bluuebunny/crossref_metadata_2025 huggingface dataset:
Polymorphous Low-Grade Adenocarcinoma of the Parotid Gland
Authors: O'Rourke Ashli K. , Gourin Christine G. , Wade Zane K. , Hessler Richard B.
Published: May 2019

Polymorphous low-grade adenocarcinoma (PLGA) of the parotid gland is rare. We describe a new case in which the patient underwent parotidectomy only to experience an extensive recurrence 2 years later. The recurrence was treated with radical surgical excision and radiation therapy, and the patient remained disease-free at 5 years of follow-up. We also review the literature on primary parotid PLGA.
A Third Branchial Pouch Cyst Presenting as a Lateral Neck Mass in an Adult
Authors: Charous Daniel D. , Charous Matthew T. , Cunnane Mary F. , Spiegel Joseph R.
Published: May 2019

Anomalies of the branchial apparatus occur with some frequency in the adult and pediatric populations. Branchial anomalies are most often derivatives of the first or second pouch. Branchial anomalies involving the third pouch may present as cysts, sinuses, fistulas, and ectopic glands. They are relatively rare, and they respond well to surgical removal. We report the case of a 53-year-old woman who was referred to us for evaluation of a persistent left upper neck mass. The patient had no history of a cervical mass as a child or young adult. The mass was excised uneventfully, and the final pathology revealed a normocellular parathyroid gland and thymic tissue.
Secretions, Occlusion Status, and Swallowing in Patients with a Tracheotomy Tube: A Descriptive Study
Authors: Donzelli Joseph , Brady Susan , Wesling Michele , Theisen Melissa
Published: May 2019

We conducted a prospective, descriptive study of 40 tracheotomized patients to investigate the relationships between (1) levels of accumulated oropharyngeal secretions and laryngeal penetration/aspiration status, (2) secretion levels and tube-occlusion status, and (3) tube-occlusion status and aspiration status. Assessments of secretion status were quantified with the use of a 5-point rating scale. All evaluations were made by fiberoptic endoscopic evaluation of swallowing. We found that patients with higher secretion levels were more likely to aspirate than were patients with lower secretion levels. Also, patients who tolerated placement of a tube cap had the lowest mean secretion level, and those who tolerated only light finger occlusion had the highest; likewise, most patients with normal secretion levels tolerated a capped tube, and a plurality of patients with profound secretion levels tolerated only light finger occlusion. Finally, no significant differences were observed with respect to occlusion status and aspiration rates.
Endolymphatic Sac Tumor: A Report of 3 Cases and Discussion of Management
Authors: Doherty Joni K. , Yong Mona , Maceri Dennis
Published: May 2019

Patients with an endolymphatic sac tumor (ELST) typically present with palsy of cranial nerves VII and/or VIII; other presenting symptoms include hearing loss, otalgia, occipital headaches, cranial nerve palsies, vertigo, gait ataxia, tinnitus, and otorrhea. ELSTs are extremely vascular, and they can invade and destroy temporal bone. Because of these characteristics, they are often mistaken for glomus tumors of the skull base. We describe the clinical presentation, evaluation, and management of ELSTs based on our review of the limited literature and our experience with 3 adults who presented to our tertiary care referral center with large ELSTs. Although these patients presented late in the course of their disease, their symptoms were relatively minor. Preoperative tumor embolization was performed, and a near-complete resection was achieved via an extended transotic approach in all 3 patients. The facial nerve was preserved without transposition in the first patient, the second patient underwent a primary nerve anastomosis, and the third required a cable graft of the facial nerve. Postoperative radiation therapy was administered to 2 of these patients. Follow-up by MRI detected no evidence of recurrence in any of the 3 patients.
Tornwaldt's Cyst: Incidence and a Case Report
Authors: Moody Marcus W. , Chi David M. , Mason John C. , Phillips C. Douglas , Gross Charles W. , Schlosser Rodney J.
Published: May 2019

Tornwaldt's cyst is an uncommon type of nasopharyngeal cyst that may cause clinically significant symptoms. We reviewed reports of 31,855 computed tomography (CT) scans and 21,158 magnetic resonance imaging (MRI) scans to ascertain how many Tornwaldt's cysts were discovered incidentally. These images had been obtained between Jan. 1, 1994, and Dec. 31, 1999, at the University of Virginia Health Sciences Center. We found that 32 Tornwaldt's cysts had been incidentally detected in 20 women and 12 men. Four of these cysts had been found on CT (0.013%; mean size: 0.66 cm3) and 28 on MRI (0.13%; mean size: 0.58 cm3). The overall rate was 0.06% (32/53,013). The most common indications for imaging in these patients were headache, seizures, dizziness/vertigo, and pharyngeal symptoms. We also report the case of a patient with a symptomatic Tornwaldt's cyst whose symptoms resolved after treatment with endoscopic marsupialization. Tornwaldt's cyst should be remembered as an uncommon but potentially treatable cause of many symptoms seen in a typical otolaryngology practice.
Report of an Unusual Cause of Rhinolithiasis: An ‘Opioma'
Authors: Ghanbari Hadi , Farhadi Mohammad , Daneshi Ahmad
Published: May 2019

We report an unusual case of unilateral rhinolith. The patient was a 21-year-old man who had a history of left-sided nasal obstruction and recurrent bouts of fetid, purulent rhinorrhea of several years’ duration. The rhinolith, which had formed around an impacted foreign body, was extracted in several pieces under local anesthesia. Laboratory evaluation revealed that the foreign body was a hardened mixture of codeine and opium wrapped in a small sheet of nylon—what we called an “opioma.”
Aspirated Tracheobronchial Foreign Bodies: A Jordanian Experience
Authors: Mahafza Tareq , Khader Yousef
Published: May 2019

