bluuebunny/crossref_metadata_2025 huggingface dataset:
Persistent Measles Virus Infection as a Possible Cause of Otosclerosis: State of the Art
Authors: Niedermeyer Hans P. , Arnold Wolfgang , Neubert Wolfgang J. , Sedlmeier Reinhard
Published: May 2019

The etiopathogenesis of otosclerosis is still largely unexplained and remains controversial. Morphologic examinations have shown the presence of a chronic inflammation in otosclerotic tissue. Among the proposed explanations for this inflammation are an immunologic reaction against collagen, mutations of collagen gene 1A1, and a viral infection.

In this paper, we focus on the role of measles virus in otosclerosis, and we review the current literature, devoting particular attention to a suspected paramyxoviral etiopathogenesis in Paget's disease. Our examination of footplate fragments by reverse transcription polymerase chain reaction testing in 95 patients with otosclerosis revealed the presence of measles virus RNA in 83% of cases. Quantification of measles virus immunoglobulin G (IgG) in otosclerosis patients indicated that the ratio of antimeasles virus IgG in total IgG was higher in perilymph than in serum. Furthermore, an almost identical incidence of otosclerosis and measles virus-caused mortality in women suggests that women are more susceptible to measles virus infection. Finally, since the introduction of the measles virus vaccination program in Europe, there has been a decline in the incidence of otosclerosis. Moreover, the average age of patients at diagnosis and surgery at our hospital has increased to 54 years.

Our findings, when they are considered along with findings regarding the presence of paramyxoviral RNA in Paget's disease, support the hypothesis that measles virus is involved in the etiopathogenesis of otosclerosis.
The Role of Ultrasonography in the Management of Tumors of the Neck
Authors: Sajeeda Shaik , Panda Naresh , Mann Sher Baaj Singh , Katariya Sudha , Kalagara Suman
Published: May 2019

By themselves, clinical examination and palpation do not provide an accurate assessment of metastatic neck nodes. They do not yield sufficient information to ascertain the benign or malignant nature of nodes or to determine the presence of extracapsular spread and vascular invasion. The use of real-time ultrasonography with high-frequency transducers can significantly improve the evaluation of patients with neck masses. We studied the use of ultrasound in evaluating metastatic neck disease in 25 patients. We found that it is useful not only in detecting neck nodes, but in assessing their characteristics and the degree of vascular invasion. We recommend that ultrasonography be routinely performed as part of the evaluation of all patients with head and neck masses. It is also valuable in the postoperative or postirradiation followup of patients whose necks are otherwise difficult to evaluate.
Mature Teratoma of the Nasal Vestibule: A Case Report
Authors: Shetty Subhash Chandra , Gupta Sanjeev , Cherian Mahil , Chary Geetha , Shariff Shameem
Published: May 2019

Teratomas are rare congenital neoplasms that arise from pluripotent cells. They consist of tissue from all three embryonic germ layers. According to most studies, teratomas of the head and neck account for only 2 to 9% of all cases. In this article, we report the first case of a teratoma of the nasal vestibule in a newborn. We also discuss methods of diagnosis and treatment of upper airway teratomas, and we include a brief review of the literature.
Canalith Repositioning for Benign Paroxysmal Positional Vertigo: A Randomized, Controlled Trial
Authors: Asawavichianginda Saowaros , Isipradit Permsarp , Snidvongs Kornkiat , Supiyaphun Pakpoom
Published: May 2019

We assessed the efficacy of the canalith repositioning maneuver by comparing it with no treatment in a population of patients with benign paroxysmal positional vertigo (BPPV). In this randomized, controlled, 6-month efficacy trial, outcomes were measured subjectively by patients’ reports of symptom status and objectively by Hallpike testing. During the first month of the study, the treated group experienced significantly better outcomes than did the control group, but this trend was not sustained at 3 and 6 months.
Recurrent Laryngeal Nerve Paralysis: Current Concepts and Treatment: Part I-Phylogenesis and Physiology
Authors: Hartl Dana M. , Brasnu Daniel F.
Published: May 2019

The aim of this review article is to summarize current concepts in unilateral recurrent laryngeal nerve paralysis (URLNP). Important aspects of laryngeal phylogenesis, physiology, and anatomy are reviewed. Recent advances in the neurophysiology of URLNP are discussed. Revised and updated principles of diagnosis and treatment are provided. Glottic configuration and prognosis vary according to the type of neural lesion (neurapraxia, axonotmesis, or neurotmesis). Therapeutic indications depend on glottic configuration and prognosis. Treatment options include medialization thyroplasty, vocal fold augmentation by injection, arytenoid adduction, and laryngeal reinnervation. Each treatment option is summarized, and the results reported in the medical literature are reviewed.
Need for Tracheotomy is Rare in Patients with Acute Supraglottitis: Findings of a Retrospective Study
Authors: Rizk Samieh S. , Kacker Ashutosh , Komisar Arnold
Published: May 2019

