bluuebunny/crossref_metadata_2025 huggingface dataset:
Free-Radical Damage: A Possible Mechanism of Laryngeal Aging
Authors: Diamond Jason , Skaggs Jennifer , Manaligod Jose M.
Published: May 2019

We conducted a study of lipid peroxidation as a marker of age-related free-radical damage in the human larynx—the first study of its kind. A colorimetric assay for malondialdehyde (MDA) and 4-hydroxy-2-nonenal (4-HNE) was performed on extracts taken from thyroarytenoid muscle harvested from fresh cadaveric laryngeal specimens. Levels of MDA and 4-HNE were measured by spectrophotometry. Correlation studies were performed by linear regression analysis. We found that MDA levels in human thyroarytenoid muscle appeared to increase with age while 4-HNE levels showed a slight decrease with age. Our findings are consistent with those of previous studies of other organ systems and indicate that there is a need for further study of free-radical damage and the effects of aging on the human larynx and on voice production.
Effectiveness of Nonsurgical Office Closure of Tympanic Membrane Pars Tensa Perforations
Authors: Scaramella Louis F. , Farrell Brian P. , Kooiker Philip D. , Marra Silvio
Published: May 2019

We report on our experience with nonsurgical office closure of tympanic membrane pars tensa perforations with the little-used but well-established Derlacki method, a procedure that had been in general use before the introduction of tympanoplasty more than a half century ago. We describe our results—including a success rate of 84.2%—in treating 81 perforations during the 6-year span from 1996 through 2001.
Cholangiocarcinoma Metastatic to the Neck: First Report of a Case
Authors: Hardeman Scott H. , Collins Brian , Lowe Val J. , Solomon Harvey , Stack Brendan C.
Published: May 2019

We describe a unique case of a cholangiocarcinoma that metastasized to a cervical lymph node—to our knowledge the only such case ever reported. The diagnosis was based on fine-needle aspiration cytology and confirmed by excision biopsy. This case illustrates the importance of keeping all possible options in mind when diagnosing head and neck masses.
Unifocal Langerhans’ Cell Histiocytosis and Frontal Sinus Agenesis: Report of a Rare Case
Authors: Basha Shaik I. , Kinsella John B. , Napier Seamus S.
Published: May 2019

Unifocal Langerhans’ cell histiocytosis of the frontal bone is rare. We report a most unusual case of Langerhans’ cell histiocytosis of the frontal bone in a patient who had been affected by frontal sinus agenesis. We believe this is the first reported case of its kind. We also review previously reported cases of solitary eosinophilic granuloma of the frontal bone and we discuss its clinical, radiologic, and histopathologic features.
An Unusual Case of Primary Nasal Tuberculosis with Epistaxis and Epilepsy
Authors: Batra Kadambari , Chaudhary Neena , Motwani Gul , Rai A.K.
Published: May 2019

Primary nasal tuberculosis is rare. We report a case that was all the more extraordinary because of the age and sex of the patient (an 11-year-old boy), the unusual associated symptoms (epistaxis and grand mal seizures), and the presence of intracranial extension. Clinical and radiologic finding s on our initial evaluation suggested that the patient had a large sinonasal malignancy. The patient manifested no evidence of pulmonary tuberculosis. The diagnosis of primary nasal tuberculosis was established only after we obtained the results of histopathology of the excised mass and a subsequent tuberculin skin test; the diagnosis was confirmed by the patient's rapid response to antituberculosis drug therapy. We also review the relevant literature on this rare condition.
Applications of the Diode Laser in Otolaryngology
Authors: Newman Jason , Anand Vijay
Published: May 2019

We undertook a study to determine the usefulness and effectiveness of a relatively new, portable 980-nm wavelength diode laser with a fiberoptic delivery system. We tested the laser in several clinical situations, both in the operating room and in the office. We used it while performing 14 turbinate reduction procedures, one nasal polypectomy, one ablation of an oral papilloma, and one photocoagulation of nasal telangiectasias. Our preliminary findings indicate that the use of this laser was helpful in alleviating nasal congestion in the patients with turbinate dysfunction and in controlling epistaxis in the patient with telangiectasias. It was also effective in treating the polyp and papilloma patients. We did not experience any intra- or postoperative complications. The laser's flexible fiber delivery system is compatible with hollow instruments, allows for coaxial vision, and is ideally suited for intranasal use. Its portability and functional diversity make it an attractive alternative to the conventional carbon dioxide, argon, and neodymium:yttrium-aluminum-garnet lasers.
Giant Frontoethmoid Mucocele with Intracranial Extension: Case Report
Authors: Cansiz Harun , Yener Murat , Güvenç M. Güven , Canbaz Bülent
Published: May 2019

We report the case of a 31-year-old woman who came to us with a giant frontoethmoid mass that had extended into the intracranial region and invaded the left orbit. We removed the lesion in its entirety via a combined intranasal and transcranial approach. We discuss the advantages and disadvantages of different surgical approaches, and we explain why we recommend a combined approach for the type of giant lesion that we encountered.
The Prevalence of an Onodi Cell in Adult Thai Cadavers
Authors: Thanaviratananich Sanguansak , Chaisiwamongkol Kowit , Kraitrakul Suthee , Tangsawad Watcharachai
Published: May 2019

