bluuebunny/crossref_metadata_2025 huggingface dataset:
Cutaneous Mucormycosis of the Head and Neck with Parotid Gland Involvement: First report of a Case
Authors: Numa William A. , Foster Paul K. , Wachholz Jeffrey , Civantos Francisco , Gomez-Fernandez Carmen , Weed Donald T.
Published: May 2019

Cutaneous mucormycosis is an uncommon, life-threatening, opportunistic fungal infection that is a distinctly different entity from the more frequent although still uncommon rhinocerebral form that is better known to otolaryngologists. We describe what to our knowledge is the only reported case of cutaneous mucormycosis of the face with parotid gland involvement, which occurred in a 56-year-old man. The diagnosis was established by tissue biopsy. The patient was treated with antifungal medications and wide local debridement, including a total parotidectomy with sacrifice of the inferior division of the facial nerve. At the 2-year follow-up, he remained free of disease. Familiarity with the risk factors associated with the development of cutaneous mucormycosis is critical to determining the need for early tissue biopsy to confirm the diagnosis. Generally favorable clinical outcomes are associated with prompt and aggressive medical and surgical therapy.
Foreign Body Impaction: Fifty Years inside the Nose
Authors: Pitsinis Vassilis , Patel Alpa
Published: May 2019

An incidental finding of a foreign body in the nose is an infrequent event. When foreign bodies are discovered incidentally, they are usually detected during an investigation of chronic symptoms. We describe a case that is of interest because a nasal foreign body had remained clinically silent for more than 50 years.
Radiofrequency Volume Tissue Reduction of the Tonsils: Case Report and Histopathologic Findings
Authors: Terk Alyssa R. , Levine Steven B.
Published: May 2019

Innovative new techniques to resect tonsillar tissue have been described in the recent literature. We report the case of a patient who underwent volume reduction of tonsillar tissue by radiofrequency energy under local anesthesia in an office setting. Treatment resulted in a reduction of tonsillar size with minimal pain, which can be attributed to the avoidance of mucosal interruption. The patient subsequently underwent standard tonsillectomy, which allowed us to examine the histopathology of the tissue that was treated with radiofrequency. In doing so, we noted an absence of fibrosis and preservation of normal histologic architecture. We conclude that performing volume reduction of tonsillar tissue by applying radiofrequency energy to the stroma of the tonsils without temperature control results in objective improvement in airway size with minimal effects on the histopathology of the tonsillar stroma. Mucosa-sparing tonsillar reduction may be a preferable alternative to other techniques of tonsillar reduction, especially for young children, who would experience a nearly pain-free procedure.
Ototopical Ciprofloxacin in a Glycerin Vehicle for the Treatment of Acute External Otitis
Authors: Olivera María E. , Bistoni Adriana , Anun Hugo E. , Salinas Aquiles , Manzo Ruben H.
Published: May 2019

We conducted a prospective, randomized, controlled, double-blind study of 33 patients to compare the efficacy and tolerability of a new glycerin formulation of ototopical 0.3% ciprofloxacin with that of a conventional aqueous formulation of ciprofloxacin for the treatment of acute external otitis. Outcomes measures were resolution of discharge, swelling, pain, and redness and the incidence of adverse side effects. Patients were examined on three occasions: on the day of enrollment (visit 1), 48 to 72 hours later (visit 2), and 7 days after enrollment (visit 3). At visit 2, the patients in the glycerin group showed a significantly greater resolution of discharge. We observed the same pattern with respect to swelling, pain, and redness, which resolved more quickly in the glycerin group, although not significantly so. All patients were cured by visit 3, and the two treatments were equally well tolerated. On the basis of our findings, we conclude that the glycerin formulation of ototopical 0.3% ciprofloxacin appears to be at least as effective as the aqueous form in the treatment of acute external otitis—and in the case of otorrhea, more so.
Nevoid Basal Cell Carcinoma Syndrome and Fetal Rhabdomyoma: A Case Study
Authors: Watson Joseph , Depasquale Kalpana , Ghaderi Mahmoud , Zwillenberg Seth
Published: May 2019

Fetal rhabdomyoma is not generally considered part of nevoid basal cell carcinoma syndrome. However, a review of the literature revealed five patients with this syndrome who also had fetal rhabdomyomas in various locations. We report the first patient with nevoid basal cell carcinoma syndrome and a fetal rhabdomyoma of the tongue. We recommend that embryonal rhabdomyosarcoma be ruled out to avoid overly aggressive treatment of these patients.
Perineural Invasion of the Facial Nerve by a Cutaneous Squamous Cell Cancer: A Case Report
Authors: Lesnik David J. , Boey Howard P.
Published: May 2019

We report a case of perineural invasion of the facial nerve by a cutaneous squamous cell carcinoma in a 59-year-old man who presented with a slowly progressive facial paralysis. We performed a distal facial nerve dissection and a simple mastoidectomy with facial recess exposure for resection to negative margins. We also performed a simultaneous facial reconstruction and reanimation procedure with excellent results. External-beam radiation completed the treatment regimen. In addition to describing this case, we review current concepts in diagnosis and therapy, as well as the historical background of malignant perineural invasion of the cranial nerves.
Angioleiomyoma of the Internal Auditory Meatus: A Rare Occurrence in the Internal Auditory Canal
Authors: Karagama Yakubu G. , Bridges Lindsey R. , van Hille Philip T.
Published: May 2019