We conducted a descriptive study of 524 patients who had been suspected of having aspirated a foreign body and who had been evaluated at one of two major hospitals in Jordan from January 1993 through December 2003. A tracheobronchial foreign body was found in 386 of these patients (73.7%). Most of them (66.8%) were younger than 2 years, and the male-to-female ratio was 3 to 2. The mean duration between aspiration and diagnosis was 48 hours. The most common presenting symptoms were cough (90.4% of foreign-body-positive patients), diminished air entry (66.8%), and dyspnea (65.0%). The most frequently aspirated objects were seeds (35.4%), particularly watermelon seeds, nuts (26.8%), and vegetables (25.3%). The most common site of foreign-body impaction was the right bronchus (60.9%). Rigid bronchoscopy was used to remove the foreign body in all cases. The complication rate was 3.4%. Our experience with aspirated tracheobronchial foreign bodies in Jordan was not substantially different from that reported in other countries. The only difference was that the most frequently aspirated foreign body in our study was seeds.
Schwannoma of the Nasal Cavity
Authors: Dharia Amee , Karmody Collin S. , Rebeiz Elie E.
Published: May 2019

Schwannomas are benign peripheral nerve sheath tumors that occur throughout the body. They may present as either solitary or multiple masses. They rarely occur in the nasal cavity. The diagnosis is often made only after histologic examination. Because these lesions are radioresistant, the preferred treatment is complete surgical excision. We present a new case of a schwannoma of the nasal cavity.
Tongue Erosions and Diet Cola
Authors: Jacob Sharon E. , Steele Tace
Published: May 2019

We report the case of a 38-year-old woman who presented with a 10-year history of painful ulcerations on her tongue. She reported that she drank large quantities of diet cola and some orange juice daily and that she used cinnamon-flavored toothpaste and mouthwash nightly. Patch testing elicited positive reactions to balsam of Peru (a fragrance as well as a flavoring agent put in cola drinks that cross-reacts with orange juice) and cinnamic aldehyde. She was diagnosed with allergic contact dermatitis. She was put on a restricted diet and a fragrance-free regimen, and her condition resolved.
Follicular Dendritic Cell Sarcoma of the Tonsil: A Case Report and Literature Review
Authors: McDuffie Chad , Lian Timothy S. , Thibodeaux Joel
Published: May 2019

We describe a case of follicular dendritic cell sarcoma (FDCS) of the tonsil in a 59-year-old woman. She was successfully treated with excision of the mass and postoperative radiation therapy. According to our review of the literature, only 25 cases of extranodal FDCS in the head and neck have been previously reported, including only 10 cases that involved a tonsil. We briefly review these earlier reports, and we discuss the diagnosis and management of FDCS.
Tuberculous Retropharyngeal Abscess
Authors: Kamath M. Panduranga , Bhojwani Kiran M. , Kamath Surendra U. , Mahabala Chakrapani , Agarwal Salil
Published: May 2019

Chronic retropharyngeal abscess caused by tuberculosis is rare. It should be suspected in a person who presents with a destructive lesion of the vertebra and a retropharyngeal mass. Early diagnosis and treatment are necessary to prevent the serious complications of the disease. We present the case of a patient who came to our clinic with collapse of the C5-C6 vertebrae and retropharyngeal abscess. We were able to avoid any complications by initiating early surgical drainage and antituberculous therapy.
Pneumosinus Dilatans
Authors: Nowlin Thomas P. , Hall Daniel J. , Purdom Eric B. , Holtel Michael R.
Published: May 2019

Pneumosinus dilatans refers to an abnormally large aerated sinus; two other characteristic features of this disease are that the bony walls of the sinus are of normal thickness and there is no evidence of erosion. Most cases occur in the frontal sinuses. We describe a new case of pneumosinus dilatans in a 21-year-old woman. She required no treatment.
Spontaneous Splenic Rupture in Infectious Mononucleosis
Authors: Khoo Seng Guan , Ullah Ihsan , Manning Kevin P. , Fenton John E.
Published: May 2019

Abdominal complaints in patients with infectious mononucleosis should alert the surgeon to the potential, and possibly fatal, risk of splenic rupture. Radiologic evaluation by ultrasonography and computed tomography is indicated for appropriate management. We describe a case in which a diagnosis of splenic rupture occurring spontaneously on a background of infectious mononucleosis was made as a result of a high index of suspicion. The patient was treated conservatively.
The Effect of Nasal Steroid Administration on Intraocular Pressure
Authors: Spiliotopoulos Christos , Mastronikolis Nicholas S. , Petropoulos Ioannis K. , Mela Ephigenia K. , Goumas Panos D. , Gartaganis Sotirios P.
Published: May 2019

The effect of systemic steroid administration on intraocular pressure (IOP) is well established. However, less attention has been paid to the effect of steroids when administered in a nasal spray. We conducted a study to investigate a possible association between nasal steroids and elevated IOP in 54 patients who were being treated for allergic rhinitis. IOP was measured before the patients started therapy and thereafter every 5 days during that therapy. Follow-up ranged from 27 to 35 days (mean: 31). Statistical analysis revealed no significant elevation in IOP after nasal steroid administration. It seems that short-term administration of nasal steroids does not cause significant IOP elevation. Nevertheless, their long-term effects on this pressure should be investigated.
An Evaluation of Auditory Exostoses in 621 Prehistoric Human Skulls from Coastal Brazil
Authors: Okumura Maria Mercedes M. , Boyadjian Célia Helena C. , Eggers Sabine
Published: May 2019

