American Journal of Otolaryngology - Head and Neck Medicine and Surgery

Azithromycin extended release vs amoxicillin/clavulanate: symptom resolution in acute sinusitis

2009-03-09

Abstract: Objective: The aim of the study was to compare early symptom resolution with a single 2-g dose of azithromycin extended release or 10 days of amoxicillin/clavulanate 875 mg/125 mg every 12 hours in patients with acute sinusitis.Materials and methods: This was a prospective, randomized, open-label, observational study to mimic “real-world” conditions, including patients with symptoms of acute bacterial sinusitis lasting between 7 and 30 days. Key symptoms were assessed twice daily by patient diary, and patients were interviewed by telephone at 12 and 28 days. The primary end point was symptom resolution at 5 days, defined as reporting “no problem” with at least 3 of 4 diary symptoms in 2 consecutive measures in the per-protocol population. Secondary end points included additional antibiotic use, sinusitis-related quality of life, and treatment satisfaction.Results: Three hundred seventy-eight patients were randomized to a single dose of azithromycin extended release and 371 to 10 days of amoxicillin/clavulanate. In the per-protocol population at day 5, 70/236 patients (29.7%) in the azithromycin extended release arm and 45/238 patients (18.9%) in the amoxicillin/clavulanate arm had resolution of symptoms (difference = 10.8%; 95% confidence interval [CI], 3.1–18.4%). By day 28, 26/236 patients (11.0%) in the azithromycin extended release arm and 27/238 patients (11.3%) in the amoxicillin/clavulanate arm had used additional antibiotics (difference = −0.4%; 95% CI: −6.1% to 5.3%). Additional physician visits, quality of life, and overall satisfaction were similar between groups.Conclusions: More patients randomized to azithromycin extended release experienced symptom resolution at day 5 than those randomized to amoxicillin/clavulanate, without experiencing differences in second antibiotic use at 28 days.

The preventive effect of mitomycin-C on the external auditory canal fibrosis in an experimentally induced animal model

Yeo-Hoon Yoon, Jae Yong Park, Yong Ho Park — 2009-03-16

Abstract: Objective: The aim of this study was to investigate the preventive effect of mitomycin-C (MMC) on external auditory canal (EAC) fibrosis in an animal model.Study design: This is a randomized, controlled animal study.Subjects and methods: Sixteen guinea pigs were used for this study. After the skin of cartilaginous EAC was injured with an electrocautery, the cottonoid soaked in MMC solution with concentration of 0.4 mg/mL was topically applied for 5 minutes to the injured EAC in an MMC-treated group (n = 8). In addition, saline was applied in the control group (n = 8). At 4 weeks after injury, postsurgical changes of EAC were evaluated by histologic examination.Results: External auditory canal fibrosis was induced by injury with electrocautery. The MMC-treated group showed less degree of fibrosis without differences in epithelialization and inflammatory cell infiltration.Conclusion: This study suggests that MMC can be helpful in preventing EAC fibrosis after injury.

Surgery vs ventilation in adult severe obstructive sleep apnea syndrome

2009-03-09

Abstract: Background and purpose: Management of severe obstructive sleep apnea-hypopnea syndrome (OSAHS) is challenging and needs multidisciplinary cooperation. Ventilation is considered the gold standard of treatment in severe OSAHS. The aim of the study was to compare the therapeutical efficacy of a type of surgery (maxillomandibular advancement [MMA]) vs a ventilatory treatment modality (autotitrating positive airway pressure [APAP]).Materials and methods: At the ENT Department of Forlì Hospital (University of Pavia), in strict cooperation with the Sleep Lab of the University of Bologna, a prospective randomized controlled trial was designed and performed. After fully informing them, 50 consecutive patients who have severe OSAHS were enrolled and randomized into a conservative (APAP) or surgical (MMA) section. Demographic, biometric, polysomnogram (PSG) and Epworth Sleepiness Scale profiles of the 2 groups were statistically not significantly different.Results: One year after surgery or continuous APAP treatment, both groups showed a remarkable improvement of mean Apnea-Hypopnea Index (AHI) and Epworth Sleepiness Scale levels; the degree of improvement was not statistically different.Conclusions: Given the relatively small sample of subjects studied and the relatively brief follow-up, MMA proved to be a valuable alternative therapeutical tool in our adult and severe OSAHS patient group, with a success rate not inferior to APAP.

