American Journal of Otolaryngology - Head and Neck Medicine and Surgery

Magnetic resonance imaging screening in acoustic neuroma

Jonathan R. Newton, Muhammad Shakeel, Sam Flatman, Craig Beattie, Bhasker Ram — 2009-06-25

Abstract: Objectives: Magnetic resonance imaging (MRI) is the definitive investigation for detection of an acoustic neuroma. It is however an expensive resource, and pick-up rate of a tumor can be as low as 1% of all patients scanned. This study aims to examine referral patterns for MRI screening for patients presenting with asymmetrical sensorineural hearing loss (ASHL). A second aim was to suggest appropriate screening criteria.Method: All 132 MRI scans performed for ASHL in the year 2005 were reviewed retrospectively along with their case records and audiograms. In addition, MRI scans and case records were reviewed for the last 30 patients diagnosed with acoustic neuromas. Information was analyzed using 2 published protocols and additional frequency-specific defined criteria.Results: Two acoustic neuromas were picked up out of 132 scans performed. Of the scans performed for ASHL, a third did not fit with any of the published criteria. Of the 30 positive scans for a tumor, the patients/audiograms revealed that 10% did not fit the published criteria despite the patients having no other audiovestibular symptoms.Conclusions: There appears to be no universally accepted guidelines on screening in ASHL with clinical acumen being used by most ENT consultants in this region. Applying protocols may reduce the amount of scans performed, but up to 10% of tumors may be missed by this approach.

Polyarteritis nodosa: a human temporal bone study

2009-05-18

Abstract: Purpose: Polyarteritis nodosa is one of the common forms of vasculitis with multiorgan involvement. Hearing loss may be the presenting symptom of this disease. The aim of this histopathologic study was to evaluate temporal bone changes in polyarteritis nodosa and assess the correlation between otologic manifestations and histopathologic findings.Materials and methods: A retrospective human temporal bone analysis was performed at an otopathology laboratory in a tertiary academic medical center. Three cases (5 temporal bones) with pathologically confirmed diagnosis of polyarteritis nodosa were selected for study. The processed temporal bone sections were studied under light microscopy.Results: Two of the 3 cases presented with hearing loss, and one of them had facial palsy. Audiometric data available for one patient demonstrated a bilateral, rapidly progressive, mixed hearing loss. Histopathologically, we found generalized vasculitis involving small- and medium-sized arteries in all cases. Of the 5 temporal bones available for study, 3 had chronic otitis media and 2 had serous otitis media. Arteritis was seen in all middle ears. There was disruption of the organ of Corti and spiral ganglion cells in 4 temporal bones. One temporal bone showed fibrosis and osteogenesis in the scala tympani of the basal turn. Vasculitis of stylomastoid and branches of labyrinthine artery were also found in temporal bones.Conclusions: Significant temporal bone findings were seen in patients with polyarteritis nodosa, including otitis media, cochlear damage, neo-osteogenesis, and middle and inner ear vasculitis. This temporal bone series also suggests an interesting relationship between sensorineural hearing loss and labyrinthine vasculitis.

Treatment of pneumocephalus after endoscopic sinus and microscopic skull base surgery

John M. DelGaudio, Avani P. Ingley — 2009-05-18

Abstract: Background: Pneumocephalus is a rare complication of endoscopic sinus surgery (ESS) and microscopic skull base surgery (MSBS). Postoperatively, patients often present with headache and altered mental status. Unrepaired leaks are associated with an increased risk of ascending meningitis. Standard treatment of pneumocephalus after ESS or MSBS has not been addressed in the literature.Methods: The study involved a retrospective review of patients at an academic tertiary care center with pneumocephalus after ESS or MSBS.Results: Ten cases of pneumocephalus were identified, 8 after ESS and 2 after MSBS. Seven ESS defects were very small (<3 mm). The remaining three had defects more than 1 cm. Six of the 8 ESS patients had spontaneous resolution of their cerebrospinal fluid (CSF) leak and pneumocephalus, whereas all patients with larger defects failed conservative therapy with lumbar drainage. Lumbar drainage worsened the pneumocephalus in the MSBS patients. Despite resolution of pneumocephalus in many patients, all were recommended to undergo endoscopic exploration due to concern for increased risk of meningitis in unrepaired defects. Endoscopic repair was necessary in 8 cases. Repairs required a mucosal graft with or without a bone graft. Many spontaneously healed defects were found to be very tenuous. In 2 cases, patients were found to have dense scar over the defect not requiring repair.Conclusions: In patients with pneumocephalus after ESS or MSBS, consideration should be given to endoscopic exploration and repair of the defect with mucosal grafting. Even if spontaneous resolution has occurred, there may be increased risk of ascending meningitis through the thin or incompletely regenerated mucosa.