Endoscopic sinus surgery in patients who have an Onodi cell (sphenoethmoid cell) carries a high risk for optic nerve injury. We meticulously dissected 65 embalmed cadaver adult half-heads and attempted to identify an optic canal bulge in each with a nasal endoscope. Our aims were to determine the prevalence of an Onodi cell in adult Thai cadavers, to ascertain the prevalence of an overriding ethmoid cell, and to measure the length of an overriding ethmoid cell's superior and posterior extensions in relation to the anterior sphenoid wall. Moreover, we attempted to determine the minimum amount of bone thickness between an Onodi cell and the optic nerve. We found that an Onodi cell was present in 39 of the 65 specimens (60.0%). We also found that an overriding ethmoid cell was present in 14 specimens, which accounted for 21.5% of the total number of specimens and 36.8% of 38 Onodi cell-positive specimens (the presence or absence of an overriding ethmoid cell was not recorded in one of the 39 Onodi cell-positive specimens). The distance of the overriding ethmoid cell's superior and posterior extensions from the anterior sphenoid wall ranged from 3 to 13 mm (median: 7) and from 4 to 16 mm (median: 9.5), respectively. Measurements of the minimum amount of bone thicknesses between each Onodi cell and optic nerve ranged from 0.03 to 0.54 mm (median: 0.08). Our study demonstrated that the prevalence of an Onodi cell in adult Thai cadavers was as great as the prevalence reported in the only other gross anatomic dissection study performed in Asia and much higher than rates generally reported in Western countries.
Hemangioma of the Sphenoid and Ethmoid Sinuses: Two Case Reports
Authors: Kilde John D. , Rhee John S. , Balla Andre A. , Smith Michelle M. , Smith Timothy L.
Published: May 2019

Hemangiomas of the paranasal sinuses are rare, particularly those of the sphenoid and ethmoid sinuses. Although imaging of the sinuses is key to determining the extent of involvement, the diagnosis is based on the lesion's histologic appearance. Obtaining an adequate biopsy can be difficult in light of the risk of bleeding and the relative inaccessibility of lesions in this region. These obstacles can make the diagnosis and management of these lesions particularly challenging. We describe two new cases of sinonasal hemangioma—one in the ethmoid sinus and one in the ethmoid and sphenoid sinuses—and we discuss the diagnostic and therapeutic interventions that are needed to manage these lesions.
Temporal Lobe Encephalocele Appearing as a Lytic Lesion of the Skull Base and Pterygoid Process
Authors: Bolger William E. , Reger Christine
Published: May 2019

Meningoencephalocele is an uncommon condition in which brain tissue, meninges, or both protrude through a defect in the anterior cranial fossa and into the ethmoid sinus or nasal cavity. Much less often, brain tissue, meninges, or both protrude through a defect in the middle cranial fossa and into the sphenoid sinus. We report an unusual case of a middle fossa encephalocele that appeared as a lytic lesion of the skull base. The patient was treated successfully via a unique endoscopic transpterygoid approach—that is, an endoscopic approach through the maxillary sinus and pterygopalatine fossa and into the pterygoid process.
Pharmacologic Manipulation of the Labyrinth with Novel and Traditional Agents Delivered to the Inner Ear
Authors: Seidman Michael D. , Van De Water Thomas R.
Published: May 2019

We describe the methodology and rationale behind the delivery of therapeutic medicines to the inner ear. The inner ear has long been impervious to pharmacologic manipulation. This is most likely the result of a protective mechanism called the blood-labyrinth barrier, whose function closely resembles that of the blood-brain barrier. This protective barrier impedes the clinician's ability to treat inner ear diseases with systemically administered medications. Since 1935, otolaryngologists have attempted to manipulate the inner ear with transtympanically injected medicines. Success has varied widely, but medicinal ablation of vestibular function can be achieved in this manner. Unfortunately, the auditory system is also at great risk from any medicine that is delivered to the inner ear via the middle ear. Over the past 10 years, significant improvements in drug delivery have allowed for more “titratable” treatment, which has reduced (but not eliminated) the risk of permanent hearing loss. In this article, we discuss both novel and time-tested methods of delivering medicines to the inner ear. We also review the classes of medications that alter inner ear function and the attendant risks of such treatments.
Obstructive Sleep Apnea Caused by Bilateral Vocal Fold Paralysis
Authors: Aziz Luaay , Ejnell Hasse
Published: May 2019

We describe the case of a woman who had been referred to us with a history of breathing difficulties and snoring and a suspicion of obstructive sleep apnea (OSA). Our investigation revealed that she did indeed have severe OSA in addition to undiagnosed bilateral vocal fold paralysis of unknown origin. Nocturnal polysomnography found that her apnea/hypopnea index was 120 and her minimum arterial oxygen saturation level was 63%. She was treated with laterofixation of the right vocal fold, and her OSA resolved immediately. During 10 years of follow-up with nocturnal polysomnography, no recurrence of apnea or low oxygen saturation levels was noted. However, she did experience a recurrence of her snoring 4 years postoperatively, along with the onset of progressively worsening daytime fatigue. When these conditions persisted, we performed a repeat laterofixation of the same vocal fold. Following the repeat surgery, subjectively and objectively assessed results were good.
Cystosarcoma Phyllodes Metastatic to the Mandible: Report of a Rare Case and Literature Review
Authors: Staton Jonathan B. , Costello Thomas H. , Donovan F. Daniel , Laster Robert E.
Published: May 2019

