American Journal of Otolaryngology - Head and Neck Medicine and Surgery - Articles in Press

Adenoid cystic carcinoma of the head and neck - Corrected Proof

2012-01-06

Abstract: Purpose: To report our experience using radiotherapy alone or combined with surgery to treat adenoid cystic carcinoma of the head and neck.Materials and methods: Radiotherapy alone or combined with surgery was used to treat 120 previously untreated patients with adenoid cystic carcinoma (ACC) of the head and neck from August 1966 to March 2008. Patients were treated with curative intent. American Joint Committee on Cancer stage distribution was,T0 (n = 1), T1 (n = 26), T2 (n = 25), T3 (n = 14), T4 (n = 54), N0 (n = 113), N1 (n = 2), N2a (n = 1), N2b (n = 2), and N2c (n = 2). Treatment included surgery with postoperative radiotherapy (n = 71), radiotherapy alone (n = 46), and preoperative radiotherapy and surgery (n = 3). Incidental and clinical perineural invasion was found in 41 (34%) and 35 (29%) patients, respectively. Median follow-up was 8.6 and 11.6 years overall and among living patients, respectively.Results: The10-year overall, cause-specific, and distant metastasis-free survival rates, respectively, were as follows: radiotherapy alone, 37%, 46%, and 76%; surgery and radiotherapy, 57%, 71%, and 62%; and overall, 50%. The10-year local control rates were as follows: radiotherapy alone, 36%; surgery and radiotherapy, 84%; and overall, 65%. The 10-year neck control rates were as follows: elective nodal irradiation (ENI), 98%; no ENI, 89%; and overall, 95%.Conclusions: Surgery and adjuvant radiotherapy offer the best chance for cure for patients with resectable adenoid cystic carcinomas of the head and neck. Some patients with advanced, incompletely resectable disease can be cured with radiotherapy alone. ENI should be considered for primary sites located in lymphatic-rich regions.

Delayed lymph node metastases after elective neck dissection in patients with oral and oropharyngeal cancer and pN0 neck - Corrected Proof

2012-01-04

Abstract: Purpose: Patients with surgically treated head and neck cancer and clinical N0 neck with high risk of occult lymph node metastasis undergo elective neck dissection (ND). Late lymph node metastasis may appear in those patients with pN0 neck. The aim of the present study was to analyze the incidence and clinical relevance of late lymph node metastasis in patients with head and neck cancer.Materials and Methods: The clinical data of 61 patients with head and neck cancer who had undergone elective ND with pN0 neck were retrospectively analyzed. Only patients without local failure, second primary, or radiochemotherapy were included in the study.Results: Late lymph node metastasis could be observed in 4 (6.5%) cases at the margin or outside the initially dissected lymph node levels. In those patients, the primary tumor was localized in the oral cavity (n = 3) or oropharynx (n = 1) and was classified in all cases as T1 or T2. Lymph node metastasis could be found in levels I (n = 2), II (n = 1), and IV (n = 1), respectively.Conclusion: Even in the case of pN0 neck after an elective ND, the appearance of late lymph node metastases must be expected. The low proportion of patients with late lymph node metastases after a selective ND in clinical and histologic N0 does not justify an extended form of neck surgery.

The intraparotid facial nerve schwannoma: a diagnostic and management conundrum - Corrected Proof

2011-12-21

Abstract: Objectives: The aims of the study were (1) to review the management strategy and clinical outcomes of all intraparotid facial nerve (FN) schwannomas (PFNSs) treated at a single tertiary academic center from 1975 to 2010 and (2) to summarize all previously reported cases of PFNS in the international literature.Study design: A retrospective cohort study and literature review.Methods: Fifteen patients were diagnosed and treated at the authors' institution from 1975 to 2010. In addition, 124 published cases were systematically reviewed.Results: The most common presentation of PFNS was a painless parotid mass with normal FN function. Eccentric, loosely attached intraparotid tumors underwent gross total resection with nerve preservation granting satisfactory postoperative FN function, whereas “inseparable” intraparotid tumors were observed in 8 cases with stable long-term size. Lesions that extended into the fallopian canal underwent complete resection with FN sacrifice and nerve grafting in 10 cases, whereas 1 patient received subtotal resection of the intraparotid portion with stereotactic radiotherapy targeting the intratemporal component.Conclusions: Intraparotid FN schwannomas present similar to other primary salivary gland neoplasms, making an early diagnosis challenging. Intraoperative recognition of gross tumor characteristics and early histologic diagnosis with strategic biopsy are critical. Information including tumor location and extent, preoperative FN function, and the gross relationship between the tumor and the FN may guide the surgeon toward an optimal treatment plan emphasizing long-term neurologic preservation.

Heterotopic salivary tissue - Corrected Proof

Daniel E. Cannon, Sara Szabo, Valerie A. Flanary — 2011-12-21

Abstract: Salivary tissue can be present in the head and neck outside the usual locations of the major and minor salivary glands. This can be in the form of accessory salivary glands, in association with branchial cleft anomalies, or, less commonly, as heterotopic salivary gland tissue (HSGT). Heterotopic salivary gland tissue is defined as salivary tissue outside of the expected locations of major, minor, and accessory salivary glands with absence of clinical or histologic features of branchial cleft anomalies. Here we present the case of a 13-year-old girl who presented with a draining sinus of the lower neck, which was excised and, on histologic analysis, was consistent with HSGT. We include photographs and histologic images. A review of the literature on heterotopic salivary tissue in the neck is then presented including discussion of the presentation, clinical features, important considerations, and recommendations for management.

Skin carcinoma of the head and neck with perineural invasion - Corrected Proof

2011-12-21

Abstract: Purpose: The aim of the study was to update the experience treating cutaneous squamous cell and basal cell carcinomas of the head and neck with incidental or clinical perineural invasion (PNI) with radiotherapy (RT).Materials and methods: From 1965 to 2007, 216 patients received RT alone or with surgery and/or chemotherapy.Results: The 5-year overall, cause-specific, and disease-free survivals for incidental and clinical PNIs were 55% vs 54%, 73% vs 64%, and 67% vs 51%. The 5-year local control, local-regional control, and freedom from distant metastases for incidental and clinical PNIs were 80% vs 54%, 70% vs 51%, and 90% vs 94%. On univariate and multivariate (P = .0038 and .0047) analyses, clinical PNI was a poor prognostic factor for local control. The rates of grade 3 or higher complication in the incidental and clinical PNI groups were 16% and 36%, respectively.Conclusions: Radiotherapy plays a critical role in the treatment of this disease. Clinical PNI should be adequately irradiated to include the involved nerves to the skull base.