We retrospectively reviewed the cases of 23 adults and six children who had been given a presumed diagnosis of acute supraglottitis between 1987 and 1997. The most common symptoms in these patients were odynophagia, dysphagia, hoarseness, and fever. Stridor and drooling were also observed, primarily in the children. Fiberoptic laryngoscopy confirmed the presence of edema and erythema of the supraglottic structures in all patients. Blood cultures were positive for Hemophilus influenzae type b in three children and for Serratia marcescens in one adult. All other blood cultures were negative. All patients were treated with intravenous broad-spectrum antibiotics and humidified oxygen, and two-thirds received intravenous corticosteroids. Patients were monitored with pulse oximetry and serial fiberoptic laryngoscopy. Two patients required intubation; one had an epiglottic abscess, and the other had laryngeal edema so severe that vocal fold mobility could not be assessed. The length of stay in the intensive care unit ranged from 1 to 7 days (mean: 1.9). All patients recovered and were discharged free of symptoms after 2 to 11 days of overall hospitalization (mean: 4.4).
Flexible Esophagoscopy as Part of Routine Panendoscopy in ENT Resident and fellowship Training
Authors: Kim Michael K. , Deschler Daniel G. , Hayden Richard E.
Published: May 2019

We conducted a retrospective study to evaluate the use of flexible esophagoscopy as part of routine panendoscopy in an academic setting. We reviewed the results of 378 procedures that were performed over a 4-year period in an academic otolaryngology–head and neck surgery program for residents and fellows. Medical records were reviewed for early and late complications as well as for adequacy of the examination. We found no immediate or long-term complications associated with flexible esophagoscopy. Adequate examination was achieved in all but two cases (99%), both of which involved patients who had significant strictures related to radiation therapy and who were not able to be evaluated by rigid esophagoscopy. We conclude that flexible esophagoscopy is a safe and accurate means of evaluating the esophagus during a panendoscopic evaluation of the upper aerodigestive tract, and that it should be included in the diagnostic armamentarium of every otolaryngology–head and neck surgery resident and fellow.
Delayed Endolymphatic Hydrops: Study and Review of Clinical Implications and Surgical Treatment
Authors: Huang Tsun-Sheng , Lin Ching-Chen
Published: May 2019

Delayed endolymphatic hydrops (DEH) differs from Ménière's disease in that it occurs in pre-existing ear pathology in patients who have a profound unilateral or total deafness that was caused by infection, trauma, or unknown causes during childhood or adulthood. We performed a retrospective review of 160 patients with ipsilateral, contralateral, or bilateral DEH. Eighty-seven patients who did not respond to medical therapy underwent surgical treatment. Our findings indicate that the more conservative surgical procedures—endolymphatic sac surgery, cochleosacculotomy, and streptomycin perfusion—are all as effective as and less destructive than labyrinthectomy for controlling vertigo. The clinical results of this study would seem to support the observations of others that DEH and Ménière's disease are related disorders caused predominantly by cases of viral labyrinthitis with unknown etiology.
Chondrolipoma of the Oropharynx
Authors: Halaas Yael Ptachewich , Mra Zan , Edelman Morris
Published: May 2019

We describe the startling case of a man who was able to extend and retract a smooth round mass in and out of his oropharynx at will. On examination under anesthesia, the mass was found to be attached to the posterior tonsillar pillar by a stalk. The lesion was excised, and histopathology determined that it was a chondrolipoma. We believe that this is the first report of a chondrolipoma at this anatomic site.
Endoscopic Sinus Surgery for the Treatment of Chronic Sinusitis in Geriatric Patients
Authors: Jiang Rong-San , Hsu Chen-Yi
Published: May 2019

Although endoscopic sinus surgery is a well-documented procedure for the treatment of chronic sinusitis in children and adults, no study has been conducted to specifically investigate its application in a geriatric population. We undertook to fill this void by analyzing the records of 1,112 patients who had undergone endoscopic sinus surgery for chronic sinusitis in our department between April 1988 and March 1998. We categorized these patients by age. There were 171 patients (15.4%) in the geriatric group (age: ≥65 yr), 837 patients (75.3%) in the adult group (age: 17 to 64), and 104 patients (9.4%) in the pediatric group (age: ≤16 yr). We found that the geriatric group experienced a disproportionately larger share of operative complications, but most of them were minor. Outcomes were similar in all three groups. We conclude that endoscopic sinus surgery is a safe and effective treatment for older patients with chronic sinusitis.
Recurrent Glomus Tumor of the Pinna: Report of a Case
Authors: Ammar Sherif M. , Chandrasekhar Sujana S.
Published: May 2019

We describe a rare case of a glomus tumor of the pinna. The lesion produced a brief but sharp pain that occurred spontaneously, intermittently, and upon tactile stimulation. Surgical excision with wide margins was successful. We believe this to be only the third case of a glomus tumor of the auricle that has been reported in the literature.
Hereditary Angioedema: Report of a Case
Authors: Joynt Gavin M. , Abdullah Victor , Wormald Peter J.
Published: May 2019

Hereditary angioedema is caused by an absolute deficiency or the functional inactivity of C1 esterase inhibitor in plasma. A precise diagnosis is important because, unlike allergic forms of mucocutaneous edema, this condition does not respond to epinephrine, antihistamines, or corticosteroids. We report the case of a 24-year-old man who experienced an acute attack after he had stopped taking his prophylactic medication.
Structural and Ultrastructural Study of the Anterior Portion of the Nasal Septum and Inferior Nasal Concha
Authors: Augusto Arthur Guilherme L.B.S. , Filho Ivo Bussolotti , Dolci José Eduardo Lutaif , König Bruno
Published: May 2019

