bluuebunny/crossref_metadata_2025 huggingface dataset:
Myxolipoma of the Epiglottis in an Adult: A Case Report
Authors: Singhal Surinder K. , Virk Ramandeep S. , Mohan Harsh , Palta Sanjeev , Dass Arjun
Published: May 2019

Lipomas of the larynx are rare. When they do occur, they are important because some require that the surgeon perform a tracheotomy to prevent a fatal airway obstruction. We report a case of myxolipoma— that is, a lipoma with foci of myxomatous degeneration— of the epiglottis in a 56-year-old woman. We successfully treated the tumor with intubation and surgery; tracheotomy was not necessary. To the best of our knowledge, myxolipoma of the epiglottis in an adult has not been previously reported in the English-language literature.
Pneumosinus Dilatans Frontalis: A Case Report
Authors: De Riu Giacomo , Bay Alessandro , Tullio Antonio
Published: May 2019

Deformity of the forehead is usually the first clinical presentation of the abnormally large frontal sinus caused by Pneumosinus dilatans. We report the diagnosis and surgical treatment of a case. The type of osteotomy we describe is recommended as a method of surgical treatment for this condition when the aesthetic problem is the major complaint.
A Study of the Link between Gastric Reflux and Chronic Sinusitis in Adults
Authors: Pincus Robert L. , Kim Harold H. , Silvers Stacy , Gold Scott
Published: May 2019

Much discussion is taking place regarding the role of gastric reflux disease in the development and maintenance of chronic sinus disease. We studied 31 patients in a large urban private practice who had recalcitrant chronic sinusitis despite aggressive medical and surgical therapy. After we obtained information on the severity of each patient's sinus disease, we performed either double- or triple-catheter probe pH testing to assess the presence of reflux disease. Of the 30 patients who were successfully tested (1 patient did not tolerate probe testing), 25 demonstrated reflux disease, including 2 whose reflux reached the level of the nasopharynx. These 25 patients were placed on a proton-pump inhibitor (PPI) regimen and reassessed at least 1 month later. At follow-up, 14 of 15 evaluable patients demonstrated at least some improvement in their sinus symptoms, including 7 who experienced either a complete or almost-complete resolution of symptoms. The improvements in sinus symptoms corresponded with improvements in reflux symptoms. These findings suggest that antireflux therapy might play a role in the treatment of recalcitrant chronic sinus disease.
Lower-Extremity Liposarcoma Metastatic to the Larynx: Case Report
Authors: Daly Scott F. , Sciubba James , Tufano Ralph P.
Published: May 2019

Distant metastases to the larynx are rare. We describe the case of a 46-year-old man who was referred to our head and neck surgery clinic with a 6-week history of sore throat and otalgia. He was found to have a laryngeal lesion that was consistent with a primary myxoid liposarcoma that had been extirpated from a lower extremity earlier. To the best of our knowledge, no case of myxoid liposarcoma metastatic to the larynx has been previously reported in the English-language literature.
The Mechanical Reduction of Early Acquired Cholesteatomas in Children: Indications and Limitations
Authors: Grimes Eric R. , Isaacson Glenn
Published: May 2019

The standard treatment/or acquired cholesteatoma involves surgical removal of the lesion and reconstruction of the tympanic membrane. In some children, these lesions can be treated more conservatively. We conducted a retrospective study of 29 ears in 24 children who had been treated for early acquired cholesteatoma with mechanical reduction and a tympanostomy tube. Outcomes measures included hearing status, the postoperative appearance of the tympanic membrane, and the need for additional surgery. We found that anterior and inferior pars tensa lesions, with or without squamous debris, can be successfully reduced, but that posterosuperior retractions respond less well when the ossicular chain has been eroded. None of the children who responded to mechanical reduction required major reconstructive surgery later. We conclude that mechanical reduction of retraction pocket cholesteatomas with tympanostomy tube placement is sufficient to restore normal hearing and a normal tympanic membrane appearance in selected children with early lesions. We also identified several important prognostic features, including the patient's age, the specific location of the retraction pocket on the tympanic membrane, the extent of the pocket, ossicular chain involvement, and the patient's adenoid status.
Partial Middle Turbinectomy by Nasotracheal Intubation
Authors: Patiar Shalini , Ho Eu Chin , Herdman Rory C.D.
Published: May 2019

Partial middle turbinate avulsion is a rare complication of nasotracheal intubation. Patients usually experience a brisk hemorrhage at the time of injury. Postoperatively, some patients develop a unilateral nasal obstruction, while others are asymptomatic. We present an unusual case in which a patient became symptomatic many years after the incident. We hope to raise awareness that a traumatic disruption of the turbinates secondary to nasotracheal intubation might lead to the development of an abnormal nasopharyngeal mass.
Inferior Turbinate Schwannoma: Report of a Case
Authors: Khnifies Riad , Fradis Milo , Brodsky Alexander , Bajar Jacob , Luntz Michal
Published: May 2019

Schwannomas of the nasal cavity are extremely rare. We evaluated a 42-year-old woman who presented with a 4-year history of slowly progressive nasal obstruction. The cause of the obstruction was identified as a schwannoma in the left inferior turbinate. The tumor was completely excised, and no sign of recurrence was evident at the 1-year follow-up. To the best of our knowledge, this is only the third case of a schwannoma originating in the inferior nasal turbinate that has been reported in the English-language literature. We review the clinical and pathologic features of this case.
Surgical Treatment of Acquired Tracheocele
Authors: Porubsky Edward A. , Gourin Christine G.
Published: May 2019