Auditory exostoses are bone anomalies located on the floor of the external auditory canal. They frequently develop in individuals who participate in water sports and other aquatic activities. Their etiology is probably multifactorial; development seems to be triggered by regular exposure to cold water, as well as to low air temperatures and/or cold winds. The presence of auditory exostoses has been recorded in human skull fossils that date back approximately 250,000 years. We conducted a study of auditory exostoses in 621 skulls of adult humans who had been part of a marine-dependent population that lived on the Brazilian coast between 5,400 and 800 years ago. The overall frequency of exostoses was 22%, but there was a great variance among different subgroups (0 to 56%). In this article, we propose some possible explanations for this variance. We also hope that our study will stimulate multidisciplinary research aimed at deciphering the intricate bony messages contained in cryptic archaeologic remains.
Influence of long-term Airflow Deprivation on the Dimensions of the Nasal Cavity: A Study of Laryngectomy Patients using Acoustic Rhinometry
Authors: Ozgursoy Ozan Bagis , Dursun Gursel
Published: May 2019

We conducted a prospective study to investigate the long-term effect of nasal airflow deprivation on nasal dimensions after total laryngectomy. We evaluated 48 patients who had an initial diagnosis of laryngeal cancer; 6 were disqualified during follow-up, leaving us with data on 42 patients for our final analysis. Acoustic rhinometry was used to measure the minimum cross-sectional area (MCSA) and the volume of the nasal cavity on both the left and right sides before and after laryngectomy. In addition, patients underwent endoscopic nasal examinations and answered questionnaires pre- and postoperatively. At both the 1- and 2-year follow-ups, the mean MCSAs and the mean nasal volumes of both the left and right nostrils were significantly smaller than the preoperative values (p < 0.001). The endoscopic examinations revealed only a mild deterioration in the appearance of the nasal mucosa over the long term. Questionnaire responses obtained at the 2-year follow-up visit revealed that all 42 evaluable patients were experiencing a moderate degree of nasal obstruction while inhaling through the nose. Our data indicate that the dimensions of the nasal cavity appear to be substantially and permanently reduced after total laryngectomy. Our study had two important advantages over other similar studies. First, because ours was a prospective study, we were able to obtain preoperative data and use it to make postoperative comparisons of the same patients rather than using healthy controls as comparators. Second, we used acoustic rhinometry, while most other studies relied on anterior rhinoscopy or rhinomanometry, which are inferior methods of making the evaluations in question. We believe that our findings represent a substantial contribution to our knowledge of the physiologic and functional alterations of the nasal cavity that occur as a result of a complete cessation of nasal airflow.
Paranasal Sinus Melanoma Masquerading as Chronic Sinusitis and Nasal Polyposis
Authors: Kung Brian , Deschenes Geoffrey R. , Keane William , Cunnane Mary , Jacob-Ampuero Marie-Paule , Rosen Marc
Published: May 2019

Malignant melanoma of the nose and paranasal sinuses can be a devastating disease, typically presenting at an advanced stage, with a 5-year survival rate ranging between 20 and 30%. It is an uncommon process, often misdiagnosed both clinically and pathologically. We present the case of an 80-year-old man who had a 2-month history of progressively worsening left-sided epistaxis and nasal obstruction. Radiographic evidence indicated the presence of soft tissue in the left maxillary sinus and nasal cavity resembling massive nasal polyposis and chronic fungal sinusitis. Magnetic resonance imaging was not performed because the patient had a pacemaker. After endoscopic debridement of the soft-tissue mass, frozen-section analysis detected no evidence of tumor. The final pathologic diagnosis was malignant melanoma. Otolaryngologists should be familiar with the difficulties inherent in the diagnosis and management of sinonasal melanomas.
Botulinum Toxin A: A Novel Adjunct Treatment for Debilitating Habit Cough in Children
Authors: Sipp J. Andrew , Haver Kennan E. , Masek Bruce J. , Hartnick Christopher J.
Published: May 2019

Vocal fold injection with botulinum toxin type A (BTX-A) may be used as an adjunct treatment for habit cough in children. We conducted a retrospective review of 3 cases involving children aged 11 to 13 years with habit cough treated with vocal fold injection of BTX-A. Injections of BTX-A to the thyroarytenoid muscles were effective in breaking the cough cycle in all 3 children. Their coughs recurred but were controlled with 4 to 8 sessions of behavioral therapy. Behavioral therapy remains the first-line treatment, but BTX-A may be a useful complement to behavioral therapy in patients who fail standard treatments or in those with severe cough who have limited or delayed access to mental health professionals. This is the first report, to our knowledge, on the use of BTX-A in the treatment of a habit cough.
Concomitant Inflammatory Pseudotumor of the Temporal Bone and Lung: A Case Report
Authors: Lee Joo Hyung , Jung Min Kyo , Song Chang Eun , Yeo Sang Won , Lee Hye Kyung , Yang Po Song , Kim Soo Whan
Published: May 2019

