bluuebunny/crossref_metadata_2025 huggingface dataset:
A new species of arboreal toad (Anura: Bufonidae: Chaunus) from Madidi National Park, Bolivia
Authors: PADIAL JOSÉ M. , REICHLE STEFFEN , McDIARMID ROY , DE LA RIVA IGNACIO
Published: May 2019

A new arboreal species of the Chaunus veraguensis group is described for the humid montane forest of Madidi National Park, in northern Bolivia. The new species differs from other species in the group by the combination small size, long and slender extremities, webbed hands, conspicuous tympanic membrane, well developed parotoid glands, absence of large glands on dorsum and extremities, nuptial excrescences of males composed of pungent spines on dorsal surface of thumb, greenish-brown coloration on dorsum with red warts in life, and green iris. It is only known from two nearby localities in the Serranía Eslabón, Department La Paz. An operational key for species in the C. veraguensis group is provided.
Predictive Capability of a High-Resolution Hydrometeorological Forecasting Framework Coupling WRF Cycling 3DVAR and Continuum
Authors: Lagasio Martina , Silvestro Francesco , Campo Lorenzo , Parodi Antonio
Published: May 2019

The typical complex orography of the Mediterranean coastal areas support the formation of the so-called back-building mesoscale convective systems (MCS) producing torrential rainfall often resulting in flash floods. As these events are usually very small-scaled and localized, they are hardly predictable from a hydrometeorological standpoint, frequently causing a significant amount of fatalities and socioeconomic damage. Liguria, a northwestern Italian region, is characterized by small catchments with very short hydrological response time and is thus extremely prone to the impacts of back-building MCSs. Indeed, Liguria has been hit by three intense back-building MCSs between 2011 and 2014, causing a total death toll of 20 people and several hundred millions of euros of damages. Consequently, it is necessary to use hydrometeorological forecasting frameworks coupling the finescale numerical weather prediction (NWP) outputs with rainfall–runoff models to provide timely and accurate streamflow forecasts. Concerning the aforementioned back-building MCS episodes that recently occurred in Liguria, this work assesses the predictive capability of a hydrometeorological forecasting framework composed by a kilometer-scale cloud-resolving NWP model (WRF), including a 6-h cycling 3DVAR assimilation of radar reflectivity and conventional weather stations data, a rainfall downscaling model [Rainfall Filtered Autoregressive Model (RainFARM)], and a fully distributed hydrological model (Continuum). A rich portfolio of WRF 3DVAR direct and indirect reflectivity operators has been explored to drive the meteorological component of the proposed forecasting framework. The results confirm the importance of rapidly refreshing and data intensive 3DVAR for improving the quantitative precipitation forecast, and, subsequently, the flash flood prediction in cases of back-building MCS events.
Assessment to Promote Equity and Epistemic Justice: A Use-Case of a Research-Practice Partnership in Science Education
Authors: Penuel William R. , Watkins Douglas A.
Published: May 2019

Efforts to align educational assessments with the sociocultural foundations of learning and with instruction are limited because we lack evidence of how such systems can be developed and maintained in inherently complex educational settings. Credible use cases are helpful to developing the evidence base, and we present one here: a research-practice partnership between a university and a large urban school district. The goals of our codesigned system include supporting the redistribution of educational opportunities in science classrooms (equity) and supporting and repairing students’ self-perceptions as agents of knowing and reasoning in science classrooms and in the community (epistemic justice). We describe components of the partnership and educational practices that work together to accomplish these aims: curricula with embedded assessments allowing students to figure out rather than be told core ideas, exit tickets that elicit students’ classroom experience, and an instructional guidance system focused on iterative refinement of teacher learning opportunities to support student agency.
The Global Increase in the Socioeconomic Achievement Gap, 1964 to 2015
Authors: Chmielewski Anna K.
Published: May 2019

The “socioeconomic achievement gap”—the disparity in academic achievement between students from high- and low-socioeconomic status (SES) backgrounds—is well-known in the sociology of education. The SES achievement gap has been documented across a wide range of countries. Yet in most countries, we do not know whether the SES achievement gap has been changing over time. This study combines 30 international large-scale assessments over 50 years, representing 100 countries and about 5.8 million students. SES achievement gaps are computed between the 90th and 10th percentiles of three available measures of family SES: parents’ education, parents’ occupation, and the number of books in the home. Results indicate that, for each of the three SES variables examined, achievement gaps increased in a majority of sample countries. Yet there is substantial cross-national variation in the size of increases in SES achievement gaps. The largest increases are observed in countries with rapidly increasing school enrollments, implying that expanding access reveals educational inequality that was previously hidden outside the school system. However, gaps also increased in many countries with consistently high enrollments, suggesting that cognitive skills are an increasingly important dimension of educational stratification worldwide.
Coronary Intimal Thickening Begins in Fetuses and Progresses in Pediatric Population and Adolescents to Atherosclerosis
Authors: Guerri-Guttenberg Roberto , Castilla Rocío , Cao Gabriel , Azzato Francisco , Ambrosio Giuseppe , Milei José
Published: May 2019