We used scanning electron microscopy to study and compare the histologic and ultrastructural aspects of the mucosa of the anterior portion of the septum (APS) and the anterior portion of the inferior concha (APINC) in 10 healthy adults and 10 cadavers. We found that (1) in most cases, the types of epithelium were generally the same in both areas—pseudostratified cylindrical ciliated epithelium with goblet cells (respiratory epithelium), stratified cuboidal epithelium, and stratified squamous nonkeratinized epithelium; (2) the APINC had more respiratory epithelium than the APS; (3) the APS had more squamous epithelium than the APINC; (4) the basement membrane of the APINC was thicker than that of the APS; (5) moderate chronic inflammatory infiltrate was more common in the APINC, and mild infiltrate was more common in the APS; and (6) the APINC had more mucous glands and the APS had more serous glands.
A New Case of a Branchial Cyst of the Parapharyngeal Space
Authors: Bilgen Cem , Ögüt Fatih , Çeltiklioglu Feridun
Published: May 2019

Branchial cysts in the parapharyngeal space are rare. Until now, only 23 such cases have been reported in the literature. In this article, we report a new case in a 65-year-old man. Information gained from the clinical examination, fiberoscopy, and computed tomography revealed that the cyst was obstructing the oropharynx and filling the parapharyngeal and retropharyngeal spaces on the right. The mass was excised via a transcervical approach without any complications. We also review the literature on this condition.
Endoscopic Physiologic Approach to Allergy-associated Chronic Rhinosinusitis: A Preliminary Study
Authors: Nayak Dipak Ranjan , Balakrishnan Ramaswamy , Murty Kanapaka Deepak
Published: May 2019

Patients with allergy-associated chronic rhinosinusitis respond poorly to functional endoscopic sinus surgery (FESS), probably because of the altered nasosinus ventilatory physiology and the increased contamination of the nasosinus mucosa by the offending allergens. With this in mind, we describe the concept and technique of functional endoscopic nasosinus surgery (FENS) in such cases. The advantages of this technique are that it preserves the uncinate process, it limits ethmoidal exenteration via a transbullar approach, and it simultaneously corrects both septal and lateral wall pathologies. The aim of our randomized prospective study was to subjectively and objectively compare the efficacy of FESS and FENS in 64 patients with allergy-associated chronic rhinosinusitis. Subjective assessment was ascertained by visual analog scores, and objective assessment was made by nasal endoscopy. In this preliminary study, we found that FENS was superior to FESS in treating chronic sinusitis associated with nasal allergy.
A Neurilemmoma of the Parotid Gland: Report of a Case
Authors: Segas John V. , Kontrogiannis Alexandra D. , Nomikos Pericles N. , Boussiotou Angeliki H. , Psarommatis John M. , Adamopoulos George K.
Published: May 2019

Benign primary tumors of the facial nerve are frequently misdiagnosed because of the variety of their clinical manifestations. Much attention has been paid to neurilemmomas in the recent otolaryngologic literature, but far less has been focused on intraparotid facial nerve neurilemmomas. In this article, we describe a new case of this truly rare tumor, and we review its diagnosis, pathology, and treatment.
Malignancy of the Larynx in a Child
Authors: Prasad Kishore Chandra , Abraham Preetha , Peter Ranjit
Published: May 2019

Squamous cell carcinoma of the larynx in children is rare. The management of laryngeal malignancy is more difficult in children than adults for several reasons: the aggressive nature of a tumor that is often diagnosed late in children; the delicacy of pediatric anatomic structures; intraoperative blood loss; long-term post-treatment complications; and psychological factors particular to children. A tracheostomized 13-year-old boy came to us with a 4-month history of hoarseness, breathing difficulty, and swelling in the neck. A detailed examination revealed that a transglottic tumor had infiltrated the thyroid and cricoid cartilage, the upper two tracheal rings, and the thyroid gland. Such an infiltration has not been previously reported. The lesion proved to be a well-differentiated squamous cell carcinoma. We performed a wide-field total laryngectomy, which was followed by radiotherapy. Unfortunately, the child survived only 3 years postoperatively.
Effectiveness of the Ultrasonic Harmonic Scalpel for Tonsillectomy
Authors: Sood Sanjai , Corbridge Rogan , Powles James , Bates Grant , Newbegin Christopher J.R.
Published: May 2019

The Ultracision harmonic scalpel (UHS) cuts and coagulates tissue with high-frequency ultrasound. We describe the results of our use of the UHS to perform tonsillectomies in 59 patients. The mean operative blood loss was 7 ml (range: 0 to 75); 56% of patients experienced no measurable blood loss. The mean length of operating time was 8 minutes and 10 seconds (range: 3:45 to 20:25). Patients were assessed for 2 weeks for postoperative pain on the basis of a 10-point linear analog scale. The mean pain score on postoperative day 1 was 4.7; the score peaked at 6.0 on day 4 and fell to less than 3.0 by day 11. Patients returned to full function in an average of 10.9 days (range: 3 to 15). Three patients experienced secondary hemorrhage, one of whom required surgical intervention. We found the UHS to be a well-designed and easy-to-use instrument. Operating time was short, blood loss was minimal, and the degree of early postoperative pain was low. We believe that our findings are encouraging and that the UHS might well have a place in the surgical armamentarium for tonsillectomy.
Intra- and Intersession Reliability of Acoustic Rhinometry in Measuring Nasal Cross-sectional Area
Authors: Ognibene Nicole E. , Merrick Mark A. , Ingersoll Christopher D.
Published: May 2019