A novel technique for treating auricular hematomas in mixed martial artists (ultimate fighters)

Soham Roy, Lee P. Smith — 2009-03-27

Abstract: Purpose: This study aimed to describe a “bolsterless” technique for managing auricular hematomas in professional fighters.Methods: Eight auricular hematomas were drained under local anesthesia by incising along an anatomical auricular crease. After evacuation of the hematoma and copious irrigation, the resultant skin flap was replaced in anatomical position, and through-and-through absorbable mattress sutures were used to secure the flap in place. Incision sites were left open and dressed with antimicrobial ointment. No bolsters were placed. The patients were given 1 week of oral antibiotic therapy.Results: All 8 hematomas resolved without further intervention. All 8 ears returned to their preinjury cosmetic state. Fighters were able to return to training within a week of the initial injury. No postoperative infections or other complications were noted.Conclusions: In contrast to wrestlers, mixed martial artists (also called “ultimate fighters”) do not routinely wear protective head gear. As a result, they are at increased risk of recurrent auricular hematomas, often resulting in severe auricular deformities (cauliflower ear). These patients are anxious to return to training and fighting, and are reluctant to wear a bolster after repair. At their urging, we agreed to attempt this bolsterless technique. Although 2 patients in this series already had a significant cauliflower ear before being treated for the current hematoma, in all cases the auricle returned to its preinjury condition. Bolsterless treatment using mattress sutures and cosmetically placed incisions represents a successful technique for management of auricular hematomas in this population.

Intracranial complications of sinusitis: what is the role of endoscopic sinus surgery in the acute setting

John M. DelGaudio, Seth H. Evans, Steven E. Sobol, Shatul L. Parikh — 2009-04-24

Abstract: Objective: Intracranial complications of sinusitis (ICS) are uncommon in the antibiotic era. The role of neurosurgical drainage of ICS is fairly well established, but the role for acute surgical intervention for the sinus disease is not well defined. We retrospectively reviewed our experience with ICS to see if we could identify the role and effectiveness of endoscopic sinus surgery (ESS) in the acute setting of ICS.Methods: The study used a retrospective review of patients presenting to a tertiary care academic medical center for a 6-year period.Results: Twenty-three patients were identified with ICS, including epidural (8), subdural (10), intracerebral abscesses (2), and meningitis (3). Males were more affected than females (7:1). Twenty patients were 21 years old or younger. Twenty-two patients (96%) had radiologic evidence of frontal sinusitis with prefrontal or frontal lobe ICS at presentation. Medical therapy alone was successful in avoiding craniotomy in only 3 of 8 cases. Endoscopic sinus surgery and intravenous antibiotics as initial treatment was successful in avoiding craniotomy in only 1 of 6 patients. Of 23 patients, 18 underwent neurosurgical procedures—9 emergent procedures for abscesses more than 1 cm and 9 delayed procedures for persistent disease despite ICS less than 1 cm at presentation.Conclusions: Intracranial complications of sinusitis usually result from indirect spread of acute frontal sinusitis. The role of ESS in the initial treatment of ICS is not clear. In our series, ESS did not appear to alter the need for neurosurgical intervention, which was ultimately necessary in most patients with ICS, even with lesions less than 1 cm.

Health literacy and health care in an inner-city, total laryngectomy population

2009-03-27

Abstract: Background: Literacy in the head and neck cancer patient has been understudied. Health literacy (HL) is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health care decisions.” Limited HL skills reduce access to health care. We surveyed our patients who underwent total laryngectomy (TL) to evaluate their HL.Methods: Patients who had undergone TL at Grady Hospital (Atlanta, GA), an inner-city hospital, between 1988 and 1992 were identified. Sociodemographics, general health quality of life, HL, and alaryngeal voice assessment were performed.Results: Thirty patients were eligible but 14 could not be located, 4 refused, and 4 were deceased or too ill to participate. More than one third of the remaining patients had severely inadequate HL scores.Conclusion: Patients who underwent TL have a high incidence of becoming lost in the system as well as having inadequate health care literacy. Health literacy may be important when considering TL.