Cystosarcoma phyllodes is a rare breast tumor with variable malignant potential. Metastasis has been reported in a small percentage of cases. We describe the case of a 52-year-old woman who developed a large facial tumor 1 year after she had undergone a mastectomy fora rapidly enlarging breast neoplasm. The facial lesion was found to be a malignant cystosarcoma phyllodes metastatic to the mandible, and the patient died shortly after diagnosis. To our knowledge, this patient represents only the third reported case of a phyllodes tumor metastatic to the mandible.
Malignant Hyperthermia and the Otolaryngologist
Authors: Chang Christopher Y. , Scher Richard L.
Published: May 2019

Malignant hyperthermia is a rare disorder that can occur in patients who are sensitive to certain agents used in general anesthesia. The treatment of malignant hyperthermia has not changed over the years, but prevention strategies have evolved. These strategies include an increased emphasis on how patients are managed prior to a surgical procedure, on the selection of the particular anesthetic agent, and on postoperative vigilance. Susceptible patients who undergo simple excisions or a low degree of surgical stress can receive treatment safely in the office or ambulatory surgery center and be discharged the same day, provided that all known triggering agents are avoided. For more extensive procedures that cause a moderate level of surgical stress to susceptible patients, facilities for managing malignant hyperthermia should be readily available. Susceptible patients who undergo high-stress invasive procedures should be hospitalized. Routine preoperative prophylactic drug administration, even with dantrolene, is no longer considered necessary for any susceptible patients. All local anesthetics—including lidocaine, which had been previously contraindicated—are now considered to be safe for use in patients who are susceptible to malignant hyperthermia. In this article, we review the prevention, diagnosis, and management of malignant hyperthermia. We also report our experience in anesthetizing a patient who had a history of malignant hyperthermia—a case that illustrates the uncertainty that can complicate the management of such patients.
Pulmonary Involvement in a Case of Juvenile-onset Recurrent Respiratory Papillomatosis
Authors: McKay Shawn P. , Shinhar Shai Y. , Belenky Walter M.
Published: May 2019

Juvenile-onset recurrent respiratory papillomatosis is primarily a disease of children and adolescents. Although most patients experience spontaneous regression at a later age, some patients continue to be affected throughout their lives. We report the case of a 35-year-old woman with a 33-year history of juvenile-onset recurrent respiratory papillomatosis who developed pulmonary dissemination with malignant transformation. Malignant transformation is the most feared sequela of pulmonary dissemination, and it should be addressed aggressively. If treated promptly, the patient can enjoy prolonged survival. Computed tomography is superior to plain radiography for detecting and evaluating the extent of disease.
Remission of Chronic Inflammatory Demyelinating Polyneuropathy following Adenotonsillectomy
Authors: Harsha Wayne J. , Goco Paulino E. , Crawford James V.
Published: May 2019

Patients with chronic inflammatory demyelinating polyneuropathy (CIDP) experience proximal- and distal-extremity weakness, sensory loss, and often hyporeflexia or areflexia. CIDP is associated with a variety of concomitant medical illnesses, which often manifest weeks before the onset of muscle weakness and paresis. We describe what we believe is the first reported case of an association between CIDP and recurrent acute adenotonsillitis, which we observed in an 11-year-old girl. Following adenotonsillectomy, the patient's CIDP went into remission and her overall physical condition improved with physiotherapy.
Left Cervical Chyloma following Right Thyroidectomy
Authors: Madnani Dilip , Myssiorek David
Published: May 2019

Cervical chylomas are rare entities, as only four cases have been previously reported. All of these previous cases involved the left side, all were related to the thoracic duct, and all occurred following trauma or surgery. We report a new case of a left-sided chyloma that was unusual because it arose following a right-sided subtotal thyroidectomy. The chyloma arose as a left supraclavicular mass within 3 months of the thyroidectomy, and it slowly enlarged over a period of 9 years. Following evaluation by computed tomography, the mass was excised, and the patient recovered uneventfully. We also review what is known about the diagnosis and treatment of cervical chylomas.
Experience with the Malleable Ear Dressing, A Versatile Silicone-Lined Bandage for the Auricle
Authors: Godley Frederick A.
Published: May 2019

The repair of surgical wounds of the external ear—whether it be a primary skin closure, a skin flap, or a skin graft—presents several challenges with respect to healing. One of these challenges is that it is not easy to fashion a wound dressing that has a smooth, moisture-containing surface, conforms to the shape of the auricle, and adheres to it while providing light pressure. An ear dressing that features these characteristics—the malleable ear dressing—is expected to become commercially available soon. In this article, the author describes his use of this dressing in 48 patients and reviews the results of follow-up questioning of 20 of these patients. Based on these findings, the author concludes that this dressing is effective, comfortable, aesthetically acceptable, and can be worn continuously for 7 consecutive days without complications.
Efficacy and Tolerability of Telithromycin for 5 or 10 Days vs Amoxicillin/Clavulanic Acid for 10 days in Acute Maxillary Sinusitis
Authors: Luterman Maynard , Tellier Guy , Lasko Benjamin , Leroy Bruno
Published: May 2019