We describe a case of angioleiomyoma of the internal auditory meatus. A finding of this tumor at this site is very unusual. In fact, our review of the literature revealed that only 1 case has been previously reported. In our patient, the tumor was clinically and radiologically difficult to distinguish from an acoustic neuroma. It would be important to recognize this rare small tumor preoperatively because it may be appropriate to manage it conservatively.
The Carotid-Vertebral Space: An ‘Extended’ Lateral Window to the Ventromedial Cranial Base and Lower Craniocervical Junction
Authors: Kassam Amin B. , Patel Atul , Welch William , Balzer Jeffrey , Snyderman Carl , Hirsch Barry , Carrau Ricardo
Published: May 2019

We describe a unique method of accessing the ventromedial skull base and lower craniocervical junction. Our method employs a trajectory between that of the more anterior transoral or retropharyngeal approaches and the various posterior or posterolateral skull base approaches. This “extended” lateral approach allows surgeons to resect very large tumors of the skull base through a single incision. The operative field is more extensive than that achieved with other approaches; it extends from the cerebellar hemisphere to the extradural ventral upper cervical spine, and it provides access to tissue outside the spinal canal, such as the ventral strap muscles. We describe our use of this approach during a single-stage resection of a large hemangiopericytoma in a 37-year-old man.
Ossicular Chain Dislocation with Normal Hearing
Authors: Holzapfel Allison R. , Chang C.Y. Joseph , Pereira Kevin D.
Published: May 2019

We report a unique case of an ossicular chain injury in a young man. Despite the fact that the patient's incus was dislocated into the external auditory canal while remaining attached to the stapes, his hearing was not affected and remained nearly normal. We discuss the patient's presenting features and our diagnostic and management strategy in this case.
Rhabdomyoma of the Larynx: Case Report and Clinical and Pathologic Review
Authors: Brys Agata K. , Sakai Osamu , DeRosa Jaimie , Shapshay Stanley M.
Published: May 2019

We describe a case involving a 79-year-old man with symptoms of slowly progressive hoarseness resulting from a rhabdomyoma originating deep to the right true and false vocal folds. We also review the pathology and radiologic findings of rhabdomyoma.
Potential Applications of the da Vinci Minimally Invasive Surgical Robotic System in Otolaryngology
Authors: McLeod Ian K. , Mair Eric A. , Melder Patrick C.
Published: May 2019

Anatomic constraints and instrumentation design characteristics have limited the exploitation of endoscopic surgery in otolaryngology. The move toward less invasive and less morbid procedures has paved the way for the development and application of robotic and computer-assisted systems in surgery. Surgical robotics allows for the use of new instrumentation in our field. We review the operative advantages, limitations, and possible surgical applications of the da Vinci Surgical System in otolaryngology. In the laboratory setting, we explored the setup and use of the da Vinci system in porcine and cadaveric head and neck airway models; the setup was configured for optimal airway surgery. Endoscopic cautery, manipulation, and suturing of supraglottic tissues were performed in both the porcine and cadaveric models. We found that the da Vinci system provided the advantages of the lower morbidity associated with endoscopic surgery, more freedom of movement, and three-dimensional open surgical viewing. We also observed that the system has several limitations to use in otolaryngology.
Tuberculous Otitis Media: Report of 2 Cases on Long Island, N.Y., and a Review of all Cases Reported in the United States from 1990 through 2003
Authors: Chirch Lisa M. , Ahmad Khalid , Spinner Warren , Jimenez Victor E. , Donelan Susan V. , Smouha Eric
Published: May 2019

We report 2 cases of tuberculous otitis media that were diagnosed at Stony Brook University Hospital in New York since 1999. Both patients were women, aged 30 and 31 years. One patient had grown up in Russia, the other was a native-born American who had never left the East Coast region of the United States. Both patients had been symptomatic for many months; one complained of chronic otorrhea, and the other reported otorrhea, hearing loss, and discomfort. Neither patient responded to medical management, and both ultimately underwent surgery. One was diagnosed after surgical pathology revealed acid-fast bacilli on frozen-section analysis. In the other, pathology revealed chronic inflammation and granulomata, but stains were negative and her diagnosis was delayed for almost 2 years. We also review 9 other cases of tuberculous otitis media in the United States that have been reported in the literature since 1990. Our review suggests that the number of cases is rising in areas where tuberculosis is most common—that is, in major U.S. cities. Although 3 of these 9 cases occurred as reactivation disease in immigrants, most might have occurred as a result of local transmission. Clinicians should maintain a high degree of suspicion for tuberculosis in patients with chronic otitis symptoms, particularly those who are at higher risk of exposure to tuberculosis.
Bilateral Massive Conchae Bullosa Mimicking Intranasal Tumors
Authors: Yaşar Hüsamettin , Verim Ayşegül , Özkul Haluk
Published: May 2019

We describe a case of bilateral massive conchae bullosa in a 76-year-old woman. She presented with a 2-year history of nasal obstruction and frontal headache. In light of these and other findings on anterior rhinoscopic and endoscopic examinations, we initially suspected nasal tumors. However, after a prebiopsy evaluation by computed tomography, we diagnosed bilateral massive conchae bullosa that did not impair sinus ventilation. Endoscopic surgery was performed, and the patient's symptoms abated.
Nonsurgical Home Treatment of Middle Ear Effusion and Associated Hearing Loss in Children. Part I: Clinical Trial
Authors: Arick Daniel S. , Silman Shlomo
Published: May 2019