A comparison of outcomes between nonlaser endoscopic endonasal and external dacryocystorhinostomy: single-center experience and a review of British trends

Samuel C. Leong, Petros D. Karkos, Philip Burgess, Mark Halliwell, Sucha Hampal — 2009-03-27

Abstract: Objective: The purpose of this study was to evaluate outcomes between nonlaser endonasal endoscopic and external dacryocystorhinostomy (DCR) in a district general hospital in the United Kingdom.Study design: We conducted retrospective case notes review and postal questionnaire.Subjects and methods: Case notes of patients who had DCR from August 2003 to August 2007 were reviewed. All patients were sent a questionnaire that included a visual analogue scale (VAS).Results: Seventy patients were identified (35 external, 35 endoscopic). At discharge, 94% of external DCR patients reported being asymptomatic or improved compared with 86% for endoscopic DCR. The average VAS score for external DCR was 8.9 compared with 7.5 for endoscopic DCR (z = 2.1, P < .05). The average VAS score for external DCR was consistently higher than endoscopic DCR up to 30 months of follow-up.Conclusion: External DCR offers better outcomes than endoscopic DCR. Endoscopic DCR is associated with fewer reported complications. A postal questionnaire can be a good alternative method of assessing long-term outcomes rather than relying solely on protracted clinic follow-up. There are few published endoscopic DCR results from the UK, and formalized training must be introduced.

Lemierre syndrome: a pediatric case series and review of literature

2009-03-27

Abstract: Background: Lemierre syndrome is a rare disease of the head and neck often affecting adolescents and young adults. Classically, infection begins in the oropharynx with thrombosis of the tonsillar veins followed by involvement of the parapharyngeal space and the internal jugular vein. Septicemia and pulmonary lesions develop as infection spreads via septic emboli. Although a rare entity in modern times, Lemierre syndrome remains a disease of considerable morbidity and potential mortality.Methods: This was a retrospective review of 3 cases and associated literature.Results: A common 1- to 2-week history of fever, sore throat, neck pain, and fatigue was observed in all patients. Patient 1 developed right facial swelling, neck tenderness, trismus, and tonsillar exudate. Patient 2 displayed right tonsillar erythema and enlargement with right neck tenderness. Patient 3 revealed bilateral tonsillar enlargement with exudate and left neck tenderness. Subsequent studies included blood cultures and computed tomography, after which empiric antibiotic therapy was started. Patient 1 underwent drainage of a right peritonsillar abscess, right pressure equalization tube placement, and ligation of the right external jugular vein. He subsequently developed subdural empyemas, cavernous sinus thrombosis, and carotid artery narrowing and required 9 weeks of antibiotic therapy. Patients 2 and 3 developed pulmonary lesions and received 6 weeks of antibiotic therapy. Timing was crucial in all cases.Conclusions: Lemierre syndrome is a rare but severe opportunistic infection with poor prognostic outcomes if left untreated. Early diagnosis and treatment is essential. Aggressive antibiotic therapy coupled with surgical intervention, when necessary, provides excellent outcomes.

Schwannoma of the tongue in a child

2009-03-27

Abstract: Schwannomas are tumors of the peripheral nerves originating in the nerve sheaths that account for 1% of benign tumors located in the oral cavity. The tongue as a whole is the most common location for intraoral schwannomas to occur; however, it is quite rare to diagnose schwannoma in children. We are contributing a report of a 13-year-old child with a 1-year history of slowly growing swelling on the anterior part of corpus of the tongue. The patient complained of the disturbance to mastication and phonation. Diagnosis was confirmed by excisional biopsy. Histologic identification of Antoni A and B areas along with strong and diffuse staining with S-100 stain pathologically completed the diagnosis of schwannoma.

Cryptococcal meningitis with isolated otologic symptoms

Aaron C. Moberly, Ilka C. Naumann, Susan R. Cordes — 2009-03-09

Abstract: Sensorineural hearing loss (SNHL) is a known complication of cryptococcal meningitis; however, it is unusual for a patient to present with isolated otologic symptoms. We review the case of a patient who is not immunocompromised and who presented with progressive gait instability and sudden onset of left-sided SNHL followed by progression to bilateral SNHL within a 3-week period. Cryptococcal meningitis was confirmed by lumbar puncture with positive cryptococcus antigen in the cerebrospinal fluid. The patient was treated with systemic antifungals, and the hearing loss persisted. The presented report outlines this patient's unusual presentation and his treatment course and reviews the literature on the otologic manifestations of cryptococcal meningitis.

