bluuebunny/crossref_metadata_2025 huggingface dataset:
Participant Understandings and the Complexities of Educational Change: The Breakdown and Regeneration of the Greenfield Experiment
Authors: Seldin Clement A. , Maloy Robert W.
Published: January 2019

In June of 1977, the public school system of Greenfield, Massachusetts, * in conjunction with the Massachusetts State Department of Education and the School of Education at the University of Massachusetts, embarked on a two-year collaboration to conceptualize and design a more responsive and effective secondary education process. The Greenfield Secondary Schools Project (GSSP) was to be an attempt by teachers, students, administrators, and community members to develop comprehensive solutions to educational problems. The GSSP represented a major attempt at broad-based, decentralized innovation in public education.

Despite the collaborative approach, shared decision-making strategies, local control, and decentralized structure, the GSSP was unable to effectively manage major obstacles, and participant commitment to the change process began to dissolve. The main body of this article contends that preexisting expectations and assumptions about change, shared by participants, can inhibit and even break down a progressive, elaborately preplanned change model. The article's postscript describes the unique regeneration of the GSSP in terms of a new minigrant program and the consolidation of project leadership.
Implications of Biculturalism for the Learning Process of Middle-class Asian Children in the United States
Authors: Yao Esther L.
Published: January 2019

This article concerns some educational issues surrounding the increased number of Oriental immigrants and the trend of their immigration. Although diverse subgroups of Asian Americans are noticed, the article focuses on middle-class Asian Americans. The following bicultural determinants in children's learning processes are discussed: family structure, value of education, self-concept, assimilative anxiety, social adjustment, and language (both verbal and nonverbal). The article concludes with the presentation of some basic guidelines for teachers who are working with Oriental children and with other minority children.
Community Control: A Grassroots Response
Authors: Jennings James
Published: January 2019

Although the idea of “community control” has been criticized as unworkable by some social scientists and educators, it is reemerging as a possible alternative to present bureaucratic arrangements in public education and in other urban service areas. This article summarizes some of these criticisms and responds to them. The refutations are based on theory from the literature of urban politics and education and on previous empirical research in this area. It is proposed that the arguments against community control are weak and that therefore this idea should be given an opportunity to operate at the local level. The article provides a framework that encompasses a grassroots perspective. This approach has been overlooked by those who have studied participatory reforms in urban education.
Is it More Reasonable to Categorize Frontal Cells on the Basis of their Location Rather than on their Type?
Authors: Yildirim Altan
Published: January 2019

Frontal cells appear in two locations—in the frontal recess and in the frontal sinus. The aim of this study was to analyze the anatomic and clinical differences between the frontal cells at each location. The author reviewed 487 left and right sides of coronal computed tomography (CT) scans of the sinuses obtained from 300 consecutively presenting patients (600 sides) who were being evaluated for chronic sinusitis. For the purposes of this study, the frontal cells were classified according to location; group A cells were located in the area of the frontal recess (Bent and Kuhn cell types I and II), and group B cells were those that had invaded the frontal sinus itself (Bent and Kuhn cell types III and IV). The presence or absence of frontal sinusitis and concha bullosa was determined, as was the degree of frontal sinus pneumatization. Analysis revealed statistically significant differences between group A and group B in all three parameters; the prevalence of frontal sinusitis and hyperpneumatization of the frontal sinus was higher in group B, and the prevalence of concha bullosa was higher in group A (all p < 0.05). These findings imply that it might be more reasonable both clinically and anatomically to categorize frontal cells based on their location rather than on their Bent and Kuhn type.
Role of Irrigation with Hypertonic Saline for a Recurrent Skull Base Hydatid Cyst: Case Report and Review of the Literature
Authors: Zia Sadaf , Enam Ather , Salahuddin Iftikhar , Khan Aslam
Published: January 2019

Hydatid cyst is a parasitic disease caused by the tapeworm Echinococcus granulosus. This disease is a rare finding in the head and neck region, and its presentation varies according to the area involved. We report the case of a 25-year-old woman who presented with bilateral neck swelling, which was found on histopathologic examination to be caused by a hydatid cyst. The patient underwent surgical drainage of the cyst and a modified radical mastoidectomy, followed by a 3-month course of treatment with albendazole. However, she experienced a recurrence in the left neck region 1 year later. At that time, reexploration of the left mastoid cavity was performed, with debridement of diseased occipital bone and foramen magnum. Intraoperatively, we used a novel method of saline irrigation with 3% hypertonic saline, previously not tested on exposed nerves, in an attempt to prevent further recurrence. Four years after the second surgery, no disease recurrence was found, and no neurologic sequelae were noted. We conclude that hypertonic saline irrigation can be considered as an option for preventing recurrence in cases that are difficult to clear surgically, especially around cranial nerves, although more studies are needed to document the safety of this approach.
A Unique Case of Multiple Sites of Pneumatization of the Sinonasal Bony Framework in a Pediatric Patient
Authors: Giourgos Georgios , Matti Elina , Carena Paolo , Pagella Fabio
Published: January 2019

Anatomic variations of the sinonasal bony framework in the pediatric population are quite common. In children with such variations, however, bony pneumatization is uncommon. Moreover, pneumatization of the inferior turbinate in children is extremely rare; to the best of our knowledge, only 3 cases have been previously reported in the literature–none of which involved additional pneumatization variations of the sinonasal skeleton. Herein we present a new pediatric case that was unique in that an inferior concha bullosa coexisted with rarely seen pneumatized anatomic structures.
Orbital Emphysema after a Protracted Episode of Sneezing in a Patient with no History of Trauma or Sinus Surgery
Authors: Khader Qasim A. , Abdul-Baqi Khader J.
Published: January 2019