We conducted a randomized, controlled clinical trial to investigate the efficacy of treatment of persistent middle ear effusion (MEE) and associated hearing loss with a modified Politzer device used in the home setting over a 7-week period. Efficacy was determined by comparing pre-and post therapy air-conduction thresholds, tympanometric peak pressures, and otoscopic findings. The study group was made up of 94 children (174 ears), aged 4 to 11 years, who had at least a 2-month history of MEE and associated hearing loss. At study's end, patients in the treatment group experienced statistically significant improvements in all measured outcomes; no significant improvements were seen in the control group in all measured outcomes. At study's end, the hearing sensitivity of 73.9% of the treated ears was within normal limits, compared with only 26.7% of the control ears. These findings demonstrate that home treatment of children with persistent MEE and associated hearing loss with the modified Politzer device is highly efficacious.
Extramedullar Plasmacytoma Arising from the Nasal Septum
Authors: Baek Byoung J. , Kim Seong W. , Park Hoon , Park Jin K. , Han Kyung Y. , Oh Cheon H.
Published: May 2019

We report a rare case of extramedullary plasmacytoma of the nasal septum in a 65-year-old woman. She presented with a 2-month history of left-sided nasal obstruction and intermittent blood-tinged nasal crusting. Nasal endoscopy revealed that a dark-red mass had arisen from the nasal septum; no evidence of invasion to adjacent tissues was seen. A biopsy specimen was diagnosed as a plasmacytoma (kappa light chain—type). Serum and urine electrophoresis failed to detect any myeloma component or Bence Jones protein. All other screening tests to rule out multiple myeloma were negative. These findings confirmed the diagnosis of extramedullary plasmacytoma. The mass was completely removed via an endoscopic approach. No recurrence was noted at the 2-year follow-up.
Sigmoid Sinus Thrombosis Secondary to Lemierre's Syndrome
Authors: Repanos Costa , Chadha Neil K. , Griffiths Mansel V.
Published: May 2019

Lemierre's syndrome, a rare and almost forgotten cause of internal jugular vein thrombosis, is usually caused by an anaerobic head and neck infection. Left untreated, it can result in the release of septic emboli. We describe the case of a 42-year-old man who presented with fever and a tender, swollen neck mass. Computed tomography revealed an edematous parapharyngeal area and a compressed internal jugular vein. Despite antibiotic treatment, the patient's condition worsened, and a parapharyngeal fluid collection was drained 4 days later. Six weeks later, the patient returned to the outpatient department complaining of headaches, and he was found to have a tender, firm neck. He was readmitted, and magnetic resonance venography revealed a right internal jugular vein thrombosis that extended intracranially to the sigmoid sinus. He was anticoagulated for 6 months, and he remained well during outpatient follow-up. We examine the controversial roles that anticoagulation and thrombolysis play in Lemierre's syndrome and sigmoid sinus thrombosis, and we review the diagnostic options.
Review of Nasopharyngeal Carcinoma
Authors: Jeyakumar Anita , Brickman Todd M. , Jeyakumar Alwin , Doerr Timothy
Published: May 2019

We review the literature on nasopharyngeal carcinoma that has been published within the past 5 years. Nasopharyngeal carcinoma is a highly morbid disease, and survival is poor. Its management remains extremely difficult, not just for otolaryngologists but for radiation oncologists and medical oncologists, as well. A clear understanding of its etiology is still lacking, but nasopharyngeal carcinoma is widely suspected to be the result of both a genetic susceptibility and exposure to environmental factors or Epstein-Barr virus infection. With no clear cause, treatment is controversial. For example, an optimal radiation regimen has not been determined, reports in the literature regarding the role of chemotherapy for advanced disease are conflicting, and treatment of local recurrences is unsettled. Still, advances in immunologic research and chemotherapy offer hope for better control of the disease. We hope that our assessment of the recent literature will provide otolaryngologists with a more clear understanding of the etiology and management of nasopharyngeal carcinoma.
Complete Esophageal Stenosis Secondary to Peptic Stricture in the Cervical Esophagus: Case Report
Authors: Thomas Giovana R. , Raynor Tiffany
Published: May 2019

Complete esophageal stenosis secondary to peptic stricture in the upper esophagus is rare. It is, however, a serious medical problem that may require otolaryngologic intervention because of life-threatening dysphagia and weight loss. We report the case of an elderly patient who presented with an upper esophageal stricture, without the typical symptoms of gastroesophageal reflux disease, that progressed to complete esophageal obstruction despite use of proton pump inhibitors and esophageal dilatation. Definitive management of this difficult problem required esophagectomy and gastric pull-up. We discuss the pathophysiology, clinical presentation, differential diagnosis, and multidisciplinary management of peptic esophageal strictures. This case illustrates the difficulty in managing high peptic strictures.
Tinnitus and Brain Activation: Insights from Transcranial Magnetic Stimulation
Authors: Marcondes Renata , Fregni Felipe , Pascual-Leone Alvaro
Published: May 2019

The mechanisms underlying tinnitus are still not completely elucidated, but advances in neuroimaging and brain stimulation have provided us with new insights. Evidence suggests that tinnitus might actually be generated by central rather than peripheral structures. To illustrate the importance of brain activity changes in the pathology of tinnitus, we report the cases of 2 patients who experienced a recurrence/worsening of their tinnitus after they had undergone treatment for major depression with repetitive transcranial magnetic stimulation. We suggest that the tinnitus in these 2 patients was induced by changes in brain activity resulting from transcranial magnetic stimulation of the prefrontal cortex. We also review the pathophysiology and other aspects of tinnitus, focusing on associated brain reorganization.
Infantile Supraglottic Hemangioma: A Case Report
Authors: Ada Mehmet , Güvenç M. Güven , Yilmaz Süleyman
Published: May 2019

