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

Neonatal dacryocele with endonasal cyst: revisiting the management - Corrected Proof

Moshe Hain, Hana Leiba, Yosef Bawnik, Meir Warman, Doron Halperin — 2010-01-11

Abstract: Purpose: The aim of the study was to present a consecutive series of neonatal dacryocele with endonasal cyst diagnosed and treated in our institution and to compare our management regimen and outcome with those reported in the literature.Methods: The study was conducted at a university-affiliated teaching hospital. Study population included 5 infants, ages 1 day to 1 month, with either noninfected or infected neonatal dacryocele with endonasal cyst. Management included antibiotic treatment (topical and/or systemic) and local lacrimal massage. When conservative treatment failed, endoscopic identification and incision of the endonasal cyst with subsequent lacrimal duct irrigation with fluorescein and antibiotics were carried out in the office. Main outcome measures included resolution of symptoms and recurrence rate.Results: Between the years 2003 and 2007, 5 infants were diagnosed and treated. All had unilateral dacryocele with endonasal cyst. Female-to-male ratio was 4:1. Age ranged from 1 day to 1 month old. Three had dacryocystitis (60%) before treatment. None had symptoms of airway obstruction. One patient was successfully treated conservatively with firm massage by the ophthalmologist resulting in rupture of the endonasal cyst and did not require further treatment. Four patients were treated with a combined ophthalmology/otolaryngology surgical procedure. All patients were treated in an office setting without general anesthesia. One patient underwent computed tomographic imaging before treatment to confirm the diagnosis. Follow-up ranged from 1 month to 50 months with an average of 23 months. Complete resolution was observed in all patients without recurrence and without complications.Conclusions: We report on the successful surgical treatment of neonatal dacryocele with endonasal cyst in an office setting without the use of general anesthesia, using endoscopic incision of the cyst and irrigation alone. The high success rate of this relatively benign office procedure encourages its use and further supports the approach of early surgical intervention, thus, helping to avoid infectious complications that can be severe at this age.

Conservative management of transnasal intracranial injury - Corrected Proof

2010-01-08

Abstract: The purpose of this study was to explore the conservative management for an unusual case of transnasal intracranial injury. A 3-year-old female child presenting with transnasal injuries after a domestic accident whereby she apparently fell while holding a large pair of scissors, which then penetrated her left nasal cavity, piercing her nasal cavity, ethmoid sinus, and skull base. The scissors were removed from her nasal cavity. The patient had scant cerebrospinal rhinorrhea and no other additional neurologic deficits noted at the time, as well as no long-term developmental deficits. This report highlights the occurrence of this rare condition. The role of radiologic studies such as computed tomographic scans and plain films in diagnosis and management of this case is affirmed. The strategy of minimally invasive treatment of this injury can be a reasonable treatment option.

The effect of radiosurgery on cochlear implant function - Corrected Proof

Soo-Keun Kong, Eui-Kyung Goh, Il-Woo Lee, Kyong-Myong Chon — 2009-12-25

Abstract: Cochlear implants are used worldwide for the treatment of severe to profound bilateral sensorineural hearing loss in both adults and children. A number of implantees are likely to be treated with radiosurgery later in life, but very little is known about the effects of radiosurgery on cochlear implants. We report a cochlear-implanted patient who underwent radiosurgery due to a recurrent meningioma. After radiosurgery, the impedance of the implant maintained a normal range, and auditory performance tests were unchanged as compared to before radiosurgery. This is the first report addressing the effects of radiosurgery in a patient with a cochlear implant.

Biofilms in chronic suppurative otitis media and cholesteatoma: scanning electron microscopy findings - Corrected Proof

James Saunders, Michael Murray, Anthony Alleman — 2009-12-25

Abstract: Background: Biofilms play a role in the pathogenesis of a variety of otorhinolaryngologic diseases, including otitis media and cholesteatoma. Despite this, relatively few studies have undertaken to demonstrate the presence of biofilms tissues from patients with chronic otitis media or infected cholesteatoma.Objective/hypothesis: Our objective is to detect evidence of biofilms human chronic ear infections with scanning electron microscopy (SEM). We hypothesized that bacterial biofilms are present in patients with chronic otitis media.Study design: We performed prospective collection of tissue collected during middle ear surgery from 16 patients undergoing middle ear or mastoid surgery with chronic ear infections.Methods: A total of 31 middle and mastoid tissue samples were harvested at the time of surgery and processed with critical point drying for SEM analysis. Samples were then searched for evidence of biofilms.Results: Bacterial-shaped objects were identified that displayed both surface binding and the presence of a glycocalyx in 4 patients, findings consistent with bacterial biofilms. Most of these (3 of 4) were in patients with infected cholesteatoma, and biofims were identified in 60% of cholesteatoma cases (3 of 5). On the other hand, only 1 of 7 cases with chronic suppurative otitis media had evidence of biofilms.Conclusion: SEM supports the hypothesis that bacterial biofilms are common in chronic infections associated with cholesteatoma and are present in some cases of chronic suppurative otitis media without cholesteatoma.