Orbital emphysema is a benign self-limiting condition. It can occur directly (as a result of trauma to the face) or indirectly (secondary to a blowout fracture). We report a case of orbital emphysema in a 38-year-old man who presented with ecchymosis of the right eye, pressure within the right orbit, and periorbital swelling following a protracted episode of vigorous sneezing. The diagnosis was confirmed by computed tomography. Systemic antibiotics were given, and the patient was cautioned to avoid blowing his nose. His signs and symptoms resolved within 1 week.
Adenosquamous Carcinoma of the Lateral Oropharyngeal Wall
Authors: Nadeau Daniel P. , Shick Paul C. , Lindsay Robin
Published: January 2019

Adenosquamous carcinoma of the head and neck is a rare and aggressive tumor, with fewer than 100 cases reported in the world literature to date. We report a case of adenosquamous carcinoma of the oral pharynx arising as a second primary malignancy in a patient being treated for primary gastric MALT (mucosa-associated lymphoid tissue) lymphoma. We also review the literature to assess current treatment and long-term prognosis of this rare tumor.
The pH of Commonly used Topical Ear Drops in the Treatment of Otitis Externa
Authors: Eng Chee-Yean , El-Hawrani Amged S.
Published: January 2019

Healthy ear canal skin has an acidic pH. Evidence suggests that reacidification of the ear canal may lead to resolution of otitis externa. The pH of 15 commonly prescribed topical ear drop preparations used in the treatment of otitis externa was measured using a Jenway 3020 pH meter with temperature compensation at 37.5°C. The pH values ranged from 2.89 to 7.83. Two-thirds of preparations tested were of acidic pH. The remaining one-third were alkaline. Reacidification of the ear canal may help in the treatment of otitis externa.
Incidence of Tympanic Membrane Perforation after Intratympanic Steroid Treatment through Myringotomy Tubes
Authors: Rutt Amy L. , Hawkshaw Mary J. , Sataloff Robert T.
Published: January 2019

Intratympanic (IT) steroids are often used to treat inner ear disorders such as sudden idiopathic sensorineural hearing loss, autoimmune inner ear disease, and Ménière disease. Administration of corticosteroids via IT injection, via application with a pledget to the round window, or via catheter has been used for this purpose. The frequency of adverse events related to the IT injection of steroids is low, with pain, short-lasting vertigo, otitis media, and tympanic perforations being the most common complications. However, the safety of IT steroid therapy has not yet been established in a randomized clinical trial. In this article, we discuss a group of 11 patients with sensorineural hearing loss who underwent myringotomy and tube placement for home-based dexamethasone instillation and subsequently developed the complication of tympanic membrane perforation. It appears that there is a significantly increased incidence of tympanic membrane perforations in this population.
Anticoagulation Therapy as a Supplement to Recanalization for the Treatment of Sigmoid Sinus Thrombosis: A Case Report
Authors: Rosenberg Joshua D. , Parikh Sanjay R.
Published: January 2019

Treatment of sigmoid sinus thrombosis with long-term anticoagulation therapy remains controversial. We present the case of a 6-year-old boy with intraoperatively confirmed sigmoid sinus thrombosis secondary to acute otomastoiditis. Combined-modality treatment—including mastoidectomy, sigmoid sinus decompression, and antibiotic and anticoagulation therapy—resulted in a complete clinical resolution of the patient's signs and symptoms. However, a 19-month follow-up with magnetic resonance venography demonstrated that the sigmoid sinus thrombosis itself had not resolved. It is clear that occlusion of the sigmoid sinus may persist after the completion of surgical and medical therapy for sigmoid sinus thrombosis secondary to otomastoiditis. It remains unclear (1) whether anticoagulation treatment aids in recanalization of the affected sinus and (2) whether patient outcomes are affected if recanalization is achieved.
Cholesteatoma of the Nose and Maxillary and Ethmoid Sinuses: A Rare Complication of Palatal Surgery
Authors: Viswanatha Borlingegowda
Published: January 2019

A 10-year-old boy presented with a complaint of a left-sided nasal obstruction with an associated foul-smelling discharge. Physical examination and anterior rhinoscopy revealed that a whitish, friable mass had completely filled the left nasal cavity. On computed tomography, a soft-tissue mass was seen filling the cavity and extending to the paranasal sinuses with bone erosion. A biopsy of the mass suggested that it represented a cholesteatoma. The lesion was removed via nasal endoscopy, and histopathology confirmed the diagnosis of a cholesteatoma. No recurrence was noted during 6 months of follow-up. Cholesteatoma of the paranasal sinuses is a rare entity, as only a few dozen cases have been reported in the literature.
Cervical Thymic Cyst Presenting as a Possible Cystic Nodal Metastasis of Papillary Carcinoma in a 53-Year-Old Man
Authors: Na Woong , Jang Si-Hyong , Min Kyueng-Whan , Cho Seok Hyun , Paik Seung Sam
Published: January 2019

Cervical thymic cysts are rare embryonic remnants that develop along the course of thymic migration in the neck. They usually occur during infancy and childhood, and they are extremely rare in adults. We report a case of cervical thymic cyst in a 53-year-old man. The patient presented with a small mass of the thyroid gland and a cystic mass at the left level II area of the neck. On histopathology, the thyroid mass was identified as a papillary carcinoma and the left-sided neck mass was diagnosed as a cervical thymic cyst lined with nonkeratinizing, flattened squamous epithelium. The cyst wall contained atrophic thymic tissue composed of lymphoid cells, epithelial cords, and Hassall corpuscles. Although it is rare, cervical thymic cyst should be considered in the differential diagnosis of a lateral cystic neck mass in an adult.
Schwannoma of the Palatine Tonsil
Authors: Chaudhary Neena , Gupta Deepak , Natesh V.
Published: January 2019