Acquired tracheoceles are rare clinical entities that can cause a variety of chronic and recurrent aerodigestive tract symptoms. The management of acquired tracheoceles is primarily conservative, but surgical intervention may be indicated for patients with refractory symptoms. We present a case of acquired tracheocele and describe a method of successful surgical management.
Assessment of Patient Satisfaction with Various Configurations of Digital CROS and BiCROS Hearing Aids
Authors: Hill Samuel L. , Marcus Avron , Digges E. Nicholas B. , Gillman Nancy , Silverstein Herbert
Published: May 2019

We conducted a study of 91 patients with severe-to-profound asymmetric hearing loss to assess their satisfaction with digital contralateral routing of signal (CROS) or bilateral contralateral routing of signal (BiCROS) hearing aids. Satisfaction was evaluated on the basis of the number of patients who elected to purchase their hearing aid following a free 30-day trial and on the results of a subsequent 8-question survey. We found that overall patient satisfaction was generally high. At the end of the 30-day trial, 66 of the 91 patients (72.5%) elected to keep their CROS or BiCROS device, a percentage that is far greater than the acceptance rates of 10 to 20% that had been previously reported with older models of the CROS and BiCROS devices. According to the survey responses, those who kept their devices gave them an overall rating of 3.4 on a scale of 1 (very dissatisfied) to 5 (very satisfied); those who returned their devices gave them an overall rating of 1.9.
Free-Text Data Entry by Speech Recognition Software and its Impact on Clinical Routine
Authors: Ilgner Justus , Düwel Philip , Westhofen Martin
Published: May 2019

We conducted a study to evaluate speech recognition software in an otorhiriolaryngology unit and to assess its impact on productivity prior to general implementation. Current speech recognition software (IBM ViaVoice, version 10) was implemented on a personal computer with a 2-GHz central processing unit, 256 MB of RAM, and a 30-GB hard disk drive, with and without add-on professional vocabulary for otorhinolaryngology. This vocabulary was added by the automated analysis of an additional 12,257 documents from our department. We compared the word recognition error rates for three different text types and determined their impact on the amount of surgeon's time that was invested in the production of an error-free document. Although error rates without any professional vocabulary database were rather high (operation reports: 38.72%; consultation notes: 27.77%), the patient information was edited with a satisfactory result (10.65%). Best results were obtained with the specialty-related vocabulary database added by the analysis of our own documents (operation reports: 5.45%; consultation notes: 5.21%). An increase in productivity compared with that of conventional transcription was found at an error rate of less than 16%.
Primary Carcinoid Tumor of the Parotid Gland: A Case Report and Review of the Literature
Authors: Modlin Irvin M. , Shapiro Michael D. , Kidd Mark
Published: May 2019

Salivary gland tumors account for 3 to 6% of all head and neck neoplasms in adults. Some 70 to 85% of these lesions are found in the parotid. Carcinoid tumors, which represent a distinct and relatively uncommon subset of neuroendocrine tumors, are most commonly found in the gastrointestinal tract, although in rare cases they are known to occur in extragastrointestinal locations, including the larynx, middle ear, and pancreas. Malignancies of the parotid gland are uncommon (approximately 25% of parotid neoplasms), and to the best of our knowledge, a primary carcinoid tumor of the parotid has not been previously described in the literature. Reports of parotid carcinoid tumors during the past 30 years have described the presence of nonparotid primary carcinoid tumors (usually gastrointestinal) that had been diagnosed and treated several years prior to the presentation of the parotid lesion. Under such circumstances, the parotid lesion may be assumed to have been a metastatic rather than a primary carcinoid. This report documents what we believe is the first case of a primary carcinoid tumor of the parotid gland. We detail the clinical, surgical, radiologic, immunologic, and histochemical findings associated with its diagnosis, and we describe our management of this case. Although a primary carcinoid in this location is exquisitely rare, knowledge of such lesions is important because their management is substantially different from that of other parotid tumors. In particular, it is important to differentiate them from metastatic tumors from other sites.
Perforating and Migrating Pharyngoesophageal Foreign Bodies: A Series of 5 Patients
Authors: Al-Sebeih Khalid , Valvoda Miloslav , Sobeih Amro , Al-Sihan Mutlaq
Published: May 2019

Ingestion of a foreign body is a problem seen in nearly all otolaryngologic practices. One of the least common complications of foreign-body ingestion is penetration and migration, which may lead to serious morbidity or even death. We report the findings of a retrospective review of a series of 5 patients who had presented with a complete foreign-body penetration. All of them had radiologic evidence of a foreign body, but findings on rigid endoscopy were negative. Computed tomography is the radiologic study of choice to identify penetrating foreign bodies. The foreign bodies in all 5 patients were extracted via an external approach.
The ‘Sentinel Clot’ Sign in Spontaneous Retropharyngeal Hematoma Secondary to Parathyroid Apoplexy
Authors: Koulouris George , Pianta Marcus , Stuckey Stephen
Published: May 2019

Spontaneous retropharyngeal hemorrhage from a cervical parathyroid adenoma is a rare complication of primary hyperparathyroidism. Because of its rarity, it has seldom been documented in the radiologic or ENT literature. Patients may present with a variety of manifestations, ranging from dysphagia to dysphonia to life-threatening dyspnea or hemorrhage. Awareness of a possible thyroid or parathyroid etiology may expedite treatment and prevent unnecessary interventions. We present a case of spontaneous retropharyngeal hemorrhage in which the “sentinel clot” sign enabled us to identify the lesion of origin.
The Use of Silastic Nasal Splints in the Treatment of Chronic Epistaxis and Nasal Septal Ulceration
Authors: Alaani Ausama , Jassar Patrick , Smith Ian
Published: May 2019