Metastasis to head and neck area: a 16-year retrospective study - Corrected Proof

Soussan Irani — 2009-12-23

Abstract: Purpose: One of the most striking qualities of cancer is its spread throughout the body. The location of a metastatic mass may help to identify the primary tumor. Metastases to head and neck area can occur either from local structures or from distant organs.Materials and methods: This study was a retrospective review of patients from a University Hospital in Tehran, Iran, during the period 1992 to 2008. The data were analyzed for sex, age, primary site of tumors, metastatic site, and histology of the tumors. The tumors were classified into 2 groups: intraoral and extraoral.Results: A total of 191 cases were found; of these, 118 (62%) were men and 73 (38%) were women. The most common intraoral primary site was tongue (anterior and posterior parts). Thyroid gland was the most frequent primary extraoral site. The most frequent metastatic site was the lymph node, and level II most commonly involved lymph nodes, followed by level I.Conclusion: Metastases are an infrequent finding in head and neck region and they may represent the initial manifestation of the disease. Diagnostic evaluation of metastatic lesion will detect the primary tumor.

Pediatric subperiosteal orbital abscess secondary to acute sinusitis: a 5-year review - Corrected Proof

Vincent Tan Eng Soon — 2009-12-23

Abstract: Objective: Subperiosteal orbital abscesses (SPOAs) secondary to acute sinusitis are rare occurrences in the pediatric age group, more so in the neonatal period. Here, a rare case of SPOA in a 38-day-old newborn later drained via endoscopic sinus surgery is included also. This review describes the demographic data, clinical history, treatment, microbiology results, complications, and outcome.Methods: The admission records for all the patients who were admitted to the Pediatric Surgical Ward in Sarawak General Hospital, Kuching, Malaysia, between January 2004 and May 2009 were retrospectively reviewed. Records of patients who presented with preseptal cellulitis, orbital cellulitis, subperiosteal abscess (extraconal), orbital abscess (intraconal), and cavernous sinus thrombosis were closely studied. Ophthalmology consultations were obtained in all these cases. Ultimately, 3 patients having SPOA secondary to acute sinusitis were selected for this review.Results: All patients were male with rapid onset of periorbital signs, absence of purulent rhinorrhea, and presence of significant thrombocytosis (exceeding 500 × 109/L). The 38-day-old newborn had mixed infection of methicillin-resistant coagulase-negative Staphylococcus bacteremia and local Acinetobacter eye infection with Staphylococcus aureus in the SPOA. All had medially located SPOA that was adequately drained via endoscopic sinus surgery, resulting in full recovery.Conclusion: Newborns with preexisting risk factors and immature immunity are at risk of severe and rare infections. Contrast-enhanced paranasal sinus computed tomographic scan is mandatory and reliable to differentiate preseptal and postseptal orbital infection, as both conditions can present similarly and rapidly deteriorate. In the contrast-enhanced computed tomography–demonstrable SPOA, endoscopic sinus surgery drainage of the abscess proved to be safe and reliable as the main treatment modality. All patients recovered well without complications.

Study of protective effect on rat cochlear spiral ganglion after blast exposure by adenovirus-mediated human β-nerve growth factor gene - Corrected Proof

Jian Wu, Bing Liu, Jingping Fan, Qiubei Zhu, Jiang Wu — 2009-12-21

Abstract: Objective: To study whether adenovirus-mediated human β-nerve growth factor (Ad-hNGFβ) gene has any protective effect on rat cochlear spiral ganglion after blast exposure.Methods: Deafness was induced by blast exposure (172.0 dB) in 20 healthy rats. Seven days after blast exposure, Ad-hNGFβ was infused into the perilymphatic space of 10 animals as the hNGFβ/blast group, and artificial perilymph fluid (APF) was infused into the perilymphatic space of 10 animals as the APF/blast control group. An additional control group consisted of 10 healthy rats which received Ad-hNGFβ target gene with no blast exposure (hNGFβ/control group). Auditory functions were monitored by thresholds of auditory brain stem responses (ABR). At weeks 1, 4, and 8 postoperatively, the animals were killed, and the cochleae were removed for immunohistochemical, hematoxylin and eosin staining study.Results: The ABR threshold shifts in the hNGFβ/blast group were significantly smaller than that of APF/blast control group. There were no significant differences of the ABR values between before and after operation in the hNGFβ/control group. Expression of Ad-hNGFβ protein was detected in each turn of the cochlea in the first week, with almost equal intensity in all turns. In the fourth week, the reactive intensity decreased. In the eighth week, no reaction was detectable. The results of hematoxylin and eosin stain showed that the number of spiral ganglions in the hNGFβ/blast group was significantly greater than that of the APF/blast control group in the 4th week (P < .01).Conclusion: Adenovirus-mediated human β-nerve growth factor can be expressed at a high level and for a relatively long period in the blast impaired cochlea, suggesting that Ad-hNGFβ has a protective effect on rat cochlear spiral ganglion cells after blast exposure.