The prevalence of coronary intimal thickening (IT) was assessed in fetuses and pediatric population. We studied the coronary arteries of 63 hearts obtained from fetuses, infants, children, and adolescents, deceased from noncardiac disease or trauma. Histomorphometric analysis, planimetry, and immunohistochemical studies were conducted. Intimal thickening consisted of proliferation of smooth muscle cells and scarce monocytes embedded in amorphous deposits within the internal elastic membrane (IEM). Intermingled lesions of intimal hyperplasia and parietal nonstenotic plaques were also observed. Intimal thickening was found in 10% of 20 fetuses, in 33.3% of 18 infants, 73.3% of 15 children, and 100% of 10 adolescents. A significant correlation ( r = 0.671, P < 0.001) was found between the extent of IT and age. The IEM was duplicated or interrupted in 43% of patients, showing a positive correlation with the degree of IT ( P = 0.01). Intimal thickening was predominantly found near bifurcation sites in the left anterior descending coronary artery (55.6%) and in zones free of bifurcation in the right coronary artery (75%). In conclusion, the prevalence and extension of IT lesions are higher at older ages within a young population. Intimal thickening may be regarded as the first event occurring in coronary preatherosclerosis, preceding lipid deposition.
On the Legacy of Genetically Altered Mouse Models to Explore Vestibular Function: Distribution of Vestibular Hair Cell Phenotypes in the Otoferlin-Null Mouse
Authors: Prins Terry J. , Saldate Johnny J. , Berke Gerald S. , Hoffman Larry F.
Published: May 2019

Objectives:

Early in his career, David Lim recognized the scientific impact of genetically anomalous mice exhibiting otoconia agenesis as models of drastically compromised vestibular function. While these studies focused on the mutant pallid mouse, contemporary genetic tools have produced other models with engineered functional modifications. Lim and colleagues foresaw the need to analyze vestibular epithelia from pallid mice to verify the absence of downstream consequences that might be secondary to the altered load represented by otoconial agenesis. More generally, however, such comparisons also contribute to an understanding of the susceptibility of labyrinthine sensory epithelia to more widespread cellular changes associated with what may appear as isolated modifications.

Methods:

Our laboratory utilizes a model of vestibular hypofunction produced through genetic alteration, the otoferlin-null mouse, which has been shown to exhibit severely compromised stimulus-evoked neurotransmitter release in type I hair cells of the utricular striola. The present study, reminiscent of early investigations of Lim and colleagues that explored the utility of a genetically altered mouse to explore its utility as a model of vestibular hypofunction, endeavored to compare the expression of the hair cell marker oncomodulin in vestibular epithelia from wild-type and otoferlin-null mice.

Results:

We found that levels of oncomodulin expression were much greater in type I than type II hair cells, though were similar across the 3 genotypes examined (ie, including heterozygotes).

Conclusion:

These findings support the notion that modifications resulting in a specific component of vestibular hypofunction are not accompanied by widespread morphologic and cellular changes in the vestibular sensory epithelia.
External Auditory Canal Reconstruction and Mastoid Obliteration Using Modified Palva Flap in Canal Wall Down Mastoidectomy With Tympanoplasty
Authors: Kim Ji-Sun , Lim Il Gye , Oh Jeong-Hoon , Kim Byung Guk , Chang Ki-Hong
Published: May 2019

Objective:

To evaluate the effectiveness of a modified Palva flap used for external auditory canal reconstruction and mastoid obliteration in canal wall down mastoidectomy.

Methods:

We retrospectively analyzed patients who underwent canal wall down mastoidectomy with tympanoplasty using modified Palva flap. All patients underwent pure tone audiometry and temporal bone computed tomography (CT) before surgery, and the same tests were performed in the first year after surgery. The external auditory canal volumes were calculated by summing the areas of each section selected in temporal bone CT. For each patient, the ratio of external auditory canal volume was calculated from CT taken before and after surgery.

Results:

The mean of external auditory canal volume after canal wall down with a modified Palva flap was about 1.4 times larger than before surgery. The modified Palva flap is effective for the reconstruction of the external auditory canal. Both pure tone audiometry level and air-bone gap showed statistically significant improvement after surgery ( Ps = .001 and .002, respectively).

Conclusions:

The external auditory canal volume slightly increased, but the status of mastoid obliteration was well maintained 1 year after surgery. The modified Palva flap used in this study is an easy and effective method in external auditory canal reconstruction and mastoid obliteration.
Phantom Perception of Sound and the Abnormal Cortical Inhibition System: An Electroencephalography (EEG) Study
Authors: Kyong Jeong-Sug , Noh Tae-Soo , Park Moo Kyun , Oh Seung-Ha , Lee Jun Ho , Suh Myung-Whan
Published: May 2019

Objectives:

Despite no observable external sound present, a perceived feeling of a recurrent unpleasant sound is a main complaint in the patients with chronic tinnitus. This phantom perception of sound is considered as the auditory equivalent of phantom limb pain, and altered excitability may be involved in its underlying pathology. Tinnitus-related hyper-excitation is suppressed by inhibitory repetitive transcranial magnetic stimulation (rTMS). However, the neural mechanism underlying the treatment is not fully understood, and quantifying the suppression induced by rTMS has yet to be considered.

Methods:

We evaluated the effect of rTMS on the cortical inhibition status following single-site stimulation over the auditory temporal cortex (T group) or dual-site stimulation over the auditory temporal and the frontal regions (TF group). These effects were also compared with outcomes following sham stimulation (S group). Subjective response was recorded using tinnitus-related handicap index (THI), and changes in the cortical inhibition status were assessed using an auditory paired-pulse suppression index (PPSI).

