bluuebunny/crossref_metadata_2025 huggingface dataset:
Penetrating Middle Ear Trauma: A Report of 2 Cases
Authors: Neuenschwander Michael C. , Deutsch Ellen S. , Cornetta Anthony , Willcox Thomas O.
Published: May 2019

Penetrating middle ear injury can result in hearing loss, vertigo, and facial nerve injury. We describe the cases of 2 children with penetrating trauma to the right ear that resulted in ossicular chain disruption; one injury was caused by cotton-tipped swabs and the other by a wooden matchstick. Symptoms in both children included hearing loss and otalgia; in addition, one child experienced ataxia and the other vertigo. Physical examination in both cases revealed a perforation in the posterosuperior quadrant of the tympanic membrane and visible ossicles. Audiometry identified a moderate conductive hearing loss in one child and a mild sensorineural hearing loss in the other. Both children underwent middle ear exploration and reduction of a subluxed stapes. We discuss the diagnosis, causes, and management of penetrating middle ear trauma. To reduce the morbidity associated with these traumas, otologic surgeons should act promptly and be versatile in choosing methods of repairing ossicular chain injuries.
Extravascular Papillary Endothelial Hyperplasia of the Larynx: A Case Report and Review of the Literature
Authors: Sezgin Saime , Kotiloğlu Esin , Kaya Handan , Inanli Selçuk
Published: May 2019

Papillary endothelial hyperplasia (PEH), a tumor that falls along the spectrum of reactive to neoplastic vascular lesions, must be diagnosed carefully because it can resemble an angiosarcoma. PEH is generally considered to be the result of an unusual form of thrombus organization, exhibiting excessive papillary endothelial proliferation that is usually confined to the lumen of preexisting vessels or vascular malformations. Most cases of PEH are of the intravascular type; extravascular PEH is rare. We describe what we believe is the first reported case of an extravascular PEH in the larynx.
Fibromatosis Presenting as Acute Mastoiditis: A Case Report
Authors: Kaberos Antonis , Balatsouras Dimitris G. , Vasilakaki Thisvi , Economou Nicolas C. , Leontiadis Anastasios
Published: May 2019

We describe the case of a middle-aged man who presented with manifestations of acute mastoiditis caused by fibromatosis of the mastoid region. A lesion of the right mastoid bone had eroded its wall and extended toward the middle and posterior cranial fossae. The macroscopic and microscopic appearance of an excised portion of the lesion established the diagnosis of mastoid fibromatosis. After a more detailed work-up, a second procedure involving extensive removal of the tumor was performed, and the diagnosis was confirmed. The patient's postoperative period was uneventful, and he showed no evidence of recurrence during 3 years of follow-up.
Nasopharyngeal Carcinoma with Axillary Node Involvement as a Component of Failure following Chemoradiotherapy
Authors: Lee Christopher M. , Hayostek Cherie J. , Abbott Thomas M. , Hathaway Peter B. , Watson Gordon A.
Published: May 2019

We describe the treatment course and imaging correlations in a patient with a unique case of undifferentiated nasopharyngeal carcinoma with axillary lymph node involvement as a component of failure following chemoradiotherapy. To our knowledge, this is the only such case reported in the literature. A preliminary diagnosis of axillary node involvement was based on both positron-emission tomography and computed tomography; these findings were subsequently confirmed by pathologic review following dissection of the node. This case represents a rare presentation of a recurrent nasopharyngeal carcinoma and illustrates the importance of a comprehensive physical examination and correlation with imaging modalities when following these patients over time.
Da Vinci Robot-Assisted Excision of a Vallecular Cyst: A Case Report
Authors: McLeod Ian K. , Melder Patrick C.
Published: May 2019

The da Vinci Surgical System is a new and exciting entrant into the field of robotic technology. This system is undergoing considerable research and is being practically applied in general surgery, cardiothoracic surgery, urology, and gynecology. We have previously described our experience with the da Vinci system in the laboratory setting, and we have reviewed its potential applications in otolaryngology. Here we present a case report of the first da Vinci-assisted excision of a vallecular cyst in a human. Although we initially encountered some difficulties in the setup, we were able to perform the procedure with moderate ease and without complication. The potential of the da Vinci system in otolaryngology is promising. Further research is needed to explore all of its possible uses in our field.
Abnormal Computerized Dynamic Posturography Findings in Dizzy Patients with Normal ENG Results
Authors: Sataloff Robert T. , Hawkshaw Mary J. , Mandel Heidi , Zwislewski Amy B. , Armour Jonathan , Mandel Steven
Published: May 2019

The complexities of the balance system create difficulties for professionals interested in testing equilibrium function objectively. Traditionally, electronystagmography (ENG) has been used for this purpose, but it provides information on only a limited portion of the equilibrium system. Computerized dynamic posturography (CDP) is less specific than ENG, but it provides more global insight into a patient's ability to maintain equilibrium under more challenging environmental circumstances. CDP also appears to be valuable in obtaining objective confirmation of an abnormality in some dizzy patients whose ENG findings are normal. Our review of 33 patients with normal ENG results and abnormal CDP findings suggests that posturography is useful for confirming or quantifying a balance abnormality in some patients whose complaints cannot be confirmed by other tests frequently used by otologists.
Sinonasal Leiomyoma: Report of 2 Cases
Authors: Agarwal A.K. , Bansal Ramanuj , Singhal Deepti
Published: May 2019