Pathologic correlations of otologic symptoms in acute lymphocytic leukemia - Corrected Proof

2009-12-21

Abstract: Objectives: To assess the clinicopathologic correlations of otologic complaints in patients with acute lymphocytic leukemia.Design: Otologic complaints and histologic findings were evaluated in 25 temporal bones of 13 acute lymphocytic leukemia patients.Results: Nine patients had a history of otologic complaints, including hearing loss, otalgia, otorrhea, and vertigo in 5, 3, 3, and 2 patients, respectively. Hemorrhage was most commonly observed in the middle ear (6 patients, 9 temporal bones) and was also observed in cochlea (4 patients, 4 temporal bones), and vestibule (6 patients, 6 temporal bones). Leukemic infiltration was observed in the petrous apex (13 patients, 24 temporal bones), middle ear (7 patients, 14 temporal bones), cochlea (3 patients, 4 temporal bones), vestibule (3 patients, 4 temporal bones), and internal auditory canal (5 patients, 8 temporal bones). Inflammatory changes were observed in the cochlea (5 patients, 8 temporal bones) and vestibule (5 patients, 8 temporal bones). Middle ear effusion containing floating tumor cells was observed in 4 temporal bones of 3 patients. Irreversible histopathologic changes of the middle ear, such as the destruction of the ossicles, perforation of the tympanic membrane, and granulation tissues were observed in 5 temporal bones of 4 patients.Conclusions: Ear involvement is common in acute lymphocytic leukemia patients. With prolonged survival due to the progress of treatment, the diagnosis and treatment of nonhematopoietic system symptoms, such as ear problems due to acute lymphocytic leukemia, have become more important.

Osteochondroma of the coronoid process (Jacob's disease): an unusual cause of restricted jaw motion - Corrected Proof

Nicholas D'Ambrosio, Robert M. Kellman, Sasan Karimi — 2009-12-21

Abstract: Osteochondromas are the most common benign bone tumor, most commonly found in the ends of long bones; however, they rarely involve facial bones, particularly the mandible. Osteochondromas involving the coronoid process have rarely been reported in the literature but pose a diagnostic dilemma. When large enough, osteochondromas of the mandibular coronoid process can form a joint with the zygomatic arch (Jacob's disease). This pseudoarticulation results in restricted jaw motion, which can clinically be mistaken for temporomandibular joint dysfunction. We report a case of a 39-year-old man with chronic restricted jaw motion undiagnosed for several years.

The utility of fine needle aspiration to identify unusual pathology in a parapharyngeal mass - Corrected Proof

Erin L. Ohmann, Barton F. Branstetter, Jonas T. Johnson — 2009-12-21

Abstract: The parapharyngeal space is a complex and well-defined anatomical zone lying lateral to the pharynx and medial to the ramus of the mandible. Although tumors of this space are rare, the parapharyngeal space is difficult to examine clinically; and diagnostic modalities of computerized tomographic scanning and magnetic resonance imaging are primarily used in the evaluation of parapharyngeal space lesions. We present a case report of a second branchial cleft sinus of the parapharyngeal space diagnosed with the assistance of fine needle aspiration (FNA), and we recommend FNA of parapharyngeal masses to provide definitive preoperative diagnoses.

Bilateral giant submandibular sialoliths and the role for salivary endoscopy - Corrected Proof

Carlos M. Rivera-Serrano, Barry M. Schaitkin — 2009-12-21

Abstract: Salivary stones larger than 15 mm are classified as giant sialoliths. They are uncommon in the practice of otolaryngology, and their management has always been a therapeutic challenge. Traditionally, when they cannot be retrieved by marsupialization, removal of the salivary gland has been advocated. Sialendoscopy and the recent development of combined endoscopic and external approaches for extraction of large stones with preservation of the major salivary glands are promising. We present the first case of simultaneous bilateral giant sialoliths, and the first report that associates giant sialoliths and the use of salivary endoscopy. In this case, both giant stones were removed with the assistance of a salivary endoscope and without removing the submandibular glands.

Re: Analysis of 60 patients after tympanotomy and sealing of the round window membrane after acute unilateral sensorineural hearing loss - Corrected Proof

Gedlicka Claudia — 2009-12-21

Thank you for the invitation to respond to the very interesting letter to the editor written by Dong-Hee Le. First issue/ethical aspect: Regarding the objection of ethical aspect of deciding to perform tympanotomy and sealing of the round window membrane in patients with acute unilateral sensorineural hearing loss after failure of conservative treatment, I would like to explain my point of view.