A novel classification system for perineural invasion in noncutaneous head and neck squamous cell carcinoma: histologic subcategories and patient outcomes - Corrected Proof

2011-12-19

Abstract: Objective: The aims of this study were to define a novel classification system of tumor perineural invasion (PNI) with respect to tumor/nerve involvement such as intratumoral (IT), peripheral, or extratumoral (ET) and to determine the prognostic significance of each of these histologic subcategories in patients with noncutaneous head and neck squamous cell carcinoma (HNSCC).Study design: This study is a retrospective chart review and histologic analysis of patients with HNSCC in the setting of a tertiary care medical center.Methods: A clinical chart review of 142 patients with HNSCC who underwent primary surgical treatment from January 2004 through December 2007 was performed. Clinical information collected included patient age, sex, alcohol and tobacco use, tumor location, TNM stage, postoperative adjuvant chemotherapy and/or radiation treatment, and patient outcome. For each case, PNI density, the distance of each PNI focus to the tumor edge, and size of the largest nerve involved were measured. Furthermore, PNI was subcategorized as IT, peripheral, or ET. A Cox regression analysis was performed to determine if PNI was related to regional disease recurrence. Kaplan-Meier survival analysis was also performed.Results: Among the 142 patients, 37 (26%) had disease progression. The maximum extent of PNI was significantly correlated with disease-free survival on multivariate analysis (P = .019) and was also significantly related to disease-free survival when T stage (P = .017), N stage (P = .021), and T and N stages (P = .02) were added to the Cox regression model. Kaplan-Meier analysis demonstrated a trend toward increased disease-free survival of PNI negative and IT/peripheral PNI compared with ET PNI.Conclusion: Perineural invasion is correlated with nodal status and T stage and is related to disease-free survival. It can be subcategorized as IT, peripheral, or ET. This novel classification system has important implications with regard to clinical outcome and may help define a cohort of patients that may require more aggressive management.

Location of airway obstruction in term and preterm infants with laryngomalacia - Corrected Proof

Eelam Adil, Terrence Rager, Michele Carr — 2011-12-19

Abstract: Objective: The aim of this study was to describe and compare the airway findings in term and preterm infants with laryngomalacia.Methods: A retrospective review of 130 patients diagnosed as having laryngomalacia at a tertiary referral center between July 2004 and August 2009 was conducted. Medical records were reviewed for demographic data, supraglottic and glottic airway findings, concomitant airway lesions, and the need for intervention.Results: The mean gestational age and age at diagnosis was 36 and 15 weeks, respectively. Combined posterior and anterior supraglottic collapse was the most common finding (31%). Posterior collapse alone occurred in 25%, anterior collapse in 14%, and lateral collapse in 10%. Twelve percent of patients had all 3 sites of collapse. Forty-one percent of patients had a secondary airway lesion, with tracheomalacia being the most common. Preterm infants had significantly higher rates of reflux and more sites of collapse than did term infants (P < .0001). Eight patients required an intervention for their symptoms.Conclusions: Children with laryngomalacia tend to have more than 1 area of supraglottic collapse, and more than one third have a secondary lesion. All patients who required an intervention had more than 1 area of collapse, and 63% of these patients had a secondary airway lesion. Our high incidence of secondary lesions is similar to recent reports.

Subcutaneous emphysema after otologic surgery: a case report - Corrected Proof

Nipun Chhabra, Rod P. Rezaee, Harvey M. Tucker, Cliff A. Megerian — 2011-12-19

Abstract: Subcutaneous emphysema of the head and neck after otologic surgery is exceedingly rare. The mechanism relates to the intimate relationship of the temporomandibular joint to the external auditory canal. We present a rare case of subcutaneous emphysema after otologic surgery for ear disease. An astute clinical index of suspicion coupled with prompt treatment can help minimize morbidity and improve patient outcomes.

An objective comparison of leakage between commonly used earplugs - Corrected Proof

Jeremiah A. Alt, William O. Collins — 2011-12-12

Abstract: Objective: We sought to determine the efficacy of commonly used earplugs using an anatomically correct ear model.Methods: The total volume and rate of water that leaked past the earplug and subsequent defect in the tympanic membrane over separately measured 30, 60, 120, and 180-second intervals were recorded. Scenarios tested included a control with no earplug, custom molded earplug (Precision Laboratories, Orlando, FL), Mack's plug (Warren, MI), Doc's plug (Santa Cruz, CA), and cotton balls coated with petroleum jelly.Results: All plugs tested resulted in less leakage at all time points when compared with no plug (P < .05). At 30 seconds, the custom molded, Mack's and Doc's plugs all showed significantly less leakage when compared with the cotton ball coated with petroleum jelly (P < .05). At 60, 120, and 180 seconds, Mack's, Doc's, and the cotton plugs all showed significantly less leakage compared with the customized plug (P < .05). At 120 and 180 seconds, Mack's plugs had significant less leakage than the cotton plug (P < .05). Among the types of plugs, the molded variety (Mack's) showed the least volume and lowest leakage rate (f4,45 = 94 [P < .001]). In addition, Doc's and cotton balls coated with petroleum jelly were more effective than the customized earplugs.Conclusions: If the clinician feels that middle ear and external canal water exposure should be minimized, then use of earplugs, particularly the moldable variety, merits further consideration.

Imaging techniques in parathyroid surgery for primary hyperparathyroidism - Corrected Proof

Arash Mohebati, Ashok R. Shaha — 2011-12-09

Abstract: As more patients present with the incidental diagnosis of primary hyperparathyroidism due to biochemical screening, treatment guidelines have been developed for the treatment of hyperparathyroidism. Management of primary hyperparathyroidism has evolved in recent years, with considerable interest in minimally invasive approaches. Successful localization of the diseased gland(s) by nuclear imaging and anatomical studies, along with rapid intraoperative parathyroid hormone assay, has allowed for focused and minimally invasive surgical approaches. Patients in whom the localization studies have identified single-gland adenoma or unilateral disease are candidates for such focused approaches instead of the traditional approach of bilateral exploration. These imaging techniques have also been critical in the successful management of patients with persistent or recurrent disease.\

Superior laryngeal nerve syndrome and the evaluation of anterior neck pain - Corrected Proof

Reginald F. Baugh, Aaron Baugh, Frederick Bunge — 2011-12-09

A 62-year-old woman presented to the general surgery clinic for evaluation of an anterior neck mass. She complained of hoarseness and dysphagia to both solid and liquids. Significantly, at the time of initial evaluation, the patient was unable to tolerate flexible laryngoscopy. Thyroid examination found significant enlargement with extension below the sternal notch. On the basis of this clinical picture, total thyroidectomy was elected. Triple endoscopy was performed in the operating room demonstrating normal anatomy throughout. The operating surgeons made specific note of the identification and sparing of both the superior and recurrent laryngeal nerves on the right side but made no comment about the left superior laryngeal nerve. The procedure was otherwise unremarkable, and the parathyroids were reimplanted into the sternocleidomastoids bilaterally. The patient was discharged on postoperative day 2 without notable complications.

Multiple cranial nerve dysfunction caused by neurosarcoidosis - Corrected Proof

Rivkah G.J. Loor, Joost van Tongeren, Wynia Derks — 2011-12-09

Abstract: Neurosarcoidosis is a rare identity and occurs in only 5% to 15% of patients with sarcoidosis. It can manifest in many different ways, and therefore, diagnosis may be complicated. We report a case presented in a very unusual manner with involvement of 3 cranial nerves; anosmia (NI), facial palsy (NVII), and hearing loss (NVIII). When cranial nerve dysfunction occurs, it is very important to take neurosarcoidosis into consideration.

Work environment discomfort and injury: an ergonomic survey study of the American Society of Pediatric Otolaryngology members - Corrected Proof

Jonathan Cavanagh, Maria Brake, Donald Kearns, Paul Hong — 2011-12-09

Abstract: Background: Workplace-related musculoskeletal pain has been studied in various occupations, but it is rarely reported in the surgical literature.Objective: The aim of this study was to examine work-related discomfort and injury among pediatric otolaryngologists and to assess their knowledge of workplace ergonomic principles.Methods: We surveyed current North American members of the American Society of Pediatric Otolaryngology. Our main outcomes were whether the physician had ever experienced discomfort or physical symptoms that they attributed to their surgical practice.Results: Response rate of 43.7% was attained, and 62.0% of respondents reported experiencing pain or discomfort that they attributed to their surgical practice. Women were significantly more likely to report experiencing pain or discomfort that they associated with their surgical practice (P = .033). There were no significant differences found among length of time in practice, academic vs community setting, or number of surgeries completed by the surgeon. Some of the surgeons (31.0%) were aware of ergonomic principles, and of those who were aware, 83.9% had implemented ergonomic principles into their surgical practice.Conclusion: Almost two thirds of surgeons who responded to the survey reported experiencing pain or discomfort that they attributed to their surgical practice. Only a minority of respondents were aware of ergonomic principles. These findings may confirm that most physicians believe that their physical health is affected by their operative environment. Increased knowledge of surgical ergonomics may lead to strategies that improve workplace health and safety.

