients who had been referred to our institution with orbital complications of sinusitis between Jan. 1, 1985, and Dec. 31, 1999. Nine of the 43 patients had been diagnosed between Jan. 1, 1985, and Dec. 31, 1990 (mean: 1.5 patients/yr) and 34 had been diagnosed between Jan. 1, 1991, and Dec. 31, 1999 (mean: 3.8 patients/yr). Of the 43 patients, 27 had cellulitis and 16 had an abscess (one of the 16 had two abscesses—one subperiosteal and one supraorbital). All 17 abscesses were treated surgically. Five of the 7 abscesses operated on from 1985 through 1990 were treated via an open external approach, whereas 7 of the 10 abscesses that were operated on later were treated via an endoscopic approach. We conclude that orbital complications of sinonasal origin are being recognized more frequently than they were in the past and that endoscopy has supplanted the open external approach as the preferred method of drainage.
Demyelination of Vestibular Nerve Axons in Unilateral Ménière's Disease
Authors: Spencer Robert F. , Sismanis Aristides , Kilpatrick Jefferson K. , Shaia Wayne T.
Published: May 2019

We conducted a study to determine whether vestibular nerves inpatients with unilateral Ménière's disease whose symptoms are refractory to medical management exhibit neuropathologic changes. We also endeavored to determine whether retrocochlear abnormalities are primary or secondary factors in the disease process. To these ends, we obtained vestibular nerve segments from five patients during retrosigmoid (posteriorfossa) neurectomy, immediately fixed them, and processed them for light and electron microscopy. We found that all five segments exhibited moderate to severe demyelination with axonal sparing. Moreover, we noted that reactive astrocytes produced an extensive proliferation of fibrous processes and that the microglia assumed a phagocytic role. We conclude that the possible etiologies of demyelination include viral and/or immune-mediated factors similar to those seen in other demyelinating diseases, such as multiple sclerosis and Guillain-Barré syndrome. Our findings suggest that some forms of Ménière's disease that are refractory to traditional medical management might be the result of retrocochlear pathology that affects the neuroglial portion of the vestibular nerve.
Tuberculous Otitis Media: Two Case Reports and Literature Review
Authors: Awan Mohammad Sohail , Salahuddin Iftikhar
Published: May 2019

Tuberculous otitis media can be difficult to diagnose because it can easily be confused with other acute or chronic middle ear conditions. Compounding this problem is the fact that physicians are generally unfamiliar with the typical features of tuberculous otitis media. Finally, the final diagnosis can be difficult because it requires special culture and pathologic studies. To increase awareness of this condition, we describe two cases of tuberculous otitis media and we review the literature.
A Rare Case of a Sebaceous Nevus in the External Auditory Canal
Authors: Bothwell Nici Eddy , Willard Craig C. , Sorensen Douglas M. , Downey Timothy J.
Published: May 2019

We report the case of a patient who came to us for evaluation of a progressive unilateral hearing loss and who was found to have a sebaceous nevus in an unusual location: the external auditory canal. A sebaceous nevus is a congenital organoid mass that occurs primarily on the face, scalp, and periauricular regions. Despite the predilection of sebaceous nevi for the head and neck, reports of this lesion rarely appear in the otolaryngology literature. Left untreated, the lesion can progress through three stages of gross and histopathologic development; a sebaceous nevus begins as a small benign papule, grows into an enlarging mass with different characteristics, and ultimately becomes a secondary neoplasm. The lesion's potential for malignant transformation and its association with syndromes underscores the importance of prompt recognition and appropriate management. This case report adds the sebaceous nevus to the differential diagnosis of external auditory canal lesions and provides essential information about this rare mass.
Iatrogenic Maxillary Sinus Recirculation and Beyond
Authors: Gutman Michael , Houser Steve
Published: May 2019

Recirculation of nasal mucus occurs when secretions that have been transported out of the natural maxillary ostium return to the sinus via a surgically created or accessory ostium. Recirculation increases the risk of persistent sinus infection. In this article, we describe a case of mucus recirculation in a patient who had not responded to two previous sinus surgeries for recurrent rhino sinusitis. We also postulate the possibility of ethmoid recirculation.
Unilateral Temporal Muscle Hypertrophy: A Rare Clinical Entity
Authors: Lowry Thomas R. , Helling Eric
Published: May 2019