Re: Analysis of 60 patients after tympanotomy and sealing of the round window membrane after acute unilateral sensorineural hearing loss - Corrected Proof

Dong-Hee Lee — 2009-12-21

I read with great interest the article titled “Analysis of 60 patients after tympanotomy and sealing of the round window membrane after acute unilateral sensorineural hearing loss” by Gedlicka et al . Sudden sensorineural hearing loss (SSNHL) is not fatal, but patient's psychologic stress and social disability may be significant if not recovered. Although the spontaneous recovery rate is 30% to 60% and the recovery rate can be more increased when treated , the novel treatment option that can raise the recovery rate is still needed. Therefore, the authors' trial gave valuable clinical data to the readers; but I raise some questions in their article.

Improvement in smell and taste dysfunction after repetitive transcranial magnetic stimulation - Corrected Proof

Robert I. Henkin, Samuel J. Potolicchio, Lucien M. Levy — 2009-12-21

Abstract: Background: Olfactory and gustatory distortions in the absence of odors or tastants (phantosmia and phantageusia, respectively) with accompanying loss of smell and taste acuity are relatively common symptoms that can occur without other otolaryngologic symptoms. Although treatment of these symptoms has been elusive, repetitive transcranial magnetic stimulation (rTMS) has been suggested as an effective corrective therapy.Objective: The objective of the study was to assess the efficacy of rTMS treatment in patients with phantosmia and phantageusia.Methods: Seventeen patients with symptoms of persistent phantosmia and phantageusia with accompanying loss of smell and taste acuity were studied. Before and after treatment, patients were monitored by subjective responses and with psychophysical tests of smell function (olfactometry) and taste function (gustometry). Each patient was treated with rTMS that consisted of 2 sham procedures followed by a real rTMS procedure.Results: After sham rTMS, no change in measurements of distortions or acuity occurred in any patient; after initial real rTMS, 2 patients received no benefit; but in the other 15, distortions decreased and acuity increased. Two of these 15 exhibited total inhibition of distortions and return of normal sensory acuity that persisted for over 5 years of follow-up. In the other 13, inhibition of distortions and improvement in sensory acuity gradually decreased; but repeated rTMS again inhibited their distortions and improved their acuity. Eighty-eight percent of patients responded to this therapeutic method, although repeated rTMS was necessary to induce these positive changes.Interpretation: These results suggest that rTMS is a potential future therapeutic option to treat patients with the relatively common problems of persistent phantosmia and phantageusia with accompanying loss of taste and smell acuity. Additional systematic studies are necessary to confirm these results.

Laryngotracheal separation procedure for elderly patients - Corrected Proof

Kenta Watanabe, Muneo Nakaya, Kazuki Miyano, Kazuya Abe — 2009-12-21

Abstract: A procedure for laryngotracheal separation was performed on 5 elderly patients in poor general condition to prevent habitual aspiration pneumonia. Intractable aspiration was relieved in all the patients with no major postoperative complications. In this intervention, a modification of the procedure previously reported, the anterior part of the tracheal and cricoid cartilage was removed, and the subglottic mucosa was sutured to fashion a blind pouch. This procedure could be adjusted even in cases of severe laryngoptosis or after high tracheostomy. Laryngotracheal separation is likely to be useful as a simple and safe procedure even for older patients. If this comes to be, it will serve as a valuable intervention in today's aging society.

Effect of steroid, carbogen inhalation, and lipoprostaglandin E1 combination therapy for sudden sensorineural hearing loss - Corrected Proof

Myung Gu Kim, Yong Gi Jung, Young Gyu Eun — 2009-12-21

Abstract: Purpose: The purpose of this study was to evaluate the efficacy of combined therapy with steroid, carbogen inhalation, and lipoprostaglandin E1 (lipo-PGE1) treatment and compare the results with other treatment modalities in patients with idiopathic sudden sensorineural hearing loss (ISSNHL).Subjects and methods: The study group consisted of 670 patients diagnosed with unilateral ISSNHL. Two hundred patients (DCP group) were treated with steroid, lipo-PGE1 and carbogen inhalation combination therapy, 194 patients (DC group) with steroid and carbogen inhalation, and 276 patients (D group) with steroid medication only. The therapeutic effects of the treatment groups were evaluated 2 months after treatment, using pure tone averages. Siegel's criteria for hearing improvement were used for the assessments.Results: The overall recovery rate after treatment was 57.5%. For each group, the recovery rate was as follows: 67.0% in the DCP group, 52.6% in the DC group, and 53.9% in the D group. The DCP group had a significantly better improvement rate than the other 2 groups. In addition, the DCP treatment was better than the other 2 groups for patients: less than 50 years of age, with an initial hearing loss less than 90 dB HL, had treatment started within 1 week from the onset of hearing loss, had tinnitus or an ascending type audiogram, and/or had no vertigo.Conclusion: Steroid, lipo-PGE1, and carbogen inhalation therapy was more effective than the other treatment modalities studied for patients with ISSNHL.