Some cases of epistaxis are chronic and resistant to treatment. We describe a novel method of treating persistent epistaxis with Silastic splints. This procedure is simple to perform and reverse, and it is much better tolerated than is total obstruction of the nostrils (Young's procedure). In addition, the presence of the splints reduces the likelihood of digital trauma, which can prevent healing. We describe the case of a 43-year-old man with a 5-year history of persistent epistaxis who was successfully treated with this procedure.
Obstructive Sleep Apnea following Treatment of Head and Neck Cancer
Authors: Stern Thomas P. , Auckley Dennis
Published: May 2019

A growing body of literature is suggesting that there is a link between head and neck cancer treated with radiation therapy and the development of obstructive sleep apnea/hypopnea syndrome (OSAHS). We describe the case of a 54-year-old man with a history of head and neck cancer whose OSAHS had gone undiagnosed for 3 years. After the diagnosis was made on the basis of sleep study data, we determined that the OSAHS was a long-term complication of cervical radiation therapy that had been delivered to treat the patient's laryngeal squamous cell carcinoma 3 years earlier. We also review the literature regarding the association between head and neck cancer and the development of OSAHS.
Cerebrospinal Fluid Otorrhea Presenting in Complicated Chronic Suppurative Otitis Media
Authors: Bhat Vikram , Manjunath Dandinarasaiah
Published: May 2019

Since the introduction of antibiotics, the simultaneous occurrence of multiple intra- and extracranial complications in chronic suppurative otitis media (CSOM) has been uncommon. Such a combination is associated with high mortality and morbidity, especially in the pediatric age group. Cerebrospinal fluid (CSF) otorrhea presenting in CSOM is unusual and rare. To the best of our knowledge, only 19 cases of CSF otorrhea in complicated CSOM have been previously reported in the literature. Identifying the site of leak might require a high index of suspicion. Management of such a case could be challenging in terms of leak closure, disease clearance, and restoration of function. We report a new case of CSF leak in CSOM, and we describe our line of management. Even though CSOM is an uncommon indication for radical mastoidectomy today, such surgery might be necessary for these cases.
Malignant Melanoma of the Sinonasal Mucosa: Two Case Reports and a Review
Authors: Sanderson Alicia R. , Gaylis Brendan
Published: May 2019

Malignant melanoma of the sinonasal cavity is an uncommon disease, and therefore a limited amount of data exists regarding its optimal treatment. The course of the disease is highly variable. Individual survival is also highly variable, but the overall prognosis is poor, probably because patients generally present at a late stage and because the disease has a proclivity for distant dissemination. We describe 2 recent cases of primary malignant melanoma of the sinonasal mucosa, and we review the literature.
Prognostic Significance of Tumor-Infiltrating Lymphocytes in Oropharyngeal Cancer
Authors: Rajjoub Samer , Basha Suzanne R. , Einhorn Eugene , Cohen Marc C. , Marvel Doug M. , Sewell Duane A.
Published: May 2019

The presence of tumor-infiltrating lymphocytes has been shown to significantly improve clinical outcomes in many types of cancer. However, their effects on outcomes in patients with oropharyngeal cancer specifically have yet to be elucidated. We conducted a retrospective study in an effort to shed light on this issue. We reviewed the records of 48 consecutively presenting patients with oropharyngeal cancer, and we performed immunohistochemistry to analyze their archived paraffin-embedded tissue samples for the presence of CD3-positive tumor-infiltrating lymphocytes. We also used real-time polymerase chain reaction testing to look for human papillomavirus type 16 (HPV-16) in the tumors. We found that patients with large numbers of tumor-infiltrating lymphocytes (CD3high) had a significantly lower incidence of metastasis at presentation than did those with low numbers of tumor-infiltrating lymphocytes (CD3low) (40.0 vs. 88.5%; p = 0.001), regardless of HPV status. When HPV status was taken into account, the correlation between a high CD3 count and a lower rate of metastasis was maintained in the HPV-positive patients but not in the HPV-negative patients. We also found that the CD3high patients had higher rates of overall survival and disease-free survival at 3 and 5 years than did the CD3low patients; however, these differences only approached but did not reach statistical significance.
The Prevalence of Diabetes in a Series of Patients with Subglottic Stenosis
Authors: Ettema Sandra L. , Loerhl Todd A. , Toohill Robert J. , Merati Albert L.
Published: May 2019

Diabetes, which is present in 4 to 8% of adults in the United States, is a risk factor for surgical failure in laryngotracheal airway operations. We conducted a retrospective study to characterize a population of patients with subglottic stenosis—including the prevalence of diabetes, which has not been widely reported. We performed a retrospective chart review of 30 patients—22 women and 8 men, aged 17 to 77 years (mean: 47.5)—with subglottic stenosis who had presented to our facility between July 2001 and June 2004. Diabetes was present in 5 patients (16.7%); the prevalence of diabetes in our study was not significantly different from regional population-adjusted norms (8%). Although higher-grade stenosis was significantly more common in the diabetic patients than in the nondiabetic patients (p < 0.05), we were unable to conclude that diabetes plays an independent role in the development of subglottic stenosis. We intend to conduct a meta-analysis to assess the role that diabetes plays as both a risk factor for and an obstacle to the treatment of airway stenosis.
Correlation of the Ethmoid Infundibulum to the Medial Orbital wall in Maxillary Sinus Hypoplasia: “Infundibular lateralization,” a Diagnostic CT Finding
Authors: Ali Arif , Kurien Mary , Selvaraj K.G.
Published: May 2019