Hidden unilateral agenesis of the frontal sinus: human cadaver study of a potential surgical pitfall

2009-05-18

Abstract: Purpose: The aim of the study was to attract attention to the surgical significance of unilateral agenesis of the frontal sinus hidden by the overlapping expansion of the contralateral sinus toward the agenetic side.Materials and methods: Retrospective review of endoscopic transnasal sinus dissections of 55 human cadavers (42, formalin fixated; 13, fresh frozen) was done in a tertiary care academic medical center. Surgical and radiologic findings were noted.Results: Absence of right frontal sinus ostium in the presence of a connection between the right and left frontal sinuses was demonstrated in 2 (3.6%) cadavers. An absent and an incomplete septum between the frontal sinuses were also noted in these cadavers. No accompanying abnormality of other sinuses was found, and no evidence of previous sinus surgery was noted in these 2 cadavers.Conclusions: If one of the frontal sinus ostia cannot be found during sinus surgery, although this sinus and its recess can be seen on the thick-sliced coronal computed tomographic (CT) scans, keep in mind that it may be (3.6%) an agenetic frontal sinus hidden by the extensive pneumatization of the contralateral sinus that is crossing the midline. It may not be possible to foresee this variant preoperatively by endoscopic examinations or thick-sliced CT scans. If there is suspicion, thin-sliced CT scans with reconstruction will be ideal to confirm the agenesis of the frontal sinus and to avoid complications. In the presence of such variant of frontal sinus, 1-sided successful frontal sinusotomy is adequate because this sinus or cell will already be drained through the treated frontal recess.

Malleus handle: determinant of success in ossiculoplasty

Anthony Bared, Simon I. Angeli — 2009-05-18

Abstract: Objective: The purpose of this study is to identify prognostic factors affecting outcome in ossicular chain reconstruction (OCR).Study design and setting: This study is a retrospective case series of electronic database at an academic institution.Materials and methods: We reviewed 209 cases of chronic supportive otitis media performed from January 2000 through December 2007 and collected demographic, clinical, audiologic, and outcome information. Univariate analyses of group differences in terms of postoperative air-bone gap (ABG) changes were evaluated by analysis of variance. Multiple regression analyses were used to examine the relationship between postoperative ABG and the independent variables.Results: There were 105 cases of OCR the met the inclusion criteria (44 primary and 61 revision tympanoplasties), with an average follow-up of 19 months. The diagnoses were chronic suppurative otitis media without cholesteatoma in 36 cases and cholesteatoma in 69 cases. The mean preoperative ABG was 34 ± 15 dB, and the mean postoperative ABG was 20 ± 14 dB (P < 0.001). Of the independent variables analyzed, the type of procedure (ie, OCR performed during second-look tympanoplasty vs canal wall up vs canal wall down), preoperative ABG, and status of malleus handle were predictive of the success of OCR.Conclusions: Favorable prognostic factors in OCR include smaller preoperative ABG and the presence of an intact malleus handle.