Inflammatory pseudotumors are histologically benign but locally destructive lesions that are usually found in the lung, although some cases of temporal bone involvement have been reported. To the best of our knowledge, no case of simultaneous involvement of the temporal bone and the lung has been previously reported in the literature. We describe such a case in a 39-year-old man. The temporal bone lesion was removed in its entirety, and the lung lesion was treated with steroid therapy. At the 2-month follow-up, the size of the lung mass on chest x-ray was significantly reduced, and at 1 year, the patient was asymptomatic.
Correlation between Otitis Media and Craniofacial Morphology in Adults
Authors: Di Francesco Renata C. , Sampaio Perboyre Lacerda , Bento Ricardo Ferreira
Published: May 2019

We conducted a comparison study to determine if the development of otitis media in adults is correlated with craniofacial morphology. Our study population was made up of 66 adults, aged 18 to 40 years; 32 of these patients had otitis media and 34 did not. All subjects underwent a complete otolaryngologic examination, video-otoscopy, fiberoptic nasal endoscopy, and lateral cephalometry. Statistical analysis of the cephalometric measurements in the otitis media group and the control group revealed significant differences in the angle between the anterior skull base and medial skull base, upper facial height, and anterior facial height. Also, some significant differences were seen between the measurements in the otitis media group and the normal dimensions of the harmonic face as reported in the literature; these differences were seen in the length of the anterior skull base, the angle of cranial deflection, the depth of the maxilla, the angle of the mandibular plane, the angle of facial depth, the angle of the facial cone, and lower facial height. Not all of these significant differences, however, were predictive of the evolution of otitis media. Based on our analysis, we conclude that four cephalometric measurements are predictive of the evolution of otitis media: (1) the length of the anterior skull base, (2) the angle between the anterior skull base and medial skull base, (3) maxillary depth, and (4) upper facial height. No correlations were found between otitis media and nasal blockage or between otitis media and facial type.
Congenital Familial Bilateral Branchial Tracts: A Rare Case
Authors: Vent Julia , Grier Candace G. , Leopold Donald A. , Heywood Barbara B.
Published: May 2019

The embryologic development of the head and neck is directed by an ensemble of numerous genes. Embryologic malformations of the head and neck are rare. When they do occur, the most common are thyroglossal duct cysts and branchial anomalies. Most malformations are apparent at birth. Complete excision at an early stage is recommended to prevent complications such as infection. We describe an extremely rare case of bilateral branchial tracts in which there was evidence of a genetic etiology. To the best of our knowledge, this is the first case of familial bilateral branchial tracts to be described in the literature.
Spontaneous Cerebrospinal Fluid Leak Presenting as Unilateral (Left-sided) Middle ear Effusion
Authors: Rajkumar Kavadi T. , Orabi Ahmed A. , Timms Michael S.
Published: May 2019

Spontaneous leak of cerebrospinal fluid (CSF) into the middle ear occurs rarely and can easily be missed, especially in adults. Although the presenting symptoms can be subtle, early suspicion and confirmatory imaging can establish the diagnosis. Most previously reported cases of spontaneous CSF leak into the middle ear occurred on the right side. We report a case of left-sided single-defect spontaneous leak.
Tension Pneumocephalus after Endoscopic Sinus Surgery: Case Report of Repair and Management in Absence of Obvious Skull Base Defect
Authors: Whitmore Robert G. , Bonhomme Gabrielle , Balcer Laura J. , Palmer James N.
Published: May 2019

Tension pneumocephalus is a rare complication of functional endoscopic sinus surgery that may lead to rapid neurologic deterioration. Patients typically display symptoms within hours after the operation, and computed tomography reveals the presence of a skull base defect. We report a unique case of subacute tension pneumocephalus with no obvious skull base defect, which was associated with a pupil-involving third-nerve palsy. Wediscuss management of this complication and preventive measures for avoiding pneumocephalus after functional endoscopic sinus surgery.
A Case of Turner Syndrome with Hyperparathyroidism in an Adult
Authors: Paul Thomas V. , Dinakar James , Thomas Nihal , Mathews Suma Susan , Shanthly Nylla , Nair Aravindan
Published: May 2019

Turner syndrome is a hereditary chromosomal anomaly that affects girls and women. A result of gonadal dysgenesis, its primary characteristics are short stature, osteoporosis, neck webbing, and cardiac defects. Turner syndrome may also involve the auditory system and kidneys. We report the case of a woman with Turner syndrome who presented late in adulthood with severe osteoporosis and hypercalcemia. She was subsequently diagnosed with primary hyperparathyroidism secondary to a parathyroid adenoma. After excision of the adenoma, the woman's serum calcium level normalized. To the best of our knowledge, only 4 other cases of Turner syndrome with hyperparathyroidism have been reported in the literature.
An Estimate of the Number of Mastoidectomy Procedures Performed Annually in the United States
Authors: French Lesley C. , Dietrich Mary S. , Labadie Robert F.
Published: May 2019

We conducted a study to estimate the number of mastoidectomy procedures performed annually in the United States. Our results are based on state-specific healthcare utilization data and Medicare-funded procedural data from 2002. The utilization data were obtained from the State Ambulatory Surgery Database, which is made available through the Healthcare Cost and Utilization Project. Statistical Package for the Social Sciences (SPSS) statistical software was used to quantify the number of mastoidectomy procedures performed during 2002 in Maryland, New Jersey, New York, and Florida. Information was also obtained from the Federated Ambulatory Surgery Association on the number of Medicare-funded mastoidectomy procedures performed in 2002. State and U.S. population statistics were obtained from the U.S. Census Bureau. These data were extrapolated to obtain a nationwide estimate of the number of mastoidectomies performed annually in the U.S. With 99% confidence, we determined that 0.73 to 0.94 mastoidectomy procedures were performed per 10, 000 population in Maryland and 2.55 to 2.74/10, 000 in New York. Estimates for both New Jersey and Florida fell in between. Medicare patients underwent between 1.68 and 1.79 procedures per 10, 000 population. Based on these data, we estimate that between 30, 000 and 60, 000 mastoidectomies are performed each year in the U.S., although we suspect that our range may be an underestimation of the actual number because of some limitations inherent in the data collection process. Although mastoidectomy is a common outpatient procedure, to the best of our knowledge, no report on the annual frequency of mastoidectomy procedures in the U.S. has ever been published in the English-language literature. We hope that our report will serve to motivate further research into technological and surgical advancements surrounding this procedure.
Multiple Simultaneous Complications of Acute Otitis Media in a Child Diagnosed with Chronic Granulomatous Disease: A Case Report
Authors: Wilson Robert , Bhuta Tarika , Haydon Richard
Published: May 2019