Contralateral deafness post head injury without temporal bone fractures

Alex Toh, Eu Chin Ho, Nick Turner — 2009-03-09

Abstract: We report an unusual case of contralateral deafness in a 31-year-old man after an uncomplicated blunt force head injury. The patient was presented with a left-sided head injury and complained of profound deafness in his right ear, dysequilibrium, and vertigo. Pure tone audiogram revealed total sensorineural deafness in the right ear. A high-definition computed tomography scan demonstrated no radiological evidence of bony injuries or a fistula. His dysequilibrium had improved 2 months later, but his vertigo and hearing loss persisted. We will discuss several possible mechanisms of injury that may result in deafness after head injury without bony fractures. The literature has been reviewed. Although deafness is not an uncommon complication of head injuries, its presentation in the contralateral ear in the absence of temporal bone fractures following head injury has not been reported before in the medical literature.

Headlight with fiber-optic xenon light source may cause harm to patients

Alberto J. de Armendi, Mohanad Shukry, Pratistha Strong, Jorge A. Cure — 2009-03-09

Burns in patients undergoing surgery and general anesthesia have been reported to occur from different reasons such as electrosurgical and electrocautery units, electrocardiogram, laser, and skin preparation agents . Recently, light sources have cause fires in the operating rooms especially if allowed to contact the modern paper drapes (personal experience). Newer and higher intensity surgical headlights have the potential for causing both fires and burns. We present a case report to (1) show the potential for damage to patients if these units are not used correctly, (2) encourage physicians to learn the proper and safe use of these newer fiber-optic light source units, and (3) emphasize to surgeons and anesthesiologists the potential of patient damage from fires in the operating room.

Management of temporomandibular-external auditory canal fistulas: a report of 3 cases

2009-03-16

A temporomandibular-external auditory canal (EAC) fistula is a permanently lined epithelial tract extending between the temporomandibular joint (TMJ) and the EAC. True fistulas occur rarely, and there are only a few cases reported in the literature. Previous case reports have described fistulae arising spontaneously from otitis externa and malignant otitis externa after iatrogenic trauma and a result of radiotherapy to the head and neck .

Delayed presentation of silent sinus syndrome after orbital trauma

Sachin S. Pawar, Sang Hong, David M. Poetker — 2009-03-27

Abstract: Objectives: We describe the clinical presentation and management of a patient with a remote history of orbital trauma who presented with spontaneous right enophthalmos and radiographic findings consistent with silent sinus syndrome over 30 years after her initial orbital injury.Methods: The patient chart and imaging results were reviewed. A literature review of silent sinus syndrome and traumatic enophthalmos was performed.Results: Our patient had both clinical and radiographic findings consistent with silent sinus syndrome. Only 2 other cases of silent sinus syndrome after orbital trauma have been reported in the literature. The underlying anatomic pathology common to all cases is obstruction of the ostiomeatal complex with subsequent maxillary sinus hypoventilation and sinus collapse. Our patient underwent single stage repair with endoscopic maxillary antrostomy and had resolution of the mucosal disease at 6-month follow-up.Conclusions: Posttraumatic cases of silent sinus syndrome are much less common than spontaneous cases but share similar pathophysiology and can be effectively treated using endoscopic techniques.

Isolated sphenoid mucormycosis presenting as visual impairment: changing trends?

Sandeep Bansal, Gogia Grover, Mohnish Grover, Ashok K. Gupta — 2009-04-24

Abstract: Mucormycosis of the paranasal sinuses represents an important cause of morbidity and mortality in patients whose host defenses have been altered by primary disease or immunosuppressive therapy. The pattern of involvement by this fungus is changing with reports of mucormycosis occurring also in immunocompetent host. The involvement of isolated sphenoid sinus is rare. In the present case, the only presenting symptom was visual impairment. These changing trends in presentation, the extent, and the area of involvement are challenging for the otorhinolaryngologist, ophthalmologist, and neurosurgeon. High index of suspicion, prompt intervention, and aggressive therapy are required to reduce the morbidity and mortality associated with this disease.