We evaluated the intrasession and intersession reliability of acoustic rhinometry in measuring nasal cross-sectional areas in 10 subjects. Subjects were measured under three conditions: with a Breathe Right nasal strip in place, with a sham strip in place, and with no strip in place. Two sets of three measurements were taken 1 week apart. The intrasession reliability both with and without the Breathe Right strip was very good (intraclass correlation coefficient [ICC] [2,1]: 0.97 and 0.98, respectively). The intersession reliability with and without the Breathe Right strip was not nearly as good (ICC [2,1]: 0.62 and 0.67). The Breathe Right strip increased the mean nasal cross-sectional area by 0.10 cm2 (17.4%). We conclude that acoustic rhinometry is a reliable way to measure nasal cross-sectional area during a single session of multiple tests, but it is not as reliable across sessions. We also determined that the Breathe Right nasal strip significantly increases nasal cross-sectional area.
The Treatment of Allergic Rhinitis with Immunotherapy: A Review of 1,000 Cases
Authors: Veling Maria C. , Trevino Richard J.
Published: May 2019

We conducted a 10-year retrospective chart review of 1,000 immunotherapy-treated patients to evaluate the efficacy and safety of serial dilution quantitative intradermal testing in the management of allergic rhinitis. Three months after the initiation of immunotherapy, these patients had been assessed to ascertain whether or not they had experienced any overall improvement in their initial symptoms. Also included in this evaluation were determinations of each patient's use of medications as well as the incidence of adverse reactions to treatment and recurrent sinus infections. We found that 860 patients had achieved complete relief of their symptoms and required no other treatment; the remaining 140 patients experienced a partial improvement and continued to use pharmacotherapy to control breakthrough symptoms. During skin testing, only one patient experienced a systemic reaction, which responded to subcutaneous epinephrine. There were no deaths. We conclude that serial dilution quantitative intradermal testing is safe and that quantification of skin reactivity in evaluating and treating allergic rhinitis with immunotherapy is completely effective in the vast majority of patients.
Cost-effectiveness of Two Types of Dysphagia Care in Head and Neck Cancer: A Preliminary Report
Authors: Aviv Jonathan E. , Sataloff Robert T. , Cohen Manderly , Spitzer Jaclyn , Ma Guoguang , Bhayani Rajendra , Close Lanny G.
Published: May 2019

We conducted a prospective, preliminary study to compare the cost-effectiveness of two different instrument-based techniques for diagnosing and managing dysphagia in 30 consecutive hospitalized patients with head and neck cancer. The two techniques are videofluoroscopy via modified barium swallow (MBS) and videoendoscopy via flexible endoscopic evaluation of swallowing with sensory testing (FEESST). Medicare was the primary insurer of all patients. Fifteen of these patients had their dysphagia diagnosed and managed by MBS and the other 15 by FEESST. Cost-effectiveness was assessed by determining the average Medicare reimbursement for each procedure. We found that the mean reimbursements were $451.01 (± $50.55) for MBS and $321.23 (± $3.01) for FEESST. The mean reimbursement for FEESST was significantly lower than that for MBS (p< 0.0001; Mann-Whitney U test). We conclude that FEESST appears to be more cost-effective than MBS for the inpatient management of dysphagia in patients with head and neck cancer.
Endoscopic Removal of an Ectopic Third Molar Obstructing the Osteomeatal Complex
Authors: Hasbini Abdul Salam , Hadi Usamah , Ghafari Joseph
Published: May 2019

We report a rare case of an ectopic third molar at the level of the osteomeatal complex. A 21-year-old man came to us with a left-sided nasal obstruction of 2 years’ duration. Computed tomography of the paranasal sinuses revealed that an aberrant tooth was obstructing the osteomeatal complex and bulging into the ethmoid infundibulum. Opacity of the entire left maxillary sinus indicated the presence of an associated cystic formation. A transnasal endoscopic sinus technique was employed to create a large middle meatal antrostomy and to remove the tooth as well as the cystic contents and cyst wall. Pathologic analysis revealed that the cyst was dentigerous. After recovery from surgery, the patient resumed nasal breathing. The endoscopic surgical approach used in this case caused less morbidity than do the more common methods (e.g., the Caldwell-Luc procedure) of removing ectopic teeth from the sinus.
Recent Advances in Radiotherapy for Head and Neck Cancers
Authors: Chou Rachel H. , Wilder Richard B. , Wong Michael S. , Forster Kenneth M.
Published: May 2019

Advancements in surgery have made it possible to resect cancers that had previously been regarded as incurable. Similarly, new developments in radiation oncology have helped improve the outlook for patients with locally advanced or recurrent head and neck cancers. Among these advancements are refinements in altered fractionation, three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, stereotactic radiosurgery and fractionated stereotactic radiotherapy, neutron-beam radiotherapy, charged-particle radiotherapy, and intraoperative radiotherapy. These recent developments have allowed radiation oncologists to escalate the dose of radiation delivered to tumors while minimizing the dose delivered to surrounding normal tissue. Additionally, more continues to be learned about the optimum delivery of chemotherapy. This article provides an update on the status of these new developments in the treatment of head and neck cancers.
The ‘Parachute’ Bolster Technique for Securing Intraoral Skin Grafts
Authors: Garvey Christopher M. , Panje William R. , Hoffman Henry T.
Published: May 2019

Successful skin grafting of intraoral defects can be challenging. The tie-over bolster method is the most popular technique in use today. We describe an alternate method of securing intraoral skin grafts—the “parachute” bolster technique—and we present a case report.
Unusual Paranasal Sinus Tumors in two Patients with Common Nasal Complaints
Authors: Vargas Hannah , Jennings Timothy A. , Galati Lisa T.
Published: May 2019