Schwannomas can originate in any peripheral, autonomic, or cranial nerve except the olfactory and optic nerves. Between 25 and 48% of all schwannomas have been reported to arise in the head and neck, with the acoustic nerve being the most common site of origin there. Schwannomas of the palatine tonsil are rare; as far as we know, only 6 such cases have been previously reported in the literature; 5 of these 6 occurred in adults and the other in an adolescent. We report a new case in a 42-year-old woman, which was diagnosed on the basis of histopathology.
Otomastoiditis with Acute Left Facial Nerve Paralysis Caused by Mycobacterium Chelonae
Authors: Wu Kang-Chao , Shu Min-Tsan , Chen Bo-Nien
Published: January 2019

Mycobacterium chelonae usually causes soft-tissue and skin infection. It is a rare cause of otomastoiditis. The clinical presentation and operative findings are similar to those of other nontuberculous mycobacterial infections. We describe a case of left-sided otomastoiditis with acute facial nerve paralysis caused by this organism in a previously well middle-aged woman. Her facial palsy totally resolved after tympanomastoidectomy plus a 7-week regimen of clarithromycin and moxifloxacin. To our knowledge, a case of otomastoiditis with acute facial nerve paralysis caused by M chelonae has not been reported previously.
Bilateral Skull Base Osteomyelitis in an Immunocompetent Patient
Authors: Leventhal Douglas , Willcox Thomas O. , Evans James J. , Finden Steven G.
Published: January 2019

A 75-year-old immunocompetent man presented to our office with right otalgia. After a comprehensive workup, he was found to have right temporal bone osteomyelitis and was treated with intravenous antibiotics. He then began to experience left-sided otalgia and was diagnosed with and treated for left temporal bone osteomyelitis. Subsequently, he began to exhibit myelopathic symptoms, and imaging revealed a C2 inflammatory process. The patient underwent endoscopic transoral odontoidectomy with resection of a large C1 to C2 pannus and recovered with no neurologic deficit. Skull base osteomyelitis is an uncommon condition that usually occurs in immunocompromised patients. Prompt diagnosis and appropriate treatment are of utmost importance in managing this condition.
The effect of Snoring on Voice: A Controlled study of 30 Subjects
Authors: Hamdan Abdul Latif , Al-Barazi Randa , Kanaan Alyssa , Al-Tamimi Wasan , Sinno Solara , Husari Ahmad
Published: January 2019

We conducted a study to determine the prevalence of vocal symptoms in snorers. A total of 30 patients with a history of snoring were investigated for the presence or absence of three vocal symptoms immediately after they awoke from sleep: hoarseness, voice weakness, and other changes in voice quality. All patients were also asked to complete a voice-related quality-of-life (V-RQOL) questionnaire. Findings were compared with those of an age- and sex-matched control group of 30 nonsnorers. The most common vocal symptom in the snoring group was hoarseness, which occurred in 11 patients (36.7%); voice weakness and other voice quality changes were present in 8 snorers each (26.7%). In the control group, the most common vocal symptom was voice weakness, which was present in 7 subjects (23.3%); 5 controls (16.7%) experienced other changes in voice quality, and 3 controls (10.0%) experienced hoarseness. The difference between the prevalence of hoarseness in the two groups was statistically significant (p = 0.030), and the differences in voice weakness and other voice quality changes were not. The mean V-RQOL score was 87.50 ± 26.89 in the snoring group and 96.00 ± 5.82 in the control group—again, not a statistically significant difference. Finally, we found no association between any of the three vocal symptoms and the prevalence of mouth breathing, the level of snoring loudness, and the mean number of snores per minute. We conclude that snorers are more likely to experience hoarseness than are nonsnorers.
Hepatocellular Carcinoma Presenting as An Isolated Sphenoid Sinus Lesion: A Case Report
Authors: Tandon Shantanu , Nair Arun , Sawkar Anisha , Balasubramanya A.M. , Hazarika Diganta
Published: January 2019

We report a rare case of a metastatic sphenoid sinus lesion originating from an undiagnosed hepatocellular carcinoma (HCC) in a 53-year-old man who presented with gradually progressive external ophthalmoplegia. Imaging showed a right sphenoid sinus lesion infiltrating the parasellar region. Although a primary sphenoid biopsy was inconclusive, positive hepatitis B surface antigen and CT-guided fine-needle aspiration cytology suggested an HCC. A repeat endoscopic biopsy from the sphenoid with immunohistochemistry confirmed the lesion to be metastatic HCC. Metastasis to the paranasal sinuses is extremely rare, and metastasis from a liver primary even more rare. Because of clinical and radiologic similarity between the primary and metastatic lesions, metastasis to the sphenoid sinus is often undiagnosed. Patients with features suggestive of sphenoid sinus malignancy should also be evaluated for the possibility of a metastatic tumor. In this article, we emphasize the rarity of the tumor, the unusual presenting symptoms, and problems with early diagnosis.
Hodgkin lymphoma of the Maxillary Sinus: An Unusual Occurrence
Authors: Peterson Jennifer L. , Hayostek Cherie J. , Garvey Christopher , Menke David M. , Rivera Candido E.
Published: January 2019