Telithromycin (HMR 3647) is a new ketolide antimicrobial that was developed for the treatment of community-acquired respiratory tract infections. We conducted a randomized, double-blind, multicenter study to compare the clinical efficacy and safety of oral telithromycin, at 800 mg once daily for 5 or 10 days, with that of amoxicillin/clavulanic acid, at 500/125 mg three times daily for 10 days, in adults with acute maxillary sinusitis (AMS). A total of 754 patients with AMS of less than 28 days’ duration were randomized to receive either telithromycin for 5 days followed by placebo for 5 days, telithromycin for 10 days, or amoxicillin/clavulanic acid for 10 days. Clinical outcome was assessed at a test-of-cure (TOC) visit between days 17 and 24 and at a late post-therapy visit between days 31 and 45. Analysis of clinical outcome on a per-protocol basis (n = 434) demonstrated therapeutic equivalence among the three regimens at the TOC visit; in each treatment group, the clinical cure rate was approximately 75%. Only a few patients (3 to 5 in each group) had relapsed by the late post-therapy follow-up visit. Telithromycin was generally safe and well tolerated. The most common adverse events were mild or moderate gastrointestinal effects, which occurred with similar frequency in all three groups. We conclude that 5 or 10 days of telithromycin at 800 mg once daily is as effective clinically and as well tolerated as 10 days of treatment with amoxicillin/clavulanic acid. Telithromycin, therefore, appears to be a valuable option for the treatment of AMS.
Concha Bullosa of an Inferior Turbinate
Authors: Ingram Alan , Richardson Brynn E.
Published: May 2019

Pneumatization of the inferior turbinate is a rare intranasal anatomic variant. In the English-language world literature, only 10 cases of inferior turbinate concha bullosa have been reported. We present the 11th such case, which we discovered during an evaluation of a patient who had chronic rhino sinusitis with allergic manifestations.
Assessment of Intravenous Lidocaine for the Treatment of Subjective Tinnitus
Authors: Otsuka Koji , Pulec Jack L. , Suzuki Mamoru
Published: May 2019

Despite the development of sophisticated diagnostic procedures and treatments for other otologic and neurotologic conditions, tinnitus remains difficult to manage. Several investigators have shown that lidocaine has an effect on temporarily (for several minutes) relieving subjective tinnitus, but few reports have described the response to lidocaine according to different individual patient characteristics. Over a 24-year period, we administered either 60 or 100 mg of intravenous lidocaine to 117 ears in 103 patients with subjective tinnitus (14 patients received treatment bilaterally). Within 5 minutes of treatment, 83 ears (70.9%) experienced either complete or partial relief. The 100-mg dose was more effective than the 60-mg dose in completely eliminating tinnitus (34.9 vs 20.6%), but the two doses were comparable when elimination rates were combined with rates of reduction of tinnitus (71.1 and 70.6%, respectively). With respect to individual patient characteristics, ears with low- to middle-tone tinnitus had a better response, as did ears in which the hearing level was 40 dB or higher and ears of patients aged 60 years and older. The response to lidocaine was not correlated with the baseline loudness of tinnitus or to its duration.
Middle Turbinate Resection: Impact on Outcomes in Endoscopic Sinus Surgery
Authors: Shih Charles , Chin Gregory , Rice Dale H.
Published: May 2019

There is considerable controversy concerning the advisability and efficacy of middle turbinate resection in endoscopic sinus surgery. Some have reported that it causes an increase in the incidence of frontal sinusitis, while others have found no such association. Surprisingly, in a 35-year review of turbinate surgery literature, Clement and White did not find a single prospective study of turbinate surgery. In this article, we briefly report our prospective study of middle turbinate resection during endoscopic sinus surgery. Our findings lead us to believe that middle turbinate resection has no deleterious effects on the results of endoscopic sinus surgery.
The Prevalence of Major Psychiatric Pathologies in Patients with Voice Disorders
Authors: Mirza Natasha , Ruiz Cesar , Baum Eric D. , Staab Jeffrey P.
Published: May 2019

We conducted a study of 47 patients with various voice disorders to determine the prevalence of concomitant psychopathology. The prevalence of psychiatric symptoms varied considerably among patients with the three most common voice disorders: 63.6% among patients with vocal fold paralysis, 29.4% among those with functional dysphonia, and 7.1% among those with spasmodic dysphonia. Levels of anxiety and depression correlated moderately with the severity of voice symptoms in patients with vocal fold paralysis, but not in those with functional or spasmodic dysphonia. Certain abnormal personality traits—including interpersonal sensitivity and distrust of others—were more common among patients with functional dysphonia. The low rate of psychopathology among patients with spasmodic dysphonia is consistent with rates reported in previous investigations. Our findings suggest that the prevalence of psychopathology in patients with voice disorders varies according to the specific voice diagnosis, as does the relationship between specific psychiatric and voice symptoms.
Expression of EphB4 in Head and Neck Squamous Cell Carcinoma
Authors: Sinha Uttam K. , Kundra Ajay , Scalia Pierluigi , Smith Diane L. , Parsa Behdad , Masood Rizwan , Gill Parkash S.
Published: May 2019

EphB4 is a receptor tyrosine kinase that is expressed on epithelial cells during fetal life. It is also expressed on some venous endothelial cells. We conducted a study of six men with primary squamous cell carcinoma of the head and neck (HNSCC) that had metastasized to the cervical lymph nodes. Our goal was to determine if EphB4 is aberrantly expressed in cases of HNSCC and to determine if there is a qualitative difference between the expression of EphB4 on primary and metastatic tumors and its expression on normal mucosa adjacent to primary tumors. From each patient, we obtained specimens of the primary tumor, the nodal metastasis, and the adjacent normal mucosa, and we performed immunocytochemistry on each. We observed EphB4 expression in all primary and metastatic tumors and no expression in the normal tissue. In each of the six patients, expression was greater in the metastatic tumor than in the primary tumor. We conclude that EphB4 is a novel target in the treatment of HNSCC.
Giant-Cell Reparative Granuloma of the Temporal Bone: A Case Report and Review of the Literature
Authors: Boedeker Carsten Christof , Kayser Gian , Ridder Gerd Jürgen , Maier Wolfgang , Schipper Jörg
Published: May 2019