Results:

TF group showed the greatest benefit from the treatment evidenced in the reduced PPSI and THI scores. T and S groups did not benefit much. TF group overlapped mostly with the responder group, indicating improvement in both subjective THI and objective PPSI measurements.

Conclusion:

Our results suggest that rTMS is a beneficial therapeutic treatment for chronic tinnitus patients and the dual-site treatment was the most effective in terms of both tinnitus complaint and quantitative indices. Thus, subjective reports and electrophysiological signatures may be complementary for the diagnosis/prognosis of tinnitus.
Low-dose Oral Methotrexate Management of Patients with Bilateral Ménière's Disease
Authors: Kilpatrick Jefferson K. , Sismanis Aristides , Spencer Robert F. , Wise Christopher M.
Published: May 2019

In this retrospective clinical trial, we evaluated the effectiveness of low-dose oral methotrexate in the management of bilateral Ménière's disease of immune-mediated origin. At our tertiary-care referral center, we evaluated ten men and eight women who had longstanding bilateral Ménière's disease that had been unresponsive to traditional conservative medical management. Sixteen of these patients had steroid-responsive bilateral Ménière's disease. Two patients had contraindications to steroids, but their clinical and laboratory evaluations were consistent with an immune-mediated process.

Patients were treated with 7.5 to 20 mg/week of oral methotrexate. The mean duration of treatment was 16.7 months (range: 8 to 35), with a mean followup of 2 years (range: 9 mo to 5 yr). Changes in clinical symptoms (vertigo, hearing loss, tinnitus, and aural fullness), audiometric changes, and side effects of therapy were evaluated.

Vertigo resolved in 14 patients (78%), was substantially alleviated in three patients (17%), and remained unchanged in one patient (6%). Hearing improved in five patients (28%) and stabilized in seven patients (39%). Tinnitus and aural fullness resolved or was relieved in 11 of 17 (65%) and 13 of 14 (93%) patients, respectively. Side effects were minimal and reversible.

We conclude that low-dose oral methotrexate is effective and safe for treating bilateral Ménierè's disease of immune-mediated origin. In this study, methotrexate alleviated vertiginous symptoms and improved or stabilized hearing in most patients. Low-dose methotrexate can be considered for patients with immune-mediated bilateral Meniérè's disease when long-term treatment is required or when a steroid or cyclophosphamide is contraindicated.
Cutaneous Metastatic Lung Cancer: Literature Review and Report of a Tumor on the Nose from a Large Cell Undifferentiated Carcinoma
Authors: Rubinstein Ran Y. , Baredes Soly , Caputo Joseph , Galati Lisa , Schwartz Robert A.
Published: May 2019

Cutaneous metastatic disease is a prognostically important diagnosis. We report the case of a 64-year-old man who had an uncommon histologic type of lung cancer—a large cell undifferentiated carcinoma, which was metastatic to the skin of the nose. The relative frequency of cutaneous metastasis is similar to that of primary cancers. Cutaneous disease as the first sign of metastasis is most often seen in cancer of the lung. However, its appearance as a large tumor on the nose, which was observed in this case, is unusual.
Granular Cell Tumors Arising Nearly Simultaneously in the Larynx and Subcutaneous Cervical Region
Authors: Kawaida Masahiro , Fukuda Hiroyuki , Kohno Naoyuki
Published: May 2019

Granular cell tumors are benign, relatively rare lesions that can occur in any organ in the body. Tumors are known to occasionally arise in two or more different organs. We report the case of a 60-year-old woman in whom granular cell tumors arose almost simultaneously in her subcutaneous cervical region and her larynx. The two tumors were surgically resected and examined histopathologically, and they exhibited the same histopathologic features. The tumor of the larynx was resected with the help of a carbon dioxide laser. Immunohistochemical staining revealed that both were positive for S-100 protein and neuron-specific enolase. Cases of the nearly simultaneous appearance of granular cell tumors in the neck and larynx are rather unusual. The results of immunohistochemical staining suggested that this tumor originates in nerve tissue.
Aggressive Combination Treatment for Invasive Fungal Sinusitis in Immunocompromised Patients
Authors: Rizk Samieh S. , Kraus Dennis H. , Gerresheim Goetz , Mudan Satvinder
Published: May 2019

Invasive sinonasal fungal disease is a potentially fatal complication of chemotherapy-induced immunosuppression and neutropenia. We reviewed the outcomes of seven cancer patients who had been diagnosed with invasive fungal sinusitis; six patients had hematologic malignancies and one had breast cancer. At the time of their sinus diagnosis, all patients had been hospitalized and were receiving combination chemotherapy for their underlying malignancy. Impairment of their immune function was characterized by an absolute neutrophil count of less than 1,000/mm3. Aggressive management of their sinonasal fungal disease consisted of surgical debridement and systemic amphotericin B for all patients, and treatment with granulocyte colony-stimulating factor for two patients. Invasive Aspergillus infection was identified in six patients and invasive Candida albicans infection in one. Although the prognosis for these patients was poor and two patients died of the fungal infection, the aggressive treatment strategy resulted in long-term survival for the remaining five patients.
Superior Adenoidectomy in Children with Palatal Abnormalities
Authors: Kakani Rajesh S. , Callan Noreen D. , April Max M.
Published: May 2019