The maxillary sinus is a rare anatomic site for Hodgkin lymphoma, as only 1 such case has been previously reported in the literature. Nevertheless, we recommend that lymphoma be considered in the differential diagnosis of a mass that involves the maxillary sinus or any other unusual extranodal site in the head and neck. Lymphoma in a patient who presents with disease in an unusual site and without lymphadenopathy is difficult to diagnose. We report the case of a 60-year-old woman who presented with nasal congestion and obstruction. Examination revealed an abnormal-appearing mucosa involving the maxillary sinus. Subsequent evaluation led to a diagnosis of Hodgkin lymphoma. Because making such a diagnosis is difficult, close attention to radiologic and pathologic findings is important. Our review of the literature revealed that treatment commonly includes chemotherapy and radiotherapy, which yield excellent outcomes. The current standard of care for patients with similar-stage Hodgkin lymphoma at other sites can guide the treatment course for patients with extranodal Hodgkin lymphoma.
The effects of An Antistick Phospholipid Solution on Pediatric Electrocautery Adenoidectomy
Authors: Baker Jeffrey C. , Ramadan Hassan H.
Published: January 2019

We conducted a study to determine if coating a suction cautery tip with an antistick phospholipid solution would decrease the amount of time required to complete primary pediatric adenoidectomies. The aim of the study was focused on two main criteria: the amount of surgical time required to complete each procedure and the number of times an operation had to be interrupted because the suction cautery tip needed to be cleaned (each interruption was called a “handback”). We obtained data prospectively during 61 pediatric adenoidectomies performed at our institution from February through June 2009. These patients were randomized to undergo surgery either with (n = 31) or without (n = 30) the use of the antistick phospholipid solution (Electro Lube; Mectra Labs; Bloomfield, Ind.). The overall mean amount of time needed to complete an adenoidectomy was 6 minutes and 39 seconds (6:39); use of the antistick solution shortened the amount of surgical time by 1:45—a decrease of 23.2% (p = 0.0360). Likewise, surgeries performed with Electro Lube required an average of 3.0 fewer handbacks for cleaning during the operation (p 0.0001). The benefits of the antistick solution were even more pronounced in patients with larger adenoids than in those with smaller adenoids.
Atypical Carcinoid (Moderately Differentiated Neuroendocrine carcinoma) of the Uvula
Authors: Goldman Nelson C. , Barnes Robert E.
Published: January 2019

Carcinoid (neuroendocrine) tumors of the head and neck rarely occur outside the larynx and, until now, none has been reported in the oral cavity. We describe what we believe is the first reported case of an atypical carcinoid tumor, or any other type of neuroendocrine carcinoma, of the uvula.
Myxoid/Round Cell liposarcoma of the Supraclavicular Fossa
Authors: Oysu Cagatay , Uslu Celil , Naiboglu Bans , Ogredik Evren Ay
Published: January 2019

Metastases from the tracheobronchial tree and the genitourinary and gastrointestinal systems are the most common malignant lesions of the supraclavicular fossa. Liposarcomas in this region, as primary tumors, are rarely encountered. In this article, we report a case of myxoid liposarcoma of the supraclavicular fossa with a fulminant course.
Folliculosebaceous Cystic hamartoma of the External Auditory Canal in An Adult
Authors: Carneiro Fabiana Pirani , de Souza Vianna Leonora Maciel , dos Santos Aline Marques , Raymundo Igor Teixeira , de Azevedo Ana Emilia Borges
Published: January 2019

Folliculosebaceous cystic hamartoma (FSCH) is a cutaneous hamartoma of pilosebaceous origin that usually occurs on the face. We present what we believe is only the second reported case of FSCH of the external auditory canal, and the first in an adult. The patient was a 59-year-old woman who presented with a 4-year history of a firm nodule on the left external auditory canal that had caused hearing loss, pruritus, and pain. The lesion was excised, and histopathologic examination identified infundibular cysts, hyperplasia of the sebaceous lobules, and a large amount of mucin, features that are consistent with FSCH. One year postoperatively, the patient was asymptomatic, and no evidence of recurrence was noted.
Endolaryngeal Lipoma: Case Report and Literature Review
Authors: Nader Saki , Nikakhlagh Soheila , Rahim Fakher , Fatehizade Payam
Published: January 2019

Lipomas are the most common benign tumors affecting the soft tissues. They can occur at any age, but they typically appear in patients older than 40 years. They are found equally in men and women. Lipomas are uncommon in the head and neck, but when they do appear there, they can arise in any location, including the palate, tongue, tonsil, larynx, and parotid gland. We report the case of a 63-year-old man who presented to the emergency department with a large spindle-cell lipoma of the endolarynx. The patient was followed for 6 months, and he exhibited no snoring or breathing difficulties.
Microbial colonization of Blom-Singer Indwelling Voice Prostheses in Laryngectomized Patients: A Perspective from India
Authors: Sayed Suhail I. , Kazi Rehan , Sengupta Shubhra , Chowdhari Abhay , Jagade Mohan
Published: January 2019