Hemangiomas of the airway are benign vascular lesions that can involve any site from the nares to the tracheobronchial tree. Most of these lesions are seen in the subglottic area in infants. Supraglottic infantile hemangiomas are very rare. We report a case of supraglottic hemangioma in a 2-month-old boy who had been admitted to our hospital with inspiratory stridor and dyspnea. The hemangioma involved the left arytenoid and aryepiglottic fold. A tracheostomy was performed, and the patient was followed up endoscopically every 6 months thereafter. The hemangioma disappeared when the child was 30 months old. Subsequently, a Montgomery T-tube was placed for 6 months to assist in maintaining normal breathing. The patient remains disease-free during ongoing follow-up. We also discuss the management strategies for infantile laryngeal hemangiomas.
Long-Term follow-up after Gentamicin Application via the Silverstein MicroWick in the Treatment of Ménière's Disease
Authors: Hill Samuel L. , Digges E. Nicholas B. , Silverstein Herbert
Published: May 2019

We conducted a retrospective study to evaluate the long-term effectiveness of gentamicin applied directly to the round window membrane via the Silverstein MicroWick system in patients with definite or probable Ménière's disease. The study population was made up of 69 patients who had received 3 drops of gentamicin 10 mg/ml three times daily; the duration of treatment was guided by objective data obtained from weekly electronystagmography and audiometry. Relief of vertigo was assessed by chart review and telephone interviews. After a minimum follow-up of 24 months, we found that vertiginous symptoms remained controlled in 53 patients (76.8%) after one or more courses of drug therapy. A single course of treatment was successful in 41 patients (59.4%). We conclude that long-term control of vertigo can be achieved in patients with Ménierè's disease by direct application of gentamicin to the round window membrane via the Silverstein MicroWick. This minimally invasive self-treatment technique was well tolerated and free of long-term complications.
Do Corticosteroids Prevent Hearing Loss in Pediatric Bacterial Meningitis? An Analysis of the Evidence
Authors: Manolidis Spiros , Johnson Romaine
Published: May 2019

We reviewed the MEDLINE database of articles published from January 1966 through December 2001 in search of data on the ability of the corticosteroid dexamethasone to protect against sensorineural hearing loss in children with meningitis. We found 1,034 articles that matched our keyword entries, and after various exclusions, we winnowed this number down to 16 articles that contained adequate data regarding audiometric evaluation and follow-up. The 16 articles included reports of 11 randomized controlled trials (only 10 are considered in this analysis), two meta-analyses, two retrospective case series, and two consensus statements. Of the 10 clinical trials (all of which contained level I evidence), four showed that dexamethasone had a protective effect and six showed that it did not. The authors of the two meta-analyses (both level I) concluded that there was a protective effect, and the authors of the two retrospective case series (both level IV) concluded that there was not. Both consensus statements (both level V) recommended the use of dexamethasone only in Haemophilus influenzae meningitis. We conclude that well-designed studies with level I evidence have shown that the benefit of dexamethasone in preventing hearing loss in children with meningitis remains unclear. Significant variables in treatment response include the specific pathogen, the type of antibiotic, and the timing of dexamethasone administration.
Incorporating the Endoscope into Middle Ear Surgery
Authors: Ghaffar Shehzad , Ikram Mubasher , Zia Sadaf , Raza Ahsan
Published: May 2019

We conducted a study to evaluate the use of a pediatric rigid otoendoscope for determining the extent of middle ear disease and for assessing ossicular integrity and mobility during tympanoplasty. Our study population was made up of 132 patients who were undergoing surgery for the treatment of chronic suppurative otitis media; of this group, 41 patients underwent otoendoscopy and 91 underwent scutum lowering for purposes of visualization. In the otoendoscopy group, the ossicles were successfully visualized and their mobility assessed in 34 patients; the remaining 7 patients subsequently underwent scutum lowering. A 30° endoscope allowed for complete visualization of the middle ear in almost all of the 34 cases. The mean duration of surgery for the 34 patients in the otoendoscopy group was 62.85 minutes (± 15.57), which was significantly shorter than the duration of surgery (71.23 ± 15.65 mitt) for the 98 patients who underwent scutum lowering (p < 0.005). A total of 50 patients required less than 60 minutes of surgical time—26 of 34 (76.5%) in the endoscopy group and 24 of 98 (24.5%) in the scutum-lowering group. Statistical analysis revealed that the possibility of completing a procedure in less than 60 minutes was 73.65% (± 12.56%) when endoscopy was used and 58.62% (± 12.60%) when scutum lowering was used—again, a statistically significant difference (p < 0.005). We conclude that incorporation of an angled otoendoscope into middle ear surgery is a worthwhile alternative to scutum lowering.
Cutaneous Angiosarcoma of the Head and Neck: A Case Presentation and Review of the Literature
Authors: Glickstein Jonathan , Sebelik Merry E. , Lu Qing
Published: May 2019