When treating a child with a palatal abnormality for otitis media or a nasal obstruction, otolaryngologists often face the question of whether the benefits of adenoidectomy are worth the risk of the development of velopharyngeal insufficiency. Treatment options for these patients include a complete adenoidectomy, a partial adenoidectomy, or no surgical intervention. In this retrospective study, we describe the outcomes of 22 such patients who were treated with a superior adenoidectomy performed with a St. Clair adenoid forceps under indirect vision with a laryngeal mirror. All patients experienced a complete or near-complete resolution of their nasal obstruction, and none developed permanent velopharyngeal insufficiency. Only three patients experienced a recurrence of otitis media. Our experience suggests that superior adenoidectomy is a safe and effective procedure.
Removal of a Fish Bone in the Thyroid Gland without the Need for Thyroid Lobectomy
Authors: Arumainathan Usha D. , Lwin Saw , Suan Tan Lye , Raman R.
Published: May 2019

We report the first published case of the removal of a migratory fish bone from the thyroid gland that did not necessitate a thyroid lobectomy.
Effect of Tympanic Perforations on the Detection of Distortion-product Otoacoustic Emissions
Authors: LeBourgeois H. Wadsworth , Anand Vinod K. , McAuley James R. , Dickman J. David , Malphurs Ojus
Published: May 2019

The detection of distortion-product otoacoustic emissions (DPOAEs) depends on the viability of the ear's conduction apparatus. However, tympanic membrane perforations and other conductive disorders have not been fully investigated with regard to the examination of DPOAEs. Using the guinea pig model, we made perforations of different sizes and loci on the tympanic membrane and collected DPOAE data for frequencies between 2,193 and 5,508 Hz for each condition. We found that small perforations, up to 25% of the area of the tympanic membrane, still allow us to detect emissions at the specified frequencies. However, perforations of 50% and larger, as well as those accompanied by traumatic perilymph fistulas and ossicular disarticulations, severely interfered with the detection of DPOAEs. We discuss the clinical relevance of these findings with respect to the potential uses of DPOAEs.
Botulinum Toxin in Otolaryngology: A Review of its Actions and Opportunities for Use
Authors: Neuenschwander Michael C. , Pribitkin Edmund A. , Sataloff Robert T.
Published: May 2019

Botulinum toxin has several important properties that make it an ideal chemical denervator. These include its high degree of specificity for the neuromuscular junction, its ability to induce temporary and reversible denervation, and its limited degree of side effects and complications. Botulinum toxin is being used safely in a wide variety of clinical settings by many different specialists. In otolaryngologic practice, it is being administered for the treatment of at least a dozen conditions, including various dysphonias, dystonias, and spasms as well as torticollis, facial nerve paralysis, and hyperkinetic facial lines. Studies have shown that botulinum toxin injections have a high rate of success in temporarily relieving symptoms.
Sleep-disordered Breathing: A Survey of Otolaryngologic Practice at Military Hospitals
Authors: Davidson Terence M. , Do Katherine L.
Published: May 2019

We conducted a survey of otolaryngologists at all Veterans Administration and Department of Defense hospitals in the United States to ascertain the nature and scope of their treatment of sleep-disordered breathing. Questionnaire responses indicated that head and neck surgeons in military hospitals have a strong interest in the management of patients with snoring and sleep apnea. Because of the difficulty in obtaining timely sleep test results and the low number of referrals from physicians who perform such testing, many otolaryngologists expressed a desire to be able to perform their own sleep testing.
The Microbiology of Chronic Rhinosinusitis: Results of a Community Surveillance Study
Authors: Chan James , Hadley James
Published: May 2019

In view of the rapidly changing patterns of antibiotic resistance, community surveillance studies are providing important information to help guide practitioners in making their choice of antibiotics. For this community surveillance study, we performed a retrospective chart review of nasal and sinus culture data obtained from 83 patients with typical symptoms of chronic rhinosinusitis who visited a community otolaryngologist in Rochester, New York. Pathogens were isolated in 59 of these patients (71%). The most common were coagulase-negative staphylococci (31% of isolates). Among the other isolated pathogens were Hemophilus influenzae (25%), Streptococcus pneumoniae (12%), Moraxella catarrhalis (10%), Pseudomonas aeruginosa (7%), alpha-hemolytic streptococci (5%), and Staphylococcus aureus (3%). Approximately 39% of the coagulase-negative staphylococci isolates were resistant to penicillin. Some 20% of the H influenzae isolates were beta-lactamase-positive, and 14% of all isolates were resistant to multiple antibiotics. Approximately 12% of the 83 patients cultured positive for multiple organisms. Our findings provide important surveillance information about the resistance patterns of pathogens in our area. Although the prevalence of beta-lactamase-positive H influenzae that we observed was consistent with those of other reports, we found a lower prevalence of polymicrobial flora. Our findings suggest that culture- and sensitivity-directed therapy should be effective in the treatment of chronic rhinosinusitis.
Spindle Cell Lipoma of the Parapharyngeal Space: First Report of a Case
Authors: Baumann Ingo , Dammann Florian , Horny Hans Peter , Plinkert Peter Karl
Published: May 2019