We analyzed a series of adults with an implanted voice prosthesis that had malfunctioned and required removal as a result of the attachment and growth of microorganisms. Our goal was to determine the characteristics of these colonizing microbes. We swabbed the esophageal side of each prosthesis to obtain microbial flora for analysis with standard culture media. In all, we studied 22 prostheses in 18 patients (3 patients had received multiple prostheses). We found mixed contamination (both yeast and bacteria) in 19 of the 22 cultures (86.4%); the other 3 cultures yielded bacteria only, and there was no instance of yeast only. The most common yeast isolated was Candida albicans (68.2% of cultures), and the most common bacterium was Pseudomonas aeruginosa (63.6%). The average lifetime of the prostheses was 201 days (~6 mo, 3 wk). This study, which was the first of its kind in India, revealed that the microbial picture here was different from that found in previously reported studies of European populations. We presume the differences are attributable to different lifestyles and dietary habits.
Laryngeal Ulceration and Hemoptysis Secondary to Inadvertent Alendronate Overdose: Case Report and review of the Literature
Authors: Hanna John , Bee Joseph , Sataloff Robert T.
Published: January 2019

Alendronate is commonly used in the treatment of osteoporosis and other bone diseases. Its drug profile includes many recognized side effects, and the literature includes case reports of esophageal irritation and ulceration. However, little has been published about laryngeal effects. We describe the case of a 77-year-old man who presented with hemoptysis secondary to laryngeal ulceration caused by the inadvertent misuse of alendronate. This case highlights the need for otolaryngologists to be familiar with alendronate and its side effects.
Rapidly Developing Iatrogenic Hyponatremia in a Child following Tonsillectomy
Authors: Taskin Umit , Binay Omer , Binay Cigdem , Yigit Ozgur
Published: January 2019

Hyponatremia develops as a result of the inappropriate secretion of antidiuretic hormone. In rare cases, it develops as an iatrogenic complication. For example, acute iatrogenic post-tonsillectomy hyponatremia has been described in children following the infusion of hypo- or isotonic fluid. We report a case of rapidly developing post-tonsillectomy iatrogenic hyponatremia in a 5-year-old girl following an excessive infusion of hypotonic fluid. Her signs and symptoms began with nausea and vomiting and progressed to seizures and coma. We corrected the electrolyte disturbance by infusing a 3% sodium chloride solution until her neurologic manifestations disappeared, at which time her serum sodium concentration had risen back to 135 mEq/L. Otolaryngologists are not generally exposed to much information about hyponatremia, so we must be aware of its associated neurologic signs and symptoms.
Tympanomastoidectomy with Otoendoscopy
Authors: Rehl Ryan M. , Oliaei Sepehr , Ziai Kasra , Mahboubi Hossein , Djalilian Hamid R.
Published: January 2019

A cadaveric study was performed to test the hypothesis that intact-canal-wall mastoidectomy (ICWM) with otoendoscopy allows for equal or better visualization of the middle ear cavity structures when compared with canal-wall-down mastoidectomy (CWDM) with microscopy. Ten temporal bones were prepared with a reversible canal-wall-down tympanomastoidectomy technique. Five anatomic sites in each middle ear cavity (lateral epitympanum, posterior crus of the stapes, the sinus tympani, eustachian tube orifice, and round window niche) were marked with paint. Two otolaryngologists blinded to the purpose of the study viewed the temporal bones with the microscope. Following replacement of the posterior canal walls, the bones were then viewed with a 30° and a 70° otoendoscope. All visualized paint marks for each viewing were recorded and compared. We found that ICWM with 30° or 70° otoendoscopy provided significantly better visualization of the sinus tympani than did CWDM (p ≤ 0.001). There was no significant difference among the three methods in visualization of the lateral epitympanum, posterior crus of the stapes, and round window niche. With respect to the eustachian tube orifice, one of the observers reported significantly better visualization with CWDM (p = 0.036). With adjunctive otoendoscopy, it is not necessary to remove the posterior canal wall to adequately visualize or remove disease from various areas of the middle ear cleft. The use of otoendoscopy during cholesteatoma surgery may allow for more frequent preservation of the posterior canal wall and reduced rates of residual cholesteatoma, given the equal or better visualization of the middle ear cavity.
Sinonasal Teratocarcinosarcoma with Intracranial Extension: Case Report and Literature Review
Authors: Wassef Shafik N. , Kapur Payal , Barnett Samuel L. , Myers Larry L.
Published: January 2019

Sinonasal teratocarcinosarcoma (SNTCS) is an extremely rare malignancy of the paranasal sinuses that possesses the histopathologic features of both teratomas and carcinosarcomas. We report the case of a 58-year-old white man who presented with a 1-year history of a gradually enlarging left-sided nasal mass. The patient had previously undergone endoscopic sinus surgery at another facility, and the final pathologic specimen was reported as an SNTCS with positive margins. He was then referred to our institution, where he underwent a craniofacial resection combined with endoscopic intranasal resection. Postoperatively, he received combined chemotherapy and irradiation. At 48 months of follow-up, he was alive without evidence of disease.
Primary Cutaneous CD30-Positive Anaplastic Large-Cell lymphoma of the External Auditory Canal
Authors: Marçal Nuno , Campelos Sofia , Dias Luís , Gonçalves Matos , Pereira Gabriel , Godinho Tiago
Published: January 2019

Primary cutaneous T-cell lymphoma is rare. Cutaneous lymphoma is defined as primary when there is an absence of nodal or systemic disease during the first 6 months following diagnosis. We report what we believe to be the first documented case of a primary cutaneous CD30-positive anaplastic large-cell lymphoma of the external auditory canal. The patient was an elderly woman who presented with progressively worsening right otalgia and hypoacusis. Otoscopy revealed an erythematic, ulcerative, nonbleeding, localized lesion in the anterosuperior area of the external auditory canal. The patient underwent an excisional biopsy and after the diagnosis was established, she underwent 22 sessions of radiotherapy. During follow-up, she exhibited no evidence of recurrence.
Bilateral Silent Sinus Syndrome
Authors: Suh Jeffrey D. , Ramakrishnan Vijay , Lee Jennifer Y. , Chiu Alexander G.
Published: January 2019