While the prevalence of acute otitis media complications in pediatric patients has decreased over the past 30 years because of effective antibiotic therapy, the incidence has begun to rise again recently, possibly because of increased antibiotic resistance. Patients who simultaneously manifest multiple complications may require a more thorough evaluation, including an immunologic work-up. The presented case should encourage physicians to investigate the possibility of an underlying immunodeficiency when treating patients with multiple simultaneous complications of acute otitis media.
Leiomyosarcoma of the Larynx: Case Report and Review of the Literature
Authors: Goda Jayant Sastri , Saravanan Karuppiah , Vashistha R.K. , Kumar Vinay , Gupta Ashok K.
Published: May 2019

Leiomyosarcoma of the larynx is an extremely rare entity. This tumor is aggressive and is associated with dismal treatment results. We present a case of leiomyosarcoma of the larynx treated with surgery and postoperative radiotherapy. In this article we also discuss laryngeal leiomyosarcoma's clinical manifestations, associated diagnostic dilemmas, and optimal management, as well as a review of the literature.
Onset of Action of Ciclesonide Once Daily in the Treatment of Seasonal Allergic Rhinitis
Authors: Patel Piyush , Patel Deepen , Kunjibettu Sudeesha , Hall Nancy , Wingertzahn Mark A.
Published: May 2019

Ciclesonide is an intranasal corticosteroid approved for the treatment of allergic rhinitis. We conducted a randomized, double-blind, parallel-group, placebo-controlled study to evaluate the time to onset of action of ciclesonide 200 μg once daily in 502 adults with seasonal allergic rhinitis of at least 2 years’ duration. To trigger immunologic priming, patients underwent between one and five priming sessions with exposure to 3,500 grains/m3 (±500) of ragweed pollen in an environmental exposure chamber. The criteria for a successful priming session was a patient-assessed instantaneous total nasal symptom score of at least 6 (of a possible 12) and a nasal congestion or rhinorrhea score of at least 2 (of a possible 3) 90 minutes after allergen exposure during at least two consecutive priming sessions. Patients were then randomly assigned to receive either a single dose of ciclesonide 200 μg (n = 251) or placebo (n = 251) administered intranasally. The difference in the change from baseline total nasal symptom scores in the two groups was assessed hourly for 12 hours after administration. Onset of action was determined to have taken place the first time that the effects of ciclesonide, as reflected in the total nasal symptom score, were significantly greater than those of placebo at a particular hourly assessment, provided that the subsequent hourly assessment also showed a statistically significant difference. The onset of action of ciclesonide occurred within 1 hour of administration (p = 0.01 vs. placebo), and the significant difference in total nasal symptom scores between ciclesonide and placebo was maintained through post-treatment hour 12 (p ≤ 0.018).
Harmonic Scalpel Tonsillectomy versus Monopolar Diathermy Tonsillectomy: A Prospective Study
Authors: Roth Jason A. , Pincock Tobias , Sacks Raymond , Forer Martin , Boustred Neil , Johnston William , Bailey Michael
Published: May 2019

For tonsillectomy, the ultrasonic harmonic scalpel has been purported to cause less tissue injury and postoperative morbidity while providing adequate levels of hemostasis. We undertook a prospective study to compare outcomes in 162 patients who had undergone harmonic scalpel tonsillectomy and 40 patients who had undergone monopolar diathermy tonsillectomy over a 33-month period. We found that patients in the harmonic scalpel group experienced significantly less intraoperative bleeding (5.0 vs. 16.5 ml; p < 0.0001). There was no clinically significant difference between the groups with respect to (1) the amount of operating time, (2) the incidence of postoperative nausea and vomiting, dysphonia, and primary or secondary bleeding, and (3) the amount of time patients needed to resume normal diet and activities.
Office CO2 Laser Turbinoplasty
Authors: Siegel Gordon J. , Seiberling Kristin A. , Haines Kenneth G. , Aguado Allison S.
Published: May 2019

We conducted a prospective study of office carbon dioxide (CO2) laser turbinoplasty as a treatment for symptoms related to turbinate dysfunction in 58 patients. All patients completed surveys before and 1 month after treatment, and 23 patients completed longer-term follow-up surveys 8 to 24 months postoperatively. The 1-month postoperative assessments demonstrated a trend toward symptom improvement, as many patients reported a decrease in their use of pretreatment medications. Long-term benefit was achieved in 70% of patients. Ten patients underwent pre- and post-treatment biopsies, and histologic evaluation demonstrated minimal tissue alteration following treatment, alleviating concerns of physiological and functional compromise. We conclude that office-based CO2 laser turbinoplasty is a useful tool for the treatment of disorders related to turbinate dysfunction. We describe one clinician's method of performing office CO2 laser turbinoplasty, and we report his experience and findings.
Cavernous Hemangioma of the Middle Turbinate: A Case Report
Authors: Çaylakli Fatma , Çağici Alper Can , Hürcan Cem , Bal Nebil , Kizilkiliç Osman , Kiroğlu Fikret
Published: May 2019