Case report: atypical presentation of jugular foramen mass - Corrected Proof

Megan Wilson, James Dale Browne, Tim Martin, Carol Geer — 2011-12-08

Abstract: Introduction: Jugular foramen lesions are often associated with pathology of adjacent structures due to either compression or direct invasion. Common presenting symptoms include pulsatile tinnitus, a neck mass, hearing loss, and cranial nerve palsies, leading to changes in taste, vocal cord paralysis, dysphagia, and sternocleidomastoid/trapezius weakness (A. Hakuba, K. Hashi, K. Fujitani, et al., Jugular foramen neurinomas. Surg Neurol 1979; 11:83-94). This patient was found to have a jugular foramen mass after presenting with the unusual constellation of visual changes and headache.Case presentation: A jugular foramen mass in a young woman was discovered after presenting with visual changes and headache; the patient was found to have papilledema on initial examination. Otologic and head and neck examination were normal. Subsequent imaging demonstrated a mass at the right jugular foramen with compression of this structure; a contralateral transverse sinus stenosis was also seen. This latter abnormality (along with obstruction of the jugular foramen) impeded venous drainage leading to papilledema and visual changes.Discussion: In a patient presenting with papilledema and severe headache with an associated jugular foramen mass, a multidisciplinary approach benefits the patient with input from interventional neuroradiology, neurosurgery, and neuro-ophthalmology. Venous outflow was compromised through the left stenotic transverse sinus, and the normal outflow on the right side through the jugular bulb was impeded by the tumor; obstructions of both led to symptomatic impeded venous outflow. This compromise in venous outflow led to an increase in superior sagittal sinus pressure, with subsequent increase in intracranial pressure and resultant papilledema. In an attempt to increase blood flow, an angioplasty was performed on the patient's affected transverse sinus. In addition, symptomatology consistent with pseudotumor cerebri prompted the use of acetazolamide for medical management. After both therapies, the patient's symptoms dramatically improved and were stable. The tumor has also remained stable, with no immediate need for surgical resection, stereotactic radiation, or consideration of an intraluminal transverse sinus stent placement or shunting.Conclusion: The unique presentation of a jugular foramen mass in a young woman leading to papilledema highlights the need for high clinical suspicion of potential etiologies necessary for diagnosis. Despite the benign nature of her disease process, an unusual constellation of anatomical factors lead to the need for acute intervention.

Quantitative diffusion-weighted magnetic resonance imaging as a powerful adjunct to fine needle aspiration cytology for assessment of thyroid nodules - Corrected Proof

2011-12-08

Abstract: Objectives: The purpose of this study was to assess the value of the apparent diffusion coefficient (ADC) in the differential diagnosis between benign and malignant thyroid nodules, particularly those found to have indeterminate cytology with fine needle aspiration (FNA).Methods: Thirty-eight patients with 42 thyroid nodules underwent neck magnetic resonance imaging consisting of T1-, T2-, and diffusion-weighted imaging. The final diagnosis of all nodules was confirmed by surgery, revealing 23 with benign and 19 with malignant lesions. Preoperative FNA cytology was performed in 38 of 42 nodules, including 15 of indeterminate cytology. The mean ADC values in benign and malignant groups were compared.Results: There was a significant difference between mean ADC values in benign and malignant nodules and between mean ADC in benign and malignant nodules of indeterminate cytology. A cutoff value for malignant nodules of 1.60 × 10−3 mm2/s yielded sensitivity, specificity, and accuracy of 94.73%, 82.60%, and 88.09%, respectively.Conclusion: The present study revealed that ADC measurements could potentially quantitatively differentiate between benign and malignant thyroid nodules, even those of indeterminate cytology. We propose that diffusion-weighted imaging evaluation should be used for the assessment of thyroid nodules in addition to FNA cytology.

Prophylactic valacyclovir in a patient with recurrent vestibular disturbances secondary to vestibular neuritis - Corrected Proof

Kyle T. Amber, Johnathan E. Castaño, Simon I. Angeli — 2011-12-08

Abstract: A 57-year-old woman with herpes labialis and previously diagnosed with vestibular neuritis experienced recurrences of vertigo and disequilibrium. Initially preceded by oral herpes outbreaks or upper respiratory infections, these recurrences became spontaneous and more frequent. Vestibular function demonstrated a 25% decrease in energy function in the right and the patient had left beating nystagmus on positional maneuver. Her reoccurrences of vestibular disturbances were followed up. Concurrently, she was prescribed daily valacyclovir (500 mg, 1 per day) given for the prevention of herpes labialis outbreaks by her primary care physician. Recurrences of disequilibrium stopped completely as well as oral herpes outbreaks.

The validity and reliability of the Turkish version of the University of Washington Quality of Life Questionnaire for patients with head and neck cancer - Corrected Proof

2011-12-02

Abstract: Purpose: The University of Washington Quality of Life Questionnaire (UW-QOL) is an English-language survey used to assess the quality of life of patients with head and neck cancer. The present study aimed to translate this widely used questionnaire into Turkish according to international guidelines and to statistically determine its validity and reliability by administering it to native Turkish-speaking patients.Materials and methods: This prospective study was performed at Hacettepe University, Faculty of Medicine, Turkey. The study included patients newly diagnosed as having head and neck cancer. Translation and cultural adaptation of the questionnaire were performed first. Then, the translated version was tested on a consecutive series of patients seen in the department of otorhinolaryngology head and neck surgery and the department of radiation oncology between September 2006 and February 2008. The patients were asked to complete 3 sets of questionnaires. The first set was completed 1 day before the beginning of treatment, the second 3 months after the completion of treatment, and the third 10 days after the second questionnaire was completed. The first and second sets included the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire–Turkish version and UW-QOL–Turkish version. The third set included the Turkish UW-QOL only. Performance status was assessed and rated by a physician using the Karnofsky and ZEW (Zubrod/The Eastern Cooperative Oncology Group (ECOG)/World Health Organization) performance scales, synchronous with the first and second sets of questionnaires.Results: The original English version of UW-QOL was carefully translated into Turkish, and a final Turkish version of UW-QOL was developed in an iterative fashion. To determine its validity and reliability, 67 patients were included in the study. Internal consistency (Cronbach α = .757) was adequate, and test-retest reliability (interclass correlation coefficient, 0.941) was excellent. The composite scores of the translated UW-QOL were compared statistically with the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire scores, Karnofsky and ZEW performance scales, T stage of the disease, and UW-QOL global questions scores to support the scale's construct validity, and statistically significant associations were observed.Conclusions: The Turkish UW-QOL appears to be a valid and reliable tool for use with Turkish patients with head and neck cancer; it can also be used in clinical investigations and routine clinical practice in Turkey.