Biofilms and chronic otitis media: an initial exploration into the role of biofilms in the pathogenesis of chronic otitis media

2009-06-04

Abstract: Purpose: The aim of the study was to compare the extent of biofilm infection in percentage of mucosal surface area of adenoids removed from children with otitis media with effusion (OME) vs those with recurrent acute otitis media (RAOM) and obstructive sleep apnea (OSA).Materials and methods: Comparative microanatomical investigation of adenoid mucosa using scanning electron microscopy obtained from 30 children with OME, RAOM, and OSA was used in this study. Seventeen males and 13 females ranging in age from 9 months to 10 years were included in this study. Percentage of biofilm surface area involvement was the main measure.Results: Adenoids removed from patients with OME had moderately dense mature biofilms covering the mucosal surface with a mean of 27.7% of their mucosal surface covered with mature biofilms. These results were distinct from results obtained from patients diagnosed with RAOM and OSA with means of 97.6% and 0.10% of their mucosal surfaces covered with mature biofilms, respectively. These differences were statistically significant at P < .0001.Conclusions: Adenoids removed from patients with OME were characterized by distinctly different percentage of biofilm mucosal surface area coverage, with significantly more biofilm presence than OSA patients but significantly less biofilm presence than RAOM patients. Although previous investigations have supported a dominant role of nasopharyngeal biofilms in RAOM pathogenesis, these results suggest nasopharyngeal biofilms may play a different role in the pathogenesis of OME and that this clinical entity may be more multifactorial in nature.

The oncologic safety and functional preservation of supraglottic partial laryngectomy

2009-06-11

Abstract: Objective: The purpose of this study was to evaluate the appropriateness of the conservative surgery as the initial treatment of supraglottic cancer by the comparative study of supraglottic partial laryngectomy with radiation therapy.Methods: We analyzed 48 patients diagnosed as having supraglottic cancer who underwent supraglottic partial laryngectomy and 20 patients treated with radiation therapy as initial treatment from 1991 to 2005. Oncologic safety was evaluated by comparison of survival rates. Swallowing test was performed with videoesophagofluoroscopy under the category of the pharyngeal phase and the presence or absence of aspiration. Phonologic analysis was performed with acoustic waveform analysis and stroboscopy.Results: Positive resection margin was observed in 12 of the patients who received supraglottic partial laryngectomy (SPL), and its relationship with the primary subsite was evaluated. For the patients in stages I and II, the overall survival rate in each of the SPL group and the radiotherapy (RTx) group was 87% and 80%, respectively. For the patients in stages III and IV, the overall survival rate was 87% and 80%, respectively. On evaluation of swallowing and phonation function, no significant difference was noted between the SPL group and the RTx group.Conclusion: This study suggests that for patients with supraglottic cancer, SPL provides acceptable survival, swallowing, and phonologic results in comparison with radiation therapy.

The use of complementary and alternative medicine by patients attending a general otolaryngology clinic: can we afford to ignore it?

Muhammad Shakeel, Aaron Trinidade, Shah Jehan, Kim W. Ah-See — 2009-06-11

Abstract: Background: There is growing interest in use of complementary and alternative medicine (CAM) among the general population. Little information is available, however, on CAM use in adults attending an otolaryngology outpatient clinic in the UK.Objective: The purpose of this article is to study the prevalence and pattern of CAM use among adult patients attending the ear, nose, and throat (ENT) clinic in a UK teaching hospital.Study design: A cross-sectional study was used.Subjects and methods: All patients on their primary visit to an ENT clinic were asked to complete an anonymous questionnaire for a 14-week period from October 2005 to January 2006.Results: Based on 1366 completed questionnaires, 53% (728/1366) were female and 47% (638/1366) were male. Twenty-nine percent (395/1366) were older than 60 years, and 56% (763/1366) were married. Twenty percent (275/1366) had a university education. Sixty-one percent (833/1366) had used CAM, almost 36% in the preceding 12 months. The popular remedies were cod liver oil (368/833), garlic (197/833), cranberry (181/833), aloe vera (176/833), primrose oil (174/833), and Echinacea (163/833). Nonherbal therapies included massage (230/833), acupuncture (186/833), aromatherapy (135/833), chiropractic (121/833), reflexology (119/833), and homeopathy (110/833). Seventeen percent (143/833) used CAM for their current illness. Only 8% (64/833) found CAM ineffective; yet, 57% (473/833) would recommend CAM to others. Fifty-one percent (421/833) failed to inform their primary physician of their CAM use.Conclusion: Despite concerns over CAM efficacy, safety, and cost effectiveness, use of CAM is popular among patients attending an ENT clinic. Their use is not generally related to their presenting illness. Otolaryngologists should be aware of current trends in CAM use when managing patients, including possible interactions with other medication.