In patients with chronic rhinosinusitis, the presence of maxillary sinus hypoplasia (MSH) may be obscured by extensive mucosal disease or nasal polyposis. Recognition of MSH and its effect on adjacent anatomic structures is of utmost clinical significance in endoscopic sinus surgery. Failure to recognize the impact that MSH has on the position of the ethmoid infundibulum relative to the medial orbital wall could lead to inadvertent damage to the wall during surgery. We conducted a prospective study of 75 patients with clinically and endoscopically proven chronic rhinosinusitis to evaluate the prevalence of MSH. We found that MSH was present in 12 patients (16.0%); 7 of the 75 patients (9.3%) had bilateral disease, and 5 (6.7%) had unilateral disease. We then correlated the relationship of the ethmoid infundibulum to the medial orbital wall as determined by computed tomography in patients with and without MSH. We found that in most cases of MSH, the ethmoid infundibulum was displaced lateral to the medial wall of the orbit; the correlation between MSH status and displacement was statistically significant (p < 0.05). We propose the term “infundibular lateralization” to describe this consistent radiologic finding in MSH.
Unilateral Inferior Turbinate Hypoplasia caused by a Longstanding (approximately 35 yr) Nasal Foreign Body
Authors: Derosas Fiorenza , Marioni Gino , Brescia Giuseppe , Florio Alessandra , Staffieri Claudia , Staffieri Alberto
Published: May 2019

We report the unusual case of a 44-year-old man who presented with a plastic foreign body that had been lodged in his right nasal cavity for approximately 35 years. Initial attempts to remove the object were unsuccessful; only after it was broken into several parts was removal achieved. Rigid nasal endoscopy and computed tomography revealed hypoplasia of the ipsilateral inferior turbinate.
Management of Hypopharyngeal and Esophageal Perforations in Children: Three Case Reports and a Review of the Literature
Authors: Baum Eric D. , Elden Lisa M. , Handler Steven D. , Tom Lawrence W.C.
Published: May 2019

We report 2 cases of pediatric hypopharyngeal perforation that occurred during endoscopy and 1 case of esophageal perforation that developed during nasogastric tube insertion at a tertiary care academic medical center. These cases were identified during a retrospective chart review. All 3 patients were treated with intravenous antibiotics and nasogastric tube feedings, and none experienced further sequelae. Perforations of the hypopharynx and esophagus in children during endoscopy or insertion of endotracheal and nasogastric tubes are not uncommon. Many affected children can be managed conservatively without surgical drainage, depending on the cause and specific location of the perforation and the timing of the diagnosis. We discuss the clinical criteria for various management options, and we offer an algorithm that outlines important clinical considerations in the decision-making process. Our aim in presenting these cases is to increase awareness of the management options for children with hypopharyngeal and esophageal perforations and to demonstrate the effectiveness of nonsurgical management in selected cases.
Neurosarcoidosis Presenting as Complicated Sinusitis: A Case Report and Review
Authors: Brigger Matthew T. , McLeod Ian K. , Sorensen Martin P.
Published: May 2019

Sarcoidosis is a systemic granulomatous disease with widely variable clinical characteristics, including numerous head and neck manifestations. We describe the case of a 49-year-old man who presented to the emergency department with symptoms consistent with complicated sinusitis. He was ultimately found to have an atypical case of neurosarcoidosis. This case illustrates the varied multisystem presentation of sarcoidosis and the diagnostic considerations that are merited.
Hearing Loss and Cerebrospinal Fluid Pressure: Case Report and Review of the Literature
Authors: Pogodzinski Matthew S. , Shallop Jon K. , Sprung Juraj , Weingarten Toby N. , Wong Gilbert Y. , McDonald Thomas J.
Published: May 2019

A decrease in cerebrospinal fluid pressure may result in an endolymphatic hydrops through a patent cochlear aqueduct or through the fundus of the internal auditory canal. This hydrops typically leads to low-frequency sensorineural hearing loss. We describe the case of a man who presented with a subjective and objective hearing loss in addition to a headache 4 days after he had undergone a dural puncture. We treated him with a standard epidural blood patch. Immediately after treatment, his hearing improved and his headache resolved.
Extracanalicular Osteoma of the Temporal Bone
Authors: Viswanatha Borlingegowda
Published: May 2019

Extracanalicular osteomas of the temporal bone are rare, slow-growing, benign neoplasms. Although they may occur anywhere in the temporal bone, they are most common in the mastoid area. Often, symptoms are negligible and treatment is unnecessary. However, surgical removal is indicated when growth of the osteoma causes distressing symptoms or cosmetic issues. The patient described in this report had no symptoms but underwent surgical excision of a mastoid osteoma for cosmetic reasons. At 4-month follow-up, she remains asymptomatic and recurrence-free.
Transcervical Resection of the Styloid Process in Eagle Syndrome
Authors: Martin Timothy J. , Friedland David R. , Merati Albert L.
Published: May 2019