Giant-cell reparative granuloma (GCRG) is an unusual, non-neoplastic fibrous lesion that most often arises in the mandible and maxilla. GCRG of the temporal bone is exceedingly rare. To the best of our knowledge, only 17 cases have been previously reported in the international medical literature. Although no case of metastasis has-been reported, this malignancy can be locally aggressive, and it often recurs following incomplete excision. We report the case of a young woman with a very large GCRG of the right temporal bone. We discuss the clinical picture, differential diagnosis, histologic evaluation, appearance on computed tomography and magnetic resonance imaging, and treatment options. We also review the cases of temporal bone GCRG that have been reported in the literature so far.
An unusual Case of External Ear Inflammation Caused by Sarcoidosis
Authors: Lang Emer E. , Zaruk Jamilla El , Colreavy Michael P. , Kennedy Susan , Rowley Helena , Timon Conrad
Published: May 2019

Inflammation of the pinna can occur in conjunction with polychondritis and otitis externa. We describe a case of pinneal inflammation that proved to be sarcoidosis, and we discuss the otolaryngologic manifestations of sarcoidosis.
Odontogenic Keratocysts in Nevoid Basal Cell Carcinoma (Gorlin's) Syndrome: CT and MRI Evaluation
Authors: Palacios Enrique , Serou Michael , Restrepo Santiago , Rojas Rafael
Published: May 2019

We describe the imaging findings in a 13-year-old boy with nevoid basal cell carcinoma syndrome (NBCCS). The initial imaging work-up included plain radiographs and computed tomography (CT) of the facial area and mandible. CT detected large expansile cystic changes on both sides of the body and angle of the mandible. When the patient's condition worsened, magnetic resonance imaging (MRI) was performed to further characterize the nature of the lesions and to rule out intracranial anomalies. We agree with others who have published previous reports that although CT is valuable in elucidating osseous craniofacial anomalies associated with NBCCS, MRI is superior in demonstrating the internal composition and structure of the odontogenic keratocysts that are commonly seen in this syndrome.
Functional Outcomes following Palatal Reconstruction with a Folded Radial Forearm Free Flap
Authors: Sinha Uttam K. , Young Philip , Hurvitz Keith , Crockett Dennis M.
Published: May 2019

Defects of the soft palate often occur after extirpative procedures are performed to treat oropharyngeal cancers. These defects usually result in velopharyngeal insufficiency and an alteration in speech and deglutition. Palatal prostheses have been used to circumvent this problem in the past. Recently, however, folded radial forearm free flaps have been introduced for reconstruction of the soft palate to eliminate velopharyngeal insufficiency and the need for a prosthesis. We conducted a study to evaluate pharyngeal and palatal functions following reconstruction of soft-palate defects with radial forearm free flaps in 16 patients who had undergone resection of the soft palate for squamous cell carcinoma. Nine patients had partial soft-palate defects and 7 had total defects. All patients had lateral pharyngeal-wall defects. In addition, 14 patients had defects of the base of the tongue. Patients were followed for 3 to 40 months. Outcome measures were determined according to several parameters, including postoperative complications, resumption of diet, intelligibility of speech, and decannulation. All patients were evaluated by a speech pathologist and an otolaryngologist with a bedside swallowing evaluation and flexible nasopharyngoscopy. Twelve patients underwent videofluoroscopic studies. There was no incidence of flap failure. One patient developed a transient salivary fistula, which resolved with conservative management. Four patients without dysphagia resumed oral intake 2 weeks after surgery. The 12 patients with dysphagia underwent swallowing therapy. Ten of them responded and were able to resume oral intake, while the other 2 required a palatal prosthesis. Overall, 10 patients resumed a normal diet and 4 tolerated a soft diet within 6 weeks. The 2 patients who required a palatal prosthesis were able to take purees. All patients were decannulated, and all were able to speak intelligibly. Speech was hypernasal in 2 patients and hyponasal in 3. We conclude that the folded radial forearm free flap procedure is a useful alternative for reconstruction of palatal and pharyngeal defects. It is safe and effective, and it results in excellent functional outcomes.
A Case of Pneumocephalus and Meningitis as a Complication of Silent Otitis Media
Authors: Turgut Suat , Ercan Ibrahim , Alkan Zeynep , Çakir Burak
Published: May 2019

Silent otitis media is a progressive otogenic disease. Intracranial manifestations of this complication are limited; the most common is meningitis. We report a case of meningitis and pneumocephalus as a complication of silent otitis media. To the best of our knowledge, this is the first reported case of pneumocephalus as a complication of silent otitis media.
Pedunculated Cribriform Adenocarcinoma of the base of the Tongue
Authors: Prasad Kishore Chandra , Kaniyur Vishnu , Pai Radha R. , Nesari Satish S.
Published: May 2019

A handful of cases of cribriform adenocarcinoma of the tongue have been reported in the literature, but in none of these cases was the tumor pedunculated. By the time these patients sought treatment, most of the tumors had metastasized to the cervical lymph nodes. We report the case of a 65-year-old woman who had a large, pedunculated, cribriform adenocarcinoma that had arisen from the base of the tongue. This case was also unusual because the tumor had not metastasized. The patient was treated with surgery and radiotherapy. To the best of our knowledge, cribriform pedunculated adenocarcinoma of the base of the tongue has not been previously reported.
Coexisting Facial Nerve Schwannoma and Monomorphic Adenoma of the Parotid Gland
Authors: Richmon Jeremy D. , Wahl Carter E. , Chia Stanley
Published: May 2019