Influence of audit on clinical practice: multidisciplinary team data documentation for cutaneous head and neck malignancy

Ravinder Natt, Peter D. Karkos, Apostolos Karkanevatos — 2009-07-06

Abstract: Background: Prognosis of cutaneous head and neck malignant neoplasms is related to type, site, and histologic feature but may also be influenced by delays in the referral process. Treatment aims to address the primary lesion and when necessary the secondary disease but at the same time maintaining quality of life and minimizing cosmetic deformity. The management plan should ideally be the “product” of a multidisciplinary team (MDT) approach of dermatologists, surgeons, oncologists, pathologists, and radiologists.Aims: The purposes of the study were as follows: (i) to review current documentation practice of cutaneous head and neck malignancies in a district hospital, (ii) to generate an MDT-approved data collection proforma, and finally (iii) to reaudit documentation of head and neck skin lesions based on the “new” standardized proforma. The MDT-approved proforma was instituted in an effort not only to collect data in a coherent and structured way but also to achieve early diagnosis and avoid delays from urgent referral to treatment with the aim of curing disease and restoring patients to as near-normal appearance and quality of life as possible.Methods: The notes of patients with head and neck cutaneous lesions were prospectively audited for a 6-month period (August 2006–January 2007). The presence and absence of a minimal standardized data set required for MDT discussion and review were recorded.Results: Documentation was deficient and a need for change in practice emerged. An MDT-approved data collection standardized proforma was designed and distributed throughout the hospital departments involved in management of patients with head and neck cutaneous lesions. The notes of these patients were prospectively reaudited through a second cycle for a 6-month period (February 2007–August 2007). The completion and deficiency of sections of the MDT-approved data collection standardized proforma were recorded, resulting in closure of the audit loop.Conclusions: The data documentation for head and neck cutaneous lesions has significantly improved after the implementation of an MDT-approved data collection standardized proforma. This has resulted in improved patient quality of care and progression on appropriate management plans.

Bone morphogenetic protein-2/4 and bone morphogenetic protein receptor type IA expression in metastatic and nonmetastatic oral squamous cell carcinoma

2009-06-04

Abstract: Purpose: The study aimed to analyze the expression of bone morphogenetic protein-2/4 (BMP-2/4) and its receptor BMPR-IA (BMP receptor type IA) in metastatic and nonmetastatic oral squamous cell carcinoma (OSCC) and its implications for disease prognosis.Materials and methods: The experimental group included 16 cases of OSCC without metastasis and 7 cases of OSCC with metastasis. The presence or absence of nodal metastasis was used as a parameter for the evaluation of disease prognosis. Ten cases of oral fibroepithelial hyperplasia were selected as the control group. The expression of BMP-2/4 and BMPR-IA was analyzed by immunohistochemistry.Results: In the experimental group with metastasis, strong expression of BMP-2/4 was observed in most cases (71.4%), whereas BMPR-IA exhibited weak expression (85.7%). In the experimental group without metastasis, there was strong expression of BMP-2/4 (62.5%) and BMPR-IA (100%). A significant association was observed between the prognosis of OSCC and the intensity of BMP-2/4 staining (P = .002). Weak immunoreactivity to BMP-2/4 and BMPR-IA was observed in all control specimens.Conclusions: The results suggest that strong expression of BMP-2/4, associated with low expression of BMPR-IA, observed in metastatic OSCC has a prognostic value, with the loss of responsiveness to BMPs through the loss of expression of their receptors being indicative of the development of metastasis.