We conducted a retrospective study to determine the treatment outcomes of 6 patients who had either unilateral or bilateral elongated styloid processes and symptoms consistent with Eagle syndrome. Five of these patients had undergone transcervical resection of the styloid process, with relief of symptoms over the follow-up period (mean: 8 mo). Two of the 5 patients experienced a transient weakness in the marginal mandibular nerve, and both recovered completely. The transcervical surgical approach to resection in patients with elongated styloid processes and Eagle syndrome appears to be safe and effective, although the risk for transient marginal mandibular nerve weakness is notable.
Prostatic Carcinoma Metastatic to the Paranasal Sinuses: A Case Report
Authors: Viswanatha Borlingegowda
Published: May 2019

In the paranasal sinuses, metastatic carcinoma is far less common than primary carcinoma. Metastasis of prostate cancer to the paranasal sinuses is very rare. The author describes a case of prostatic adenocarcinoma that metastasized to the frontal and ethmoid sinuses in a 68-year-old man. The patient was treated with radiotherapy but was lost to follow-up after 3 months.
Juvenile Nasopharyngeal Angiofibroma: Spontaneous Resolution
Authors: Spielmann Patrick M. , Adamson Richard , Cheng Kenneth , Sanderson Robert J.
Published: May 2019

Juvenile nasopharyngeal angiofibroma is a rare, benign tumor that occurs most often in adolescent males. Common practice is to excise the tumor with open or endoscopic surgery. We report the case of a 17-year-old male who presented in 1995 with a mass filling the left posterior nasal cavity. A diagnosis of juvenile nasopharyngeal angiofibroma was obtained with computed tomography and magnetic resonance imaging. The patient elected to have no treatment. On annual scans, the lesion changed little until 1998, when it began to gradually decrease in size. Although it is not well proven, the natural history of these tumors seems to be regression over time. This case supports the argument that a policy of watchful waiting with regular imaging studies may postpone or eliminate the need for surgery and its attendant risks.
Assessments of the Size of Tympanic Membrane Perforations: A Comparison of Clinical Estimations with Video-Otoscopic Calculations
Authors: Ibekwe Titus S. , Nwaorgu Onyekwere G.B. , Adeosun Aderemi A. , Kokong Daniel D. , Lawal Hakeem O. , Okundia Patrick O. , Onakoya Paul A.
Published: May 2019

We conducted a study to determine how accurate various ENT specialists were in estimating the size of 100 tympanic membrane (TM) perforations with standard otoscopy. The specialists included, in descending order of rank, 2 Consultant Surgeons, 2 Senior Registrars, and 2 Registrars, all of whom had confirmed good vision. We compared their estimates, which were made independently and expressed as a percentage of the total area of the TM, with exact measurements calculated with computer-based video-otoscopy. We found that the video-otoscopic calculations were far superior to the estimates of the specialists, even the most experienced Consultants (p < 0.01). We recommend that video-otoscopy he used whenever possible.
Middle Ear Barotrauma with Hyperbaric Oxygen Therapy: Incidence and the Predictive Value of the Nine-step Inflation/Deflation Test and Otoscopy
Authors: Karahatay Serdar , Yilmaz Yavuz Fuat , Birkent Hakan , Ay Hakan , Satar Bulent
Published: May 2019

We conducted a prospective study to determine the incidence of middle ear barotrauma in patients who were undergoing hyperbaric oxygen therapy (HBOT). We also investigated the value of the nine-step inflation/deflation test and otoscopic findings before and immediately after the initial HBOT session in predicting barotrauma in an attempt to establish some criteria for prophylaxis. The study was conducted on 36 ears of 18 adults who had no history of eustachian tube dysfunction. Patients were being treated with HBOT for sudden hearingloss, wound-healing complications, or complications of diabetes. After 7 days of HBOT, barotrauma was seen in 12 of the 18 patients (66.7%) and in 18 of the 36 ears (50.0%). The nine-step inflation/deflation tests, which were performed before and immediately after the initial HBOT session, were not predictive of barotrauma (p = 0.095 before and p = 0.099 after). However, otoscopic findings obtained immediately after the first session of HBOT were predictive of barotrauma, with a sensitivity and specificity of 83 and 100%, respectively. We conclude that patients with even minor positive pathologic findings on otoscopy immediately following HBOT are at increased risk of middle ear barotrauma if HBOT is to be continued without prophylaxis.
Noise Exposure Levels in Stock Car auto Racing
Authors: Rose Austin S. , Ebert Charles S. , Prazma Jiri , Pillsbury Harold C.
Published: May 2019

Noise-induced hearing loss associated with the workplace has been well described. Far less is known, however, about the risks to hearing from recreational sources of noise. We investigated the popular sport of stock car racing as a potentially significant source of noise exposure, and we conducted a sound-level survey at a National Association for Stock Car Auto Racing (NASCAR) event. Noise levels measured during the race ranged from 96.5 to 104 dB(A) at 46 meters (~150 feet) from the track and 99 to 109 dB(A) at 6 meters (~20 feet) from the track. The peak sound pressure level at 6 meters was 109 dB(A). Although significantly less than that associated with an immediate permanent threshold shift, such an exposure could cause a temporary threshold shift. Alhough hearing protection is recommended, particularly for track employees with longer periods of exposure, racing fans with only occasional exposure to such noise levels are unlikely to develop a permanent noise-induced hearing loss.
Transantral Endoscopic Repair of Orbital Floor Fractures with the Use of a Flexible Endoscope Holder: A Cadaver Study
Authors: Maturo Stephen C. , Wiseman Joe , Mair Eric
Published: May 2019