Spindle cell lipomas are usually located in the subcutaneous tissue of the back, shoulders, and neck. To our knowledge, the presence of such a tumor in the parapharyngeal space has not yet been described. We evaluated a 45-year-old man with a tender swelling of the right parotid area that had reached the submandibular area. Clinical examination and magnetic resonance imaging revealed the presence of a tumor that coated the parotid area laterally and extended into the center of the parapharyngeal space, thus causing a dislocation of the pharyngeal muscles and mucosa. We performed a total parotidectomy and submandibulectomy on the right side and extirpated the parapharyngeal tumor. We were able to spare the facial nerve, and no facial paralysis occurred. Histologic examination revealed an atypical lipomatous tumor with a remarkably large portion of spindles.
Psychiatric Manifestations of Medications Commonly Prescribed in Otolaryngology
Authors: Levy Steven , Abaza Mona M. , Hawkshaw Mary J. , Sataloff Robert T.
Published: May 2019

Otolaryngologists, nurses, and psychological professionals should be familiar with the potential psychiatric side effects of medications that are commonly prescribed by otolaryngologists. Because some of these side effects are atypical, their relationship to medications might not be obvious. An awareness of the potential for psychiatric side effects caused by adrenocorticoids, antihistamines and decongestants, and antisecretory medications will help the clinician avoid or detect and treat drug-induced disorders, as will an awareness of the potential for side effects caused by combinations of medications. Identification of individual risk factors such as age, pre-existing organic brain disease, a history of drug abuse or dependence, or coexisting or pre-existing psychiatric disorders is important in preventing and detecting drug-induced psychiatric disorders. The drugs discussed in this article can have serious, even fatal, interactions with certain psychiatric medications.
The Safety and Effectiveness of the Le Fort I Approach to Removing Central Skull Base Lesions
Authors: Colreavy Michael P. , Baker Tim , Campbell Matthew , Murphy Michael , Lyons Bernard
Published: May 2019

The difficulty of gaining access to the central skull base has led to the development of many surgical approaches to this area during the past decade. Yet we believe that the Le Fort I technique, which has been used for almost 140 years in orthognathic surgery, is still an excellent approach to treating anterior skull base lesions. This procedure, which entails the horizontal sectioning of the dentoalveolar maxillary segment, seemed to fall out of favor with otolaryngologists after a few reports of complications surfaced during the past 10 to 15 years. In this article, we report a series of seven patients whom we treated with a Le Fort I approach during a 3-year period for a variety of benign and malignant anterior skull base lesions. We have encountered no significant complications of surgery or recurrence of disease at a maximum postoperative followup of 3 years.
On Being a Happy Surgeon
Authors: McQuarrie Donald G.
Published: May 2019

This article is adapted from an address that Dr. McQuarrie delivered to the Minnesota Surgical Residents Society on June 15, 1999, as he was honored as the society's Surgical Alumnus of the Year. A somewhat longer version of his address appeared in the January 2000 issue of The Cutting Edge, a newsletter published for the Department of Surgery at the University of Minnesota (UM) Medical School. Dr. McQuarrie is a professor of surgery, a former vice-chairman of the Department of Surgery at the UM Medical School, and a former chief of surgery at the Veterans Affairs Medical Center in Minneapolis.
Necrotizing Fasciitis Secondary to Peritonsillar Abscess: A New Case and Review of Eight Earlier Cases
Authors: Safak Mustafa Asim , Haberal Ilknur , Kiliç Dilek , Göçmen Hakan
Published: May 2019

Necrotizing fasciitis is a potentially fatal soft-tissue infection that occurs only rarely in the head and neck region. Broad-spectrum parenteral antibiotics and surgical debridement are the mainstays of treatment. Until now, only eight cases of necrotizing fasciitis secondary to peritonsillar abscess have been described in the English-language literature. In this article, we report a new case that occurred in an otherwise healthy 43-year-old woman. In addition to standard treatment, the patient underwent a hot tonsillectomy. After 23 months of follow-up, she is in good health.
Synovial Sarcoma of the Pharynx: A Case Report
Authors: Saydam Levent , Kizilay Ahmet , Kalcioglu M. Tayyar , Mizrak Bulent , Bulut Fatih
Published: May 2019

Synovial sarcoma is a malignancy not usually encountered in the head and neck region. We describe a case of synovial sarcoma of the posterior pharyngeal wall in a 14-year-old girl. The mass was completely excised via the transoral route. Postoperatively, the patient received irradiation to 60 Gy. At 40 months of follow-up, the patient remains disease-free.
Multiple Plaques on the Face and Neck of a Middle-aged man. Diagnosis: Secondary Syphilis
Authors: Erisir Ferhat , Senocak Dogan , Inci Ender , Guclu Ender
Published: May 2019

Syphilis is an unusual diagnosis in an ENT practice. We evaluated a 55-year-old man who had generalized plaques on his face, neck, and upper extremities. Analysis of skin biopsy and serology specimens revealed that the patient had secondary syphilis. He responded rapidly to treatment. The purpose of this article is to remind otolaryngologists of the signs and symptoms of syphilis so that it can be recognized and treated in a timely fashion.
Recent Results with the MED-EL COMBI 40+ Cochlear Implant and TEMPO+ behind-the-ear Processor
Authors: Anderson Ilona , Weichbold Viktor , D'Haese Patrick
Published: May 2019

Cochlear implantation is a viable treatment for patients with severe to profound hearing loss. We report the results of speech perception tests (numbers, monosyllables, and sentence tests) achieved with MED-EL's COMBI 40+ (C40+) cochlear implant after 12 months of use. These findings, which were taken from a larger German study, were similar to those of other studies of the C40+ implant. We also compared the differences in speech perception observed with the CIS PRO+ body-worn speech processor and the newer TEMPO+ behind-the-ear speech processor. Although these results were similar with respect to most of the measured parameters, the TEMPO+ processor had a distinct advantage during tests in noise.
Multiple Primary Pleomorphic Adenomas in a Single Parotid Gland: Report of a New Case
Authors: Tanimoto Hitoshi , Kumoi Kazuo , Otsuki Naoki , Hirayama Yuji
Published: May 2019