Common nasal complaints are managed by both the otolaryngologist and the primary care physician. We describe the cases of two patients with nasal obstruction who were referred to us for evaluation—one with severe headache and the other with profuse epistaxis. Their histories prior to referral included long-term, common rhinologic complaints of low-grade headache and mild epistaxis. Neither patient had been referred to us until their symptoms had become severe. Our examination revealed that both patients had rare paranasal sinus pathology. One patient had a fibroxanthoma of the frontal sinus, and the other had extramedullary hematopoiesis of the maxillary sinus. Fibroxanthoma of the frontal sinus is rare, and extramedullary hematopoiesis of the maxillary sinus has not been previously reported. These two unique cases serve as a reminder that long-term common rhinologic complaints can occasionally be a sign of life-threatening pathology and require a full evaluation by an otolaryngologist.
Concomitant Vagal Neurofibroma and Aplasia of the Internal Carotid Artery in Neurofibromatosis Type 1
Authors: Ozcan Muge , Tuncel Umit , Unal Adnan , Erdogan Aysun , Han Ozge , Nalca Yildirim
Published: May 2019

We report the case of a patient with neurofibromatosis type 1 who had both aplasia of an internal carotid artery (ICA) and a vagal neurofibroma. To our knowledge, this is the first report in the literature of the simultaneous presence of these two rare disorders in a single patient. We believe that this is also the first report of an absence of an ICA in a patient with neurofibromatosis type 1. The patient was a 19-year-old woman who complained of a slowly growing neck mass. The mass occupied the right parapharyngeal space and upper cervical region. The patient had no other masses on physical examination, but widespread café au lait spots were evident. This led us to suspect the presence of a vagal neurofibroma. The tumor was removed, and pathology confirmed the diagnosis. No intracranial aneurysms were detected on cerebral angiography.
Aspirated Foreign Body in a Laryngectomized Patient: Case Report and Literature Review
Authors: Nwiloh Jonathan , Fortson James
Published: May 2019

The presence of a permanent tracheal stoma in a laryngectomized adult is a predisposing factor for foreign-body aspiration, as are conditions that impair normal protective airway mechanisms. Such an aspiration can cause significant morbidity if it is not properly managed. The use of rigid bronchoscopy to remove an aspirated object can be difficult in these patients, and a high percentage of them require thoracotomy, especially for the removal of sharp objects. An emphasis on patient education regarding the handling of objects around the stoma in laryngectomized adults is key to preventing aspiration and its complications.
Central Tinnitus: A Case Report
Authors: Yoneoka Yuichiro , Fujii Yukihiko , Nakada Tsutomu
Published: May 2019

We report a case of acute-onset unilateral tinnitus in a 25-year-old woman. Analysis of imaging studies indicated that the tinnitus was likely caused by an acute hemorrhage of a small cavernous angioma that was located adjacent to the contralateral primary auditory cortex. This case provides substantial support for the concept that central tinnitus might indeed represent a pathologic activation of neural networks of nonspecific auditory perception.
Panic Disorder in Otolaryngologic Practice: A Brief Review
Authors: Shipko Stuart
Published: May 2019

Panic disorder is typically characterized by a sudden, inexplicable feeling of terror and a fear that one is losing control, “going crazy, “ or on the verge of death. Because these anxiety attacks can appear spontaneously and unpredictably, they often create a companion state in which the patient continually worries about when the next attack will occur. Left untreated, panic disorder can be seriously debilitating and can progress to the development of phobias and impose severe limitations on quality of life. Otolaryngologists are likely to see patients with panic disorder, particularly those who have complaints of dizziness, tinnitus, or extraesophageal manifestations of gastroesophageal reflux. This article briefly reviews the diagnosis and treatment of panic disorder.
Spontaneous Vertigo and Headache: Endolymphatic Hydrops or Migraine?
Authors: Boismier Thomas E. , Disher Michael J.
Published: May 2019

We undertook a study to assess whether patients who had both spontaneous vertigo and headache would respond to treatment for endolymphatic hydrops rather than treatment for migraine. We also attempted to discover if there were any individual characteristics that might predict which patients with an equivocal history and symptoms would he more likely to have either of the two conditions as opposed to the other. All patients were initially treated for endolymphatic hydrops with sodium restriction and increased water intake. Response to treatment was assessed by three tools: the Dizziness Handicap Inventory, a symptom severity scale, and a disability scale. Patients who did not respond to treatment for endolymphatic hydrops were switched to treatment for migraine. At the first follow-up period, 23 patients were available for analysis by telephone survey. According to data obtained by the three assessment tools, 14 patients (60.9%) improved after initial therapy and six (26.1%) improved following subsequent migraine treatment; the remaining three patients (13.0%) did not comply with their initial treatment regimen, and they showed no improvement. Although no statistically significant conclusions can be drawn because of the small sample size, there were trends to suggest that certain demographic, clinical, and objective-testing characteristics might predict which patients are likely to have one of these two conditions as opposed to the other. We conclude that a stepwise approach to treatment, beginning with therapy for endolymphatic hydrops, is an appropriate strategy. Also, the fact that no improvement was seen among the three patients who did not comply suggests that improvement is indeed the result of treatment rather than simply a function of the passage of time.
Options for Preserving the Larynx in Patients with Advanced Laryngeal and Hypopharyngeal Cancer
Authors: Wolf Gregory T.
Published: May 2019