Leiomyomas are benign smooth-muscle tumors that are common in the alimentary tract, uterus, skin, and subcutaneous tissue. They are very uncommon in the upper respiratory tract and rare in the nasal cavity and paranasal sinuses. To the best of our knowledge, only 23 such cases have heretofore been published in the literature. We report 2 new cases of sinonasal leiomyoma that originated at different sites in the nasal cavity. We also discuss the various investigative and therapeutic modalities available.
Prevalence of Penicillin Allergy in Adults with Peritonsillar Abscess
Authors: Chandra Rakesh K. , Lee Collin E. , Pelzer Harold
Published: May 2019

We noticed a seemingly high prevalence of penicillin allergy in patients who had been diagnosed with peritonsillar abscess (PTA) at our institution. To formally investigate this observation, we reviewed the emergency room (ER) records of 118 patients who had presented between Jan. 1, 1995, and Dec. 31, 1999, with suspected PTA. A diagnosis of PTA was confirmed by the presence of pus on incision and drainage in 78 of these patients (66.1%). The remaining 40 patients (33.9%) were diagnosed with peritonsillar cellulitis (PTC). Of the 7 8 patients with confirmed PTA, 13 (16.7%) self-reported an allergy to an antibiotic, including 11 (14.1%) who claimed to be allergic to penicillin. In the 40 patients with PTC, the corresponding figures were only 3 (7.5%) and 1 (2.5%). The difference between the PTA and PTC groups with respect to the prevalence of self reported penicillin allergy was statistically significant (p < 0.05). We also compared the prevalence of antibiotic allergies in our patients with that of 1,893 consecutively presenting patients whose records had been entered into a pharmacy database at our institution. We found that the overall prevalence of patient-reported penicillin allergy in our PTA group was similar to that of the database population, although penicillin allergy did account for a greater percentage of all antibiotic allergies (84.6%) in our PTA group than in the larger population (62.8%). In our series, patients with PTA were more likely to have reported an allergy to penicillin than were patients without an abscess. Additionally, the prevalence of patient-reported antibiotic allergy is high at our institution. Although self-reported penicillin allergy may not represent a true hypersensitivity reaction, it can influence antibiotic selection and/or compliance. Prospective studies are needed to determine what influence allergic status and antibiotic choice has on abscess development.
Does Helicobacter Pylori Play a Role in Upper Respiratory Tract Inflammation? A Case Report
Authors: Dinis Paulo Borges , Martins Maria Luz , Subtil João
Published: May 2019

Persistent isolated inflammation of the sphenoid sinus, an entity that is not diagnosed very often, poses a challenge to clinicians and researchers alike. Its features tend to suggest that its etiopathogenesis is different from that of more common forms of chronic rhinosinusitis. We report the case of a 54-year-old woman who had a history of distressing chronic postnasal drip and a globus sensation with opacification of the sphenoid sinus. She was diagnosed with gastroesophageal reflux, and Helicobacter pylori was detected in her gastric contents and in the inflamed mucosa of the sphenoid sinus, as well. Complete symptom relief was achieved only after she had undergone surgical sphenoidotomy and treatment with anti—H pylori medication. We discuss the potential for this ubiquitous gastric bacterium to play a role in at least some forms of chronic sinonasal inflammation.
Simultaneous Contralateral Vestibular Schwannoma and Glomus Jugulare Tumor: A Case Report
Authors: Moumoulidis Ioannis , Brewis Clive , Moffat David A.
Published: May 2019

To the best of our knowledge, only 3 cases of a simultaneous vestibular schwannoma and a glomus jugulare tumor have been previously reported in the literature. In all 3 cases, the lesions were located on the same side. We report a new case of simultaneous vestibular schwannoma and glomus jugulare tumor that is unique in that the two lesions arose on opposite sides. The glomus tumor was treated with embolization followed by radiotherapy, while the schwannoma was managed via radiologic observation.
Endoscopic Ligation of the Sphenopalatine Artery as a Primary Management of Severe Posterior Epistaxis in Patients with Coagulopathy
Authors: Shah Anand G. , Stachler Robert J. , Krause John H.
Published: May 2019

We describe our experience with endoscopic ligation of the sphenopalatine artery in the treatment of severe posterior epistaxis in 2 patients with coagulopathy. Conservative treatment had failed in both cases. The key elements of this procedure are the identification of the branches of the sphenopalatine artery via an endoscopic endonasal approach and the application of two titanium clips under direct vision. This procedure was successful in both patients, and we recommend it in selected cases.
Pneumomediastinum, an Unusual Complication of Facial Trauma
Authors: Monksfield Peter , Whiteside Olivia , Jaffé Susan , Steventon Nick , Milford Chris
Published: May 2019

Pneumomediastinum is often an incidental finding following a blunt or penetrating trauma to the neck or chest. We report a rare case of pneumomediastinum following an isolated facial trauma that was diagnosed on imaging. We also review the clinical signs of this condition, its radiologic characteristics, and the 18 previously reported cases of pneumomediastinum following facial trauma.
Minimally Invasive Surgery for Parotid Pleomorphic Adenoma
Authors: Witt Robert L.
Published: May 2019