Most cavernous hemangiomas present at birth or soon after. Cavernous hemangiomas of the nasal cavity, which are rare, usually do not present until adulthood; their incidence peaks in the fourth decade of life. Most affected patients experience epistaxis or hemoptysis and an enlarging lesion in the nose. Histologically, cavernous hemangiomas appear as closely packed, dilated vascular channels lined with a layer of flattened endothelial cells. We describe the case of a 32-year-old man who was admitted to our clinic with the complaint of a nasal obstruction. On anterior rhinoscopy, he was found to have a hypervascularized and hypertrophied left middle turbinate and septal deviation. Computed tomography and magnetic resonance imaging of the paranasal sinuses demonstrated a well-defined cystic lesion that had arisen within the bony left middle turbinate and caused deviation of the septum to the right. The lesion was excised via endoscopic surgery with general anesthesia. No complications occurred during the postoperative period. Histologic examination identified the tumor as a cavernous hemangioma. To the best of our knowledge, this is the first case reported in the English-language literature of a cavernous hemangioma appearing as a cystic mass in the middle turbinate.
Results of Exploratory Tympanotomy following Sudden Unilateral Deafness and its Effects on Hearing Restoration
Authors: Maier Wolfgang , Fradis Milo , Kimpel Susanne , Schipper Jörg , Laszig Roland
Published: May 2019

In cases of acute unilateral deafness, no consensus exists as to whether tympanotomy and sealing of the round window should be performed routinely. To further address this issue, we conducted a retrospective study of pre-, intra-, and postoperative findings in 97 patients who had undergone exploratory tympanotomy (EXT) after the onset of sudden and severe unilateral deafness. Our goal was to ascertain, if we could, whether the benefits of EXT outweigh the risks. We also took into account the effects of perilymph fistula (PLF) on the etiology of sudden hearing loss and postoperative outcomes. We found that routine EXT was indeed beneficial for these patients. It was associated with a very low surgical complication rate, and its effects on hearing as assessed by objective measures were beneficial. The greatest benefits were seen in patients who underwent EXT within 7 days after the onset of their hearing loss. With respect to PLF, we found that the presence or absence of the “typical history” of PLF (i.e., a sudden unilateral hearing loss within 48 hours after a precipitating trauma or physical exertion) had no bearing on whether a PLF was actually present in our group; nor was vertigo a reliable predictor of PLF. We recommend that EXT be performed on all patients with new-onset acute unilateral deafness, barring any contraindications, of course. The absence of a typical history of PLF should not dissuade the surgeon from proceeding with EXT.
Auditory Brainstem Response Threshold Differences in Patients with Vestibular Schwannoma: A New Diagnostic Index
Authors: Bush Matthew L. , Jones Raleigh O. , Shinn Jennifer B.
Published: May 2019

Auditory brainstem response (ABR) testing is less sensitive in detecting small vestibular schwannomas than medium-size tumors. Magnetic resonance imaging (MRI) is more sensitive than ABR alone for small and large tumors, but it carries with it increased cost and issues of unavailability and patient discomfort. We conducted a prospective pilot study of 7 patients with untreated MRI-proven, unilateral vestibular schwannoma to determine if we could increase the sensitivity of ABR testing in detecting small tumors. Our method involved the use of a new ABR index that is based on threshold differences. All patients underwent pure-tone audiometry followed by a determination of behavioral threshold and neurodiagnostic threshold ABR in the normal ear, which was used as a control, and in the diseased ear. Analysis of results revealed that all 7 patients had an abnormal ABR threshold difference, and 5 patients displayed abnormal traditional ABR indices. The mean difference between the ABR and behavioral click thresholds was 41.4 dB in the diseased ears (with the ABR threshold being higher than the click threshold) and 15.8 dB in the normal ears. None of the control ears had a threshold difference >30 dB.
Epistaxis and its Relationship to Handedness with use of Intranasal Steroid Spray
Authors: Benninger Michael S.
Published: May 2019

Topical intranasal steroid spray is often used to treat allergic and nonallergic rhinitis, and epistaxis is a common side effect. The prospective, observational study described was designed to determine the incidence of epistaxis and the relationship between the side of bleeding and the hand used to administer the spray, as well as the handedness of the patient, in a noninvestigational, real-world setting. Of 559 consecutive patients using an intranasal steroid for more than 3 months, 28 patients (5%) reported epistaxis within the prior 2 months. Of the 32 reported sides of bleeding (unilateral and bilateral combined), 25 episodes (78%) were on the same side as the hand used to apply the spray. A strong correlation was found between the side of bleeding and both the hand used (p < 0.001) and the handedness of the patient (p < 0.002). Patient instruction on technique may reduce the incidence of epistaxis.
Expression of PCNA and Bcl-2 in Basaloid Squamous Cell Carcinoma of the Larynx: A Controlled Study
Authors: Deniz Kemal , Yüce İmdat , Çağlı Sedat , Okten Turhan , Güney Ercihan
Published: May 2019