The introduction of newer surgical and combined-modality approaches to organ preservation in patients with advanced laryngeal or hypopharyngeal cancer is the most exciting clinical frontier in head and neck cancer-treatment today. The use of these techniques at other sites, the exploration of improved methods for patient selection and tumor assessment, and the development of newer combination regimens will need to be rigorously studied in future clinical trials. In all these efforts, the major focus must remain on improving survival. This article reviews the latest developments in organ-preservation strategies and techniques for patients with advanced laryngeal or hypopharyngeal cancer.
Facial Reanimation by Cross-facial Nerve Grafting: Report of Five Cases
Authors: Galli Suzanne K. Doud , Valauri Fredrick , Komisar Arnold
Published: May 2019

Facial nerve repair is a dynamic reanimation technique. Direct nerve repair by suturing or grafting can provide good results within a specific time frame. Immediate nerve repair has been successful in cases of laceration injuries, but nerve grafting techniques are typically delayed when it is clear that direct suturing to the nerve trunk cannot be achieved without tension. Delayed nerve grafting is also employed following ablative procedures and in cases of trauma that cause segmental nerve deficits. Cross-facial nerve grafting is particularly useful when the peripheral branches are intact and the main trunk of the facial nerve is inaccessible. This method is also typically performed in a delayed fashion. Rehabilitation of the facial nerve and subsequent reinnervation of the mimetic motor endplates are achieved through axonal growth. In this article, we describe a consecutive series of five patients who developed facial paralysis following cranial surgery for acoustic neuroma. Each underwent successful cross-facial nerve grafting during the first week following their initial surgery. Each received a sural nerve graft to at least two main divisions of the VIIth cranial nerve. We discuss our operative technique and the degree of restored nerve function.
Typical Carcinoid Tumor of the Larynx Occurring with Otalgia: A Case Report
Authors: Cuzzourt Jeremy C. , Pezold John C. , Dunn C. Warren
Published: May 2019

Neuroendocrine neoplasms of the larynx comprise a rare group of tumors that have a controversial history with regard to their classification. The World Health Organization categorizes these tumors as typical carcinoids, atypical carcinoids, small-cell neuroendocrine carcinomas, and paragangliomas. A typical carcinoids and small-cell neuroendocrine carcinomas are the more common. Only 13 cases of typical carcinoid have been reported. Local excision is sufficient for typical carcinoids and paragangliomas, but atypical carcinoids require neck dissection because of their tendency to metastasize. Small-cell neuroendocrine carcinomas are not cured by local excision, and these patients have the worst prognosis (5-year survival: 5%); their treatment is limited to chemo- and radiotherapy. Because of these variations in tumor behavior and treatment, it is essential that otolaryngologists and pathologists be able to correctly identify the specific type of tumor in order to optimize patient treatment and survival. We report a case of typical carcinoid and review the pertinent literature on this subject.
A Case of Mucocutaneous Leishmaniasis
Authors: Galioto Pietro , Fornaro Vincenzo
Published: May 2019

Leishmaniasis is prevalent in most warm-climate areas of the world. We describe a long-undiagnosed case of mucocutaneous leishmaniasis in Italy that might have been contracted in Costa Rica. The patient's signs and symptoms included granulomatous-like lesions on the forehead and legs, nasal obstruction accompanied by serous and crusted rhinorrhea, and diffuse granulomatous-like lesions in the septum and turbinates. The patient was treated with three on-off cycles of itraconazole. At the 1-year follow-up, all his lesions had nearly disappeared.
Nasolabial Cyst: A Retrospective Analysis of 18 Cases
Authors: Choi Jin Ho , Cho Jae Hoon , Kang Hee Joon , Chae Sung Won , Lee Sang Hag , Hwang Soon Jae , Lee Heung-Man
Published: May 2019

Nasolabial cysts are rare but easily identifiable when they do occur. They are thought to arise from the remnants of the nasolacrimal ducts, but most of the available information on these cysts is limited to isolated case reports. The purpose of our study was to examine the clinical and pathologic features of nasolabial cysts in order to provide a basis for their correct diagnosis and treatment. Eighteen patients with nasolabial cysts were treated at Korea University's Guro Hospital between Jan. 1, 1988, and Dec. 31, 1999. We retrospectively analyzed the clinical appearance, pathologic findings, and treatment results in each case. All patients underwent surgery via the sublabial approach. The lining epithelia were identified as either pseudostratified, stratified squamous, or simple cuboidal. A cyst recurred in only one case, and there were no surgical complications on follow-up. The results of our study provide a basis for sound diagnosis and treatment.
Facial palsy from metastatic nasopharyngeal carcinoma at various sites: Three reports
Authors: Low Wong-Kein
Published: May 2019

Nasopharyngeal carcinoma that causes clinically evident facial palsy is uncommon. This article describes and discusses a series of cases that illustrates how nasopharyngeal carcinoma caused facial palsy as a result of facial nerve involvement at three sites: the cerebellopontine angle, the middle ear, and the parotid. The maxim, “All that palsies is not Bell's, “ is particularly relevant with respect to patients who have previously been treated for advanced nasopharyngeal carcinoma. In these patients, recurrent or persistent nasopharyngeal carcinoma involving the cerebellopontine angle, temporal bone, or parotid should be excluded.
Tuberculosis of the Maxillary Sinus Manifesting as a Facial Abscess
Authors: Jha Devanand , Deka R.C. , Sharma M.C.
Published: May 2019