Cutaneous angiosarcoma of the head and neck is a rare vascular neoplasm. When it does occur, it is most common in elderly white men. Early diagnosis and treatment are essential for local control of this aggressive tumor, but recognition can be delayed because of its rarity or because of difficulty in making a pathologic diagnosis. A combined-modality treatment approach is most often advocated. We report the case of a 77-year-old black man who presented with a 1-month history of two painless, violaceous, sub-centimeter nodules of the upper lip. After a diagnosis of low-grade angiosarcoma was definitively established, the lesions were locally excised with good cosmetic and functional results. The patient subsequently was found to have probable metastatic disease, but he declined further intervention. We review the literature on cutaneous angiosarcoma, and we discuss its epidemiology, presentation, tissue diagnosis, treatment, and prognosis in an effort to increase awareness of this rare malignancy.
Middle Ear Injury through the External Auditory Canal: A Review of 44 Cases
Authors: Lasak John M. , Van Ess Mark , Kryzer Thomas C. , Cummings Richard J.
Published: May 2019

We performed a retrospective review of 44 patients with middle ear injury incurred through the external auditory canal. Twenty-two of the 44 patients had presented to our center within 1 month of their injury (early group), and 22 presented later (delayed group); the mean interval from the time of the trauma to presentation was 6 days in the early group and 7 years in the delayed group. The causes of injury were penetrating trauma (70% of cases), thermal insults (20%), and explosive and nonexplosive blasts (9%). Purulent otorrhea, cholesteatoma, and ossicular discontinuity were more common in the delayed group. Otologic surgery was required in 9 early-group patients (41%) and in all 22 delayed-group patients (100%). Two patients in the early group developed a dead ear. The mean pure-tone averages (PTAs) at presentation were 30.7 and 52.2 dB in the early and delayed groups, respectively; after management, the corresponding mean PTAs were 21.0 and 42.5 dB. The respective mean air-bone gaps in the two groups were 14.6 and 28.2 dB at presentation and 8.0 and 17.2 dB after management. We conclude that middle ear injury incurred as a result of trauma sustained through the external auditory canal is associated with considerable morbidity. Patients who present in a delayed fashion have significantly poorer hearing at presentation and after management. Patients who do not develop a dead ear generally derive benefit from reconstruction of the middle ear sound-conduction mechanism.
Invasive Fungal Sinusitis Caused by Pseudallescheria Boydii: Case Report and Literature Review
Authors: Bates Dwight D. , Minis J. Whitman
Published: May 2019

Fungal sinusitis secondary to Pseudallescheria boydii is rare, as only 25 cases have been previously reported in the literature. Although P boydii resembles Aspergillus on pathologic examination, it is typically resistant to amphotericin B. Therefore, culture is necessary to differentiate the two. Patients with P boydii sinusitis should generally be treated with a combination of surgery and antifungal therapy. Combination treatment is particularly important for immunocompromised patients with fungal invasion because mortality among these patients is high. The prognosis is better for immunocompetent patients, even those with fungal invasion. We describe a new case of invasive fungal sinusitis secondary to P boydii infection, and we review the literature on this emerging pathogen.
Transnasal Endoscopic Resection of Juvenile Nasopharyngeal Angiofibroma without Preoperative Embolization
Authors: Borghei Peyman , Baradaranfar Mohammad Hossein , Borghei Seyed Hebatodin , Sokhandon Farnoosh
Published: May 2019

Juvenile nasopharyngeal angiofibroma (JNA) is a benign, highly vascular, and locally invasive tumor. Because the location of these tumors makes conventional surgery difficult, interest in endoscopic resection is increasing, particularly for the treatment of lesions that do not extend laterally into the infratemporal fossa. We report the results of our series of 23 patients with JNA (stage IIB or lower) who underwent transnasal endoscopic resection under hypotensive general anesthesia without preoperative embolization of the tumor. All tumors were successfully excised. The amount of intraoperative blood loss was acceptable. We observed only 1 recurrence, which was diagnosed 19 months postoperatively in a patient with a stage IIB primary tumor. We observed only 3 complications during follow-up—all synechia. We conclude that endoscopic resection of JNAs is safe and effective. The low incidence of recurrence and complications in this series indicates that preoperative embolization may not be necessary for lesions that have not undergone extensive spread; instead, intraoperative bleeding can be adequately controlled with good hypotensive general anesthesia.
Amyloidosis of the External Auditory Canal and Middle Ear: Unusual Ear Tumor
Authors: Gheriani Heitham , Tewary Rajesh , O'Sullivan Timothy J.
Published: May 2019

Amyloidosis of the ear is rare. We describe the case of a 41-year-old man who had localized amyloidosis that involved the external auditory canal and middle ear. To the best of our knowledge, only 4 other cases of amyloidosis involving the external auditory canal have been previously reported; in none of these cases was the middle ear involved. We also discuss the clinical importance of this condition and its treatment.
Solitary Polyps of the Uncinate Process
Authors: Cagici Can Alper , Ozer Cem , Yilmaz Ismail , Bolat Filiz Aka , Cakmak Ozcan
Published: May 2019

Cases of a solitary polyp of the nasal cavity are much less common than cases of massive polyposis. The most important factor in the formation of solitary polyps is the anatomic variations that result in mucosal contacts. We report the case of a patient who had bilateral solitary polyps of the uncinate process. Radiologic and clinical examinations revealed a medially bent uncinate process in the right nasal cavity and a bifid uncinate process in the left nasal cavity. These structures were the origins of the polyps.
The Role of Endoscopic Sinus Surgery in the Diagnosis and Treatment of Metastatic Orbital Carcinoid Tumors
Authors: Gerencer Roland Z. , Patel Uresh , Hunter Charles , Heffernan J. Timothy
Published: May 2019