Compared with total parotidectomy and complete superficial parotidectomy for the removal of a parotid pleomorphic adenoma, partial superficial parotidectomy with dissection and preservation of the facial nerve—defined as the excision of a tumor with a 2-cm margin of normal parotid parenchyma except at the point where the tumor abuts the facial nerve—is associated with a lower incidence of transient facial nerve dysfunction, facial contour disfigurement, and subsequent Frey's syndrome. The partial procedure is not associated with any increase in recurrence, and it requires less operating time. The author hypothesized that the use of this procedure to remove a benign pleomorphic adenoma might result in even less morbidity (transient or permanent facial nerve dysfunction, facial contour disfigurement, Frey's syndrome, and hypoesthesia) without increasing the risk of recurrence if only a 1-cm margin of normal parotid parenchyma was removed and if the posterior branches of the great auricular nerve were preserved. To test this hypothesis, the author conducted a retrospective study of 30 patients—15 who had undergone the standard partial procedure (2-cm margin with great auricular nerve sacrifice) and 15 who had undergone the modified version (1-cm margin with great auricular nerve preservation). After a mean follow-up of 10 years, there were no significant differences between the two groups in terms of facial nerve dysfunction, facial contour disfigurement, Frey's syndrome, and recurrence. Moreover, preservation of the posterior branches of the great auricular nerve did not prevent alterations in sensitivity (i.e., hypoesthesia) in 7 of the 15 patients (46.7%). Although a 1-cm area of normal parotid parenchyma around a benign pleomorphic adenoma was a safe margin, it was no better than a 2-cm margin in terms of morbidity and recurrence. Preservation of the posterior branches of the great auricular nerve will result in an objective reduction in hypoesthesia in approximately half of patients, but because it does not ensure freedom from sensitivity alterations in all cases, patients should be advised of the risk of postoperative numbness in the earlobe and the infraauricular area.
Recurrent Polymorphous Low-Grade Adenocarcinoma Manifesting as a Sinonasal Mass: A Case Report
Authors: Charous Daniel D. , Cunnane Mary F. , Rosen Marc R. , Keane William M.
Published: May 2019

Polymorphous low-grade adenocarcinoma (PLGA) is a malignant neoplasm that tends to follow a benign clinical course. Recurrences are uncommon. We report a case of recurrent PLGA of the paranasal sinuses that manifested as a large mass that filled the entire nasal cavity and left maxillary sinus. To our knowledge, this is the first reported case of a recurrent PLGA of the paranasal sinuses.
Xanthogranulomatous Sialadenitis: A Case Report and Literature Review
Authors: Cocco Amy E. , MacLennan Gregory T. , Lavertu Pierre , Wasman Jay K.
Published: May 2019

Xanthogranulomatous tissue reaction is an uncommon but well-documented process that occurs at many sites in the body. It is most often recognized in the kidney and gallbladder, where its etiology is believed to involve an outflow obstruction. We report the case of a man with a parotid mass that exhibited features consistent with an inflammatory process on fine-needle aspiration biopsy. The mass persisted despite medical management, and the patient subsequently underwent a superficial parotidectomy. Histologic examination of the resected specimen identified a xanthogranulomatous tissue reaction adjacent to a Warthin's tumor. We compare the features of this case with those of the 2 previously reported cases of xanthogranulomatous sialadenitis, and we discuss its possible etiologies.
Diagnostic Accuracy of Palpation-Guided and Image-Guided Fine-Needle Aspiration Biopsy of the Thyroid
Authors: Goudy Steven L. , Flynn Michael B.
Published: May 2019

We conducted a retrospective study to compare the sensitivity and specificity of traditional palpation-guided fine-needle aspiration biopsy (FNAB) performed by clinicians and pathologists with that of image-guided FNAB performed by radiologists for the evaluation of thyroid nodules. We reviewed the medical records of 89 patients who had undergone thyroid FNAB and subsequent surgical excision and pathology. Of this group, 58 patients had undergone palpation-guided FNAB performed by a clinician, 20 had undergone palpation-guided FNAB performed by a pathologist, and 11 had undergone image-guided FNAB performed by a radiologist. The sensitivity of the three techniques was 86, 100, and 100%, respectively, and the specificity was 78, 94, and 44%; there were no statistically significant differences in sensitivity or specificity among the three groups. Our data indicate that FNAB of the thyroid can be performed with equal reliability by clinicians, pathologists, and radiologists.
Angiolipoma of the Neck: A Case Report
Authors: Saydam Levent , Bozkurt Mete Kaan , Ugur Mehmet Birol , Ozcelik Tuncay , Kutluay Lale
Published: May 2019

Angiolipomas of the neck are extremely rare; to our knowledge, only 2 cases have been previously reported. We report a new case, which occurred in a 28-year-old woman. The mass was totally resected, and the patient showed no recurrence at the 18-month follow-up.
The Effect of Stapedotomy on Tinnitus in Patients with Otospongiosis
Authors: da Silva Lima Adriana , Sanchez Tanit Ganz , Marcondes Renata , Bento Ricardo Ferreira
Published: May 2019

Stapedotomy is primarily performed to treat hearing loss secondary to otospongiosis, although some patients find that the accompanying tinnitus is more bothersome than the hearing loss. We prospectively studied 23 consecutive patients with tinnitus secondary to otospongiosis who had undergone stapedotomy, and we compared their pre- and postoperative medical and audiologic findings. Patients annoyance with their tinnitus was quantified by means of a visual analog scale, and their air-conduction thresholds were determined by measurements of a 4-frequency pure-tone average (0.5, 1, 2, and 4 kHz). Statistical analysis was performed using the paired Student's t test and Fisher's exact test. In the group as a whole, the mean tinnitus annoyance visual analog scores were 8.34 preoperatively and 1.56 postoperatively, a highly significant difference. Clinically, 22 of the 23 patients (95.7%) achieved satisfactory control of their tinnitus (improvement or complete resolution) following stapedotomy. With respect to hearing loss, all patients clinically improved postoperatively, and audiometry confirmed improvement at all 4 frequencies between 0.5 and 4 kHz. An air-bone gap of less than 10 dB was noted in 17 patients (73.9%). We conclude that in addition to improving hearing, stapedotomy also provides good control of tinnitus.
Leiomyosarcoma of the Larynx: A Case Report
Authors: Abbas Akbar , Ikram Mubasher , Yaqoob Nausheen
Published: May 2019