Isolated unilateral temporal muscle hypertrophy is a rarely reported clinical entity with an unclear etiology. Consideration of a broad differential diagnosis combined with a detailed histologic and radiologic work-up will help the physician diagnose the underlying pathology. We report a new case of this uncommon entity, and we review the pertinent literature.
Primitive Neuroectodermal Tumor of the Mandible: Report of a Rare Case
Authors: Sundine Michael J. , Bumpous Jeffrey M.
Published: May 2019

We describe what we believe is only the second reported case of primitive neuroectodermal tumor of the mandible. Our patient was successfully treated initially with surgery and adjuvant radiation and chemotherapy, but 18 months later she developed a fatal pulmonary metastasis. Although this tumor is aggressive and prone to recurrence and metastasis, early intervention might improve the prognosis in affectedpatients. In patients with unresectable disease, radiation and chemotherapy might have palliative value.
Salivary Duct Carcinoma of the Larynx: Report of a Rare Case
Authors: Goel Madhu M. , Agrawal Satya P. , Srivastava Anand N.
Published: May 2019

Salivary duct carcinomas are primarily high-grade, aggressive malignancies that affect men in the fifth and sixth decades of life. These tumors are usually found in the major salivary glands; rarely do they originate in the minor salivary glands. The distinctive feature of these neoplasms is their remarkable histologic resemblance to infiltrating ductal carcinomas of the mammary gland; both types of tumor feature epithelial and myoepithelial cells arrayed in solid, papillary, and cribriform patterns. To the best of our knowledge, only one case of a primary salivary duct carcinoma of the larynx has been previously reported. In this article, we describe a new case, and we review the literature on salivary duct carcinomas.
Intralingual Foregut Duplication Cyst in a Newborn
Authors: El-Bitar Mohamed A. , Milmoe Gregory , Kumar Shimareet
Published: May 2019

Congenital lingual cystic masses are challenging entities that can be detected prenatally or discovered in various forms after birth. We report what we believe is only the ninth case of an intralingual foregut duplication cyst that was lined with gastric mucosa. The preoperative evaluation of lingual cystic masses in newborns can include palpation, high-resolution sonography, computed tomography (CT), or magnetic resonance imaging (MRI). However, CT and MRI can pose a risk to the infant because they require sedation in order to properly position the patient for imaging. In our patient, we found that high-resolution sonography was most useful in revealing the nature of the mass as a nonvascular cystic lesion and in delineating its extension. We excised this lesion via bipolar cautery, which we prefer to cold-knife or CO2 laser surgery.
Prescribing Guidelines for ENT Medications during Pregnancy
Authors: Ambro Bryan T. , Scheid Sara C. , Pribitkin Edmund A.
Published: May 2019

Profound physiologic changes occur during pregnancy, and they can alter the pharmacodynamics of an administered drug. Almost 85% of women take at least one prescription medication during a pregnancy. Nearly every drug administered to a mother crosses the placenta, and fetal drug levels can reach 50 to 100% of maternal serum concentrations. Because many otolaryngologic conditions are associated with pregnancy, it is essential that otolaryngologists who care for gravid patients know which drugs are safe and avoid unnecessary prescriptions so that the best care can be delivered to the pregnant patient without harming her unborn child. In this article, we discuss the relative safety and efficacy of various types of drugs frequently prescribed for pregnant women by otolaryngologists.
Multiple Intraparenchymal Parotid Calculi: A Case Report and Review of the Literature
Authors: Lindman Jonathan P. , Woolley Audie L.
Published: May 2019

We describe an unusual case of bilateral intraparenchymal parotid stones with unilateral parotitis in a 17-year-old boy. The patient went on to develop multiple parotid abscesses, which we treated with a superficial parotidectomy. To our knowledge, this is only the second report of intraparenchymal parotid stones in a pediatric patient.
Oncocytic Carcinoma of the Parotid Gland: Report of a New Case
Authors: Cinar Ugur , Vural Cetin , Basak Tulay , Turgut Suat
Published: May 2019