Carcinoid tumor metastatic to the orbit is a rare occurrence. We report such a case in a patient with a carcinoid metastasis that was found in the medial rectus muscle. The diagnosis was established via a transnasal endoscopic approach. We also discuss the treatment of metastatic orbital carcinoid in the hope that we will increase awareness of the utility of transnasal endoscopy in facilitating both the diagnosis and treatment of posteromedial orbital pathology.
Unilateral Hearing Impairment in Oman: A Community-Based Cross-Sectional Study
Authors: Khabori Mazin Al , Khandekar Rajiv
Published: May 2019

This report on unilateral hearing loss is based on the findings of a national survey on hearing loss and blindness in Oman. The survey of randomly selected households was conducted by trained healthcare personnel between Oct. 1, 1996, and Feb. 28, 1997. A total of 11,402 subjects of all ages were screened for hearing loss. Those who reported hearing impairment in either ear were subsequently reexamined by otologists in hospitals to confirm the findings and to determine the cause of the hearing loss. Based on these findings, we calculated that the prevalence of unilateral hearing impairment throughout Oman was 30.06 per 1,000 population (95% confidence interval [CI]: 29.80 to 30.31). Males had a significantly higher rate (36.67/1,000 [95% CI: 34.55 to 38.79]) than females (23.88/1,000 [95% CI: 21.82 to 25.94]). The causes of unilateral hearing loss were different from the reported causes of bilateral hearing loss. Impacted earwax (16.0% of cases) and otitis media with effusion (13.1%) were the most common identifiable causes of unilateral hearing loss; genetic causes were responsible for less than 2% of cases. Just over one-half of the hearing-impaired patients had only a mild hearing loss. Impairment rates varied in different regions of the country.
Otogenic Tension Pneumocephalus Caused by Therapeutic Lumbar Csf Drainage for Post-Traumatic Hydrocephalus: A Case Report
Authors: Chan Edwin K. , Meiteles Lawrence Z.
Published: May 2019

Tension pneumocephalus occurs when a continuous flow of air accumulates in the intracranial cavity and produces a mass effect on the brain. We describe a case in which tension pneumocephalus was caused by the performance of continuous lumbar CSF drainage in a middle-aged man who had experienced a temporal bone fracture. Continuous lumbar CSF drainage is commonly performed in patients with temporal bone or basilar skull fractures to treat concomitant post-traumatic CSF rhinorrhea, CSF otorrhea, and/or hydrocephalus. However, to the best of our knowledge, there has been no previously reported case of tension pneumocephalus occurring as a complication of this procedure in a patient with a temporal bone fracture.
Undifferentiated Metastatic Carcinoma and Myoepithelioma: Two Rare Causes of Hypervascular Masses of the Parapharyngeal Space
Authors: Koenigsberg Robert A. , Vakil Nakul , Noronha Bosco
Published: May 2019

We report 2 unusual cases of hypervascular masses in the parapharyngeal space. The first case involved a poorly differentiated metastatic carcinoma of oropharyngeal origin that mimicked a carotid body tumor. The second case involved a highly vascular myoepithelioma located in the parapharyngeal space.
Intratracheal Ectopic Thyroid: Case Report and Review
Authors: Karakullukçu Bariş , Güvenç M. Güven , Cansiz Harun , Öktem Fatih , Öz Büge
Published: May 2019

Intratracheal ectopic thyroid tissue is a rare abnormality that can cause airway obstruction. The symptoms can easily be confused with those of bronchial asthma. We describe the case of a 40-year-old man with subglottic thyroid tissue and multinodular goiter who had been misdiagnosed earlier with bronchial asthma. After the correct diagnosis was established, the lesion was excised via an external approach. We also discuss the clinical features and management of intratracheal thyroid tissue.
Castleman's Disease: Three Case Reports and a Review of the Literature
Authors: Newlon James L. , Couch Marion , Brennan Joseph
Published: May 2019

Castleman's disease is a rare lymphoproliferative disorder that is easily misdiagnosed. When it occurs in the head/neck and thorax, it can pose a diagnostic dilemma because of its lack of any specific presenting characteristics and distinguishing radiographic features. An accurate histopathologic diagnosis and careful staging are crucial to planning treatment. The highly vascular nature of the tumor makes surgical management challenging, and it warrants preoperative embolization whenever possible. We report 3 cases of Castleman's disease that involved the head/neck and thorax. We also review the presenting clinical features of Castleman's disease, its histopathologic characteristics, and the diagnostic and treatment challenges that it poses.
Efficacy Comparison of Multiple-Antigen Subcutaneous Injection Immunotherapy and Multiple-Antigen Sublingual Immunotherapy
Authors: Saporta Diego , McDaniel Alan B.
Published: May 2019