Leiomyosarcoma of the larynx is an extremely rare neoplasm; only about 50 cases have been reported in the English-language literature. We report a new case of laryngeal leiomyosarcoma in a 65-year-old man. The metastatic work-up was negative, and the patient underwent total laryngectomy. He remained disease-free 12 months postoperatively.
Endoscopic Resection of a Venous Hemangioma of the Optic Nerve Sheath
Authors: Monin Daniel L. , Blumner Kate , Cohen Noam A. , Brooks John S.J. , Chen Chien , Kennedy David W.
Published: May 2019

We describe a case of a venous hemangioma that arose in the optic nerve sheath of the orbital apex in a 28-year-old man who presented with progressive vision loss. To the best of our knowledge, this is the first reported case of a venous hemangioma occurring at this location. A definitive diagnosis and partial excision was achieved via an endoscopic transsphenoethmoid approach with interactive, computer-assisted, frameless stereotactic surgical navigation. The intervention resulted in minimal morbidity, demonstrating yet again that this surgical approach is a safe and effective way to treat lesions of the orbital apex.
Acinic Cell Carcinoma of the Parotid Gland: A 15-Year Review Limited to a Single Surgeon at a Single Institution
Authors: Kim S. Alex , Mathog Robert H.
Published: May 2019

The course of acinic cell carcinoma of the parotid gland following surgical and nonsurgical interventions is variable. The objective of this study was to report our experience in treating this disease and to evaluate the factors that might be involved in the treatment of the tumor and the prognosis of the patient. To limit the contributory variables that are usually found in most studies, we included only those patients (n - 11) who had been treated by a single surgeon at a single institution from 1988 through 2003. Hospital and office records were evaluated for demographic information, signs and symptoms, treatment modalities, pathology, and outcomes. Additional follow-up data were obtained through telephone interviews. For the most part, treatment included either superficial parotidectomy or total parotidectomy with facial nerve preservation; 1 patient with coexisting adenocarcinoma underwent a more radical procedure, and 4 patients underwent adjuvant radiation therapy. The most prevalent morphologic pattern of these tumors was microcystic. Follow-up ranged from 1 year and 3 months to 10 years and 9 months (mean: 4 yr and 11 mo). During that time, we found no recurrences of acinic cell carcinoma and no evidence of metastatic disease. Therefore, we conclude that acinic cell carcinoma can be successfully treated with a superficial or total parotidectomy with sparing of the facial nerve. Radiation therapy may provide adjunctive benefit.
A Study of Prognostic Factors in Sudden Hearing Loss
Authors: Mamak Aydin , Yilmaz Süleyman , Cansiz Harun , Inci Ender , Güçlü Ender , Dereköylü Levent
Published: May 2019

We investigated the prognostic significance of the presence or absence of vertigo and tinnitus, the timing of the initiation of treatment, the type and severity of hearing loss, and age in 72 patients who had experienced sudden hearing loss. We found that the factors associated with a positive prognosis were the absence of vertigo, the presence of tinnitus, initiation of treatment within 7 days, a greater degree of hearing loss in the low frequencies, and a hearing loss of less than 45 dB. Age had no effect on prognosis.
Surgical Emphysema following Tonsillectomy
Authors: Patel Nitesh , Brookes Gerald
Published: May 2019

Complications of tonsillectomy have been well documented. However, subcutaneous emphysema of the neck following tonsillectomy has rarely been described. We report a case of this complication in a young man who forcefully performed Valsalva's maneuver following a tonsillectomy.
Adenoid Cystic Carcinoma of the Salivary Glands: A 20-year Review with Long-Term Follow-Up
Authors: Khafif Avi , Anavi Yakir , Haviv Jacob , Fienmesser Rafael , Calderon Shlomo , Marshak Gideon
Published: May 2019

The behavior of adenoid cystic carcinoma (ACC) of the salivary glands has been shown to be unpredictable in terms of local and distant spread and mortality. We retrospectively studied 35 operations in 34 patients who had had a pathologic diagnosis of ACC of the salivary glands and who had been treated over a 20-year period and followed for a minimum of 10 years. We analyzed the effect that different factors had on outcomes. The site of origin appeared to be an important factor in survival rates; survival among patients with tumors that had originated in the parotid gland was fairly good, while survival among those with tumors that originated in the minor salivary glands was significantly worse. TNM staging was another significant factor in survival. Other poor prognostic indicators were local spread, nodal positivity, distant metastasis, and local and regional recurrence. Radiation and chemotherapy did not appear to be beneficial for patients with advanced disease. We recommend radical surgery with complete resection for all patients with ACC of the salivary glands and a careful assessment of the neck in patients with minor salivary gland tumors.
Preoperative Computed Tomography May Fail to Detect Patients at Risk for Perilymph Gusher
Authors: McFadden Michael D. , Wilmoth Jason G. , Mancuso Anthony A. , Antonelli Patrick J.
Published: May 2019