Prior to 2003, only 39 cases of oncocytic carcinoma of salivary gland origin had been reported in the English-language literature. We report a new case, which occurred in a 48-year-old woman whose disease had metastasized to regional lymph nodes. She was treated by radical parotidectomy, with sacrifice of the facial nerve, and radical neck dissection. At the 3-year follow-up, she remained free of disease. Our review of the literature suggests that patients with such tumors who undergo aggressive surgery rather than conservative treatment have the best prognosis.
A Different Type of ‘Glue Ear’: Report of an Unusual Case of Prominent Ears
Authors: Purcell Elizabeth M. , O'Neill Ann C. , Regan Padraic J.
Published: May 2019

Prominent ears is a condition that can cause extreme psychological distress in young people. This cosmetic deformity can be corrected by otoplasty, an outpatient surgical procedure that is associated with a high rate of patient satisfaction. We report the unusual case of a teenage boy who had repeatedly applied cyanoacrylate adhesive (“superglue”) to his postauricular skin in an attempt to pin back his prominent ears. This case of “glue ear” was ultimately resolved by successful otoplasty, although the residual effects of the glue resulted in delayed healing of the surgical wound.
Bacteriologic findings in Patients with Chronic Sinusitis
Authors: Merino Luis Antonio , Ronconi María Cristina , Hreñuk Gabriela Edith , de Pepe Marta G.D.
Published: May 2019

We studied the bacteriology of maxillary sinus aspirates obtained from patients diagnosed with chronic sinusitis. We recovered 659 strains from 510 aspirates; of these, 572 (86.8%) were aerobes and 87 (13.2%) were anaerobes. Aerobes only were recovered from 310 of the 510 specimens (60.8%) and anaerobes only from 31 (6.1%). Among the 572 aerobic bacteria, the most prevalent organisms were Streptococcus viridans (158 strains [27.6%]), Streptococcus pneumoniae (67 [11.7%]), Corynebacterium species (66 [11.5%]), Staphylococcus aureus (54 [9.4%]), Moraxella catarrhalis (38 [6.6%]), Hemophilus parainfluenzae (33 [5.8%]), and group C beta-hemolytic streptococci (26 [4.5%]). Among the 87 recovered anaerobes were species of Peptostreptococcus (32 strains [36.8%]), Prevotella (22 [25.3%]), Actinomyces (13 [14.9%]), Propionibacterium (11 [12.6%]), Fusobacterium (8 [9.2%]), and Veillonella (1 [1.1%]). Beta-lactamase production was detected in 115 of the 572 aerobic strains (20.1%) and in 10 of the 87 anaerobic strains (11.5%). We found that the prevalence and type of organisms we identified in chronic sinusitis did not differ substantially from those reported in previous studies. Our study is one of the more extensive reports on the type and prevalence of pathogens in chronic sinusitis that has been published to date.
Glandular Tularemia in a Native American Child
Authors: Collison Patrick J. , Adams Brent
Published: May 2019

This case report details the clinical manifestation and course of glandular tularemia, an uncommon but significant cause of cervical lymphadenopathy in children. We discuss the unique attributes of this disease along with appropriate steps that lead to early identification of the organism and effective treatment. The potential use of the organism as a bioterrorism agent is another interesting aspect of this entity.
Cervical Emphysema Secondary to Pneumomediastinum as a Complication of Childbirth
Authors: Nakagawa Hideki , Yamauchi Miwa , Kusuyama Toshiyuki , Fukuda Hiroyuki , Ogawa Kaoru
Published: May 2019

Pneumomediastinum and cervical emphysema usually occur following esophageal or chest trauma. Rarely do they occur as a complication of childbirth, and only approximately 200 such cases have been reported in the literature worldwide. We describe a new case, and we review the clinical picture, pathophysiology, and management of these conditions. In view of the head and neck symptoms of pneumomediastinum and cervical emphysema during labor—which include dyspnea, cough, sore throat, pain on swallowing, and dysphagia—otolaryngologists might be consulted and should therefore be aware of these conditions in order to recognize and treat them.
Telephone Use and Understanding in Patients with Cochlear Implants
Authors: Adams Jeffrey S. , Hasenstab M. Suzanne , Pippin Gregory W. , Sismanis Aristides
Published: May 2019