The development of multiple primary pleomorphic adenomas in a single parotid gland is extremely rare in previously untreated patients, as only nine cases have been previously reported. In this article, we report the tenth such case, which occurred in an 87-year-old Japanese woman. We also report the results of our 7-plus-year review of the types of parotid tumors seen at our institution. We identified 98 tumors in 89 patients; pleomorphic adenomas were the most common tumors, accounting for 45.9% of the total.
Peritonsillar Abscess: A Study of 724 Cases in Japan
Authors: Matsuda Akifumi , Tanaka Hidekazu , Kanaya Takeo , Kamata Keita , Hasegawa Makoto
Published: May 2019

We reviewed the records of 724 patients diagnosed with peritonsillar abscess who had been admitted to our hospital between January 1988 and December 1999. We analyzed their clinical features, disease course, and treatment. The male:female ratio was 3:1, and approximately two-thirds of these patients were between 20 and 39 years of age. The most common aerobic bacteria cultured from patients’ pus were α-hemolytic streptococci. Severe complications—including deep neck infections and mediastinals—were seen in 13 patients (1.8%). This complication rate suggests that patients with peritonsillar abscess should undergo immediate incision and drainage rather than needle aspiration.
Report of a Rare Case of Trauma-Induced Thyroid Storm
Authors: Vora Neil M. , Fedok Fred , Stack Brendan C.
Published: May 2019

Thyroid storm is a potentially life-threatening endocrinologic emergency characterized by an exacerbation of a hyperthyroid state. Several inciting factors can instigate the conversion of thyrotoxicosis to thyroid storm; trauma is one such trigger, but it is rare. Patients with thyroid storm can manifest fever, nervous system disorders, gastrointestinal or hepatic dysfunction (e.g., nausea, vomiting, diarrhea, and/or jaundice), and arrhythmia and other cardiovascular abnormalities. Treatment of thyroid storm is multimodal and is best managed by the endocrinologist and medical intensivist. Initial medical and supportive therapies are directed at stabilizing the patient, correcting the hyperthyroid state, managing the systemic decompensation, and treating the underlying cause. Once this has been achieved, definitive treatment in the form of radioactive ablation or surgery should be undertaken. We describe a case of thyroid storm in a young man that was precipitated by a motor vehicle accident.
Intracranial Complications of Sinusitis: A 15-Year Review of 39 Cases
Authors: Younis Ramzi T. , Lazar Rande H. , Anand Vinod K.
Published: May 2019

Despite improvements in antibiotic therapies and surgical techniques, sinusitis still carries a risk of serious and potentially fatal complications. We examined the charts of 82 patients who had been admitted to the University of Mississippi Medical Center between Jan. 1, 1985, and Dec. 31, 1999, for treatment of complications of sinusitis. Of these 82 patients, 43 had orbital complications and 39 had intracranial complications. In this article, we describe our findings in those patients who had intracranial complications (our findings in patients with orbital complications will be reported in a future article). The most common intracranial complication was meningitis; others were epidural abscess, subdural abscess, intracerebral abscess, Pott's puffy tumor, and superior sagittal sinus thrombosis. Most patients with meningitis were treated with drug therapy only; patients with abscesses were generally treated with intravenous antibiotics and drainage of the affected sinus and the abscess. Advancements in antibiotic therapy, endoscopic surgery, imaging studies, and computer-assisted surgery have helped improve outcomes. Management of these patients should be undertaken immediately and is best achieved via a multidisciplinary approach, involving the otolaryngologist, neurosurgeon, radiologist, anesthesiologist, infection disease specialist, pediatrician, internist, and others.
Delayed Diagnosis of a Pediatric Airway Foreign Body: Case Report and Review of the Literature
Authors: Franzese Christine B. , Schweinfurth John M.
Published: May 2019

Foreign body aspiration is a common pediatric problem that affects children of all ages, including those who are well into their adolescence. We describe the case of a 9-year old boy with an airway foreign body that had gone unrecognized for 3 months. We also review the literature on pediatric airway foreign bodies, with a focus on delayed diagnosis. A diagnosis of foreign body aspiration should be considered whenever a previously healthy child suddenly exhibits unexplained symptoms that are refractory to medical treatment and are consistent with airway obstruction.
Delay in Maturation of the Auditory Pathway and its Relationship to Language Acquisition Disorders
Authors: Fuess Vera Lucia Ribeiro , Bento Ricardo Ferreira , Alexandre Médicis da Silveira José
Published: May 2019