Perilymph gusher (PG) is a very rare occurrence that can lead to an adverse outcome during inner ear surgery. In the absence of a family history of X-linked mixed deafness syndrome, surgeons may have difficulty determining if a patient is at risk preoperatively. Radiographic imaging is often performed in an attempt to identify such a possibility, but there are few data to support the value of negative studies. We conducted a retrospective study of 3 cases of PG in which findings on preoperative high-resolution computed tomography (CT) of the temporal bone had been interpreted as normal. We reviewed these CTs to discern if they did in fact demonstrate any abnormalities that might have indicated a risk of PG, and we found that the original radiologist had missed a dilated internal auditory canal and a deformity of the cochlear modiolus in the affected ear of 1 of these patients. No abnormality was detected on review of the CTs of the other 2 patients. Therefore, we conclude that negative CT findings do not necessarily rule out a risk of PG.
Intraoperative use of Mitomycin C in Fibrous Atresia of the External Auditory Canal
Authors: Battelino Saba , Hocevar-Boltezar Irena , Zargi Miha
Published: May 2019

The ability of mitomycin C to inhibit fibroblasts in vitro has prompted its use during standard surgical procedures as a means of preventing the development of adhesions and stenosis. We conducted a prospective study to evaluate the effectiveness of topical mitomycin C in maintaining an open external auditory canal in 6 ears of 4 patients with aural fibrotic atresia who were undergoing meatoplasty. During the procedure, we applied 1 ml of mitomycin C (0.4 mg/ml)for 4 minutes to the external auditory canal (in 1 case, mitomycin C was reapplied to an ear 1 month later). Between 3 and 14 months postoperatively, the patency of the ear canal was assessed visually and hearing was evaluated audiometrically. Adequate patency was achieved in 5 of the 6 ears (83.3%), and the air-bone gap in these 5 ears had improved to 10 dB or less. No postoperative complications or sensorineural hearing loss was observed. In this very limited number of cases, we found that the intraoperative use of mitomycin C appeared to have been helpful in preventing scarring in both congenital and secondary fibrotic atresias of the external auditory canal. These preliminary results are encouraging, and a prospective, placebo-controlled study appears to be warranted.
An Alternative to a Postnasal Pack for the Arrest of Perioperative Hemorrhage following Curettage Adenoidectomy
Authors: Savage Julian , Pace-Balzan Albert
Published: May 2019

Controlling bleeding with standard postnasal packing following curettage adenoidectomy is only occasionally warranted. Children find the packing experience unpleasant, and removal of the packing usually requires general anesthesia. We describe a simple technique for packing the nasopharynx with bilateral nasal tampons via an anterior approach. The tampons are much easier to insert than standard packing, they are well tolerated while in place, and they can be easily removed with perhaps only some light sedation rather than general anesthesia.
Polymorphous Low-Grade Adenocarcinoma at the Base of the Tongue: An Unusual Location
Authors: Tincani Alfio J. , Altemani Albina , Martins Antonio S. , Barreto Gilson , Valério João B. , Del Negro André , Araújo Priscila P.C.
Published: May 2019

Polymorphous low-grade adenocarcinoma (PLGA) is a malignant neoplasm of low aggressiveness that occurs almost exclusively in the minor salivary glands, primarily those in the palate. We report a case of PLGA that arose in the base of the tongue and subsequently metastasized to the neck. The tumor was resected through the oral cavity with wide margins and dissection. The neck metastasis was treated with radical neck dissection and radiotherapy. The patient recovered and remained disease-free at follow-up 30 months later. This case shows that PLGA, which has a variable morphologic appearance, can occur at sites other than the salivary glands.
Surgical Management of Intracranial Complications of Otogenic Infection
Authors: Bento Ricardo , de Brito Rubens , Ribas Guilherme Carvalhal
Published: May 2019

We conducted a prospective study of 24 patients to evaluate the evolution of intracranial complications resulting from otogenic infection and to correlate the course of the disease with surgical treatment. Almost half of the patients were younger than 18 years, and most were male. The most common intracranial complication was brain abscess, followed by meningitis, lateral sinus thrombosis, and extradural abscess. Cholesteatoma was found in 14 patients. After the complications were confirmed by computed tomography, initial treatment consisted of intravenous systemic antibiotics followed by mastoid surgery. The surgical approach was determined by the type of ear disease, not by the type of neurologic complication. Modified radical mastoidectomy was performed in 16 patients, tympanomastoidectomy in 6, and myringotomy in 2. No significant morbidity, mortality, recurrence, or residual neurologic deficit was observed at the 6-month follow-up. Early surgical intervention is important in achieving positive outcomes in patients with such intracranial complications.
Multimodality Approach to Sinus and Nasal Disorders: Results of Treatment as Determined by a Patient Survey
Authors: Lanfranchi Paul V. , Brigandi Laurie A. , Becker Samuel S. , Becker Daniel G.
Published: May 2019

Patients with sinus and nasal disorders whose symptoms persist despite primary care may benefit from a referral to a dedicated nose and sinus center where all treatment modalities are available. The essential principle of a multimodality approach is that medical therapy, allergy treatment, and surgery are all important and useful tools. While various medical and surgical treatments of sinus and nasal disorders have been well described in the literature, overall assessments of comprehensive treatment are uncommon. For more than 7 years, the office practice of the senior author (D.G.B.) has been dedicated to the treatment of sinus and nasal disorders. In an effort to assess the results of the multimodality approach to therapy delivered there, we mailed questionnaires to 1,800 patients who had been treated at this practice over a 3-year period. Responses from 222 of these patients revealed that patients required less medication following treatment with a multimodality approach and that they expressed a high degree of satisfaction with the comprehensive care they received. In addition, most patients with asthma experienced relief of their asthma symptoms following treatment for sinonasal disease. We conclude that a stepwise, multimodality, specialty-center approach to treatment is beneficial for patients with persistent sinonasal disorders.
Transseptal Suture to Secure Middle Meatal Spacers
Authors: Hockstein Neil G. , Bales Christina B. , Palmer James N.
Published: May 2019