We conducted a mail survey of patients who had received cochlear implants to ascertain their ability to communicate on the telephone. Of 86 patients who responded, 38 (44%) did not use the telephone at all, 36 (42%) were able to use the telephone without assistance (independent users), and 12 (14%) were able to use the telephone with some type of assistance. Factors associated with independent use were male sex, older age at the onset of hearing loss, longer duration of hearing loss, successful use of hearing aids prior to cochlear implantation, implantation with a MED-EL Combi 40+ device, and a shorter duration of implant use. But regardless of circumstances, our findings suggest that many cochlear implant patients can use the telephone during daily activity without the need for assistive devices or relay services.
SSRI use by Tinnitus Patients: Interactions between Depression and Tinnitus Severity
Authors: Folmer Robert L. , Shi Yong-Bing
Published: May 2019

Depression is often coincident with chronic tinnitus, and several studies have suggested that antidepressant medications may play a role in relieving tinnitus as well as depression. We conducted a retrospective study of the use of selective serotonin reuptake inhibitors (SSRIs) by patients at a large tinnitus clinic to assess the effects of these antidepressants on tinnitus severity. We focused on a subgroup of 30 patients with depression who had begun taking SSRI medication after the onset of their tinnitus; these patients had also been treated with psychotherapy by a mental health clinician. At a mean follow-up of 20.6 months, only 10 of the 30 patients reported that they were still experiencing major depression. Moreover, this group as a whole demonstrated a statistically significant improvement in tinnitus symptoms as reflected by a reduction in their Tinnitus Severity Index scores. We conclude that SSRIs represent one category of tools that can be used to help patients with severe tinnitus and depression. Like all antidepressant medications, SSRIs should be used in conjunction with psychotherapy to facilitate patient improvement.
Endoscopic Sinus Surgery in Cystic Fibrosis: Effects on Pulmonary Function and Ideal Body Weight
Authors: Jarrett William A. , Militsakh Oleg , Anstad Michael , Manaligod Jose
Published: May 2019

There is some question as to whether surgical treatment of sinus disease in patients with cystic fibrosis improves pulmonary function or helps patients achieve their ideal body weight. To investigate this matter, we retrospectively studied 17 children with cystic fibrosis who had undergone endoscopic sinus surgery at the University of Kentucky College of Medicine over a 15-year period. All patients had advanced sinus disease at the time of surgery. Although there was an overall increase in mean pulmonary function values, which peaked 1 month postoperatively, no statistically significant improvements were maintained at 6 and 12 months. Nor was there any significant change in these patients’ percentage of ideal body weight.
Laryngomalacia: An Atypical Case and Review of the Literature
Authors: Awan Sohail , Saleheen Danish , Ahmad Zafar
Published: May 2019

Laryngomalacia is the most common cause of stridor in newborns and infants. Patients usually present with an inspiratory stridor only, although some exhibit other anomalies. To rule out other possible pathologies, bronchoscopy is advisable. However, the authors of some recent studies have advocated the use of fiberoptic laryngoscopy as a more cost-effective and less-invasive alternative. No surgical intervention is required to treat laryngomalacia in most cases. The disease usually resolves spontaneously by the time a patient reaches the age of 24 months. In this article, we describe a case of laryngomalacia that was atypical in that the patient was 10 years old. We also review the literature in an effort to increase awareness of this condition.
Intratympanic Steroid Perfusion for the Treatment of Ménière's Disease: A Retrospective Study
Authors: Dodson Kelley M. , Woodson Erika , Sismanis Aristides
Published: May 2019

We conducted a retrospective outcomes review of the charts of 22 patients with Ménière's disease who were treated with intratympanic perfusion of methylprednisolone and/or dexamethasone. Outcomes were determined by subjective assessment of vertigo control and by objective changes in audiometric pure-tone average (PTA) and speech discrimination score (SDS). These evaluations were made at the first postperfusion visit (short term) and at least 12 months later (long term). In the short term, 12 patients (54.5%) achieved vertigo control, 4 patients (18.2%) demonstrated a greater than 10-dB improvement in PTA, and 1 patient (4.5%) experienced an increase in SDS of at least 15%. In the long term, the corresponding numbers of patients were 4 (18.2%), 2 (9.1%), and 1 (4.5%). The level of hearing ultimately deteriorated in 9 patients (40.9%). These findings suggest that intratympanic steroid perfusion does not result in any long-term alleviation of vertigo or hearing loss. However, the short-term alleviation of vertigo seen in approximately half of these patients suggests that this treatment may be useful for the temporary relief of symptoms of Ménière's disease.
Naturally Draining Ostium of an Agger Nasi Cell: A Case Report
Authors: Yoo Michael J. , Kim Namou , Houser Steven M.
Published: May 2019