We investigated the difference in the biologic nature of typical squamous cell carcinoma (SCC) and basaloid SCC (BSCC) of the larynx by studying proliferation and antiapoptotic markers. We performed an immunohistochemical analysis of the expression of proliferating cell nuclear antigen (PCNA) and bcl-2 protein in 15 patients with laryngeal BSCC and 15 stage-and site-matched controls with typical laryngeal SCC. We found no significant difference between the two groups in the PCNA index or the frequency of bcl-2 overexpression, nor did we find any significant difference in survival. Our findings indicate that the biologic nature of typical laryngeal SCC and laryngeal BSCC is similar. In addition, our follow-up data suggest that the clinical course of laryngeal BSCC is no worse than that of typical laryngeal SCC.
Tracheal Diverticulum: A Rare Finding in a Patient with Worsening Chronic Cough
Authors: Danielson Gregory P. , Jedlovszky Veronika , Landrigan Gary P.
Published: May 2019

Acquired tracheal diverticulum is a rare clinical entity with only limited reports in the literature. We report a case of a tracheal diverticulum that was identified as part of a work-up for a worsening cough. In this case the diverticulum was observed 2 years after surgical management of a retropharyngeal abscess. It was felt that pooling of secretions in the acquired pouch was a contributing factor in the exacerbation of the patient's chronic cough. Because of the patient's extensive comorbidities, observation and serial computed tomography scans were recommended.
Mastoiditis on MRI: Fact or Artifact?
Authors: Meredith James R. , Boyev K. Paul
Published: May 2019

Fluid signal in the mastoid can be an incidental finding on T2-weighted magnetic resonance imaging and often is interpreted as mastoiditis by radiologists. This study examines 28 consecutive cases of such erroneously diagnosed “mastoiditis” and documents the presence or absence of otologic symptoms and clinical signs. We found a very low prevalence of otologic symptoms or pathology and no cases of mastoiditis in these patients, and we determined that magnetic resonance imaging is not an effective screening modality for mastoiditis. We also reviewed the literature on current diagnostic criteria for mastoiditis and propose alternative terminology to replace the use of excessively alarming terms such as “mastoiditis” unless they apply to that specific clinical diagnosis.
Rehabilitation of the Olfactory Sense after Laryngectomy: Long-term Use of the Larynx Bypass
Authors: Göktas Önder , Fleiner Franca , Paschen Christian , Lammert Ingeborg , Schrom Thomas
Published: May 2019

Patients who undergo laryngectomy typically lose their sense of smell. One device that has been used to rehabilitate olfactory function in these patients is the larynx bypass. We conducted a long-term study of the larynx bypass in 16 laryngectomized patients. After undergoing objective and subjective baseline evaluations, patients were asked to use the device at home for at least 30 minutes each day for 3 months. They were also asked to record in a diary subjective ratings of their sense of smell and the practicability of using the device every day. At study's end, patients experienced a statistically significant improvement (p < 0.001) in olfactory function on objective measurement (Sniffin’ Sticks testing). Subjective improvement was seen after 1 week (p < 0.001) and maintained throughout the study. Practicability scores improved statistically (p = 0.003), but the device remained difficult to use. The long-term use of the larynx bypass has not been studied previously, and we hope that our findings will serve as a basis for further investigation.
Lipoid Proteinosis (Urbach-Wiethe Disease): A Case Report from India
Authors: Batra Kadambari , Safaya Anil , Aggarwal Kiran
Published: May 2019

Lipoid proteinosis (Urbach-Wiethe disease) is a rare autosomal-recessive anomaly that primarily affects the skin and the mucosa of the upper aerodigestive tract in children. It is caused by hyaline deposits in tissues. Hoarseness secondary to laryngeal involvement is frequently the first presenting feature. It is important to consider this disease in the differential diagnosis of hoarseness because it might lead to life-threatening airway compromise. We report a case of lipoid proteinosis in a 12-year-old girl who presented with hoarseness and skin lesions.
Nasoseptal Chondrosarcoma Resection Requiring Anterior Fossa Floor Repair: A Case Report
Authors: Spear Samuel , Iskandar John , Seaquist Derek , Sorensen Douglas
Published: May 2019

We present a case in which a 23-year-old male patient diagnosed with nasoseptal chondrosarcoma with anterior cranial fossa extension underwent combined surgical approaches to optimize complete resection of the tumor. Surgery was followed by a 6-month course of proton-beam radiation therapy. Extensive tumors of this type with significant intracranial extension require surgical repair of the anterior fossa floor. We employed a repair technique not previously associated with the resection of these tumors, using a split-calvaria osteoplastic rotational flap. This method provided structural integrity while avoiding the risks associated with the use of free bone grafts and metallic meshes.
Intravascular Papillary Endothelial Hyperplasia (Masson Lesion) of the Hypopharynx and Larynx
Authors: Güvenç M. Güven , Dereköylü Levent , Korkut Nazım , Öz Ferhan , Öz Büge
Published: May 2019

Masson lesion is characterized by a benign intravascular papillary hyperplasia and subsequent thrombosis. Clinically, this lesion can be misdiagnosed as mucocele, hemangioma, Kaposi sarcoma, angiosarcoma, pyogenic granuloma, and several other lesions. In this article, we report a case of intravascular papillary endothelial hyperplasia of the hypopharynx and larynx, which caused dysphagia in an 18-year-old female patient. The lesion was excised entirely via a lateral pharyngotomy approach. We discuss the clinical and histopathologic features, differential diagnosis, and treatment of this uncommon entity.
Transfistula Endoscopic Closure of Frontocutaneous Fistula: A Novel Approach
Authors: Chokkalingam Perumal Gounder , Sachidananda Ravi , Verma Sanjay , Maheshwar Arcot , Roderick Robert Duncan
Published: May 2019