Endoscopic treatment of tracheocele in pediatric patients

Marco Berlucchi, Barbara Pedruzzi, Rita Padoan, Nader Nassif, Stefania Stefini — 2009-06-04

Abstract: Acquired tracheal pouch known also as tracheocele is a rare air-filled diverticulum of tracheal pars membranacea. This disease may be due to esophageal or tracheal surgery, orotracheal intubation, or increased intralunimal pressure through a weak area of tracheal wall. When symptomatic and medical therapy is insufficient, this disorder must be treated surgically. Several surgical methods ranging from open neck or thoracic surgery to endoscopic managements have been reported. We report the case history of a 7-year-old boy affected by recurrent pneumonia due to tracheal pouch. The patient underwent successful brushing of tracheocele plus fibrin glue application by rigid tracheobroncoscopy. Furthermore, particular emphasis on endoscopic treatments of tracheal diverticulum is also presented.

Spontaneous tracheal rupture caused by vomiting

Matthew S. Stevens, T. Corbin Mullis, Jeffrey D. Carron — 2009-05-18

Abstract: Objectives: To present a pediatric case of spontaneous tracheal rupture caused solely by vomiting and to discuss its diagnosis and management.Study design: Case presentation and literature review.Results: A 14-year-old girl with a new diagnosis of type 1 diabetes mellitus presented with respiratory distress. History was significant only for 4 days of violent vomiting, and she was diagnosed with diabetic ketoacidosis. Examination revealed tachypnea and considerable subcutaneous air overlying the upper chest and neck; chest x-ray showed pneumomediastinum. A swallow study showed no evidence of an esophageal tear. Computed tomography of the chest showed a posterior tracheal tear 4.5 cm distal to the cricoid cartilage. The patient's ketoacidosis was controlled, and supplemental oxygen was administered temporarily to promote absorption of the extravasated air. Serial chest x-rays showed complete resolution within 5 days and intubation was not required.Conclusions: To our knowledge, this is the first reported pediatric case of tracheal rupture secondary to vomiting. Previous reports of spontaneous tracheal rupture have been related to paroxysmal coughing. In similar cases of subcutaneous emphysema and pneumomediastinum after retching, an esophageal rupture should be ruled out. Conservative management was successful in this case.

Atypical Cogan's syndrome: a case report

Yu-Lan Mary Ying, Barry E. Hirsch — 2009-06-11

Abstract: Cogan's syndrome is a rare presumed autoimmune disorder characterized by nonsyphilitic interstitial keratitis and progressive audiovestibular symptoms. The initial report by David G. Cogan in 1945 was modified by Haynes et al in 1980 who proposed diagnostic criteria for patients with other ocular or vestibular symptoms and suggested this to be atypical Cogan's syndrome. In a more typical presentation of Cogan's syndrome, ocular and audiovestibular signs and symptoms usually appear alone and are bilateral. We report a case of 50-year-old woman with an atypical Cogan's syndrome manifested by unusual relatively rapid clinical deterioration.

Carotid artery blow-out during mastoidectomy: management using endovascular coils

2009-07-13

Bleeding during modified radical mastoidectomy usually occurs due to injury to dura matter and sigmoid sinus and, in most cases, can be controlled easily. Iatrogenic injury to the carotid artery as it traverses the middle ear in its normal anatomical position is a rare but potentially life-threatening event. Predisposing factors include a thin or dehiscent plate of bone which normally protects the artery at the level of the Eustachian tube, erosive middle ear disease such as cholesteatoma, or previous trauma. Review of literature shows that iatrogenic cases of bleeding from internal carotid artery (ICA) during middle ear surgery are rare, and in almost all the cases, the carotid artery followed an anomalous route through the temporal bone. We report an extremely rare case of a carotid blow out during mastoidectomy and management of the resulting pseudoaneurysm using microcoils via an endovascular approach.

Endoscopic management of a massive nasal osteoma presenting as an orbital abscess

Matthew S. Stevens, Byron P. Windham, Jeffrey Carron — 2009-06-04

A 13-year-old female with a 1-week history of sinusitis and a 3-day history of right-sided proptosis and diplopia from limited extraocular muscle movement was evaluated in our pediatric emergency department. The patient also had complaints of prior nasal obstruction for several years and had undergone 2 prior adenoidectomies for these complaints. No history of craniofacial trauma was elicited. Computed tomographic scan of the orbit revealed a large abscess involving the superior medial aspect of the orbit, displacing the globe laterally. Also noted was a large, dense, homogenous bony mass essentially involving the entire right nasal cavity, including the ethmoid and maxillary sinuses (). Magnetic resonance imaging showed no intracranial extension. A diagnosis of nasal osteoma with secondary orbital abscess was made, and the patient was taken to the operating room for biopsy of the mass and drainage of the orbital abscess. An external approach was necessary due to the intranasal obstruction from the tumor.