Severe transient hypertension after greater palatine foramen block in a patient taking midodrine

Mark D. Rizzi, Robert J. Weil, Robert R. Lorenz — 2009-04-24

Abstract: We report an episode of transient, severe hypertension occurring within 2 minutes of injection of 1% lidocaine with 1:100 000 U of epinephrine in a patient taking midodrine for orthostatic hypotension. We hypothesize that the patient's autonomic nervous system was dangerously susceptible to the effect of local anesthetic when combined with the vasoactive systemic effect of midodrine. Surgeons should minimize the use of vasoconstrictors in patients treated with midodrine to avoid hypertensive complications.

Clinical and histopathologic examination of ulcerating vocal fold lesions in an immunosuppressed patient

Ben Saltman, Matt Bramlage, Ryan C. Branski, Snehal Patel, Lucian Sulica — 2009-03-27

Abstract: We present the unique opportunity to correlate videostroboscopic findings with histologic examination. An immunocompromised patient with hoarseness because of ulcerative lesions of both vocal folds of uncertain cause died within a few weeks of initial presentation, and the larynx was donated for postmortem examination. Relevant history, as well as endoscopic and histopathologic findings, is presented.

Facial nerve sheath tumors

Mohnish Grover — 2009-03-27

It was a treat to read your article “The presenting features of middle ear facial nerve sheath tumors: a clinical review” published in the January 2008 volume of this journal. It was surprising to know the various ways in which facial nerve tumors can present. During my tenure at various tertiary institutions of India—All India Institute of Medical Sciences, New Delhi, and Post-Graduate Institute of Medical education and Research, Chandigarh—I was fortunate enough to see a few of such patients. However, the cases that I saw presented as conductive deafness and/or aural polyp, with progressive facial palsy. None of the cases had any postaural lump. Thus, these varied presentations that you mentioned in your article actually help us in keeping this condition in mind while dealing with such cases.

Commentary

Deb Biswas — 2009-04-15

We appreciate the valuable comments from Dr Mohnish Grover. We refer to case 1 in Table 1, where facial nerve function was House-Brakeman grade 1. This particular patient presented with conductive deafness and more interestingly with loss of the stapedial reflex at 250 Hz. The diagnosis of otosclerosis was made based on clinical findings. Computed tomography after the initial tympanotomy revealed extensive nature of the disease and trans-labyrinthine approach was undertaken. We would like to remind ourselves that nerve sheath tumor is one of the most common benign neoplasms arising from the middle ear, and the paraganglioma of the glomus jugulare is the commonest tumor of the middle ear.

Editorial Board

2010-01-01

Guidelines for Contributing Authors

2010-01-01

American Journal of Otolaryngology - Head and Neck Medicine and Surgery

Azithromycin extended release vs amoxicillin/clavulanate: symptom resolution in acute sinusitis

The preventive effect of mitomycin-C on the external auditory canal fibrosis in an experimentally induced animal model

Surgery vs ventilation in adult severe obstructive sleep apnea syndrome

A novel technique for treating auricular hematomas in mixed martial artists (ultimate fighters)

Intracranial complications of sinusitis: what is the role of endoscopic sinus surgery in the acute setting

Health literacy and health care in an inner-city, total laryngectomy population

A comparison of outcomes between nonlaser endoscopic endonasal and external dacryocystorhinostomy: single-center experience and a review of British trends

Lemierre syndrome: a pediatric case series and review of literature

Schwannoma of the tongue in a child

Cryptococcal meningitis with isolated otologic symptoms

Contralateral deafness post head injury without temporal bone fractures

Headlight with fiber-optic xenon light source may cause harm to patients

Management of temporomandibular-external auditory canal fistulas: a report of 3 cases

Delayed presentation of silent sinus syndrome after orbital trauma

Isolated sphenoid mucormycosis presenting as visual impairment: changing trends?

Severe transient hypertension after greater palatine foramen block in a patient taking midodrine

Clinical and histopathologic examination of ulcerating vocal fold lesions in an immunosuppressed patient

Facial nerve sheath tumors

Commentary

Editorial Board

Table of Contents

Guidelines for Contributing Authors