We performed an observational study to determine whether allergen-specific sublingual immunotherapy (SLIT) is as effective as allergen-specific subcutaneous injection immunotherapy (SCIT). Our study population was comprised of 66 patients who had been taking SLIT. Of this group, 36 patients had switched to SLIT after having been treated with SCIT (group I), while the remaining 30 patients had received SLIT only (group II). A questionnaire was used to evaluate the results of treatment. In group I, 33 patients (92%) gave SLIT a favorable rating; 27 of these patients (75%) said it was just as effective as SCIT, and 6 (17%) said it was actually superior (the remaining 3 patients [8%] said that SCIT was better). In group II, 27 of 30 patients (90%) said they had attained symptom relief with SLIT; 21 (70%) said that the relief had been very significant. Overall, 60 of the 66 patients (91 %) expressed various degrees of satisfaction with SLIT. We believe that our SLIT protocol, which is based on established guidelines for SCIT administration, is an effective, safe, well-tolerated, and easy-to-use regimen. Future prospective studies of larger groups are clearly indicated.
Pediatric Nasal Septal Perforation Secondary to Magnet Misuse: A Case Report
Authors: Shermetaro Carl , Charnesky Melissa
Published: May 2019

We describe the case of a 7-year-old girl who had placed magnetic earrings bilaterally on her nasal ala. However, the two backing magnets that had been placed inside the nasal cavity became attached to each other rather than to the outer jewelry, compressing the nasal septum. Several weeks later, the septum became perforated. The patient was treated conservatively with mupirocin ointment, oral amoxicillin, and nasal saline. Subsequent examinations revealed no enlargement of the perforation, and the patient was followed conservatively with saline nasal spray.
Extramedullary Plasmacytoma of the Larynx: A Case Report from Japan
Authors: Kusunoki Takeshi , Ikeda Katsuhisa , Murata Kiyotaka , Nishida Shozo , Tsubaki Masanobu
Published: May 2019

Laryngeal plasmacytoma is rare in Japan; to the best of our knowledge, only 8 other cases have been previously reported. We report a new case of extramedullary plasmacytoma of the larynx in a 76-year-old Japanese woman. Immunohistochemical investigation revealed that her disease had not progressed to multiple myeloma. The patient declined radiotherapy, and her condition remained stable at the 6-month follow-up.
Giant Mastoid Osteoma with Postoperative High-Frequency Sensorineural Hearing Loss
Authors: Lee Raymond E. , Balkany Thomas J.
Published: May 2019

Osteomas occur throughout the temporal bone and, depending on their location, may cause tinnitus, hearing loss, vertigo, and facial nerve paresis. We present a rare case of a 25-year-old woman with a mastoid osteoma enlarging over a 6-month period. Other than a cosmetic deformity of her upper neck, the patient was asymptomatic. After surgical removal of the bony neoplasm, the patient was noted to have a high-frequency sensorineural hearing loss. This case study presents clinical, radiologic, intraoperative, pathologic, and audiometric findings of a mastoid osteoma and a review of the literature.
Marginal-zone B-cell Lymphoma of the Bony Palate presenting as Sinusitis
Authors: Ayers Lisa Skultety , Oxenberg Jacqueline , Zwillenberg Seth , Ghaderi Mahmoud
Published: May 2019

The diagnosis of low-grade B-cell lymphoma consistent with marginal-zone lymphoma has proven to be challenging when the disease involves the hard palate. The diagnosis is complicated by the nonspecific nature of the presenting symptoms and a difficult-to-differentiate histologic picture. We describe a case of low-grade B-cell lymphoma of the hard palate with a delayed presentation. We also compare the features of this case with the features of the small number of other such cases that have been reported in the literature. Finally, we review the etiology of low-grade B-cell lymphoma, we discuss its radiologic and pathologic features, and we briefly describe the treatment options.
Masticatory Diplopia
Authors: Militsakh Oleg , Kriet J. David
Published: May 2019

We report a case of diplopia that was exacerbated by chewing in a patient who had sustained facial fractures in a motorcycle crash. The diplopia was corrected surgically 1 year following the accident. To the best of our knowledge, masticatory diplopia as a result of adhesion of the temporalis muscle to the periorbita secondary to facial trauma has not been previously reported.
Auricular Ossification Resulting in External Auditory Canal Stenosis
Authors: Carfrae Matthew J. , Foyt David
Published: May 2019

We report the case of a 49-year-old man who presented with left aural fullness, hearing loss, and a stenotic left external auditory meatus. Physical examination and computed tomography revealed the presence of an idiopathic ossification of the cartilaginous auricle and external auditory canal. The patient was successfully treated with meatoplasty. Pathologic examination of the removed specimen revealed osseous metaplasia.
An Atypical Case of Fatal Zygomycosis: Simultaneous Cutaneous and Laryngeal Infection in a Patient with a Non-neutropenic Solid Prostatic Tumor
Authors: Johnson Kristine E. , Leahy Kevin , Owens Christopher , Blankson Joel N. , Merz William G. , Goldstein Bradley J.
Published: May 2019

We describe what we believe is the first reported case of simultaneous highly invasive cutaneous and laryngopharyngeal zygomycosis in a non-neutropenic, nondiabetic but immunosuppressed patient with prostate cancer. An invasive fungal process was not suspected until late in the patient's hospital course; when it was, a tracheotomy and direct laryngoscopic biopsies were performed. Unresectable invasive zygomycosis with Rhizopus rhizopodiformis was diagnosed. The patient was managed with liposomal amphotericin B initially and later with palliative medical therapy until he died. This case emphasizes the need for a rapid and specific diagnosis with timely introduction of appropriate antifungal management, particularly now that voriconazole is frequently used as empiric prophylaxis against aspergillosis in high-risk patients.
Formation of an Airway Foreign Body during Removal of a Metal Tracheostomy Tube: A Case Report
Authors: Gore Mitchell R. , Rose Austin S.
Published: May 2019