Sphenoid sinus barotrauma after free diving - Corrected Proof

Constantinos Bourolias, Antonios Gkotsis — 2009-12-21

Abstract: We report 2 cases of a 29- and a 37-year-old male patient both having sphenoid sinus barotrauma associated with free diving at about 12-m depth. A unilateral occupation of the sphenoid sinus was revealed in both cases by computed tomography and magnetic resonance imaging examination of the paranasal sinuses.

Nontraumatic and postirradiated intracavernous carotid hemorrhage: an unusual case of epistaxis and review of the literature - Corrected Proof

Jing-Jing Wang, Yong Wang, Po-Hung Chang, Ta-Jen Lee, De-Hui Wang — 2009-12-21

Abstract: Intracavernous carotid hemorrhage is a rare cause of epistaxis. We present a case of epistaxis caused by postradiotherapy and nontraumatic cavernous internal carotid artery (ICA) hemorrhage. An 80-year-old man was admitted to our hospital with a one week history of recurrent left-sided epistaxis and a past history of radiotherapy after radical maxillectomy. Emergent angiography revealed a leak in the cavernous segment of the ICA and subsequent detachable balloon occlusion embolization of the left internal carotid artery was performed without sequelae. We conclude that carotid artery hemorrhage must be considered in the differential diagnosis of profuse and recurrent epistaxis, especially for patients after craniofacial radiotherapy. ICA embolization is the definitive treatment provided cross circulation is adequate.

Comparison between topical honey and mafenide acetate in treatment of auricular burn - Corrected Proof

Basir Hashemi, Akbar Bayat, Tayebe Kazemei, Negar Azarpira — 2009-11-25

Abstract: The auricle is a frequently injured part of the head and neck during thermal injury leading to ear deformity. The burned ear represents one of the most difficult problems for reconstructive surgeons. Mafenide acetate is a topical agent used routinely for these patients, but it has some disadvantages including painful application and allergic rash. Some authors have reported the healing effect and antibacterial activity of honey. The study reported here was undertaken to compare the effect of honey and mafenide acetate on auricular burn in rabbit. In our study, although the pathologic score of the honey group was better than that of the mafenide group both on 14 and 21 days after burning, it was not statistically significant. In the mafenide acetate group, deep complication of burn (chondritis) was significantly lower than that of the honey group. In conclusion, in contrast to healing and antibiotic activity reported for honey, it may have failure in preventing deep bacterial complications of wound (like chondritis). So in deep wounds, the use of honey as dressing is not recommended.

Endoscope-assisted intra-oral resection of the external thyroglossal duct cyst - Corrected Proof

Yoon Kyoung So, Jong In Jeong, Hye-Youn Youm, Han-Sin Jeong — 2009-11-09

Abstract: Objective: Surgical removal of a thyroglossal duct cyst (TGDC) and its tract is usually accomplished through an external neck incision, including the removal of the middle part of hyoid bone and a block of tissues extending to the foramen cecum. However, this procedure inevitably results in neck scarring. We implemented a modified approach to TGDC removal in a 28-year-old woman through the floor of the mouth using an endoscope system.Case report: Here, we describe the detailed procedure of the endoscope-assisted intra-oral resection for TGDC. The total operative time was 130 minutes. The patient complained of swelling and pain in the floor of the mouth for 2 days, but did not require any intervention. Follow-up imaging studies confirmed no recurrence (18 months) without any sequelae, and the patient was satisfied with her surgical outcome.Conclusion: The intra-oral approach through the floor of the mouth is a technically feasible alternative surgical option that allows for complete removal of a TGDC without the neck scar.

Antioxidant micronutrient impact on hearing disorders: concept, rationale, and evidence - Corrected Proof

2009-11-09

Abstract: Purpose: Although auditory disorders are complex conditions, device-related modalities dominate current treatment. However, dysfunction from the central cortex to the inner ear apparatus is increasingly thought to be related to biochemical pathway abnormalities and to free radical–induced oxidative damage and chronic inflammation. Therefore, considering appropriate biologic therapy as an adjunct to standard care against these damaging factors may provide rational expansion of treatment options for otolaryngologists and audiologists.Methods: This review outlines the biologic concepts related to some auditory and vestibular conditions and details the current rationale for utilizing antioxidants for a spectrum of hearing disorders. The strategy is based on the authors' collective experience in antioxidant science and supported with published research, pilot animal data and preliminary clinical observations.Results: A comprehensive micronutrient approach was developed to exploit these pathways, and demonstrated safety and efficacy against oxidative damage and inflammation and clinically relevant neuroprotection. Cooperative research with Department of Defense institutions used prospective, randomized designs to show (1) reduction in oxidative damage measured in plasma and urine over six months, (2) protection against oxidative damage during 12 weeks of intense military training, (3) protection against inflammation after total body blast exposure (rodents), (4) strong neuroprotection against chemically-induced Parkinson's disease (rodents), (5) nerve VIII function improvement after concussive head injury in military personnel, and (6) tinnitus improvement in majority of patients after 90-day evaluation.Conclusion: This systematic review of biologic strategies against hearing disorders combined with new animal and human observations may provide a rational basis for expanding current practice paradigms.