Recognition and management of perioperative serotonin syndrome - Corrected Proof

Lisa Wilson, Thomas Rooney, Reginald F. Baugh, Belinda Millington — 2011-12-01

Abstract: Mild forms of serotonin syndrome can potentially be fatal, if not recognized. The increased use of serotonergic agents makes the awareness of its prevalence, various presentations, diagnostic evaluation, and treatment a clinical imperative. It is important to note that serotonin syndrome can only be diagnosed clinically in the presence of 3 clinical criteria: mental status changes, autonomic manifestations, and neuromuscular abnormalities. This case report describes a patient who underwent an uncomplicated closed nasal fracture reduction and subsequently developed serotonin syndrome.

Dichotic listening test in patients with chronic cerebellar disease - Corrected Proof

2011-12-01

Abstract: Purpose: The aim of the study was to identify alterations in the auditory processing of patients with chronic cerebellar disease using a dichotic listening test with alternating dissyllables, also known as the Staggered Spondaic Word (SSW) test.Materials and methods: A study involving a control group of 20 subjects and a study group of 18 patients with chronic cerebellar disease of both sexes aged between 9 and 56 years was performed. The SSW test was conducted in accordance with strict standard protocols along with the analysis procedures.Results: Findings revealed a statistically significant difference in the quantitative alterations on the SSW test in the study group compared with the control group (P < .001). Results of the qualitative evaluation showed no statistically significant differences between the study and control groups for order or auditory effects. However, a statistically significant difference for presence of inversions was identified, with the worse result in the study group.Conclusion: The present study identified quantitative and qualitative changes in auditory processing for decodifying, gradual memory loss, and organization modes on the dichotic listening test with alternating dissyllables (SSW) in individuals with chronic cerebellar disease.

Transoral robotic surgery for supraglottic squamous cell carcinoma - Corrected Proof

2011-12-01

Abstract: Purpose: We present our experience with the use of transoral robotic surgery (TORS) for treatment of supraglottic squamous cell carcinoma.Materials and Methods: We studied all patients who underwent TORS for supraglottic squamous cell carcinoma, with or without adjuvant therapy, from March 2007 through June 2009, who had a minimum of 2 years of follow-up. Primary functional outcomes included dysphonia, tracheostomy dependence, and gastrostomy tube dependence. Disease control and survival were estimated with the Kaplan-Meier method.Results: Of 9 patients in the study group, 7 (78%) had advanced-stage disease. All 9 patients had negative margins after TORS, with no perioperative complications. Regional recurrence and local recurrence developed in 1 patient each. One patient died of disease. At last follow-up, 7 patients (78%) were tracheostomy free, and 7 (78%) were gastrostomy tube free.Conclusions: Transoral robotic surgery is a promising modality for resection of supraglottic squamous cell carcinoma. Transoral robotic surgery achieved functional laryngeal preservation in most patients with no complications.

Assessment of cochlear and auditory pathways in patients with migraine - Corrected Proof

Sherifa Ahmad Hamed, Ahmed Hamdy Youssef, Amal Mohammad Elattar — 2011-12-01

Abstract: Purpose: In this study, we aimed to determine the function of the cochlea and peripheral and central auditory pathways with migraine.Materials and methods: Fifty-eight patients with migraine and 40 healthy subjects were assessed using routine diagnostic audiometry along with transient evoked otoacoustic emissions (TOAEs), distortion product otoacoustic emissions (DPOAEs), and auditory brainstem response (ABR) at high and low repetition rate frequencies.Results: Nearly two thirds of patients with migraine had one or more abnormalities in electrophysiological testing. Compared with control subjects, patients reported significant lowering of TOAEs amplitude at frequencies of 1 kHz (right: P = .0003; left: P = .002), 3 kHz (right: P = .025), and 4 kHz (right: P = .019); prolonged wave III latency (right: P = .009); and I-V interpeak latency (IPL) (left: P = .024) at high repetition rate frequencies. Significant correlations were identified between age, duration of illness and frequency of migraine and TOAEs total response and at amplitude of 4 kHz, amplitudes of DPOAEs at 1, 1.5, 2, 3, and 5 kHz and I, III and wave latencies and I-V IPL of ABR at high rate frequencies.Conclusions: These data suggest that subclinical changes in cochlear function and auditory pathways are associated with chronic migraine. It is possible that migraine could be accompanied by compromise of blood supply of auditory system.

Clinical significance of micrometastases in lymph nodes from laryngeal squamous cell carcinoma - Corrected Proof

Yanan Xu, Mengjia Fei, Jiadong Wang, Luying Zheng, Yiming Chen, Qiang Liu — 2011-12-01

Abstract: Objective: To assess the role of lymph nodes micrometastases in laryngeal squamous cell carcinoma and correlate the results with survival.Methods: We performed immunohistochemical analyses of lymph nodes after the resection of 126 patients for detection of micrometastasis. The lymph nodes were examined with hematoxylin and eosin (HE)–stained and cytokeratin (CK) antibodies AE1/AE3 stained. Recurrences and metastases were recorded during follow-up. The Kaplan-Meier method was used for survival analysis.Results: In total, 126 patients underwent neck dissection. Forty-one patients were HE positive (group 1), while 85 were HE negative. Thirty-three of these HE negative patients were CK positive (group 2), while 52 were CK negative (group 3). Patients in groups 2 and 3 had a different outcome (P < .001). Survival was worse in patients in group 2 (10-year survival of 52.12% vs 81.16% in group 3, P < .01).Conclusion: Immunohistochemical analysis is an efficient way to detect micrometastasis in lymph nodes after the resection of conventionally node-negative patients. The detection of CK-positive cells is an independent prognostic factor, and more aggressive treatment should be indicated in these patients.

Preauricular sinus: advantage of the drainless minimal supra-auricular approach - Corrected Proof

2011-12-01

Abstract: Objectives: We performed this study to introduce our minimal supra-auricular approach for the surgical management of a preauricular sinus (PAS) and to evaluate the advantages of this drainless technique.Study design: This was a retrospective study.Setting: The study was done in a tertiary referral center.Methods: We enrolled 94 patients (101 ears) with a PAS who underwent surgical treatment via a minimal supra-auricular approach performed by one surgeon between April 1999 and May 2010. After removing the specimen, meticulous subcutaneous suturing and no drain were used in 83 patients (89 ears) and a postoperative drain was inserted in 11 patients (12 ears). Surgical outcomes of this technique were compared between the groups with and without postoperative drain insertion.Results: With a good surgical view and meticulous subcutaneous mattress sutures in our minimal supra-auricular approach for PAS excision, there was no postoperative recurrence or other serious complication. In the drain group, previous operation history was more frequent (P = .010), and the rate of preoperative infection was higher than in the drainless group (P = .018). Postoperatively, a compression dressing was required more frequently (P = .002) and for longer in the drain group (P = .001). The rate of immediate postoperative wound infection was higher in the drain group (P = .003).Conclusion: Our drainless minimal supra-auricular approach for the surgical removal of a PAS has advantage in terms of good surgical results of no recurrence and is more comfortable for patients because of the reduced need for a compression dressing. We suggest that this technique is effective and safe for PAS excision.

Sphenoid sinus barotrauma after scuba diving - Corrected Proof

Jin Hyeok Jeong, Kuk Kim, Seok Hyun Cho, Kyung Rae Kim — 2011-12-01

Abstract: We report the case of an 18-year-old male patient operated on for sphenoid sinus barotrauma after scuba diving. The patient attended our emergency department because of intractable headache but did not improve with conservative treatment. After computed tomography and magnetic resonance imaging examination, he was diagnosed with sphenoid sinusitis that extended to the nasal septum. He therefore underwent surgery for sinus ventilation and abscess drainage.