We describe the case of a patient with a parotid mass that was found to consist of both a facial nerve schwannoma and a monomorphic adenoma. To our knowledge, this is the first report of these two lesions presenting as a single tumor. We also discuss the incidence, diagnosis, and treatment of parotid facial nerve schwannomas.
Muscle Tension Dysphonia in Patients who use Computerized Speech recognition Systems
Authors: Olson David E.L. , Cruz Raul M. , Izdebski Krzysztof , Baldwin Tracey
Published: May 2019

The use of speech recognition systems as a replacement for other types of transcription systems is increasing rapidly, partly because many people are unable to use conventional keyboards as a result of upper-extremity repetitive strain injury (RSI). However, the frequent or continuous use of such systems can cause muscle tension dysphonia in some patients. The scientific literature suggests that there is an association between upper-extremity RSI and muscle tension dysphonia. We present a retrospective case series of five patients with workplace upper-extremity RSI who developed muscle tension dysphonia soon after they began using discrete computerized speech recognition software. The diagnosis of dysphonia was based on laryngovideostroboscopy, acoustic analyses, and voice load testing. All patients had normal voice when using everyday speech, but speaking into the computer resulted in the rapid onset of aperiodicity, strain, and a decrease in fundamental frequency. In three of the five patients, laryngovideostroboscopy showed posterior glottic overapproximation, but no other abnormalities. Treatment was centered on voice therapy and avoidance of long periods of using computerized speech recognition systems. The condition of three of the five patients improved with therapy. We conclude that computer speech recognition programs can lead to the onset of muscle tension dysphonia in some patients. These patients can be successfully treated with voice therapy.
Lidocaine for the Relief of Incapacitating Tinnitus
Authors: Marzo Sam , Stankiewicz James A. , Consiglio Angelo P.
Published: May 2019

Tinnitus is tolerated by most patients, but in others it is enough of a problem that they seek medical attention. Results of treatment have been mixed. On occasion, a patient is so distressed by tinnitus that he or she is incapacitated and seeks help in an emergency department. We describe what we believe is the first reported case of recurrent incapacitating tinnitus secondary to inner ear tertiary syphilis in which a patient successfully responded to emergency treatment with intravenous lidocaine.
A New Method of Studying the Anatomy of the Posterior Tympanum
Authors: Holt James J.
Published: May 2019

The anatomic position of the posterior tympanum compromises direct visualization and investigation of its structures. Therefore, assessment of its anatomy is limited, and surgical removal of disease in this area remains a challenge. In this article, the author describes a new method that can be used to fully expose, visualize, and measure the structures in the posterior tympanum, thereby allowing for further definition of the anatomy and, in turn, refinement of surgical techniques for the removal of disease in this portion of the middle ear. The new technique involves removal of the anterior canal bone and its overlying tissues to eliminate the mechanical barriers to the posterior tympanum, which allows for direct visualization and measurement of the posterior tympanic structures. This method has three primary advantages over other methods used to study the posterior tympanum. First, observations of the anatomy can be made under direct visualization. Second, this method permits investigators to study the anatomy and the relationships between structures of the posterior tympanum as they occur in their normal unaltered state. Third, this method allows for wide anterior access to the posterior tympanum, thereby making scientific research into its anatomy possible. Information obtained from future studies of this method can help further refine surgical techniques for removal of disease from the posterior tympanum.
Novel use of a Leyla-Yasargil Retractor as an Endoscope Holder during Endoscopic Sinus Surgery
Authors: Raman Rajagopalan , Prepageran Narayanan
Published: May 2019

The authors describe a novel way of fashioning an endoscope holder from a common retractor and an ear speculum. Using such a device during endoscopic shuts surgery leaves both of the surgeon's hands free to manipulate the instruments.
Sinonasal Adenoid Cystic Carcinoma with Widespread Symptomatic Bony Metastasis
Authors: Lee Wha-Joon , Kapadia Silloo B. , Stack Brendan C.
Published: May 2019

Adenoid cystic carcinoma is a fairly uncommon salivary neoplasm of the head and neck. These lesions often progress insidiously, and they have a propensity for early perineural spread and bony invasion. Distant metastasis to the lungs is fairly common and is usually fatal. We report a rare case of adenoid cystic carcinoma in a patient who on initial evaluation had widespread bony metastasis but no pulmonary involvement.
Malignant Fibrous Histiocytoma of the Head and Neck after Radiation for Squamous Cell Carcinoma
Authors: Sadati Kevin S. , Haber Marian , Sataloff Robert T.
Published: May 2019