Toxic epidermal necrolysis caused by cetuximab plus minocycline in head and neck cancer

Shan-Shien Lee, Pen-Yuan Chu — 2009-06-04

Abstract: We present a unique case of toxic epidermal necrolysis (TEN) caused by cetuximab plus minocycline during chemoradiation for recurrent squamous cell carcinoma of the head and neck (SCCHN). In April 2008, a 49-year-old man was diagnosed with recurrent SCCHN. He received surgery and postoperative adjuvant therapy with cetuximab plus chemoradiation. Because of exacerbation of acneform rash by cetuximab, minocycline was added thereafter. However, TEN appeared after the fifth course of weekly cetuximab, and cetuximab plus minocycline was assumed to be the cause. Cetuximab plus minocycline carries a risk of evoking TEN, and the side effects of chemoradiation for SCCHN mask some early signs of TEN. Noticing the transformation of skin lesions makes early diagnosis possible, and prompt cessation of the causative agent is essential for patients with TEN. We review the literature on cetuximab, minocycline, and TEN and discuss the impact of TEN on cancer therapy.

Malignant transformation of a highly aggressive human papillomavirus type 11–associated recurrent respiratory papillomatosis

2009-07-13

Abstract: Objective: The objective is to present an uncommon case of squamous cell carcinoma (SCC) arising from extensive recurrent respiratory papillomatosis (RRP) involving the upper and lower airway and temporal bone.Study Design: This is a case report and a review of the literature.Methods: We describe a case of a 24-year–old woman with a history of human papillomavirus (HPV) type 11 since childhood originating in the larynx and trachea, then progressing to involve the distal pulmonary alveoli and right middle ear through the eustachian tube. Papillomatous growth was treated with multiple surgeries including laser cytoreduction of laryngotracheal papillomatosis and radical mastoidectomy, followed by a trial of chemotherapy. Despite this aggressive treatment regimen, papillomatous growth progressed with recurrence in the right eustachian tube, middle ear, and mastoid eventually extending to involve the calvaria and scalp.Results: The patient underwent a composite resection of involved tissues, including the scalp, auricle, and lateral temporal bone, with reconstruction using a latissimus dorsi free flap. Final pathologic analysis revealed an extensive infiltrative well-differentiated SCC arising from the papilloma. A review of the literature on aggressive respiratory papillomatosis suggests that malignant transformation of juvenile-onset RRP occurs exclusively in cases positive for HPV-11.Conclusions: We report an unusual case of SCC originating from extensive RRP involving the airway, temporal bone, and scalp and describe the medical and surgical management. Although the incidence of juvenile-onset RRP transformation to SCC is very low, the presence of HPV-11 as a risk factor for malignant transformation of RRP is becoming evident.

Imaging findings in a case with cholesteatoma in complete aural atresia

2009-06-04

Abstract: We report a case of cholesteatoma in congenital aural atresia in which preoperative imaging analysis provided useful information. A 30-year–old man with total aural atresia had had ear symptoms on his right side for 10 years. Evaluation by computerized tomography and magnetic resonance imaging suggested that the mass in the atretic external auditory canal and the anterior part of the mastoid was cholesteatoma and that the mass in the posterior part of the mastoid was inflammatory granulation tissue and chronic osteomyelitis. Three-dimensional fluid-attenuated inversion recovery images showed increased signals in the labyrinth. The extent of the cholesteatoma revealed during surgery was consistent with the preoperative image findings. Imaging analysis provides useful information for management of congenital aural atresia, and combined examination with computerized tomography and magnetic resonance imaging could be beneficial for preoperative evaluation of state of ears in cases of congenital aural atresia.