Middle meatal spacers are used by many sinus surgeons to aid postoperative care. Aspiration of a spacer is a concern. We demonstrate a novel method of securing spacers with a transseptal suture to prevent aspiration. We fashion each spacer from a powder-free, nonlatex glove finger that is packed with a Merocel sponge. The open end of the finger is closed with 2-0 Prolene sutures. For a bilateral procedure, the needle is left attached to one of the spacers. A spacer is placed in each ethmoid cavity, the attached needle is passed through the anterior cartilaginous septum, and the suture is tied to the suture on the opposite spacer. For unilateral procedures, the suture on the single spacer is passed to the contralateral side and tied on itself. One week later, the transseptal suture is cut and the spacers are removed. We performed this procedure on 78 patients who had undergone total ethmoidectomy. None of the spacers migrated during the 1 week they were in place. One patient complained of pain during removal of a spacer. During follow-up of 2 to 10 months, we found no evidence of injury to the septum at the site of the transseptal suture. We conclude that the transseptal suture is a safe and cosmetically superior method of securing middle meatal spacers.
Congenital Laryngeal Saccular Cyst: Report of a Case in an Infant
Authors: Prasad Kishore Chandra , Ranjan Ramakrishna Kadri , Agarwal Salil , Prasad Sampath Chandra , Bhat Jayalaxmi
Published: May 2019

Respiratory obstruction and stridor in infants and children are not uncommon. A rare cause of these life-threatening symptoms is congenital saccular cyst. An accurate diagnosis of saccular cyst can be made by eliciting a good history, by endoscopic visualization of the lesion, and by computed tomography. Endoscopic excision is the preferred treatment for infants, whereas an external approach is reserved for older children. It can be difficult for anesthetists to intubate infants when the anatomy of the larynx is distorted, but the choice of tracheotomy for an infant has many drawbacks as well. We discuss the clinical presentation and management of a 3-month-old boy who was brought to us with a congenital laryngeal saccular cyst.
Safety and Efficacy of Sofenz Ceruminolytic Solution
Authors: Midani Aiman , Carels Inez , Marks Michael , Wall Michael ,   Ear Wax Removal Solution Study Team, Monoyer André , Michaux Jean-Paul , Snel Frédéric , Badot Jean-Louis , Eeckhout Emmanuel , Gillet Annie , Bolly Fernand , Wiame Pascal , Halford Guy , Hofer Christiane , Brickmanne Bernard , Poncelet Etienne , Gorller Brigitte , Vassart Serge
Published: May 2019

We conducted an open-label study of 109 untreated patients who had excessive or impacted cerumen. Our goal was to evaluate the safety and efficacy of Sofenz Cerumenolytic Solution, a methyltrypsin-containing earwax removal solution. Each patient's external auditory canal was filled with Sofenz for 15 minutes. The primary measure of efficacy—visibility of the tympanic membrane—was assessed after the solution had been drained from the canal and again after the canal had been irrigated with lukewarm water. If the tympanic membrane was not completely visible following either application, the procedure was repeated. A safety examination was conducted 1 to 3 days after treatment. Secondary outcomes measures included relief of otologic symptoms (e.g., hearing loss, tinnitus, etc.) and patients’ overall satisfaction with treatment. Immediately after treatment, we found that the external auditory canal was completely visible in 81 patients (74.3%) after 1 application of Sofenz and subsequent irrigation, and in 98 patients (89.9%) after 2 applications of each. At the safety follow-up visit, we determined that the number of otologic symptoms had declined by 93.2%. A self-reported assessment completed by each patient following the procedure revealed a high degree of satisfaction with treatment. A total of 58 adverse events were reported, but only 16 were directly related to treatment, and all were transient and either mild or moderate. We conclude that 1 or 2 applications of Sofenz followed by irrigation with lukewarm water is a safe, well-tolerated, and effective treatment for excessive or impacted cerumen in the external auditory canal.
Combined Therapy in the Treatment of Auricular Keloids
Authors: Yencha Myron W. , Oberman James P.
Published: May 2019

Management of earlobe keloids is still controversial. Many different treatment modalities have been employed; however, no single approach has been completely successful. We used combination therapy that included compression therapy, laser excision, and serial steroid injection, which has improved our therapeutic outcomes for earlobe keloids.
Primary Laryngeal Lymphoma: Case Report
Authors: Word Ronnie , Urquhart Andrew C. , Ejercito Victor S.
Published: May 2019

Extranodal laryngeal lymphoma is extremely rare. We report a case of primary laryngeal lymphoma in a 76-year-old man who had presented with a 7-week history of progressive hoarseness. Laryngoscopy revealed asymmetry of the right false vocal fold. Pathology of a deep biopsy specimen identified a malignant, diffuse, CD20-positive, B-cell lymphoma. The stage IE lymphoma completely resolved after treatment with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) and rituximab. Despite its relative rarity, the consequences of a missed diagnosis warrant vigilance for this type of laryngeal tumor.
Unusual Paratracheal Masses Presenting with Vocal Fold Paralysis
Authors: Reiter Evan R. , Idowu Michael O. , Powers Celeste N.
Published: May 2019