A 60-year-old man presented with malignant fibrous histiocytoma of the oropharynx. The mass extended into the nasopharynx and larynx and caused severe upper airway obstruction that required emergency tracheotomy. Ten years earlier, he had undergone a right partial glossectomy and segmental mandibulectomy for squamous cell carcinoma of the right tongue base, followed by 50 Gy of radiation delivered over 33 sessions. The tumor was so aggressive that changes in its volume were visually distinguishable during physical examination over a 2-week hospital stay. Histologic evaluation revealed 7 mitotic figures per high-power field. Although radiation-induced malignant fibrous histiocytoma is rare in the head and neck, the recent medical literature indicates that its incidence is rising. This rise has been attributed to the increased effectiveness of head and neck cancer therapy, which results in prolonging patients’ survival and, hence, their risk of subsequent disease. Because malignant fibrous histiocytoma is a late complication of radiation therapy, appearing on average 10 years following treatment, it is important that physicians who treat head and neck cancer monitor these patients over the long term and remain alert for its appearance, even despite the apparent “cure” of their original neoplasm.
Actinomycosis of the Temporal Bone: A Report of a Case
Authors: Sobol Steven E. , Samadi Daniel S. , Wetmore Ralph F.
Published: May 2019

Actinomycosis is a chronic suppurative infection of the cervicofacial region caused by Actinomyces species, which are anaerobic, gram-positive filamentous bacteria. Although actinomycosis has a propensity for involving the oral cavity, rare cases of actinomycosis involving the temporal bone have been published. We report the case of a 14-year-old girl who presented with clinical, audiometric, and radiologic findings consistent with right chronic suppurative otitis media that persisted despite tympanomastoidectomy. Findings on histologic evaluation of a specimen obtained during revision surgery were consistent with a diagnosis of actinomycosis. Although actinomycosis of the temporal bone is rare, it should be considered in the differential diagnosis of chronic suppurative temporal bone infections that are resistant to standard therapy.
Isolated Nasopharyngeal Aspergillosis Caused by A flavus and Associated with Oxalosis
Authors: Dogan Müzeyyen , Pabuçcuoglu Ugur , Sarioglu Sülen , Yücesoy Mine
Published: May 2019

We report a case of isolated nasopharyngeal aspergillosis in a 52-year-old woman with Hashimoto's thyroiditis. We found the nasopharyngeal lesion incidentally while evaluating bilateral cervical lymphadenopathy, which we had discovered during a routine follow-up examination pursuant to the patient's thyroid problem. Biopsy analysis of the nasopharyngeal lesion revealed the presence of a mycelium made up of septate hyphae and associated oxalosis. Mycologic examination confirmed that Aspergillus flavus was the responsible pathogen. No systemic involvement or involvement of other head and neck sites was found. The patient had been exposed to a considerable amount of dust during the construction of her house, and this may have been the precipitating factor in the development of her infection. We treated the patient with a 4-week course of itraconazole. At the end of therapy, she exhibited no evidence of A flavus on physical and mycologic examinations.
Metastatic Seminoma with Cervical Lymphadenopathy as the Initial Manifestation
Authors: Akst Lee M. , Discolo Christopher , Dipasquale Bruno , Greene David , Roberts Jay
Published: May 2019

Advanced testicular germ cell tumors commonly involve cervical lymph nodes. In most circumstances, the diagnosis of germ cell tumor is established before the neck disease is noted. In rare cases, these tumors have been found along with cervical lymphadenopathy in patients with a previously undiagnosed primary tumor. In this article, we report the unusual case of a 71-year-old man whose metastatic seminoma initially manifested as an asymptomatic neck mass. This finding reinforces the need to include metastatic disease in the differential diagnosis of neck masses. Our discussion of this case focuses on the appropriate management of cervical metastases of germ cell tumors.
Myofibroma of the Cheek: A Case Report
Authors: Kassenoff Tali L. , Tabaee Abtin , Kacker Ashutosh
Published: May 2019

Myofibromas are benign mesenchymal tumors that are commonly found in the dermis and subcutaneous tissues of the head and neck. Although most lesions are recognized daring infancy and early childhood, several cases have been reported in older children and adults. We describe the case of a 9-year-old girl who presented with a solitary nodule in the left cheek and a history of minor trauma. Preoperative imaging detected the presence of a subcutaneous soft-tissue mass consistent with a soft-tissue neoplasm rather than a hematoma. Analysis of fine-needle aspiration material was nondiagnostic. Incisional biopsy revealed that the lesion was a myofibroma.
Percutaneous Endoscopic Gastrostomy Tube Feeding in Patients with Head and Neck Cancer
Authors: Baredes Soly , Benin Daniel , Deitch Edwin
Published: May 2019

We performed a retrospective chart review of 55 patients who had been treated for head and neck cancer to evaluate the complication rate associated with percutaneous endoscopic gastrostomy (PEG) for nutritional support. We found that complications occurred in only 6 patients (10.9%); 3 of these patients (5.5%) had granulation around the site of the PEG tube, and 1 each experienced a tube malfunction, migration of the PEG tube, and leakage around the tube. No wound infection or other complication associated with PEG tubes was noted. Of the 6 complications, 3 occurred in 31 patients who underwent PEG tube placement at the time of tumor resection, and 3 occurred among 16 patients who received a PEG tube postoperatively. We conclude that placement of a PEG tube is a safe method of providing nonoral nutritional support for patients with head and neck cancer.
The Relationship of Tinnitus, Hyperacusis, and Hearing Loss
Authors: Nelson Jeffrey J. , Chen Kejian
Published: May 2019