We conducted a cadaver study to determine the ease of use and functionality of a flexible endoscope holder in the visualization and repair of orbital floor fractures via a transantral approach. Four fresh cadaver heads were dissected through a sublabial antrotomy incision with a 30° endoscope attached to a flexible holder. An implant was placed to restore the normal anatomy. With the use of this exclusive endoscopic approach, all orbital floor fractures were identified in their entirety and completely reduced with alloplastic material. We conclude that the flexible endoscope holder provides clearer visualization, greater instrument mobility, and an overall superior dissection and placement of implants in the endoscopic repair of orbital floor fractures.
Periorbital Emphysema as a Complication of Functional Endoscopic Sinus Surgery
Authors: Rodriguez Michael J. , Dave Sandeep P. , Astor Frank C.
Published: May 2019

Clinically significant periorbital emphysema is an unusual complication of functional endoscopic sinus surgery (FESS). In most instances, it resolves spontaneously without any serious sequelae. Rarely, it can progress rapidly and become severe enough to cause irreversible blindness. We present and discuss the management of 2 cases of periorbital emphysema after FESS.
The Role of Angiography in Managing Patients with Temporal Bone Fractures: A Retrospective Study of 64 Cases
Authors: Ahmed K. Asif , Alison David , Whatley Wesley S. , Chandra Rakesh K.
Published: May 2019

We conducted a retrospective study of the utility of angiography in the evaluation of patients with temporal bone-fractures. Our study population was made up of 64 patients—58 males and 6 females, aged 14 to 75 years (mean: 35.3)—with a temporal bone fracture who had presented to a level I trauma center over a 1-year period. Records were reviewed and data were obtained on the mechanism of injury; the type of fracture; associated injuries, particularly neurocranial injuries detected on computed tomography (CT) of the head; and any angiographic findings that might have been obtained. The primary outcomes measures were the type of treatment administered (conservative vs. surgical) and mortality. Patients were assigned to 1 of 4 groups according to CT results and angiographic findings, if any: normal CT and no angiogram (group 1; n = 12), abnormal CT and no angiogram (group 2; n = 28), abnormal CT and an abnormal angiogram (group 3; n = 9), and abnormal CT and a normal angiogram (group 4; n = 15). Conservative treatment was administered to all 12 patients in group 1 and to 9 patients (60%) in group 4; surgical treatment was provided to two-thirds of the patients in both group 2 and group 3. Mortality was low in group 1 (n = 0), group 3 (n = 1; 11 %), and group 4 (n = 1; 7%), but high in group 2 (n = 10; 36%). In fact, the key finding of this study was that mortality in the group with an abnormal CT and no angiogram (group 2) was significantly higher than mortality in the group with an abnormal CT and an abnormal angiogram (group 3) (p = 0.02), even though the injuries in the 2 groups were similarly severe and their management was similarly aggressive. We conclude that current guidelines for angiography may need to be expanded to include all patients who have CT evidence of neurocranial injury in order to detect those vascular injuries that need aggressive management and thus lower overall mortality.
Should We Treat Lung Metastases from Adenoid Cystic Carcinoma of the Head and Neck in Asymptomatic Patients?
Authors: Syed Irfan M. , Howard David J.
Published: May 2019

Adenoid cystic carcinoma is a rare malignant tumor that is well known for its deceptively encouraging 5-year survival rate and its dismal survival rate at longer intervals. Controversy exists as to the benefit of regularly following asymptomatic patients to look for distant metastases because even if one is found, the options for further management are limited. When a metastasis is limited to the lung in an asymptomatic patient with no locoregional recurrence, metastasectomy might provide some long-term benefit, although we cannot know for certain. We encountered such a case, and we opted for surgical resection rather than a conservative approach. There is a need for multicenter trials so that the management of such patients, be it active or conservative, can be evidence-based.
Salivary Gland Myoepithelioma with Focal Capsular Invasion
Authors: Gun Banu Dogan , Ozdamar Sukru Oguz , Bahadir Burak , Uzun Lokman
Published: May 2019

Salivary gland tumors that display myoepithelial differentiation exclusively or predominantly are relatively uncommon, and the assessment of malignancy in a myoepithelial tumor can be difficult. We report a case of parotid gland myoepithelioma composed predominantly of spindle cells with focal capsular invasion. The patient was a 65-year-old woman who presented with a painless mass in the right preauricular region. Histologically, the tumor had a solid and multinodular growth pattern and was predominantly made up of spindle cells with a minor component of epithelioid cells with moderate cellular atypia. Focal regions of tumor cells infiltrated the capsule with tongue-like processes, hut tumor infiltration into the adjacent parotid tissue was absent. The tumor cells showed strong cytoplasmic immunoexpression of vimentin, pankeratin, S-100 protein, and smooth-muscle actin. Immunostains with glial fibrillary acidic protein, melanoma marker, epithelial membrane antigen, and carcinoembryonic antigen were negative. Expression of p53 was observed focally in the nuclei of the tumor cells. A final diagnosis of salivary gland myoepithelioma with focal capsular invasion was made, and the case was regarded as a myoepithelial tumor of uncertain malignant potential. In this report, we discuss the histologic criteria required to diagnose malignancy in salivary gland myoepithelial tumors.
Epidemiologic Study to Explore Links between Ménière Syndrome and Migraine Headache
Authors: Gopen Quinton , Viirre Erik , Anderson John
Published: May 2019