Most paratracheal masses are of thyroid origin. We describe two cases of vocal fold paralysis that were caused by unusual paratracheal masses. In one case, a 35-year-old man was found to have a malignant lymphoma that originated in the mediastinum and extended above the clavicle. The other patient was a 53-year-old man with an enlarged left thyroid lobe, tumor invasion of the adjacent larynx and trachea, and multiple pulmonary nodules all due to adenoid cystic carcinoma. Unusual paratracheal masses presenting with vocal fold paralysis may mimic thyroid malignancies, thereby posing both diagnostic and therapeutic challenges. Fine-needle aspiration cytology is often helpful in making a definitive diagnosis, but incisional biopsy is necessary in some cases.
A Study of the Effects of Cellular Telephone Microwave Radiation on the Auditory System in Healthy Men
Authors: Mora Renzo , Crippa Barbara , Mora Francesco , Dellepiane Massimo
Published: May 2019

We conducted a study of the effects of mobile cellular telephone microwave radiation on the auditory system in 20 healthy men. After the subjects underwent baseline measurements of transient evoked otoacoustic emission (TEOAE) and auditory brainstem response (ABR), they participated in three sessions of exposure to an electromagnetic field of 900 to 1,800 MHz produced by a cellular phone. Sessions ranged from 15 to 30 minutes in length. TEOAE and ABR were again measured after or during each exposure. Throughout the study, no significant changes in either measurement were noted. We conclude that the use of cellular phones does not alter the auditory system in the short term.
An Unusual Site of a CSF Leak following Resection of a Retrosigmoid Acoustic Neuroma
Authors: Ondik Michael P. , Benson Aaron G. , Djalilian Hamid
Published: May 2019

Cerebrospinal fluid (CSF) leaks may occur after acoustic neuroma resection. These leaks are usually the result of an iatrogenic injury during removal. The retrosigmoid approach is commonly associated with leaks that occur through the lateral end of the internal auditory canal, through the perilabyrinthine cells extending to the region of the internal auditory canal, or through the retrosigmoid air cells. We describe a case of an infracochlear CSF leak that developed following the retrosigmoid resection of an acoustic neuroma. To the best of our knowledge, this leak was unique for both its location and etiology.
Isolated Cementoossifying Fibroma of the Ethmoid Bulla: A Case Report
Authors: Yilmaz Ismail , Bal Nebil , Ozluoglu Levent N.
Published: May 2019

Cementoossifying fibroma is a rare nonodontogenic tumor of the periodontal membrane that arises from the mesodermal germ layer. This nonneoplastic, locally destructive tumor has occurred as an osseous lesion in the mandible, the maxilla, the zygoma, all the paranasal sinuses, and the orbital and petromastoid regions. It has occurred as an extraosseous lesion in the gingiva and the auricle. The diagnosis requires correlating a variety of clinical, radiologic, and histologic factors. The recurrence rate is high, particularly for lesions in the paranasal sinuses. Surgical management via a local excision as wide as possible is suggested. We describe the case of a 32-year-old woman with an isolated cementoossifying fibroma of the right ethmoid bulla, and we review the diagnosis, differential diagnosis, and management of this tumor.
Sinonasal Lymphoma: A Case Report
Authors: Kamath M. Panduranga , Kamath Gurudath , Bhojwani Kiran , Pai Mukhta , Shameem Ahamed , Agarwal Salil
Published: May 2019

Sinonasal lymphomas are uncommon malignancies. They are difficult to differentiate from carcinomas, and immune-histochemistry is needed to make the diagnosis. We describe an unusual case of a T cell lymphoma that involved only the paranasal sinuses in a middle-aged man. The patient presented with a complete loss of vision in one eye and lateral rectus muscle palsy, but no nasal symptoms.
Supracricoid Partial Laryngectomy as a Primary Treatment for Carcinosarcoma of the Larynx
Authors: Luna-Ortiz Kuauhyama , Mosqueda-Taylor Adalberto
Published: May 2019

Carcinosarcoma of the larynx is uncommon. When it does occur, its clinical features resemble those of sarcomatoid carcinoma, and its biologic behavior is similar to that of malignant mesenchymal neoplasms. We describe 2 cases of carcinosarcoma of the glottis. The tumors were staged as T3N0M0 and T2N0M0. Both patients were treated with supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Eight months postoperatively, 1 of the 2 patients experienced a recurrence of the sarcomatous component of the tumor, and he underwent a total laryngectomy. The other patient remained free of disease at 12 months of follow-up. We conclude that supracricoid partial laryngectomy may be offered as an organ-preserving measure even in patients with sarcomatous disease; total laryngectomy can be held in reserve as a rescue measure. Patients must be closely monitored for early detection of recurrence. The role of adjuvant therapy for sarcomatous neoplasms in this area has not yet been clearly established.
Nasal Septal Perforation Secondary to Rhinitis Medicamentosa
Authors: Keyserling Harold F. , Grimme John D. , Camacho Daniel L.A. , Castillo Mauricio
Published: May 2019

Nasal septal perforation is a rarely reported complication of rhinitis medicamentosa. We describe such a complication in a 54-year-old man, and we discuss the clinical, pathologic, and imaging aspects of this case.
Development of Nasal Skin Necrosis associated with Rituximab Treatment for Waldenström's Macroglobulinemia and Subsequent Spontaneous Resolution
Authors: Pearlman Aaron N. , Fechner Frank P. , Constantinides Minas
Published: May 2019