Tuberculosis of the maxillary sinus is rare. Likewise, an acute onset that necessitates incision and drainage is also very uncommon. We report the case of a 15-year-old girl who came to us with an abscess on the left side of her face. She was found to have tuberculosis of the left maxillary antrum.
The Radiologic Work-up in Thyroid Surgery: Fine-needle Biopsy versus Scintigraphy and Ultrasound
Authors: Kountakis Stilianos E. , Skoulas Ioannis G. , Maillard A.A.J.
Published: May 2019

To compare the effectiveness and predictive value of radiologic studies with fine-needle aspiration biopsy (FNAB) in correctly diagnosing thyroid lesions, we reviewed the medical records of 441 patients who had been treated surgically for thyroid disease from 1987 through 1999. We compared the results of thyroid scintigraphy, ultrasound, and FNAB with findings on final surgical pathology. The data were analyzed according to the chisquared (χ2) test. Of 189 thyroid scintigraphy scans that showed a hypofunctional (cold) nodule, 52 (27.5%) were found to be cancerous, and of 35 hyperfunctional (hot) nodules, two (5.7%) were malignant (sensitivity = 91 %; specificity = 19%; accuracy = 38%; χ2 = 7.67; p = 0.006). Of 66 ultrasounds that detected a solid or a mixed solid-cystic mass, 16 (24.2%) were cancerous, while none of the eight sonograms that showed a purely cystic lesion was malignant (sensitivity = 100%; specificity = 14%; accuracy = 32%; χ2 = 2.47; p = 0.116 [not statistically significant]). Of the 119 patients whose FNABs were diagnostic, 55 biopsies revealed follicular cells. Of the remaining 64 biopsies, cancer was correctly predicted in 35 of 44 patients (79.5%) and benign disease was correctly diagnosed in 18 of 20 patients (90.0%) (sensitivity = 95%; specificity = 67%; accuracy = 83%; χ2 = 27.3; p = 0.00). We conclude that in the evaluation of thyroid lesions, FNAB is superior to imaging studies, which yield a relatively high rate of false-positive results.
Enzyme-potentiated Desensitization in Otolaryngic Allergy
Authors: Pulec Jack L.
Published: May 2019

This is a preliminary report of a new method of treating otolaryngic allergy with enzyme-potentiated desensitization (EPD). The nature of EPD and its use in otolaryngology are described. Thirty-six patients have been treated and followed in a private medical practice since February 1997. This article reviews the clinical features of EPD and provides six cases as examples; the clinical features described include allergic rhinitis, serous otitis media, asthma, dermatitis, fixed food allergy, and Ménière's disease. EPD is an effective technique for the treatment of otolaryngic allergy and offers advantages over conventional techniques.
Midline Nasal and Hard Palate Destruction in Cocaine Abusers and Cocaine's Role in Rhinologic Practice
Authors: Smith Jonathan C. , Kacker Ashutosh , Anand Vijay K.
Published: May 2019

Intranasal cocaine abuse can lead to destruction of the palate and perforation of the nasal septum. The pathophysiology of cocaine-induced midline destructive lesions is multifactorial and includes local ischemia secondary to vasoconstriction, chemical irritation from adulterants put in “cut” cocaine, and infection secondary to trauma, impaired mucociliary transport, and decreased humoral and cell-mediated immunity. Cocaine abuse should be suspected in patients with a palatal or septal perforation of unknown etiology.
Endoscopic Resection of a Nasal Septal Chondrosarcoma: First Report of a Case
Authors: Matthews Brian , Whang Chris , Smith Steve
Published: May 2019

Advances in endoscopic sinus surgery technique and technology have provided the otolaryngologist with a wide array of surgical options for the management of nasal and paranasal sinus diseases that were once limited to procedures requiring invasive surgery. We describe the case of a patient with a chondrosarcoma of the posterior nasal septum that was resected endoscopically. There have been fewer than 30 reports in the English-language literature of chondrosarcomas arising at this location, and the reported approaches to surgical excision in these cases involved craniofacial procedures, facial degloving, facial splitting, and maxillectomy techniques. Until now, no case of endoscopic removal has been reported.
Kikuchi's Disease: A Case Report and Review of the Literature
Authors: Baumgartner Brian J. , Helling Eric R.
Published: May 2019

Kikuchi's disease is a necrotizing lymphadenitis that is prevalent in Asia and is being increasingly recognized in other areas of the world. It usually occurs in women in their late 20s or early 30s and manifests as a posterior cervical adenopathy. It resolves spontaneously, usually over a period of several weeks to 6 months. Its initial clinical appearance is commonly similar to that of a lymphoma, and it can be pathologically misdiagnosed as such. Kikuchi's disease might be associated with systemic lupus erythematosus. We report a case of Kikuchi's disease that occurred in a 36-year-old Asian woman. We discuss the clinical features, differential diagnosis, radiographic evaluation, and pathology of this case, and we review the literature in an effort to assist otolaryngologists in diagnosing this benign and uncommon entity.
Endoscopic Transethmoidal Decompression of a Thrombosed Orbital Venous Malformation
Authors: Gigantelli James W. , Gagnon Michael R. , Arthur Jason A. , Leopold Donald A.
Published: May 2019