Silent sinus syndrome is a rare clinical entity associated with progressive enophthalmos, collapse of the maxillary sinus, and hypoglobus. We report a case of bilateral silent sinus syndrome in a 29-year-old man. Representative radiographic and intraoperative images are presented. The purpose of this article is to illustrate a new presentation of the disease and to review the current diagnostic and treatment modalities.
Low-Grade B-Cell Lymphoma Presenting as a Uvular Mass
Authors: Walker Ryan , Heffelfinger Ryan
Published: January 2019

Uvular enlargement may occur acutely as a result of infection, allergy, or trauma. Squamous cell carcinoma may present as a progressively enlarging uvular mass. Primary MALT (mucosa-associated lymphoid tissue) lymphoma of the uvula and a neuroendocrine tumor of the parapharyngeal space presenting as a uvular mass have each been previously described in the literature. Here we present a case of low-grade B-cell lymphoma presenting as a uvular mass in a 55-year-old patient with progressive throat swelling and dysphagia.
Does Tonsillectomy Affect the Outcome of Drug Treatment for the Eradication of Gastric H Pylori Infection? A Pilot Study
Authors: Sezen Ozan Seymen , Kubilay Utku , Erzin Yusuf , Tuncer Murat , Unver Seref
Published: January 2019

Eradication of Helicobacter pylori, which is associated with diverse gastroduodenal pathologies of varying severity, is sometimes challenging. We conducted a prospective study to determine the effect of tonsillectomy on the eradication of H pylori from the gastrointestinal tract. Our study population was made up of 46 patients—32 females and 14 males, aged 14 to 58 years (mean: 28.84 ± 9.65)—who had chronic tonsillitis and concomitant dyspepsia. An initial gastrointestinal endoscopy was performed to obtain specimens for histology and a rapid urease test. These gastroscopies revealed that 32 patients were H pylori -positive (69.6%) and 14 were H pylori- negative (30.4%); these groups were designated A and B, respectively. The 32 H pylori- positive patients were divided into three subgroups based on the sequence in which they underwent drug therapy and tonsillectomy. All 3 subgroups received the same 14-day combination-drug regimen for eradication of gastric H pylori. Te patients in group A1 (n = 12) underwent tonsillectomy prior to receiving drug treatment; 2 months after the cessation of drug therapy, they underwent a second gastroscopy. The patients in group A2 (n = 10) received drug treatment first followed by tonsillectomy; 2 months later, they underwent their second gastroscopy. The patients in group A3 (n = 10) received drug treatment first, then they underwent a second gastroscopy, and then they were taken for tonsillectomy. The success or failure of H pylori eradication was determined by the second gastroscopy. Also, analyses were performed after tonsillectomy to look for H pylori infection in tonsillar specimens. Eradication of gastric H pylori was achieved in 9 of the 12 group A1 patients (75.0%), 8 of the 10 group A2 patients (80.0%), and 7 of the 10 group A3 patients (70.0%); there were no statistically significant differences among the three groups. Likewise, there were no significant differences between any subgroups or combination of subgroups in terms of tonsillar positivity. As far as we know, this is the first study to investigate the effect of tonsillectomy on the outcome of H pylori eradication treatment. In light of our findings, we may speculate that tonsillar tissue does not seem to be a reservoir for H pylori infection. Although tonsillectomy had no significant effect on gastric H pylori eradication in our study, our results might have been skewed by the relatively small size of our sample.
Necrotizing Cervical Fasciitis: Prognosis Based on a New Grading System
Authors: Takur Jagdeep Singh , Verma Neeti , Takur Anamika , Sharma Dev Raj , Mohindroo Narinder Kumar
Published: January 2019

We conducted a 10-year retrospective study to determine the prognosis of necrotizing cervical fasciitis (NCF). Our study population included 38 patients—32 males and 6 females, aged 10 months to 70 years (mean: 55 yr)—who had presented for management of NCF at our tertiary care hospital between Jan. 1, 2000, and Dec. 31, 2009. We classified each case into four categories based on the duration of disease prior to presentation, the severity of disease, and other factors that influence outcomes. We found that the most important factor in determining prognosis was the time interval between the onset of NCF and subsequent presentation for specialist or surgical intervention. Patients with a higher grade of NCF had longer hospital stays. Although aggressive surgical and medical intervention is the gold standard for the management of NCF, many of our patients presented with a relatively healthy appearing wound, which could mislead the evaluating clinician and delay prompt management. We believe that our new grading system will help obviate this problem and make clinicians more vigilant when faced with a new case of necrotizing fasciitis.
Subfreezing versus Room-Temperature Balloon Dilation of Benign Tracheal Stenosis: A Pilot Study in Rabbits
Authors: Wycherly Benjamin J. , Steehler Matthew K. , Hesham Hosai , Burke Kevin , Malekzadeh Sonya
Published: January 2019