Orthostatic hypotension and psychiatric comorbidities in patients with dizziness - Corrected Proof

2011-11-24

Abstract: Purpose: The present study was undertaken to investigate orthostatic hypotension and psychiatric comorbidity with anxiety and depression in dizzy patients.Materials and methods: Sixty-three patients with nonspecific dizziness and 27 volunteer subjects were evaluated with the head-up tilt test (HUTT) and the Standardized Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I.Results: Orthostatic hypotension was induced by HUTT in 44% of patients and in 15% of volunteers (P = .0082); we found that the incidence of anxiety and depression was significantly higher (P < .05) in patients with nonspecific dizziness than in controls. Orthostatic hypotension was related to age but not to antihypertensive therapy and sex. Dizziness during the HUTT was reported by 49% of patients and 33% of volunteers (P = .2469). Among patients, dizziness was found to be related to sex (female) and anxiety. A correlation between dizziness and anxiety was also present in volunteers. Head-up tilt test induced vasovagal reactions in 2 volunteers.Conclusions: Orthostatic hypotension is present in a high percentage of patients with orthostatic dizziness, and anxiety and depression are an important factor in the onset of dizziness. A high percentage of abnormal responses in volunteer subjects seems to indicate that the HUTT is not indicated for routine use.

Cognitive behavior therapy for chronic subjective dizziness: a randomized, controlled trial - Corrected Proof

Sarah Edelman, Alison E.J. Mahoney, Phillip D. Cremer — 2011-11-21

Abstract: Purpose: The aim of this study was to evaluate the effects of a brief cognitive behavior therapy (CBT) intervention on the physical symptoms, illness-related disability, and psychologic distress of patients with chronic subjective dizziness.Materials and methods: Forty-one patients with chronic subjective dizziness referred by a neurootologic clinic were randomly assigned to immediate treatment or a wait-list control. Three weekly treatment sessions based on the CBT model of panic disorder, adapted for patients with dizziness, were administered by a clinical psychologist. Treatment included psychoeducation, behavioral experiments, exposure to feared stimuli, and attentional refocusing. Outcomes were measured on the Dizziness Handicap Inventory and the Depression, Anxiety and Stress Scales. Two further measures developed for this study; the Dizziness Symptoms Inventory and the Safety Behaviours Inventory were used to measure physical symptoms and safety behaviors.Results: The intervention was associated with significant reductions in disability on the Dizziness Handicap Inventory, reduced dizziness and related physical symptoms on the Dizziness Symptoms Inventory, and reduced avoidance and safety behaviors as measured by the Safety Behaviours Inventory. Pre- to posteffect sizes ranged from 0.98 to 1.15. There was no change in psychologic outcomes measured on the Depression, Anxiety and Stress Scales.Conclusions: A 3-session psychologic intervention based on the CBT model can produce significant improvements in dizziness-related symptoms, disability, and functional impairment among patients with chronic subjective dizziness. This suggests that treatment of this condition may be reasonably simple and cost-effective for most of the patients.

Comparative audiometric evaluation of hearing loss between the premenopausal and postmenopausal period in young women - Corrected Proof

Fatih Oghan, Hakan Coksuer — 2011-11-14

Abstract: Aim: The aim of this study was to determine the audiologic status and severity of hearing loss in different frequencies between the premenopausal and postmenopausal period in women.Materials and Methods: This prospective study involved 28 premenopausal and 27 postmenopausal women. Premenopausal and postmenopausal women were younger than 46 years. Age range for premenopausal and menopause patients was 37 to 46 years. The mean age of menopause women with sensorineural hearing loss in our study was not suitable for the age range of presbyacousis that is commonly seen. Each subject was tested with low- (250–2000 Hz) and high-frequency (4000–8000 Hz) audiometry. For each set of tests, mean values of air conduction at each frequency were calculated for the premenopausal and postmenopausal groups and compared.Results: The mean ages of the women on premenopausal and postmenopausal groups were 42.0 ± 2.4 and 43.4 ± 2.6 years, respectively. Duration of menopausal period in second group was 2.03 ± 0.85 years. The corresponding mean body mass indexes were 29.7 ± 2.9 and 31.1 ± 3.8 kg/m2. There was no statistical significance between the 2 groups in mean ages and mean body mass indexes. Hearing thresholds at low and high frequencies were analyzed between the 2 groups in . At low (250, 500, 1000, and 2000 Hz) and high frequencies (4000, 6000, and 8000 Hz), the mean air-conduction threshold values between the 2 groups were not statistically significant.Conclusion: Estrogen deficiency may not elevate hearing thresholds in early postmenopausal period; however, further studies of larger series are needed to confirm this.

Topical timolol for the treatment of epistaxis in hereditary hemorrhagic telangiectasia - Corrected Proof

Scott E. Olitsky — 2011-11-14

Epistaxis is the most common problem affecting patients with hereditary hemorrhagic telangiectasia (HHT). Approximately 90% of patients with HHT experience epistaxis that can range in severity from a social nuisance to life-threatening hemorrhages. Until recently, the treatment of significant epistaxis in these patients consisted of surgery. Surgical options have included laser photocoagulation, septal dermoplasty, and modified Young's procedure . Recently, the vascular endothelial growth factor (VEGF) inhibitor bevacizumab has shown promise as a medical treatment for HHT-related epistaxis .

Clinical manifestations and prognosis of patients with Ramsay Hunt syndrome - Corrected Proof

Eun Woong Ryu, Ho Yun Lee, So Yoon Lee, Moon Suh Park, Seung Geun Yeo — 2011-11-10

Abstract: Purpose: Patients with Ramsay Hunt syndrome have a poorer prognosis than those with Bell palsy despite the use of various treatment modalities. We compared the clinical characteristics, treatment methods, and outcomes in patients with Ramsay Hunt syndrome and Bell palsy.Materials and Methods: Patients with Ramsay Hunt syndrome were compared with patients with Bell palsy treated using oral steroids and with those treated with both steroids and an antiviral agent. Functional recovery of the facial nerve was scored according to the House-Brackmann grading system. Patients were followed up until recovery or for 3 months. Recovery rates in each group were assessed by age, sex, and initial and last House-Brackmann grade.Results: Compared with patients with Bell palsy, those with Ramsay Hunt syndrome were generally younger, had initially more severe facial palsy, and a lower recovery rate. Various factors including initial House-Brackmann grade, starting time to treatment, age, comorbid disease, electroneurography, and electromyography showed some correlations with prognosis in all groups. The addition of antiviral agents to an oral steroid regimen did not improve the recovery rate of patients with Bell palsy.Conclusion: Patients with Ramsay Hunt syndrome have a poorer prognosis than do those with Bell palsy.

Morphometric endoscopic study of the pharynx in patients with sleep apnea - Corrected Proof

2011-11-10

Abstract: Purpose: The aims of the study were to measure endoscopically the retrolingual pharynx during wakefulness and sleep before and after maxillomandibular advancement surgery and to quantify the changes observed.Materials and Methods: Eighteen patients with mild to severe grade obstructive sleep apnea hypopnea were evaluated during wakefulness while sitting and lying down and during induced sleep in dorsal decubitus while breathing naturally. Images of the retrolingual region of the pharynx were captured with a nasofibroscope and recorded on a DVD using the Sony Vegas 8.0 software (Sony Creative Software, Madison, WI). The images captured in greater and smaller aperture were measured with the Image J software (produced by Wayne Rasband, United States National Institutes of Health, Bethesda, MD) in linear anteroposterior and linear laterolateral areas. A correction factor was then applied to equalize the size of the images and thus compare them to one another.Results: The postoperative dimensions of the pharynx always increased significantly in all measurements compared with the preoperative ones. During induced sleep in dorsal decubitus, there was a greater gain in the area of smaller aperture (201.33%).Conclusions: The proposed method showed that the dimensions of the pharynx always increased significantly after surgery for maxillomandibular advancement, although the gain was not homogeneous in all dimensions and also varied according to state of consciousness. The greatest gain was observed in the area of smaller aperture with the patient in induced sleep, thus reducing the collapse of the pharynx.