We report the unusual case of a 72-year-old man who developed acute and extensive necrosis of the nasal skin and soft-tissue envelope while undergoing chemotherapy for Waldenström's macroglobulinemia, a lymphoproliferative disorder. The patient's treatment involved infusions of rituximab, a chimeric monoclonal antibody that is directed against B cell surface membrane protein CD20. The patient refused surgery to restore the nose, and he was treated conservatively with wet-to-dry dressings and antibiotic ointment. Approximately 5 weeks after admission, the eschar had exfoliated, revealing that the underlying skin was pink and healthy; no significant areas of necrosis remained. Within weeks, the nose had healed completely without scarring. A good aesthetic result was achieved exclusively through healing by secondary intention. We wish to alert the medical community that (1) conservative management of even extensive nasal skin loss should be considered when clinically acceptable, and (2) there may be an association between anti-CD20 antibody therapy for Waldenström's macroglobulinemia and skin necrosis.
Extra Medullary Plasmacytoma of the Nasal Cavity: Treatment Perspective in a Developing Nation
Authors: Grover Nancy , Chary Geetha , Makhija Purnima , Rout Pritilata
Published: May 2019

Extramedullary plasmacytomas are uncommon tumors, with a worldwide annual incidence of 3 per 100,000 population. They account for 1% of all tumors of the head and neck and 4% of all nonepithelial tumors of the nasal tract. A variety of treatment options has been suggested. These treatments vary according to the site of presentation, the presence of locoregional spread, and the histologic picture. Radiotherapy has been widely used as a treatment modality, but little has been written about surgery as a single management modality. However, such an option assumes importance in a developing nation, where patient follow-up is erratic and treatment costs must be kept low. We discuss the feasibility of surgery in such a circumstance, and we describe our surgical treatment of a case of extramedullary plasmacytoma in an elderly woman who presented to our hospital in India.
Sialoblastoma: A Rare Submandibular Gland Neoplasm
Authors: Verret D.J. , Galindo Rene L. , DeFatta Robert J. , Bauer Paul W.
Published: May 2019

A sialoblastoma is a rare congenital epithelial tumor that arises in a major salivary gland. To our knowledge, only 24 cases of sialoblastoma have been previously reported in the English-language literature. We report a new case, that of a 15-month-old boy who presented with a submandibular mass. Surgical excision of the mass was undertaken. Intraoperatively, the mass appeared to be adjacent to the submandibular gland, but it had not invaded it. The mass was excised, and the submandibular gland was left in place. Pathology identified the tumor as a sialoblastoma. However, pathology also revealed that residual tumor was present at the surgical margin. The patient was returned to the operating room for excision of the left submandibular gland and the level I lymph nodes. Following revision surgery, the surgical margins were negative. The patient remained disease-free at the 1-year follow-up. Despite the need for revision surgery, this case provides support for the idea that surgery alone is sufficient for curative treatment.
Aberrant Thymus and Parathyroid Gland Presenting as a Recurrent Lateral Neck Mass: A Case Report
Authors: Daneshbod Yahya , Banani Abbas , Kumar Perikala V.
Published: May 2019

We report an interesting case of a recurrent left lateral neck mass in a 6-year-old boy. When the tumor failed to disappear after a course of antibiotic therapy, it was excised. Histologic study revealed that the encapsulated mass contained a parathyroid gland embedded within a histologically normal thymus. The presence of thymic and parathyroid tissue within a single capsule supports the idea that these two structures have a common embryologic origin. The combination of thymic and parathyroid tissue in a neck mass in a patient so young is rarely reported.
Primary B Cell Lymphoma of the External Auditory Canal
Authors: Hersh Sheldon P. , Harrison Winston G. , Hersh David J.
Published: May 2019

Temporal bone lymphomas are rare and typically metastatic neoplasms. We describe a case of primary B cell lymphoma that originated in the external auditory canal of an elderly woman. The diagnosis was based on histopathologic examination supplemented by immunophenotypic analysis. The patient was treated with external-beam radiation and remained disease-free throughout 9 years of follow-up. We also point out that the presence of non-Hodgkin's lymphoma in an unusual site may be an indication that the patient has an acquired immunodeficiency syndrome.
Fibrous Dysplasia of the Frontal Bone
Authors: Hempel John M. , Karkos Petros D. , Issing Wolfgang J.
Published: May 2019

Fibrous dysplasia typically occurs inpatients between the ages of 5 and 15 years. We report the case of a middle-aged woman with longstanding monostotic fibrous dysplasia who responded well to conservative treatment. She had presented with a very long (15 yr) history of frontal headache and pressure over the frontal sinus. On examination, a protuberance was noted in the region of the right frontal sinus. No other symptoms were evident, and findings on the ENT examination were normal. Computed tomography (CT) detected a widening of the frontal bone with osteolytic changes of the cancellous bone of the diploë. Partial multiphase skeletal scintigraphy and single-photon emission CT of the cranium showed increased bone metabolism in the area of the right frontal bone. No other hot spots were seen. In view of the absence of any complications, no tissue biopsy was performed. The patient was prescribed bisphosphonates for symptom relief. Follow-up CT 1 year later revealed no progression of the lesion. Overtreatment of fibrous dysplasia should be avoided because most patients respond to conservative management. In those cases that are refractory to medical treatment, surgery—in experienced hands—can result in a good functional and cosmetic outcome.