A fistula of the anterior table of the frontal sinus is an uncommon complication of acute frontal sinus abscess. Various methods to close a frontocutaneous fistula have been described. We present the second reported transfistula endoscopically assisted primary closure of a frontocutaneous fistula, which eliminated the need for major surgical intervention. We also review the etiology, pathogenesis, diagnosis, and management of frontocutaneous fistula.
Vascular Hamartoma of the Paranasal Sinuses: Report of 3 Rare Cases and a Short Review of the Literature
Authors: Mannan A.A.S. Rifat , Sharma Mehar C. , Singh Manoj K. , Bahadur Sudhir , Hatimota Pradeep
Published: May 2019

The paranasal sinuses are an extremely unusual location for a vascular hamartoma. As far as we know, only 1 such case has been previously reported in the English-language literature. We report 3 new cases of vascular hamartoma of the paranasal sinuses, which occurred in a 20-year-old woman and in 2 men aged 36 and 45 years. Radiologically, the lesion in the woman was confined to the sinuses, while evidence of intraorbital extension was seen in the 2 men. No intracranial extension was seen in any patient. The diagnosis was confirmed by histopathologic examination of the excised lesions. All 3 patients were alive without recurrence at 12 to 24 months of follow-up.
An Unusual Presentation of Teflon Granuloma: Case Report and Discussion
Authors: Pagedar Nitin A. , Listinsky Catherine M. , Tucker Harvey M.
Published: May 2019

For more than 25 years, Teflon was the most commonly used material for injection laryngoplasty. However, the incidence of Teflon granuloma and the consequent deterioration of glottic function ultimately led to the development of other injectable materials, and as a result, Teflon granulomas are no longer frequently encountered. We present a case of Teflon granuloma that was unusual in that (1) a long period of time had elapsed between the injection and the granuloma formation and (2) there was no change in the patient's glottic function.
Avoiding Oral Burns during Electrocautery Tonsillectomy
Authors: Lowry Thomas R. , Workman Jonathon R.
Published: May 2019

Electrocautery tonsillectomy is a common method of tonsil removal, and electrocautery devices are widely available. Although these devices are relatively safe, inadvertent patient injury may occur with their use, such as oral cavity burns. We describe a simple surgical technique that reduces the risk of oral burns during electrocautery tonsillectomy and review additional safety considerations.
Effects of Sequential Dermatophagoides Pteronyssinus Antigen Stimulation on Anatomy and Physiology of the Larynx
Authors: Dworkin James P. , Reidy Patrick M. , Stachler Robert J. , Krouse John H.
Published: May 2019

The goal of this investigation was to study the effects of sequential dust mite antigen stimulation on the appearance and function of the larynx. To that end, we designed a randomized, placebo-controlled, double-blind, prospective analysis of adults who had tested positive for perennial dust mite allergy. The larynx of patients who received the active antigen was challenged directly with a low (1:100) and a high (1:40) concentration of the dust mite allergen via an oral nebulizer. Voice laboratory assessment tools included voice and allergy questionnaires, videostroboscopic examination of the larynx, acoustic and speech aerodynamic analyses, and digital audio voice recordings. The study was prematurely terminated after 2 patients had been treated with the highest concentration of the antigenic suspension because of adverse effects, including chest tightness, coughing, and voice difficulties. Both of these patients had demonstrated viscous endolaryngeal secretions and vocal fold edema on videostroboscopy. No reactions were noted at the lower concentration of antigen exposure or in 1 control patient who completed the study. We believe that our findings, as preliminary as they are, may serve as an initial template for the differential diagnosis and treatment of other patients with inhalant allergies who present with chief complaints suggestive of allergic laryngitis.
Sudden-onset Life-threatening Stridor in an Adult Caused by a Laryngeal Ductal Cyst
Authors: Ozgursoy Ozan Bagis , Batikhan Hunkar , Beton Suha , Dursun Gursel
Published: May 2019

Laryngeal cysts are rare in adults; therefore, the majority of previous reports deal primarily with laryngeal cysts in infants and children. Ductal cysts of the larynx arise from the submucous glands when the ducts of these glands are occluded. They are most commonly located in the vallecula. In this report, we present a rare cause of life-threatening stridor in adults, a large ductal cyst of the larynx that was removed via endoscopic CO2 laser resection. On the basis of clinical observations during the postoperative period, we conclude that endoscopic CO2 laser resection is a reliable and safe method for removing cysts of the larynx. It is also a cost-effective procedure that minimizes hospitalization time and the need for tracheotomy.
Angiomyomatous Hamartoma in a Submandibular Lymph Node: A Case Report
Authors: Barzilai Geva , Schindler Yaakov , Cohen-Kerem Raanan
Published: May 2019

Angiomyomatous hamartomas have been found almost exclusively in the inguinal and femoral lymph nodes; few reports of these lesions in the head and neck region have been published. We present a case of angiomyomatous hamartoma in the submandibular area, a site that has not been previously reported in the literature. The mass was initially diagnosed as an enlarged lymph node. When it did not regress following broad-spectrum antibiotic treatment, the patient, a 51-year-old woman, underwent an excisional biopsy. Histopathology identified the mass as an angiomyomatous hamartoma. At follow-up 3 years and 9 months postoperatively, the patient exhibited no evidence of recurrence on physical examination and computed tomography. Even though angiomyomatous hamartoma of the head and neck is rare, we suggest that otolaryngologists include it in the differential diagnosis of head and neck masses.