Comparison of mandarin tone and speech perception between advanced combination encoder and continuous interleaved sampling speech-processing strategies in children - Corrected Proof

Chung-Feng Hwang, Hsiao-Chuan Chen, Chao-Hui Yang, Jyh-Ping Peng, Chia-Hui Weng — 2011-10-07

Abstract: Objective: This study was performed to compare cochlear implant (CI) users' performance in Mandarin speech and tone perception between 2 types of speech-processing strategies—advanced combination encoder (ACE) and continuous interleaved sampling (CIS)—under quiet and noisy conditions.Methods: This study involved 10 congenitally deaf children (age range, 5.7–15.3 years; mean, 9.2 years) who received the Nucleus 24-channel CI system cochlear device (CI24R; Cochlear Ltd, Lane Cove NSW, Australia). The subjects used ACE since switching on their CI devices. Speech and tone perception tests were administered under quiet and noisy (+5 dB signal-to-noise ratio) conditions with ACE and CIS strategies 20 minutes and 2 weeks apart.Results: Regardless of the strategy used, subjects showed significantly higher scores in speech perception than in tone recognition. Under noisy conditions, subjects had significantly higher tone identification scores with the CIS than the ACE strategy (P = .038). There was no significant difference in speech identification score between the strategies. Subjects showed significant higher tone identification and speech perception scores under quiet than noisy (+5 dB signal-to-noise ratio) conditions. Subjectively, 6 subjects preferred the ACE strategy, and the remaining 4 preferred the CIS strategy. The strategy preference of the subjects was related to speech perception performance rather than tone identification. A significant correlation was observed between tone identification and speech recognition, regardless of whether speech was evaluated by consonants (r = 0.669, P < .001), vowels (r = 0.426, P = .001), or sentences (r = 0.294, P = .023).Conclusion: There are only 4 patterns of tone in Mandarin, which is far fewer than the number of speech sounds. However, tone identification is poorer than speech perception. The CIS speech-processing strategy may improve tone identification under noisy conditions. Before improved speech strategies to code acoustic characteristics of tone can be developed, it would be worthwhile to try both CIS and ACE for CI users and to select the most suitable speech-processing strategy according to the subjective preference and objective performance.

Nasal septal angiofibroma, a subclass of extranasopharyngeal angiofibroma - Corrected Proof

2011-10-05

Abstract: Objective: Extranasopharyngeal angiofibromas (ENA) arising from the nasal septum or nasal septal angiofibromas are extremely rare; only 13 such cases have been reported in the international literature. Our objective is to describe the presentation, workup, and surgical management of these lesions.Study design: Case reports were done.Setting: The setting was a tertiary care referral center and the Veterans Affairs Medical Center.Patients, interventions, and results: We present 2 cases of extranasopharyngeal angiofibroma occurring on the nasal septum.Conclusions: In this report, we discuss the occurrence, the histopathologic findings, and the treatment of nasal septal angiofibroma.

Benign paroxysmal positional vertigo after use of noise-canceling headphones - Corrected Proof

Eric Dan-Goor, Monica Samra — 2011-10-05

Abstract: Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo. We describe a case of a woman presenting acutely with a severe episode of disabling positional vertigo. Although she had no known etiologic risk factors, this attack followed 12 hours of continuously wearing digital noise-canceling headphones. This is the first such reported association between BPPV and the use of this gadget. We also provide a short review of BPPV and speculate on the possible pathogenic mechanisms involved.

Postlaryngectomy dysphagia masking as velopharyngeal insufficiency: a simple solution for an anterior neopharyngeal diverticulum - Corrected Proof

2011-10-05

Abstract: Postlaryngectomy dysphagia is a common occurrence and can be a source of emotional distress that results in a decrease in quality of life among a patient population that is already exposed to considerable morbidity. One etiologic source that is less commonly reported as a source for postlaryngectomy dysphagia, and perhaps overlooked, is an anterior neopharyngeal diverticulum. Herein, we describe a postlaryngectomy dysphagia caused by a neopharyngeal diverticulum masking as velopharyngeal insufficiency of liquids. The liquid dysphagia was immediately relieved via transoral endoscopic approach using the Harmonic scalpel to resect and simultaneously coagulate the posterior wall.

Vocal symptoms in women undergoing in vitro fertilization - Corrected Proof

Abdul-latif Hamdan, Randa Al Barazi, Alyssa Kanaan, Solara Sinno, Anwar Soubra — 2011-09-29

Abstract: Objective: The aim of this study was to investigate changes in vocal symptoms in relation to estrogen level in women undergoing in vitro fertilization.Materials and methods: A total of 31 women were enrolled in this study. The following vocal symptoms were investigated: vocal tiring or fatigue, vocal straining, throat clearing, lump sensation, hoarseness, and aphonia (or loss of voice). The severity of these symptoms was graded from 0 to 4, where 0 means absence of the symptom and 3 means severe symptom presence. The frequency of these symptoms was evaluated in the first visit at presentation; second visit, 4 to 5 days after ovarian stimulation; and third visit, 8 to 10 days after stimulation. In the second and third visits, the estradiol levels were measured.Results: The mean age was 32.33 ± 4.80 years. Ten of the 31 patients had at least 1 vocal symptom. The most common vocal symptom in all 3 visits was throat clearing, with an incidence of 22.6% in the first and second visits and 19.4% in the third visit. This was followed by vocal fatigue or tiring and lump sensation, with an incidence of 9.68% for both. The incidence of all the vocal symptoms as well as their severity did not change throughout the visits, except for throat clearing, which has decreased in the third visit but not significantly (22.6% vs 19.4%, P = 1). Subjects with vocal symptoms had lower estradiol level compared with those with no vocal symptoms; however, the difference was not statistically significant (P = .108 and .267, respectively).Conclusion: Subjects undergoing in vitro fertilization do not experience changes in their vocal symptoms when present, except for throat clearing. However, those with vocal symptoms have lower levels of estradiol compared with those with no vocal symptoms.

Brainstem hemorrhage presented as audiovestibular syndromes - Corrected Proof

Chia-I Chou, Hung-Ching Lin, Kang-Chao Wu, Min-Tsan Shu — 2011-09-29

Abstract: Brainstem hemorrhage usually presented with acute multiple neurologic dysfunction, and the prognosis was poor. Rarely, it can manifest with audiovestibular symptoms only. Here, we report a case of brainstem hemorrhage involving the right middle cerebellar peduncle and dorsal lateral pons presented with constant nonpulsatile tinnitus and rotatory vertigo. We believed that rotatory nystagmus should be regarded as a central sign until proven otherwise even if the neurologic signs are subtle.

Mucoepidermoid carcinoma of the parotid infiltrating the chorda tympani nerve - Corrected Proof

Abhineet Lall, Hans-Rudolf Zenklusen, Thomas E. Linder — 2011-09-29

Abstract: We present here the first case report of a mucoepidermoid carcinoma of the parotid infiltrating the chorda tympani nerve and also discuss why an initial diagnosis of Bell palsy may be misleading.