Clinicopathologic similarities between Mikulicz disease and Küttner tumor - Corrected Proof

2009-11-02

Abstract: Purpose: Recent studies have revealed that Mikulicz disease (MD) differs from Sjögren syndrome and is an immunoglobulin G4 (IgG4)–related systemic disease. Küttner tumor (KT) is also reported to be an IgG4-related disease. In this study, we examined the clinicopathologic and serologic findings in MD (39 patients) and KT (6 patients) and attempted to discern the similarities between MD and KT.Materials and methods: We diagnosed 39 patients with MD and 6 patients with KT. We analyzed the clinicopathologic and serologic findings (IgG subclasses) in 39 patients with MD and 6 patients with KT. Submandibular and labial salivary gland specimens obtained from patients with MD and KT were stained with anti-IgG4 antibodies.Results: The mean IgG4 concentration (±SD) was 931.1 ± 796.2 mg/dL in patients with MD and 756.2 ± 449.2 mg/dL in patients with KT. Abundant infiltration of IgG4-positive plasmacytes into the salivary glands was observed in both patients with MD and patients with KT.Conclusion: The serologic and histopathologic findings in MD and KT are very similar, and these 2 conditions may be IgG4-related systemic diseases.

Cystic masses of the supraclavicular fossa: clinical features and diagnostic strategies - Corrected Proof

Harrison W. Lin, Matthew T. Lister, Daniel G. Deschler — 2009-11-02

Abstract: Purpose: Cystic masses of the supraclavicular fossa (SCF) are uncommon. The diverse anatomical structures within the SCF create an extended differential diagnosis for any mass arising in the SCF. This study describes the presenting symptoms, radiologic findings, medical and surgical management, and posttreatment outcomes of various cystic mass presenting in the SCF. A review of the literature and diagnostic and therapeutic algorithms are also provided.Methods: A retrospective study of an academic tertiary care head and neck cancer center was done. Seven cases of treated cystic masses of the SCF were identified. Diagnostic and therapeutic interventions are described.Results: Cross-sectional imaging and needle aspiration or biopsy were obtained in all 7 cases. Aspirates accurately differentiated benign from malignant lesions in 6 cases, identified the offending pathology in 3 cases, and provided inoculum for culture-directed antibiotic therapy in 1 case. Surgical intervention was used for definitive therapy in 6 cases. All patients achieved complete resolution of signs and symptoms of the mass.Conclusions: Effective evaluation of a cystic lesion within the SCF mandates a thorough understanding of the anatomy and differential diagnosis. A well-defined algorithm allows successful management of benign and malignant lesions in the SCF.

Endoscopic evaluation of middle ear ventilation route blockage - Corrected Proof

2009-11-02

Abstract: Objectives: To describe middle ear ventilation route blockage, relieved during middle ear endoscopic surgery, and to analyze its association with mastoid hypopneumatization/sclerotization.Study design: Prospective case series with intraoperative analyses, and with a case-control computed tomographic scan comparison.Methods: Intraoperative findings during endoscopic middle ear surgery are described. Patients with middle ear ventilation route blockage were included in the study group (22 patients), while patients without middle ear ventilation route blockage were included in the control group (16 patients). An intra-patient and inter-group comparison of evaluated mastoid pneumatization was performed from the preoperative computed tomographic scans.Results: Middle ear ventilation route blockage was classified into three types (A, B, C) according to intraoperative findings. Intrapatient and intergroup comparisons showed that the presence of blockages of middle ear ventilation trajectories is associated with a statistically significantly higher prevalence of hypopneumatization/sclerotization of the mastoid in the study group, a typical sign of middle ear dysventilation pathologies.Conclusions: Intraoperative evaluation of the middle ear anatomy during endoscopic surgery for inflammatory pathology allows us to clearly visualize the presence of anatomic blockages of the middle ear ventilation trajectories. These blockages might provoke a sectorial dysventilation of the middle ear, with consequent reduction of pneumatization of the mastoid. Further studies will be able to clarify to what extent selective dysventilation phenomena could be a principal factor in influencing middle ear pressure homeostasis.