We conducted an experiment to compare collagen deposition in tracheal stenoses dilated with room-temperature balloons and stenoses dilated with balloons at a subfreezing temperature (–10°C). Six New Zealand white rabbits underwent endoscopic tracheal injury. Tracheal dilation was performed at 3 weeks postinjury with either a room-temperature balloon or a vascular cryoplasty balloon. Five surviving rabbits were sacrificed at either 2 weeks (n = 3) or 4 weeks (n = 2) postdilation (1 rabbit that was not able to tolerate dilation was euthanized during the procedure). A blinded pathologist graded histologic sections of the injured tracheas for collagen content. The tracheal collagen deposits in the 3 animals sacrificed at 2 weeks postdilation were all graded as moderate. However, at the 4-week postdilation examination, there was a marked difference in collagen deposition between the rabbit that underwent room-temperature dilation and the rabbit that underwent subfreezing dilation; while the former showed moderate collagen deposition, the deposition in the latter was only mild. In conclusion, this pilot study showed that tracheal dilation with balloon cryotherapy decreased collagen deposition in the injured airway of 1 animal. Larger studies are required to determine whether balloon cryotherapy improves the long-term patency of immature tracheal stenosis.
Giant Osteoma of the Middle Turbinate: A Case Report
Authors: Singh Yadav Samar Pal , Gulia Joginder Singh , Hooda Anita , Khaowas Ajoy Kumar
Published: January 2019

Osteoma of the nose is a slowly developing benign tumor with a reported incidence of 0.6% of all the osteomas of the nose and paranasal sinuses. It is asymptomatic in initial stages and is usually diagnosed when it causes nasal obstruction. Osteoma arising from the middle turbinate is very rare and only two cases have been previously reported. We report a giant middle turbinate measuring 36 × 35 × 20 mm which, to the best of our knowledge, is the largest reported osteoma arising from the middle turbinate.
A Case of Glomangiopericytoma Involving the Orbital Wall
Authors: Jung Eun Sun , Yang Suk-Woo , Kim Ji-Hong , Kim Soo Whan
Published: January 2019

Sinonasal type hemangiopericytomas are very rare tumors, and are often called glomangiopericytoma. They are believed to be derived from perivascular modified smooth muscle cells. Their origin is similar to glomus tumors but some distinct differences exist. Glomangiopericytomas are indolent tumors and overall survival rates are higher after complete surgical excision. Recurrence rates are as high as 30%. We present a case of glomangiopericytoma which involves the orbital wall, noteworthy because such bone-dissolving glomangiopericytomas are extremely rare.
Tonsillitis with Acute Myeloid Leukemia: A Case Series for Caution
Authors: Thakur Jagdeep S. , Mohindroo N.K. , Sharma D.R. , Mohindroo Shobha , Thakur Anamika
Published: January 2019

Worldwide, tonsillitis is very common. The most common etiology is cross-infection with bacteria and viruses. These cases are managed with antibiotics and anti-inflammatory drugs without any further investigation because the diagnosis is based on simple clinical examination. Usually, leukemia presents with bleeding, weight loss, lymphadenopathy, fever, and frequent infection. Tonsillitis is a rare first presentation of leukemia. We present 3 cases in which the diagnosis of leukemia was made on routine examination, and in 1 case diagnosis was suspected during tonsillectomy.
Outcomes following Ossicular Chain Reconstruction with Composite Prostheses: Hydroxyapatite-Polyethylene vs. Hydroxyapatite-Titanium
Authors: Hahn Yoav , Bojrab Dennis I.
Published: January 2019

We conducted a retrospective study to compare the results of ossicular chain reconstruction (OCR) with two types of composite prosthesis: a hydroxyapatite-polyethylene (HAPEX) implant and a hydroxyapatite-titanium (HATi) prosthesis. We reviewed the records of 222 patients—104 males and 118 females, aged 8 to 79 years (mean: 39.7)—who had undergone OCR for ossicular chain dysfunction and who met our eligibility criteria. In addition to demographic data and the type of prosthesis, we compiled information on pre- and postoperative audiometric findings, the underlying diagnosis, the timing of surgery (primary, planned, or revision), the type of surgery (tympanoplasty alone, tympanoplasty with antrotomy, intact-canal-wall tympanomastoidectomy, or canal-wall-down tympano-mastoidectomy), the extent of reconstruction (partial or total), the use of the malleus, the use of a tragal cartilage graft, and evidence of extrusion. Of the 222 patients, 46 had undergone insertion of either a partial (n = 36) or total (n = 10) ossicular replacement prosthesis (PORP and TORP, respectively) made with HAPEX, and 176 had received a PORP (n = 101) or TORP (n = 75) made with HATi. Postoperatively, the mean air-bone gap (ABG) was 14.0 dB in the HAPEX group and 14.7 dB in the HATi group, which was not a significant difference (p = 0.61). Postoperative success (ABG ≤20 dB) with PORP was obtained in 30 of the 36 patients in the HAPEX group (83.3%) and in 87 of the 101 patients in the HATi group (86.1%), while success with TORP was achieved in 7 of 10 HAPEX patients (70.0%) and 56 of 75 HATi patients (74.7%); there was no significant difference in either PORP or TORP success rates between the HAPEX and HATi groups (p = 0.32). A significantly better hearing result was obtained when the malleus was used in reconstruction (p = 0.035), but the use of tragal cartilage led to a significantly worse outcome (p = 0.026). Revision surgery was associated with a significantly worse postoperative result (p = 0.034). Prosthesis extrusion was observed in 9.0% of all cases. The two types of composite assessed in this study yielded similar results in terms of functional hearing and stability, but the HATi prosthesis had some significant advantages. For example, it was associated with more cases in which the ABG closed to less than 10 dB. In addition, because of its thinner stem and lower profile, it can be used in situations that are not possible with the HAPEX implant.
Facial Nerve Preservation in total Parotidectomy for Parotid Tumors: A Review of 27 Cases
Authors: El-Shakhs Soliman , Khalil Yaser , Abdou Asmaa Gaber
Published: January 2019