Sinonasal teratocarcinosarcoma

Yan-Ye Su, Michael Friedman, Chun-Chen Huang, Meghan Wilson, Hsin-Ching Lin — 2009-05-20

Abstract: Sinonasal teratocarcinosarcoma (SNTCS) is a rare and aggressive neoplasm characterized by the combination of malignant teratoma and carcinosarcoma. Sinonasal teratocarcinosarcoma usually is found mainly among adults, and the common original sites of SNTCS were nasal cavities and paranasal sinuses. There are fewer than 50 reported SNTCS cases in the literature. The most common cause of treatment failure is local recurrence. Distant metastasis of SNTCS is seldom described because of the invasive character of the cancer. We report on a 52-year-old man with SNTCS involving the left sinonasal cavity. Recurrent cervical metastasis developed in the 18th, 23rd, and 28th month after initial sinonasal surgery. Despite multiple aggressive neck surgeries and postoperative adjuvant radiotherapy, the patient died of lung metastasis 43 months after the initial surgery. Our patient was younger than other reported patients with SNTCS; besides, good locoregional control and lung metastasis have not been reported previously. An aggressive elective neck dissection should be performed in the early disease stage, and more attention should be given to the soft tissue surrounding any possible lymphadenopathy. This may decrease the risk of lower cervical lymph node or distant metastasis in patients with SNTCS.

Deep neck abscess due to Acinetobacter baumannii infection

2009-07-06

Abstract: Acinetobacter baumannii strains are isolated in up to 1% of nosocomial infections mostly from intensive care units immunocompromised patients and are associated with high mortality rates. A baumannii infections include pneumonia, urinary tract infection, endocarditis, skin and soft-tissue infections, surgical-site infection, meningitis, osteomyelitis, and septicemia. We report an extremely rare case of deep neck abscess due to multidrug-resistant A baumannii infection. The isolate strain was analyzed by a repetitive sequence-based polymerase chain reaction typing method: the isolate profile was compared with other strains obtained from isolates recovered in the hospital in that period. Our patient underwent 2 neck explorations and antibiotic treatment (tigecycline 50 mg, twice per day). Five weeks after admission, the patient was discharged in good general conditions. Considering the other obtained strains, 4 different profiles were identified, one as prominent (profile A, 18 isolates), the index case (B), and 2 others (C, D) as divergent.

Editorial Board

2010-07-01

Guidelines for Contributing Authors

2010-07-01

American Journal of Otolaryngology - Head and Neck Medicine and Surgery

Magnetic resonance imaging screening in acoustic neuroma

Polyarteritis nodosa: a human temporal bone study

Treatment of pneumocephalus after endoscopic sinus and microscopic skull base surgery

Hidden unilateral agenesis of the frontal sinus: human cadaver study of a potential surgical pitfall

Malleus handle: determinant of success in ossiculoplasty

Biofilms and chronic otitis media: an initial exploration into the role of biofilms in the pathogenesis of chronic otitis media

The oncologic safety and functional preservation of supraglottic partial laryngectomy

The use of complementary and alternative medicine by patients attending a general otolaryngology clinic: can we afford to ignore it?

Influence of audit on clinical practice: multidisciplinary team data documentation for cutaneous head and neck malignancy

Bone morphogenetic protein-2/4 and bone morphogenetic protein receptor type IA expression in metastatic and nonmetastatic oral squamous cell carcinoma

Endoscopic treatment of tracheocele in pediatric patients

Spontaneous tracheal rupture caused by vomiting

Atypical Cogan's syndrome: a case report

Carotid artery blow-out during mastoidectomy: management using endovascular coils

Endoscopic management of a massive nasal osteoma presenting as an orbital abscess

Toxic epidermal necrolysis caused by cetuximab plus minocycline in head and neck cancer

Malignant transformation of a highly aggressive human papillomavirus type 11–associated recurrent respiratory papillomatosis

Imaging findings in a case with cholesteatoma in complete aural atresia

Sinonasal teratocarcinosarcoma

Deep neck abscess due to Acinetobacter baumannii infection

Editorial Board

Table of Contents

Guidelines for Contributing Authors