We describe the case of a 37-year-old woman who experienced a painful thrombosis of an orbital venous malformation. We successfully treated her with surgical decompression via a computer-assisted, endoscopic transethmoidal orbitotomy. Removal of the lamina papyracea and evacuation of the thrombus provided immediate symptomatic relief. Decompression via an endoscopic transethmoidal route provides a more direct and less invasive approach than other techniques.
Malignant Eccrine Acrospiroma with Metastasis to the Parotid
Authors: Holden Bridget , Colome-Grimmer Maria , Savage Clare , Stierman Karen , Pou Anna M.
Published: May 2019

Malignant eccrine acrospiromas are rare. Clinically, they resemble other cutaneous lesions. A high index of suspicion must be maintained in cases of histologically benign eccrine acrospiromas for three reasons: (1) malignant transformation can occur, (2) the presence of both benign and malignant tissue can lead to a false-negative diagnosis if only the benign component is obtained in the biopsy specimen, and (3) benign-appearing tumors can recur locally or metastasize. The primary treatment is wide local excision with or without lymph node dissection. The efficacy of adjuvant chemotherapy and radiation therapy requires further investigation. We describe a case of malignant eccrine acrospiroma in an 80-year-old man, and we review the literature on this tumor, with emphasis on the differential diagnosis.
The Hunsaker Mon-Jet Ventilation Tube for Microlaryngeal Surgery: Optimal Laryngeal Exposure
Authors: Orloff Lisa A. , Parhizkar Nooshin , Ortiz Erica
Published: May 2019

Methods of delivering and monitoring anesthesia during microlaryngeal surgery are constantly evolving. In 1994, Hunsaker and colleagues introduced a laser-safe subglottic Mon-Jet ventilation tube, which has the ability to periodically measure end-tidal carbon dioxide levels. We conducted a retrospective review of 84 consecutive patients who had undergone microlaryngeal procedures with the aid of the Hunsaker Mon-Jet tube. Study parameters included the length of anesthetic induction and recovery times, the duration of surgery, the degree of surgical access to the larynx, and the incidence of anesthetic and surgical complications. We found that anesthetic induction and recovery times with the use of the Mon-Jet tube were comparable to those seen with standard endotracheal intubation. We also observed an apparent reduction in surgical time and a consistent subjective improvement in surgical visualization and access. The complication rate was acceptable, airway control was adequate, and use of the Mon-Jet tube was safe in all patients. We conclude that the Mon-Jet tube is a safe and effective subglottic jet ventilation system and that it has distinct advantages over other methods for both the surgeon and the anesthesiologist.
Primary Hyperparathyroidism Secondary to Simultaneous Bilateral Parathyroid Carcinoma
Authors: Brown Jimmy J. , Mohamed Hezla , Williams-Smith Lorraine , Osborne Ryan , Coker Joan , Yee Brian
Published: May 2019

Parathyroid carcinoma is a rare malignancy, and experience with its management is limited. It is generally accepted that surgery is the treatment of choice, and the initial operative intervention might represent the only chance for long-term success. At the time of surgery, a high index of suspicion for carcinoma is vital to performing the appropriate surgical procedures, because frozen-section diagnosis of parathyroid carcinoma is notoriously unreliable. In this article, we describe our experience with this rare entity.
Evidence that Taste Buds are not Present on the Human Adult Uvula
Authors: Ambro Bryan T. , Pribitkin Edmund A. , Wysocki Linda , Brand Joseph G. , Keane William M.
Published: May 2019

We conducted a study to investigate whether taste buds are present on the human adult uvula. Our impetus was to determine whether surgical procedures that involve removal of the uvula can affect taste perception. Five human uvulae were removed via a modified carbon dioxide laser-assisted uvulopalatoplasty in an outpatient office setting. The uvulae were serially sectioned and stained with a solution specific for membrane-bound calcium-modulated adenosine triphosphatase, a high concentration of which is found in taste receptors. Examination of the stained sections under light microscopy failed to show that any taste receptors were present in any of the uvulae. This finding suggests that the taste disturbances noted after surgical procedures involving removal of the uvula are not attributable to a loss of taste receptors.
Chronic Invasive Fungal Sinusitis: A Report of Two Atypical Cases
Authors: Busaba Nicolas Y. , Colden Daryl G. , Faquin William C. , Salman Salah D.
Published: May 2019

The purpose of this article is to describe a chronic variant of invasive fungal sinusitis (IFS) and discuss its management. This is a retrospective review of two cases of IFS that were characterized by atypical clinical courses. Patient 1 was a 75-year-old man with noninsulin-dependent diabetes mellitus who came to us with a 5-month history of headache. Computed tomography detected an opacified left sphenoid sinus. After the man failed to respond to medical therapy, he underwent a left endoscopic sphenoidotomy. Pathologic examination revealed that septate, branching fungal hyphae had invaded the soft tissues. The patient was started on oral itraconazole, but later switched to intravenous amphotericin B in response to intracranial extension. The man's disease stabilized, but he died a little more than 1 year later of unrelated causes. Patient 2 was an otherwise healthy 41-year-old woman who came to us with nasal congestion and unilateral nasal polyps. She underwent endoscopic sinus surgery. Pathologic examination identified granulomatous sinusitis and septate, branching fungal hyphae that had invaded the soft tissue of the middle turbinate. The patient was not treated with systemic antifungal medications because of the localized nature of the fungal invasion and the lack of bone invasion or erosion. She has now been symptom-free for 5 years. These two cases demonstrate that IFS can appear in a chronic variant form that is characterized by an indolent course and histologic evidence of tissue invasion by fungal hyphae. The type of treatment is dependent on the extent of the disease on initial examination and the rapidity of its progression.