We conducted a study to evaluate the success of facial nerve preservation in 27 adults with a parotid tumor who underwent total parotidectomy. Of this group, 11 patients had a malignant tumor, 10 had a recurrent benign tumor, and 6 had a primary benign tumor. Preoperatively, 7 patients had facial nerve paresis. Postoperatively, facial nerve preservation was achieved in all but 1 case; in the exception, the nerve was sacrificed and grafting was necessary. In conclusion, facial nerve preservation can be achieved in almost all cases of total parotidectomy.
Intrapharyngeal Schwannoma in a Pediatric Patient
Authors: Nassif Nader , Cottelli Mariaelisabetta , Farina Davide , Berlucchi Marco
Published: January 2019

Schwannomas are benign peripheral nerve neoplasms that arise from Schwann cells. They usually occur in the adult population. The most common site in the head and neck region is the parapharyngeal space. Intrapharyngeal schwannomas are extremely rare, and those that have been reported all occurred in adults. We report what to the best of our knowledge is the first case of an intrapharyngeal schwannoma in a pediatric patient. The patient, a 15-year-old boy, was treated successfully with surgical excision.
Oral Hairy Leukoplakia in an HIV-Negative Patient
Authors: Graboyes Evan M. , Allen Clint T. , Chernock Rebecca D. , Diaz Jason A.
Published: January 2019

We report the case of a 31-year-old woman with systemic lupus erythematosus who was found to have oral hairy leukoplakia (OHL). She was on immunosuppressive therapy but was human immunodeficiency virus (HIV)-negative. OHL has been previously reported in HIV-negative patients who were immunosuppressed for other reasons, such as solid organ or hematopoietic stem cell transplantation, hematologic malignancies, or systemic diseases. To the best of our knowledge, this is the first case of OHL in an HIV-negative patient reported in the otolaryngology literature. It adds to the growing list of cases of OHL in HIV-negative patients and serves as a reminder to physicians to include OHL in the differential diagnosis for oral cavity lesions in all immunosuppressed patients. The article also summarizes the current state of knowledge about the pathogenesis of OHL, its relation to the Epstein-Barr virus, and the treatment options.
Primary Pleural Malignant Mesothelioma with Delayed Metastasis to the Piriform Sinus: Report of a Case
Authors: Taskin Umit , Yigit Ozgur , Aricigil Mithat , Huq Gulben
Published: January 2019

Piriform sinus tumors are uncommon and silent lesions. Their prognosis is poor because these tumors are usually not detected until they have reached an advanced stage. Almost all piriform sinus cancers are primary squamous cell carcinomas; other primary and metastatic tumors of the hypopharynx are exceedingly rare. One of the rare tumors in the laryngopharyngeal area is sarcomatoid carcinoma, which is an unusual type of squamous cell carcinoma. Another uncommon malignant tumor that is histologically similar to sarcomatoid carcinoma is malignant mesothelioma, which is a rare form of lung carcinoma. The macroscopic appearance and histologic characteristics of sarcomatoid carcinoma and malignant mesothelioma are so similar that differentiation is usually achieved by immunohistochemical examination. To the best of our knowledge, no case of primary or metastatic laryngohypopharyngeal malignant mesothelioma has been previously reported in the literature. In this article, we describe a case of isolated malignant mesothelioma of the piriform sinus that resembled a sarcomatoid carcinoma in a 50-year-old man with a history of lung mesothelioma.
Giant Cell Tumor of the Larynx: A Case of Malignant Sarcomatous Transformation
Authors: Vivero Richard J. , Dave Sandeep P. , Gomez Carmen R. , Weed Donald T.
Published: January 2019

We report what is to the best of our knowledge the first case of malignant transformation of a giant cell tumor of the larynx. The patient, a 34-year-old man, presented to our tertiary care university teaching hospital where he underwent hemilaryngopharyngectomy with radial forearm free flap reconstruction and 11 of 15 cycles of chemotherapy. He remained disease-free at approximately 6 years and 4 months of follow-up. The patient is decannulated and continues to have a good voice with excellent quality of life to this day. We discuss the patient's clinical course and subsequent treatment within the context of a review of the current literature regarding this disease entity. Our experience demonstrates that giant cell tumor of the larynx may present as a malignant neoplasm without adversely affecting the patient's prognosis when treated aggressively with surgical resection and adjunct chemotherapy.
Dengue Fever: A Primer for the Otolaryngologist
Authors: Arnaoutakis Demetri , Padhya Tapan A.
Published: January 2019

It has been estimated that more than 50 million cases of dengue occur worldwide each year, mostly in the tropics. In light of recent cases appearing in central and southern Florida, dengue has reemerged as a public health issue in the United States with respect to infection control and prevention. We review the course of dengue infection and its clinical presentation from the perspective of the practicing otolaryngologist, and we outline tactics for prevention and management.
Pigmented Villonodular Synovitis of the Temporomandibular Joint
Authors: Giannakopoulos Helen , Chou Joli C. , Quinn Peter D.
Published: January 2019

Pigmented villonodular synovitis (PVNS) is a proliferative disorder that affects synovium-lined joints, bursae, and tendon sheaths. It appears in both diffuse and localized forms, depending on the extent of synovial involvement. PVNS rarely involves the temporomandibular joint (TMJ); when it does, it manifests clinically as a slowly growing and painless preauricular mass that resembles a parotid tumor. TMJ dysfunction, paresthesia, and/or hearing loss can result. We present a case of a large extra-articular PVNS of the TMJ, and we review the literature.