Many authors have noted an association between Ménière syndrome and migraine headache. In an attempt to explore a possible link between these two disorders, we performed an epidemiologic study. The National Health Interview Survey (NHIS) includes interviews with tens of thousands of patients annually to estimate the incidence of various diseases. In this study the data collected from the NHIS for the years 1986 to 1988 and 1994 were analyzed to determine the incidence of Ménière syndrome and migraine headache. A total of 423,400 individuals were interviewed over the combined 4 years included in this evaluation. The incidence of migraine headache was calculated at 3.8%, and the incidence of Ménière syndrome was estimated at 0.14%. The incidence of migraine headache inpatients with Ménière syndrome was estimated at 4.5%. The incidence of migraine headache was not substantially elevated in patients with Ménière syndrome when compared to the general population.
Validation of a Pediatric Cough Questionnaire
Authors: Hartnick Christopher J. , Zurakowski David , Haver Kenan
Published: May 2019

We conducted a study to determine if a five-item pediatric cough questionnaire (PCQ) is a valid and reliable means of measuring cough-specific quality of life in children. The five questions, which are answered by the child's parent or caregiver, cover cough frequency (Q1), sleep disturbance of the child (Q2), sleep disturbance of the parent (Q3), cough severity (Q4), and the degree of bothersomeness to the child (Q5). Each of the five items was scored on a 6-point Likert scale. The PCQ was administered three times. The first occurred when the parent telephoned to schedule an appointment for the child at a pediatric pulmonology outpatient clinic for a chief complaint of cough. The second PCQ was administered within 2 weeks of the first but before any treatment had been instituted so that test-retest reliability could be assessed. Each child was then diagnosed and treated in accordance with standard care practices. The third PCQ was administered 3 weeks after the second to determine if it would accurately reflect the parent's perception of how the child's cough had changed following treatment. Also, at the second and third encounters, parents were asked to provide their global assessment of whether their child's cough had improved, worsened, or stayed the same since the previous encounter. The parents of 120 children (70 boys and 50 girls; mean age: 6.8 yr) completed all three PCQs. Test-retest reliability was established (p < 0.001) for each of the five PCQ questions by Spearman correlation analysis (Q1: r = 0.5; Q2: r = 0.38; Q3: r = 0.42; Q4: r = 0.53; Q5: r = 0.5). Other statistical analyses confirmed the PCQ's internal consistency, discriminant validity, and convergent validity. Based on our findings, we conclude that the PCQ is a valid and reliable instrument with which to follow children with chronic cough longitudinally.
Type III Thyroplasty for the Treatment of Glottic Gap in a Patient Undergoing Laryngofissure Cordectomy for Squamous Cell Carcinoma of the Vocal Fold: Technique and Outcome
Authors: Kandogan Tolga
Published: May 2019

A 44-year-old man presented with squamous cell carcinoma (T1aN0M0) on the left vocal fold and was prepared for a combined laryngofissure cordectomy and type III thyroplasty. The author performed both procedures together—not only to lower the tension on the healthy vocal fold, but also to determine whether the thyroplasty would successfully close the glottic gap created by the cordectomy, resulting in relatively fast improvement in the patient's voice. Satisfactory glottic closure and a satisfactory voice result were achieved rather quickly. The patient was satisfied with his new voice, both in the early and late postoperative periods.
Loracarbef (LY163892) vs Amoxicillin/Clavulanate in Bacterial Maxillary Sinusitis
Authors: Sydnor Thomas Austin , Scheld William Michael , Gwaltney Jack , Nielsen Richard W. , Huck Werner , Therasse Donal G.
Published: May 2019

Loracarbef (LY 163892), a β-lactam antibiotic (carbacephem), was compared with amoxicillin/ clavulanate potassium in a 10-day, single-blind, randomized parallel trial in the treatment of acute bacterial maxillary sinusitis. Based on posttherapy aspirate and culture, there was a 95.2% bacteriologic cure rate in patients receiving loracarbef (400 mg twice daily) and an 86.7% cure rate in patients receiving amoxicillin/clavulanate (500/125 mg three times daily) ( p = 0.359). Loracarbef was comparable in efficacy to amoxicillin/clavulanate with a more desirable safety profile.
Pulse Oximetry Monitoring in Patients with Nasal Packing
Authors: Cannon C. Ron
Published: May 2019

Pulse oximetry is a safe, effective method of monitoring for hypoxia in patients with nasal packing. It provides continuous in vivo measurements of the patients’ arterial oxygenation in a non-invasive fashion based on the principles of the hemoglobin dissociation curve.
Chondritis of the Burned Ear: A Review
Authors: Skedros Demetrios G. , Goldfarb I. William , Slater Harvey , Rocco James
Published: May 2019

Seventy-six patients with burns of the ears presented to the Western Pennsylvania Hospital Burn Trauma Center over a three year period. Toprevent chondritis, all ears were treated prophylactically with periauricular hair shaving, daily cleaning, avoidance of pressure dressings and Sulfamylon Burn Cream. Chondritis developed in two patients. Aspects of auricular chondritis prevention and treatment are reviewed. Biology of the disease is discussed.
Contemporary Skin Grafting in Otologic Surgery
Authors: Morris Michael S. , Mitchell Clark C. , Snell Stephen W. , Sperling Neil
Published: May 2019

In the post-operative healing phase following external auditory canalplasty or open cavity mastoidectomy, problematic epithelialization of surfaces may ensue. Exposed surfaces or surface epithelialized with tissues other than skin may predispose to secondary infection and result in recurrent otorrhea. Split-thickness skin grafts can be useful in promoting healing of exposed canal and mastoid cavity surfaces. Our experience and methodology for harvesting and placing these grafts are reviewed. The indications, management, and complications of split-thickness otologic skin grafting will be presented.
Sudden Cardiac Arrest during Adenotonsillectomy in a Patient with Subclinical Duchenne's Muscular Dystrophy
Authors: Benton Nick C. , Wolgat Robert A.
Published: May 2019