We describe the case of a 61-year-old woman who underwent functional endoscopic sinus surgery for chronic hyperplastic rhinosinusitis. During surgery, we were able to visualize the natural ostium of her left agger nasi cell. To our knowledge, such a finding has not been previously documented in the literature.
The Roles of the Anterior Tonsillar Pillar and Previous Tonsillectomy on Sleep-Disordered Breathing
Authors: Chan James , Akst Lee M. , Eliachar Isaac
Published: May 2019

We conducted a study to determine if there is a correlation between inadequate anterior tonsillar pillar support and sleep-disordered breathing. We examined 11 patients with a history of tonsillectomy to ascertain the structural and functional integrity of their anterior tonsillar pillars. All 11 demonstrated a loss of anterior pillar support and collapse of their soft palate to the extent that the soft palate passively pressed against the posterior pharyngeal wall. We conclude that a deficiency of anterior tonsillar pillar support does indeed predispose patients to obstructive sleep apnea syndrome. Knowledge of this correlation can help guide the method of surgical treatment and should reinforce the need to maintain the integrity of the anterior tonsillar pillars.
Grisel's Syndrome: The Two-Hit Hypothesis-A Case Report and Literature Review
Authors: Battiata Andrew P. , Pazos George
Published: May 2019

Grisel's syndrome is a rare but well-documented clinical entity. It is a nontraumatic, fixed rotary subluxation of C1 on C2 (atlantoaxial). Although first described in 1830, the exact mechanism of Grisel's syndrome remains unclear. We present a postoperative case of Grisel's syndrome and an extensive literature review, and we propose a mechanism for its pathogenesis. In addition, we propose a treatment algorithm for Grisel's syndrome.
Feasibility of Treating Hearing Disorders with Stem Cells: Update
Authors: Watters Karen , Corrales C. Eduardo
Published: May 2019

The recent isolation of adult stem cells from the mouse utricle that have the capacity to differentiate into cells from all three germ layers—and more importantly, into inner ear hair cells—offers a viable option for the treatment of hearing loss. The finding that embryonic stem cells are also capable of differentiating into hair cells further expands the possibility that we may someday develop restorative treatment of sensorineural hearing loss.
Harmonic Scalpel versus Conventional Tonsillectomy: A Double-Blind Clinical Trial
Authors: Collison Patrick J. , Weiner Robin
Published: May 2019

We conducted a prospective, double-blind clinical trial to evaluate the differences in operating time, intraoperative blood loss, postoperative pain at 3 hours and 1 week, and delayed (> 24 hr) bleeding associated with ultrasonic harmonic scalpel tonsillectomy and conventional tonsillectomy. The study was carried out on 28 patients with recurrent tonsillitis and/or adenotonsillar hypertrophy who underwent harmonic scalpel tonsillectomy on one side and cold dissection tonsillectomy with suction electrocautery hemostasis on the other. The harmonic scalpel was associated with significantly less intraoperative blood loss (mean: 6.2 vs. 58.8 ml; p < 0.0001) and less early (3 hr) postoperative pain as determined by scores on a 10-point visual analog scale (mean: 3.5 vs. 4.4; p = 0.0042); although the difference in early pain scores is statistically significant, it is probably not clinically significant. Pain scores at 1 week were nearly identical (mean: 2.7 vs. 2.6; p = 0.9246). The length of operating time was similar (mean: 10.9 vs. 7.7 min; p = 0.0022). An unanticipated finding was the fact that delayed bleeding, which occurred in 3 patients (10.7%), occurred only on the harmonic scalpel side. We conclude that the only clearly demonstrable advantage that the harmonic scalpel had over cold dissection was that it caused less intraoperative blood loss.