Arytenoid adduction combined with medialization laryngoplasty under general anesthesia using a laryngeal mask airway - Corrected Proof

2011-09-29

Abstract: Purpose: Laryngeal framework surgery is usually performed under local anesthesia but cannot be tolerated by some patients. To develop a new procedure for these patients, we evaluated voice outcomes after arytenoid adduction combined with medialization laryngoplasty under general anesthesia using a laryngeal mask airway (LMA) for unilateral vocal cord paralysis.Materials and Methods: Eleven consecutive patients with severe unilateral vocal cord paralysis, with a maximum phonation time of less than 5 seconds, underwent arytenoid adduction combined with medialization laryngoplasty under general anesthesia using an LMA. Each paralyzed vocal cord was observed by intraoperative videolaryngoscopy. The vocal cord was moved to the position where the best vocal outcome could be expected, according to 3 parameters obtained from glottal images.Results: All patients achieved a maximum phonation time of more than 11 seconds. The mean airflow rate, which ranged from 550 to 1000 mL/s before surgery, improved to less than 390 mL/s. Perceptual evaluation using the grade, roughness, breathiness, asthenia and strain scale also improved significantly.Conclusions: These results were equivalent to those of previous reports of surgeries performed under local anesthesia. Intraoperative endoscopic vocal cord observation through the LMA may have contributed to the positive results.

Role of positron emission tomography in management of sinonasal neoplasms—a single institution's experience - Corrected Proof

2011-09-20

Abstract: Objective: The objective of the study is to examine the utility of positron emission tomography (PET) for staging and restaging after treatment of paranasal sinus carcinomas.Study design: Retrospective data review was done.Subjects and methods: Patients selected underwent PET for sinonasal neoplasms from 2003 to 2008 at a tertiary care referral center.Results: Seventy-seven scans were reviewed from 31 patients. The pathologies included olfactory neuroblastoma (n = 9), squamous cell carcinoma (n = 6), sinonasal undifferentiated carcinoma (n = 6), sinonasal melanoma (n = 6), and minor salivary gland carcinomas (n = 4). The positive predictive value of studies performed for restaging at the primary, neck, and distant sites were 56%, 54%, and 63%; negative predictive values were 93%, 100%, and 98%, respectively. During restaging, 32% of patients were accurately upstaged secondary to neck or distant site involvement.Conclusion: Positron emission tomography serves as a useful adjunct to conventional imaging in the management of sinonasal malignancies. Negative studies are effective in predicting absence of disease as seen in the consistently high-negative predictive values. Positive studies need to be viewed cautiously given the high rate of false-positive studies. When viewed in conjunction with clinical examination, endoscopic assessment, and focused biopsies, they may effectively result in a more accurate assessment of the extent of disease.

Posttraumatic synostosis between the thyroid cartilage and the cervical spine causing dysphagia - Corrected Proof

In Ho Han, Byung Kwan Choi, Soo Geun Wang, Jin Choon Lee — 2011-09-20

Abstract: A 64-year-old man, 7 years after cervical trauma, presented with severe dysphagia of 3-month duration. Computed tomography showed an unusual synostosis between the thyroid cartilage and the cervical spine at C5-6-7 on the right side. A barium swallow study revealed no laryngeal elevation during swallowing. Surgical resection of the bony fusion was performed, and the patient's dysphagia immediately improved without any complications. We report a case of delayed synostosis between the thyroid cartilage and the cervical spine causing severe dysphagia 7 years after cervical trauma. Surgical resection of the bony fusion resulted in immediate improvement of the dysphagia.

Vallecular cyst in an infant: does your specimen show D2-40 immunoreactivity? - Corrected Proof

Anil Gungor — 2011-09-20

Abstract: Vallecular cysts are infrequent causes of supraglottic obstruction causing stridor and swallowing difficulty in infants. When detected early in life, the management consists of marsupialization or resection. Supraglottic lymphangiomas of the tongue base and vallecula present with similar symptoms and time of presentation. Endoscopic visualization is traditionally considered to be sufficient in identifying and differentiating these. When a vallecular cyst is visually diagnosed by the surgeon during endoscopy, surgical treatment is provided at the same time. Obtaining a specimen is rarely considered for histopathologic diagnostic verification. However, the natural presentation of a cystic lymphangioma may be indistinguishable from a solitary vallecular cyst by endoscopy alone. This case presentation argues in favor of histopathologic diagnosis in vallecular cysts because the 2 may represent a continuum of disease. A vallecular mass with a single large mucus-filled cyst and adjoining edematous soft tissue extension into the tongue base and piriform sinus diagnosed as lymphangioma through D2-40 immunoreactivity is presented.

Thyroid hemiagenesis: a case series and review of the literature - Corrected Proof

Yi-Hsuan Emmy Wu, Richard O. Wein, Barbara Carter — 2011-09-20

Abstract: Purpose: The purpose of this study is to present a case series and review recommendations within the literature concerning thyroid hemiagenesis.Materials and Methods: This is a (1) retrospective case series review of 5 patients and (2) literature review (using Medline) on thyroid hemiagenesis.Results: Most reported cases are female with the left thyroid lobe absent. Compensatory hypertrophy occurs in most thyroid remnants. Associated diagnoses in the remaining lobe include hyperthyroidism, hypothyroidism, simple and multinodular goiter, and carcinoma. There is no increased risk for the subsequent development of cancer in the remaining lobe, and empiric thyroidectomy is not justified.Conclusions: Thyroid hemiagenesis is an uncommon presentation that is frequently asymptomatic and detected incidentally when imaging for another condition. Awareness of its existence can help prevent unnecessary interventions associated with incorrect assumptions in patient care.

Clinical features and surgical outcomes of congenital choanal atresia: factors influencing success from 20-year review in an institute - Corrected Proof

2011-09-20

Abstract: Purpose: Congenital choanal atresia (CCA) is a rare disease entity. The prevention of restenosis has been the main concerns of choanoplasty. The authors retrospectively analyzed patients with CCA to investigate clinical features and factors affecting surgical outcomes.Material/methods: Forty sides in 27 patients with CCA from 1987 through 2009 were reviewed with medical records that included symptoms, associated anomalies, laterality of atresia, types of the atretic plate, surgical approaches, uses of stent or mitomycin C, ages at operation, and surgical outcomes.Results: CHARGE association was the most commonly associated malformation in bilateral CCA and cleft lip and cleft palate in unilateral CCA. Age at operation was related to restenosis rate. The cases of bilateral CCA were operated on younger ages than those of unilateral CCA (4.9 months vs 11.5 years, respectively), and the restenosis appeared to be higher in bilateral cases than in unilateral ones. The use of stent did not improve preventive rate of restenosis: 42.9% of restenosis with stent and 47.4% without stent, respectively. Mitomycin C did not seem to be effective in preventing restenosis either. No significant difference in restenosis rate was observed in terms of symptoms, associated anomalies, types of the atretic plate, and surgical approaches as well.Conclusions: Our study suggests that bilateral CCA, meaning early operation age, develops restenosis more frequently. However, the patency rate was not related to surgical approaches or postoperative use of stent and mitomycin C.