Tracheostomy tube changes are often performed in the clinic or at the bedside without complication. We report a case in which the removal of a long-term metal tube in a clinic setting was complicated by the presence of fibrinous debris on the tube. The debris had accumulated over a period of at least 3 years. The patient was taken to the operating room, and the tube was removed. However, the fibrinous debris remained behind, leaving an airway foreign body. The foreign body was subsequently removed with an optical foreign-body extraction forceps under direct visualization. Based on our experience and on the limited amount of information available in the literature, we recommend that long-term metal tracheostomy tubes be changed not in the clinic but in the operating room, where potential complications can be more easily managed.
Treatment of Tinnitus with a Customized Acoustic Neural Stimulus: A Controlled Clinical Study
Authors: Davis Paul B. , Wilde Ron A. , Steed Lyndall G. , Hanley Peter J.
Published: May 2019

In patients with tinnitus, achieving consistently positive treatment results is a challenge. We conducted a controlled clinical study of a new treatment approach (Neuromonics Tinnitus Treatment) that involves the use of a customized neural stimulus. This stimulus is delivered to the patient in the form of a pleasant acoustic sensation that is spectrally modified according to each patient's individual audiometric profile. This treatment approach is provided as part of a structured rehabilitation program. In our study, patients who received the customized stimulus (Neuromonics group) reported significantly greater and more consistent alleviation of tinnitus symptoms than did patients who participated in a counseling and support program with and without delivery of a broadband noise stimulus (Noise +Counseling group and Counseling-Only group, respectively). After 6 months of treatment, 86% of the Neuromonics patients met the minimum criterion for clinical success, defined as an alleviation of tinnitus disturbance of at least 40% (as determined by the Tinnitus Reaction Questionnaire score). By contrast, only 47 and 23% of the Noise+Counseling and Counseling-Only groups, respectively, reported a successful result according to this criterion. Mean improvements in tinnitus disturbance scores in the Neuromonics, Noise+Counseling, and Counseling-Only groups were 66, 22, and 15%, respectively. The differences between the Neuromonics group and the control groups were statistically significant. Significant differences were observed in other clinical outcomes. Patient reports of user acceptability were more consistently positive in the Neuromonics group.
A Preliminary Study of the Effectiveness of an Otolaryngology-based Multidisciplinary Falls Prevention Clinic
Authors: Alvord Lynn S. , Benninger Michael S. , Stach Brad A.
Published: May 2019

Because the cause of falls is often multifactorial, efforts to identify risk factors and promote prevention would benefit from a multidisciplinary approach in which the contributions of a broad range of body systems are considered. We describe the practices and procedures followed at the otolaryngology-based multidisciplinary Falls Prevention Clinic at Henry Ford Hospital in Detroit. Our team is made up of an otolaryngologist, an audiologist, an internist, and a physical therapist. Our multidisciplinary approach involves evaluations of vestibular and balance function, cardiovascular function, and visual function; lower-extremity strength and sensation; cognition and mood; and medication use. We also assess a number of nonmedical risk factors. Evaluations are made over the course of two clinic visits. To assess the effectiveness of our approach, we conducted a preliminary study based on chart reviews and telephone interviews of 52 patients who had been referred to our clinic for evaluation and counseling. The basis of our study was a comparison of the number of falls that patients had experienced during the 6 months prior to their first visit to our clinic and the number of falls they experienced during the 6 months after their second visit. We found that among “true fallers” (i.e., those who had actually experienced a fall at some point during the study), 64.7% reported that they had experienced fewer falls after their clinic visits than before (p < 0.001). Also, 59.1% of patients who had been “frequent fallers” prior to their clinic evaluation (i.e., ≥3 falls during the previous 6 mo) reported that they had not fallen at all during the 6 months following their last visit. Finally, our evaluations identified a substantial number of risk factors in individual patients that had been missed previously, including many nonvestibular factors that might not have been detected without a multidisciplinary approach. We conclude that the results of this preliminary study demonstrate the potential that a comprehensive falls prevention clinic can have in reducing the number of falls among outpatients at risk, and we believe that further study is warranted.
Prevalence of Autoimmune Thyroid Disease in Chronic Rhinitis
Authors: Reisacher William R.
Published: May 2019

A retrospective, controlled study was undertaken to determine the prevalence of autoimmune thyroid disease in 111 adult patients with allergic (77) and nonallergic (34) rhinitis seen in a private ENT/allergy practice in the lower Hudson Valley, New York. The control group consisted of 101 patients with no history of chronic rhinitis. Autoimmune thyroid disease was found in 10.4% of the allergic rhinitis group, 14.7% of the nonallergic rhinitis group, and 9.9% of controls, with a trend toward higher prevalence in the nonallergic rhinitis group compared with controls. No statistically significant association was noted between the 3 groups. The female-to-male ratio in the nonallergic rhinitis group was approximately twice as high as in the control group.
Radiotherapy-associated Euthyroid Graves Ophthalmopathy following Floor-of-mouth Surgery: A Case Report
Authors: Jaber James J. , Thomas Frank J. , Carfrae Mathew J. , Galati Lisa T.
Published: May 2019

The thyroid gland is commonly included in the radiation field during treatment of nonthyroidal neoplastic disease of the head and neck. As a result, thyroid abnormalities sometimes occur following external irradiation. We report an unusual case of radiotherapy-associated Graves ophthalmopathy 5 months after adjuvant external irradiation of the head and neck in a euthyroid patient who had undergone wide local excision of squamous cell carcinoma from the floor of the mouth.