A prolonged buried fish bone mimicking Ludwig angina - Corrected Proof

Chao-Lan Hsu, Cheng-Wei Chen — 2009-11-02

Abstract: Most migrated foreign bodies in the neck were removed immediately in patients with persistent symptoms. It is a rare condition that a fish bone was buried for a prolonged time in the tongue with little discomfort. We report a unique case of an ingested fish bone lodged in the tongue for 16 months until infection ensued. Ludwig angina was considered first because the patient had fever, odynophagia, swelling of the tongue, and mouth floor. The fish bone buried in the tongue was incidentally found on the computed tomography scan and successfully removed by surgical exploration. Although dental infection is the most common underlying cause in Ludwig angina, embedded foreign body should be considered as one of the pathogenesis. On the other hand, computed tomography scan can be useful in identifying extraluminal migration of fish bones in the neck.

Simvastatin and Ginkgo biloba in the treatment of subacute tinnitus: a retrospective study of 94 patients - Corrected Proof

Martin Canis, Bernhard Olzowy, Christian Welz, Markus Suckfüll, Klaus Stelter — 2009-11-02

Abstract: Objectives: Studies suggest that hypercholesterolemia promotes the development of inner ear disorders such as tinnitus. However, the underlying pathomechanisms are still not clearly defined.Methods: A retrospective study was performed to assess whether a reduction of serum cholesterol by 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors may result in a relief of subacute tinnitus. Remission rates of 58 patients were investigated after 4 months of treatment with simvastatin (40 mg). Results were compared to treatment with Ginkgo biloba (120 mg; n = 36) as control group. Differences between tinnitus score at the day of first treatment and after 4 months were used as main outcome measure.Results: After treatment with simvastatin or G biloba, tinnitus score decreased from 41.3 ± 10.4 to 37.4 ± 17.3 and from 44.7 ± 11.2 to 41.2 ± 8.7, respectively. However, independently of the treatment regimen, differences of tinnitus scores were considered not significant.Conclusions: After administration of simvastatin over 4 months, this retrospective study has shown no significant efficacy in treatment of subacute tinnitus. For a more conclusive answer, further prospective, double-blind, and placebo-controlled studies with a larger number of patients are needed.

Isolated malleus-handle fracture surgical repair using tragal cartilage - Corrected Proof

Ying-Nan Chang, Chung-Ching Hung, Jih-Chin Lee, Chih-Hung Wang — 2009-11-02

Abstract: The isolated malleus-handle fracture is a rare ossicular injury and tends to be overlooked when the tympanic membrane appears normal. Various surgical attempts have been made to correct this fracture; however, these techniques largely relied on xenograft implantation materials; the autologous cartilaginous graft application has never been reported. Herein we describe a simple, rapid, and effective method that uses available tragal cartilaginous graft to repair an isolated malleus-handle fracture. Our approach offers a reliable choice to restore continuity of the ossicular chain and produce a more satisfying, subjective hearing ability in this uncommon fracture situation.

Unilesional pemphigus vulgaris of the scalp after cochlear implantation - Corrected Proof

2009-11-02

In December 2004, a 69-year-old man came to the ENT unit of the University of Parma complaining of a painful cutaneous lesion in the left retroauricular region. The patient reported that the lesion appeared 4 weeks after a cochlear implantation procedure performed elsewhere 2 months before because of a bilateral profound deafness. The lesion was initially managed by his practitioner with oral and topical antibiotics in the suspicion of impetigo. Nevertheless, no benefits came after a 15-day antibiotic course. The patient's medical history included diagnosis of oral pemphigus vulgaris (PV) 6 years before that was treated with oral azathioprine and topical clobetasol dipropionate ointment. After complete clinical remission of the disease, a low-dose immunosuppressive therapy was prescribed for the patient, which was stopped 1 month before cochlear implant surgery.

Sarcoidosis of the submandibular gland: A systematic review - Corrected Proof

2009-10-12

Abstract: Introduction: Submandibular gland sarcoidosis is rare and little is known about its clinical presentation besides the usual neck swelling. The aim of the study was to extract clinical knowledge on submandibular sarcoidosis from the literature.Methods: A systematic review was performed using a search in Medline with the key-words “sarcoidosis,” “submandibular,” “submaxillary.”Results: Forty-six articles fitting the search criteria were found, whereas 31 had to be excluded because they did not report submandibular gland sarcoidosis. Twenty cases of submandibular gland sarcoidosis were considered suitable for analysis. Almost all reported cases concerned female patients. In some cases submandibular gland's swelling is the first and only manifestation of the disease.Conclusion: Sarcoidosis should be considered in the differential diagnosis of all progressive and painless swellings of the submandibular gland, especially in women. Rarely, it may be the first manifestation of the disease.