We studied 81 children, mostly boys, who experienced language acquisition delay but whose audiometric thresh olds were normal. We assessed the evolution of children with delayed maturation of auditory pathways by brainstem evoked response audiometry (BERA). We also used a questionnaire administered during diagnostic procedures to determine if there was a probable etiology in each patient. In addition, we further studied language evolution in 29 patients by means of a second questionnaire that was administered approximately 2 years later. Finally, we studied the evolution of the I–V interwave interval and the I/V amplitude ratio in 16 patients by performing a second BERA after a mean interval of 3 years. We ob served improvement in both brainstem transmission time and language acquisition in all 81 patients. However, only a few patients achieved normal range results. Morphologic alterations, which were most common in patients who had had perinatal jaundice, remained un changed. The most common possible risk factors for the delayed maturation pattern observed on BERA were parental consanguinity, prematurity, perinatal anoxia and jaundice, and postnatal seizure and infection. Some patients had more than one of these possible risk factors. We conclude that high-risk newborns and 2-year-old children who have no primitive verbal language skills should undergo BERA as well as investigation of hearing thresholds, interwave intervals, and I/V amplitude ratios. The alteration of these parameters points out the need for early intervention if there is no favorable prognosis.
Revision Tympanomastoid Surgery
Authors: Megerian Cliff A. , Cosenza Mathew J. , Meyer Suzanna E.
Published: May 2019

We conducted a retrospective study of 50 ears in 48 patients in whom we performed revision tympanomastoid surgery for chronic otitis media. We found that the most common probable causes for the failure of previous surgery were incomplete lowering of the facial ridge (94% of cases), persistent sinodural-angle air-cell disease (92%), persistent tegmental air-cell disease (88%), recurrent or persistent cholesteatoma (66%), persistent mastoid-tip air-cell disease (62%), a small meatus (60%), and persistent hypotympanic air-cell disease (56%). After a mean postoperative follow-up of 26 months, we found no appreciable difference in success rates between patients who had undergone only one previous surgery (93%) and those who had undergone more than one previous surgery (95%) prior to referral to our center. Follow-up hearing data revealed a statistically significant improvement in air and bone conduction and a nonsignificant reduction in the air-bone gap. We conclude that revision mastoid surgery following multiple earlier surgical failures does not carry an appreciably higher risk of failure than does initial revision surgery. Moreover, there appears to have been no change in the causes of failure following mastoid surgery over the past 3 decades.
A Simple and Reliable Method of Patient Evaluation in the Surgical Treatment of Nasal Obstruction
Authors: Constantinides Minas , Galli Suzanne K. Doud , Miller Philip J.
Published: May 2019

We have developed a simple method of evaluating nasal obstruction both before and after corrective surgery. With our system, patients self-rate their nasal patency on a 10-point visual analog scale under different conditions. After a baseline self-assessment, patients rate their breathing while the examiner lifts the lower lateral nasal cartilage with an ear curette and again during lifting of the upper lateral cartilage. Separate assessments during cartilage support are made before and after the patient has received nasal decongestion therapy. The results of these manipulations help identify the specific structural abnormality and its anatomic site, thereby serving as a reliable aid to planning surgery (i.e., open septorhinoplasty, turbinoplasty, external valve surgery with alar batten grafts, and/or internal valve surgery with spreader grafts with or without composite skin/cartilage grafts). We tested our method in preoperative evaluation and surgical planning on 19 patients with nasal obstructions. Our method was just as useful in making postoperative assessments. and it allowed us to judge the effectiveness of specific procedures in restoring nasal patency. Of the 19 patients, 18 (94.77%) reported that their nasal breathing had im proved following surgery.
Avoiding Perils and Pitfalls in Velocardiofacial Syndrome: An Otolaryngologist's Perspective
Authors: Cable Benjamin B. , Mair Eric A.
Published: May 2019

Velocardiofacial syndrome is classically characterized by clefting of the secondary palate, cardiac defects, learning disabilities, and facial dysmorphism. Knowledge of this syndrome is of significant importance to otolaryngologists because a failure to recognize it prior to head and neck surgery can result in serious iatrogenic injury, including velopalatal insufficiency and damage to anomalous carotid arteries. To illustrate these issues, we describe the case of a 5-year-old boy with velocardiofacial syndrome. We also review the literature on velocardiofacial syndrome, which is not very extensive, perhaps because it is often difficult to recognize.
Fibrin Glue Prevents Complications of Septal Surgery: Findings in a Series of 100 Patients
Authors: Daneshrad Payam , Chin Gregory Y. , Rice Dale H.
Published: May 2019

Septal surgery is a common type of otolaryngology–head and neck surgery, and it is often performed in combination with other procedures. Complications of septal surgery include bleeding, hematoma, infection, abscess formation, and perforation. The most common methods of preventing these complications are the use of nasal packing, septal splints, and quilting sutures as a means of approximating the septal flaps. In this article, we describe our study of an alternate method: fibrin glue. We used fibrin glue as the sole method of approximating flaps on 100 consecutive septal surgery patients. Our results indicate that the use of fibrin glue is effective, rapid, comfortable, and inexpensive.
Primary Meningioma of the Ethmoid Sinus: A Case Report
Authors: Daneshi Ahmad , Asghari Alimohamad , Bahramy Eshagh
Published: May 2019

Meningioma is a well-recognized tumor of the central nervous system, but it rarely appears as a primary extracranial tumor of the paranasal sinuses. We report a case of a primary right anterior ethmoid meningioma that resembled a mucocele in its presentation. A primary meningioma can be differentiated from a secondary meningioma in three ways: (1) by observing an intact bony wall of the sinus on imaging or on inspection during surgery, (2) by noting the absence of a simultaneous intracranial meningioma on imaging or on inspection during surgery, and (3) by identifying a bulging of the sinus wall toward the cranium rather than in the opposite direction.
A Case of Renal Cell Carcinoma Metastatic to the Nose and Tongue
Authors: Lang Emer E. , Patil Naishadh , Walsh Rory M. , Leader Mary , Walsh M.A.
Published: May 2019