Analysis of the effectiveness of basic fibroblast growth factor treatment on traumatic perforation of the tympanic membrane at different time points - Corrected Proof

Zhengcai Lou, Yongmei Tang, Xiaohong Wu — 2011-09-16

Abstract: Objective: The aim of this study was to evaluate the effectiveness of basic fibroblast growth factor (bFGF) treatment on traumatic perforation of the tympanic membrane at different time points.Research Design: This is a prospective clinical study.Methods: Patients with traumatic perforations of the tympanic membrane were given a treatment of gelatin sponge + bFGF at different time intervals of 3 days, 4 to 7 days, 8 to 15 days, and more than 4 weeks after the injury. Healing rate and time of perforation were also observed after 1 month.Results: In 147 ears, 144 (98.0%) were healed. The perforation healing rates were 98.6%, 97.6%, 96.3%, and 100%, respectively, at the following time intervals: within 3 days, 4 to 7 days, 8 to 14 days, and 2 to 4 weeks since the injury. This was quite true without any significant difference (P > .05). Meanwhile, in the small perforation healing of 120 ears, the average healing times from admission to perforation within 3 days, 4 to 7 days, and 8 to 14 days after the injury were 7.95 ± 2.07, 6.75 ± 2.67, and 4.18 ± 0.91 days, respectively. No significant difference was found among the 3 groups (P1 < .01).Conclusion: Treating traumatic perforation of the tympanic membrane using the bFGF technique at different times of admissions is quite effective.

Congenital sialolipoma of the parotid gland: presentation, diagnosis, and management - Corrected Proof

Trilokesh Kidambi, Mark J. Been, John Maddalozzo — 2011-09-16

Sialolipoma is a rare and newly recognized distinct salivary gland neoplasm, which in a large series of over 2,000 cases had an overall incidence of 0.3% of salivary gland tumors in adults . Grossly it is characterized as a well-circumscribed, soft, yellow mass and histologically it contains both mature adipose tissue and entrapped normal salivary glandular components surrounded by a fibrous capsule.

Treatment of bilateral vocal cord paralysis following permanent recurrent laryngeal nerve injury - Corrected Proof

2011-09-16

Abstract: Bilateral vocal cord paralysis is a serious illness requiring emergency intervention to resolve the potentially life-threatening respiratory distress. Several surgical procedures were proposed to help improve the airway and to eliminate the tracheostoma in those patients with permanent paralysis. All the procedures have their own advantages and disadvantages. We conducted a retrospective study of 30 patients affected by bilateral vocal cord paralysis following total thyroidectomy. All the patients underwent total thyroidectomy for benign thyroid pathology. In 26 patients (86.6%), cord paralysis occurred during the perioperative stage; and in the remaining 4 cases (13.3%), it occurred within the following 6 months. We treated all these bilateral recurrent laryngeal nerve paralysis patients with arytenoidectomy alone in 5 patients and arytenoidectomy with concomitant true and false posterior cordectomy in the remaining 25 patients. Twenty-four of the 25 patients who underwent the combined procedures (96%) reported subjective respiratory improvement and were decannulated within 60 days, being able to return to their normal daily activities. This study demonstrates that arytenoidectomy associated with posterior cordectomy is a satisfactory surgical treatment of bilateral vocal cord paralysis because it leads to a considerable and stable enlargement of the breathing space.

A case of ossified laryngeal cartilage mimicking a subglottic mass - Corrected Proof

Na Rae Kim, Dong Young Kim, Hee Young Hwang, Dong Hae Chung — 2011-09-16

Abstract: A previously healthy 54-year-old man complained of progressive voice changes. A firm subglottic polypoid mass was located at the right posterior site, as seen on fiberoptic laryngoscopy, with a distinctly narrowed subglottic space being seen on neck computed tomography, and there were multiple opacities from the cricoid cartilage to the tracheal rings. Resection was done under general anesthesia. The mass-like elevated lesion showed enchondral ossification of the laryngeal cartilage just beneath the squamous metaplastic surface epithelium. The vocal cord mobility was normal. Compared with the computed tomography and the laryngoscopic examination, the polypoid mass-like elevation corresponded to a ossified vocal process of the right arytenoid cartilage. To date, clinically symptomatic ossification of the laryngeal cartilages has presented with foreign body–like impaction. The present case is a rare case of ossification of the laryngeal cartilage that masqueraded as a subglottic polypoid mass. The ossification of laryngeal cartilage is part of the normal aging process, but a tumor-like mass at the airway related with voice changes, like was seen in the present case, is rare. Albeit rare, clinicians and radiologists should be aware that this heterotopic ossification may mimic a polypoid mass–like presentation as well as the accompanying symptoms.

Carotid cavernous sinus fistula caused by dental implant–associated infection - Corrected Proof

Yuzaburo Shimizu, Satoshi Tsutsumi, Yukimasa Yasumoto, Masanori Ito — 2011-09-16

Abstract: A 61-year-old woman presented with painful ophthalmoplegia, Tolosa-Hunt syndrome. The patient had undergone a placement of dental implant 5 months before the presentation and had a local maxillary sinusitis 1 month later. She had not been aware of any preceding head trauma or infection. On examination, the patient showed serious right oculomotor nerve paresis and retro-orbital pain. Blood examination showed normal findings. Magnetic resonance imaging identified abnormal structure in the right cavernous sinus with flow void signals. Angiography revealed a carotid cavernous sinus fistula fed by the intracavernous branches of the internal carotid artery on both sides, right internal maxillary and middle meningeal arteries, and left ascending pharyngeal artery. The patient underwent coil embolization via both external carotid arteries. We assumed that local maxillary sinusitis caused by dental implant might spread hematogenously into the sphenoid and cavernous sinuses and formed a carotid cavernous sinus fistula, which presented with Tolosa-Hunt syndrome. Implant-associated infection has to be managed promptly with adequate manner before it spreads.

Benign paroxysmal positional vertigo with multiple canal involvement - Corrected Proof

Dimitrios G. Balatsouras — 2011-09-14

Abstract: Purpose: The aims of this study were to describe the frequency and clinical features of benign paroxysmal positional vertigo (BPPV) with multiple canal involvement and to evaluate the results of treatment by appropriate canalith repositioning procedures.Materials and Methods: A total of 345 patients were referred for BPPV between 2006 and 2010. Thirty-two of them (9.3%) who had BPPV of multiple canals were studied. Thirteen were men (mean age, 60.4 years) and 19 were women (mean age, 56.8 years). Dix-Hallpike and supine roll tests were performed for diagnosis. Canalith repositioning procedures for treatment included modified Epley, barbecue, Gufoni, and anterior BPPV-specific maneuvers.Results: Twenty-one patients had bilateral posterior canal BPPV, and 11 had mixed canal BPPV either on the same side (7 patients) or on both sides (4 patients). Thirty-one patients were cured with an average of 2.9 therapeutic sessions per patient. Recurrences occurred in 5 patients (15.6%).Conclusions: Benign paroxysmal positional vertigo of multiple canals is not rare and presents a clinical challenge. However, accurate diagnosis results in successful treatment comparable with BPPV of 1 canal.

Plunging ranula intruding into the parapharyngeal space treated with OK-432 - Corrected Proof

Makoto Kinoshita, Wataru Kida, Haruka Nakahara — 2011-09-14

Abstract: We report a very rare case of a plunging ranula extending into the parapharyngeal space, which was treated successfully with OK-432. A 27-year-old woman presented with a 4-month history of right submandibular swelling. Based on computed tomography and magnetic resonance imaging findings, we established a diagnosis of plunging ranula intruding into the parapharyngeal space. The patient was treated with an intracystic OK-432 injection that was administered under ultrasonographic guidance. At 6 weeks after the injection, computed tomography showed complete disappearance of the cystic mass. No recurrence was noted during the 10-month follow-up.