The triad of tinnitus, hyperacusis, and hearing loss remains an often-underdiagnosed combination of symptoms that causes physical, mental, and emotional distress for millions of patients. To the best of our knowledge, no review has heretofore been published in the literature regarding the possible relationship among these three entities. We believe that these symptoms may have a common pathophysiology. Specifically, improper function of cochlear hair cells may result in a hearing loss secondary to the failure of these cells to propagate proper signals through the auditory centers. In response to an incongruous neural message, higher auditory cortical centers may adapt and remodel transmitted sound. This neuroplasticity may lead to an increased perception of volume in the auditory cortex (hyperacusis) and to the perception of phantom sounds (tinnitus). Awareness of the potential relationship among tinnitus, hyperacusis, and hearing loss may contribute to improved diagnosis, treatment, and follow-up for patients with these conditions.
Hearing Loss as the Initial Presentation of Creutzfeldt-Jakob Disease
Authors: Krishna Priya , Bauer Carol
Published: May 2019

Creutzfeldt-Jakob disease is a rare type of spongiform encephalopathy. Affected patients present with constitutional symptoms, which progress to severe mental deterioration and movement disorders. Dizziness is the most common early otologic symptom. Few reports in the literature describe patients with Creutzfeldt-Jakob disease who present with sudden-onset hearing loss as their primary symptom for seeking treatment. This paper discusses one such patient and reviews the clinical presentation, treatment options, and relevant literature.
Rhinoorbital Mucormycosis Secondary to Rhizopus Oryzae: A Case Report and Literature Review
Authors: Hilal Ali A. , Taj-Aldeen Saad J. , Mirghani Abdulla H.
Published: May 2019

Mucormycosis is a form of fulminant invasive fungal infection of the sinonasal tract that often extends to the orbit, brain, palate, and skin. It is caused by members of the order Mucorales, and it is considered to be the most fatal fungal infection known to man because it is rapidly disseminated by the blood vessels. It is most commonly associated with diabetic ketoacidosis, hematologic malignancies, acquired immunodeficiency syndrome, and immunosuppressive therapy. This rare opportunistic infection exists in many forms, the most common of which is rhinocerebral mucormycosis. Treatment includes aggressive surgical debridement of the necrotic tissue combined with systemic antifungal therapy. In this case report, we describe the successful management of rhinoorbital mucormycosis, a subtype of the rhinocerebral variety, secondary to Rhizopus oryzae that developed in a patient with lymphoma. We review the diagnostic work-up and discuss the literature with respect to the presentation, pathophysiology, management, and outcome of the disease.
Modern Acoustic Reflectometry: Accuracy in Diagnosing Otitis Media with Effusion
Authors: Babb Michael J. , Hilsinger Raymond L. , Korol Harold W. , Wilcox Robert D.
Published: May 2019

We conducted a study of 80 patients to evaluate the accuracy of a commercially available acoustic reflectometer in identifying the presence or absence of otitis media with effusion (OME). This device assesses bilateral tympanic membrane mobility and, by inference, middle ear status. We found that it was most accurate in patients with normal and grossly fluid-filled ears. We recommend screening with this acoustic reflectometer to rule out OME in adult and pediatric patients.
Selective Surgicel Packing for the Treatment of Posterior Epistaxis
Authors: Bhatnagar R. K. , Berry Sandeep
Published: May 2019

Rod lens endoscopes provide residents in otolaryngology a means of more accurately identifying the site of bleeding and, when possible, cauterizing the bleeding vessel. Identification of a posterior bleeding point is often difficult and sometimes impossible. Intranasal manipulation for electrocautery is painful, may require general anesthesia, and is associated with complications. We describe a pilot study designed to evaluate selectively packing the bleeding site with Surgicel (oxidized cellulose) to control the hemorrhage without packing the nasal cavity and to reduce patient morbidity and length of stay in the hospital. We describe the technique and present the results of treating 8 patients admitted with acute posterior epistaxis over a 10-month period in 1995–1996.
Various Presentations of Fourth Branchial Pouch Anomalies
Authors: Jeyakumar Anita , Hengerer Arthur S.
Published: May 2019

Embryologic anomalies of the fourth branchial pouch are rarely seen. They usually present as recurring episodes of deep neck infections and/or abscesses or acute suppurative thyroiditis. Failure to recognize these unusual cases may result in misdiagnosis, inadequate treatment, and subsequent recurrence. We report 3 cases of patients with fourth branchial anomalies. Diagnosis starts with a preoperative evaluation consisting of a barium swallow or sonogram followed by direct hypopharyngoscopy at the time of surgery. Treatment of acutely infected sinuses is best done with appropriate antibiotics and, if necessary, with incision and drainage. Surgical excision should be planned after the inflammation has completely resolved.
Descending Necrotizing Mediastinitis: Ten Years’ Experience
Authors: Mora Renzo , Jankowska Barbara , Catrambone Ugo , Passali Giulio Cesare , Mora Francesco , Leoncini Giacomo , Passali Francesco Maria , Barbieri Marco
Published: May 2019

Descending necrotizing mediastinitis is a rare disease that is usually caused by a spreading, diffuse inflammatory reaction (phlegmon) to an odontogenic infection or peritonsillar abscess. Reported mortality rates range from 25 to 40%. The use of antibiotics and advances in resuscitation procedures and critical care techniques have not essentially improved survival, and an effective treatment has not been clearly established. We report the findings of our 10-year study of 21 patients affected by phlegmon and/or fasciitis of the neck. The aim of our contribution is to help define the clinical criteria and diagnostic procedures that will improve the early diagnosis of mediastinal sepsis secondary to neck fasciitis and to suggest optimal treatment approaches. Our experience indicates that (1) cervical drainage alone is sufficient for cases of cervical phlegmon or mediastinal involvement that are limited to a single superior mediastinal space and (2) thoracotomy and drainage of mediastinal collections is necessary when mediastinal sepsis is more extensive.