We describe a four-year-old boy of Indian descent who had elective adenotonsillectomy for chronic sore throat and partial airway obstruction. About 10 minutes into the procedure, the patient suddenly developed cardiac asystole. After prolonged cardiac resuscitation, recovery was achieved. No permanent neurologic deficits resulted. The child was later found to have a strong family history of Duchenne's muscular dystrophy (DMD) and an elevated serum creatine kinase level documented since shortly after birth. We reviewed several case reports substantiating the risk for cardiac arrest during general anesthesia in DMD patients, and we concluded that DMD is a little-known risk for cardiac arrest during general anesthesia. The otolaryngologist must be aware of this potential complication, because tonsillectomy and adenoidectomy are commonly indicated for children at an age when DMD may be subclinical.
Endoscopic Sinus Surgery with Middle Turbinate Resection: Results and Complications
Authors: Biedlingmaier John F.
Published: May 2019

Numerous articles have been published on the techniques of endoscopic sinus surgery. Fewer articles are available regarding the effectiveness of these procedures in curing the patient's symptoms. A retrospective review of eighty patients was performed to outline their symptoms and determine the success of the surgery. Partial middle turbinate resection was performed in all patients. The high overall success rate of 93.5% and the high antrostomy patency rate of 94.8% demonstrates the benefits of partial resection.
Is Fine Needle Aspiration Biopsy of Salivary Gland Masses Really Necessary?
Authors: Candel Alvaro , Gattuso Paolo , Reddy Vijaya , Matz Gregory , Castelli Melanie
Published: May 2019

The use of fine needle aspirate biopsies (FNAB's) in the outpatient setting has progressively escalated, particularly in the area of head and neck pathology. An increasing percentage of these are for salivary gland masses. We present our experience with salivary gland FNAB's at our institution for four years, from 1988–1992. One thousand and twenty-two (1,022) FNAB's of superficial masses were performed by two pathologists. One hundred sixty-three (15.9%) were salivary gland biopsies. Of these 163 cases, 21 (12.9%) were normal tissue, 77 (47.2%) were inflammatory processes, 50 (30.7%) were benign tumors, and 15 (9.2%) were malignant tumors. None of the aspirates were unsatisfactory. Tissue correlation was possible in 47 (28.8%) cases. Two false negative cases (4.3%) were identified; these were a Warthin's tumor diagnosed as chronic sialoadenitis by FNAB; and a poorly differentiated squamous cell carcinoma diagnosed as adenocarcinoma by FNAB. There were no false positive cases. Overall sensitivity was 95.7% and specificity was 100%.

Our experience indicates that FNAB of salivary glands is an effective screening procedure in evaluating salivary gland masses. The cytologic diagnosis may assist the clinician in allaying patients' anxieties, as well as in further collateral workup prior to definitive therapy.
Esophageal Foreign Body after Smoking Crack Cocaine
Authors: Arrowood John P. , Morrison Winsor V. , Arrowood Kyle B. , Cranston Phillip E.
Published: May 2019

Injuries from cocaine abuse are often seen and have been reported more often with the introduction of crack cocaine. Burns of the upper aerodigestive tract have been reported but no reports of esophageal obstruction have been located. We report ingestion of a foreign body from smoking crack cocaine and our management. A review of other possible aspiration and ingestion injuries is included.
Laryngeal Involvement in Neurofibromatosis
Authors: Willcox Thomas O. , Rosenberg Seth I. , Handler Steven D.
Published: May 2019

Neurofibromas of the larynx are an uncommon component of neurofibromatosis, but should be considered in the differential diagnosis of patients with a submucosal supraglottic mass. Complete surgical excision is the treatment of choice; however, incomplete excision may be preferable to aggressive debilitatingsurgery. Plexiform neurofibromadiffers from non-plexiform neurofibroma in that it is poorly circumscribed and highly infiltrative. Tracheostomymaybe necessary. Sarcomatous degeneration is reportedandcarries a poor prognosis.
Bilateral Laryngoceles
Authors: Thomas D. M. , Madden G. J.
Published: May 2019

The authors present an unusual case of upper airway obstruction due to the presence of bilateral communicating laryngoceles. The use of aspiration techniques on the larger of the laryngoceles resulted in a significant improvement in upper airway function. This improvement avoided the need for a tracheostomy or intubation under potentially hazardous circumstances and allowed the eventual surgery to take place in more controlled conditions.
BAER, EOG, MRI AND 3-D MR Angiography Correlates in a Case of Locked-ln Syndrome
Authors: Benitez Jaime T. , Ernstoff Raina M. , Wang Ay-Ming , Arsenault Michael D.
Published: May 2019

A case of Locked-in syndrome is reported with correlation of BAER and EOG with MRI for localization and identification of brain lesions, and 3-D MRA and 2-D gradient echoMR imaging, a non-invasive newdiagnostic modality for confirmation and visualization of vascular pathology.

There was thrombosis of the basilar artery with extensive infarct of ventral pons and lower mid-brain. The patient had ocular bobbing. This eye movement in its classical formconsists of irregular vertical oscillations, the fast component being downward with complete absence of horizontal eye movements. To our knowledge, the change from ocular bobbing to upbeat nystagmus has not been previously reported in the Locked-in syndrome. Bilateral involvement of the lateral lemniscus might have contributed to its appearance in our patient.