Reported cases of renal cell carcinoma metastatic to the nose or to the tongue are rare. No case of renal cell carcinoma metastatic to both sites has been previously described. In this article, we report what to our knowledge is the first such case. The nasal metastasis grew rapidly and was treated with radiotherapy. Subsequently, a rapidly enlarging tongue metastasis developed, and it was removed via laser excision. Despite treatment, the patient died within 4 months of the diagnosis.
Insular Carcinoma of the Thyroid
Authors: Cornetta Anthony J. , Burchard Andrew E. , Pribitkin Edmund A. , O'Reilly Robert C. , Palazzo Juan P. , Keane William M.
Published: May 2019

Thyroid surgeons are becoming increasingly more aware of a histologically distinct subset of thyroid carcinoma whose classification falls between well-differentiated and anaplastic carcinomas with respect to both cell differentiation and clinical behavior. This subtype of tumors has been categorized as poorly differentiated or insular carcinoma, based on its characteristic cell groupings. Although the differentiation of insular carcinoma from other thyroid carcinomas has important prognostic and therapeutic significance, relatively little about insular carcinoma has been published in the otolaryngology literature. In this article, we describe a new case of insular carcinoma and we discuss the findings of our review of the literature. We conclude that insular thyroid carcinoma warrants aggressive management with total thyroidectomy followed by radioactive iodine ablation of any remaining thyroid tissue.
Leiomyosarcoma of the Maxilla with Spinal Metastasis: A Case Report
Authors: Ikram Mubasher , Ahmed Imitnan , Ahmed Daniyal , Ahmed Yassar Iftikhar
Published: May 2019

Maxillary leiomyosarcoma is an uncommon tumor, and the occurrence of its metastasis to the spine is exceedingly rare. We report the case of a patient with maxillary leiomyosarcoma who developed a spinal metastasis 18 months following a total maxillectomy. Our patient represents only the third case of metastasis to the spine that has been reported in the literature, and the only reported case of metastasis to the iliac bone.
An Unusual Cause of Facial Pain: Malignant Change in a Calcified Pleomorphic Adenoma in the Deep Lobe of the Parotid Gland
Authors: Kesse Wilfred , Violaris Nick , Howlett David C.
Published: May 2019

We describe a case of a malignant change in a calcified pleomorphic adenoma of the deep lobe of the parotid gland in a patient whose initial symptom was facial pain. We also discuss the relative merits of the different imaging modalities as they apply to the parotid gland.
Recurrent Malignant Schwannoma of the Parapharyngeal Space in Neurofibromatosis Type 1
Authors: Gallo Andrea , Suriano Maria , Simonelli Marilia , Ralli Giovanni , De Vincentiis Marco
Published: May 2019

Malignant schwannoma is an aggressive tumor that carries a poor prognosis despite wide excision, chemotherapy, and radiotherapy. Malignant schwannoma of the parapharyngeal space is an uncommon finding; to our knowledge, only four cases have been described in the literature during the past 30 years, and only one of them involved a patient who had clinical evidence of neurofibromatosis type 1. In this article, we describe a new case of malignant schwannoma of the parapharyngeal space in a patient who had clinical evidence of neurofibromatosis type 1. Following resection of the tumor and a total parotidectomy, the diagnosis was made on the basis of histology and immunohistochemistry. The patient underwent postoperative chemotherapy with carboplatin and UP16. However, 5 months following surgery, the tumor recurred and metastasized. The patient was then placed on a different polychemotherapeutic regimen, which was made up of 3 g/m2 of ifosfamide, 1.5 mg/m2 of vincristine, and 1.5 mg/m2 of doxorubicin (IVA2 protocol). The IVA2 regimen slowed tumor growth, but 13 months after the initiation of therapy, the patient died of neoplastic cachexia. Although chemotherapy is generally ineffective in most cases of malignant schwannoma, we did experience some positive results with the IVA2 protocol. Therefore, we recommend that this combination be considered as a first-line adjuvant therapy following surgery or as a first-line therapy for patients with inoperable tumors.
Ectopic Subglottic Thymic Cyst: A Rare Cause of Congenital Stridor
Authors: Sahhar Hanna S. , Marra Silvio , Boyd Christine , Akhter Javeed
Published: May 2019

We describe the case of a 10-day-old boy who was brought to the hospital with stridor and respiratory distress. He was diagnosed with stenosis caused by a subglottic cyst. After the cyst was removed endoscopically, the patient's symptoms resolved. Pathology identified the cyst as ectopic thymic tissue. This case is noteworthy because we believe it represents the first reported instance of ectopic thymic tissue in the subglottis.
Eosinophilic Angiocentric Fibrosis in a Patient with Nasal Obstruction
Authors: Nguyen Davis B. , Alex James C. , Calhoun Benjamin
Published: May 2019

Eosinophilic angiocentric fibrosis (EAF) is a rare clinicopathologic entity that usually affects the upper respiratory tract. We describe the case of a 45-year-old man with nasal obstruction caused by EAF. His lesion featured the distinct radiologic and histopathologic characteristics of EAF, which include an onionskin and whorled fibrosis that surrounds the blood vessels and an inflammatory infiltrate that is predominated by eosinophils. The etiology of EAF remains unknown. Given our increasing knowledge of this rare entity, reports of EAF may appear more frequently in the future.