Harmonic Scalpel vs “cold knife” dissection in uvulopalatopharyngoplasty - Corrected Proof

2009-10-12

Abstract: Purpose: The aim of this study has been to compare the Harmonic Scalpel (HS) and the “cold knife” dissection in the treatment of snoring by uvulopalatopharyngoplasty (UPPP).Materials and methods: The investigation included 40 adult males with snoring. Patients were assigned to two homogeneous groups (A and B) and UPPP was performed using HS or “cold knife” dissection in groups A and B, respectively.Before and 6 months after surgery, each patient was studied using the apnea-hypopnea index and a visual analogue scale of snore levels. Postoperative assessment of pain was evaluated on postoperative days 1 and 10.All the patients underwent to a perioperative evaluation concerning the duration of surgical dissection, the amount of intraoperative blood loss and days of hospitalization.Results: In group A, the HS provided excellent control without side effects on the adjacent structures and postoperative complications. Harmonic Scalpel's group experienced shorter operation time, lesser blood loss, fewer days of hospitalization and lower postoperative pain.Conclusions: The use of the HS in UPPP is safe and confers some advantages over conventional methods of UPPP: its use led to diminished bleeding, shorter operation time, lesser pain, and better wound healing in the postoperative period.

Age-related changes in the hyoepiglottic ligament: functional implications based on histopathologic study - Corrected Proof

2009-10-12

Abstract: Purpose: The study aimed to identify age-related changes in the hyoepiglottic ligament associated with function of the epiglottis during swallowing and respiration.Materials and Methods: Normal postmortem laryngeal tissue samples were obtained at autopsy from 20 individuals with no history of laryngeal disease. The subjects were divided into 2 groups: those aged 81–91 years (elderly group, n = 11) and those aged 31–48 years (non-elderly group, n = 9). Specimens were subjected to Elastica van Gieson and hematoxylin-eosin staining, and characteristics of the hyoepiglottic ligament were compared between groups.Results: The hyoepiglottic ligament extended from the epiglottis to both lingual muscles and the hyoid bone (pars lingualis and pars hyoideus). The numbers of muscle fibers (P < .001), collagenous fibers (P < .01), and elastic fibers (P < .001) were significantly decreased in the elderly group in comparison to those in the non-elderly group.Conclusion: Age-related changes in the hyoepiglottic ligament appear to be associated with aspiration, obstructive sleep apnea syndrome, and acquired laryngomalacia in the elderly.

Tonsillectomy for the treatment of tonsillitis-induced immunoglobulin A nephropathy - Corrected Proof

Benjamin D. Liess, Chelsea Mytyk, Karen H. Calhoun, Adam T. Whaley-Connell — 2009-10-12

Abstract: Tubular occlusion from red blood cell casts secondary to immunoglobulin A nephropathy (IgAN) is a rare, serious complication of tonsillitis that can cause acute renal failure, also referred to as acute kidney injury. IgAN is the most common primary glomerulonephritis with up to 20% of cases resulting in renal failure worldwide. Tonsillectomy is an effective treatment option for patients suffering from IgAN secondary to recurrent acute tonsillitis. Tonsillectomy alone or in combination with additional medical modalities improves renal function and can have a positive effect on long-term renal survival.

A systematic algorithm for the management of lower lip asymmetry - Corrected Proof

Robin W. Lindsay, Colin Edwards, Chris Smitson, Mack L. Cheney, Tessa A. Hadlock — 2009-10-12

Abstract: Purpose: An asymmetric smile, caused by loss of function of the lip depressors, can be functionally and cosmetically debilitating. Although some surgeons report excellent results with muscle transfer to the lower lip, many facial reanimation surgeons find that dynamic techniques do not consistently address the lower lip. Our objectives were to retrospectively review our outcomes after treatment of the asymmetric lower lip, and to propose a progressive, stepwise algorithm for the management of lower lip asymmetry in facial paralysis.Material/Methods: Retrospective chart review was performed on all patients treated in a multidisciplinary facial nerve center with lower lip asymmetry over an eighteen month period. Treatment ranged from a temporary trial of lidocaine, to chemodenervation with botulinum toxin, to pedicled digastric muscle transfer, and/or resection of the nonparetic depressor labii inferioris (DLI).Results: Fifty-seven patients were treated with chemodenervation with botulinum toxin, four with anterior belly of the digastric transfer, and 3 with DLI resection. All patients with DLI resection had undergone chemodenervation to the contralateral lower lip with botulinum toxin and were pleased with the appearance of their smile.Conclusions: We have found that lower lip asymmetry is optimally managed by adherence to a standardized protocol that offers patients insight into the likely outcome of chemodenervation or surgery and progresses systematically from the reversible to the irreversible. We present our algorithm for the management of the asymmetric lower lip, which reflects this graduated approach and has resulted in high patient satisfaction.

Low-dose computed tomography of the paranasal sinuses: radiation doses and reliability analysis - Corrected Proof

Kasim Abul-Kasim, Anita Strömbeck, Pernilla Sahlstrand-Johnson — 2009-10-12

Abstract: Purpose: The study aimed to (1) optimize the radiation doses of computed tomography (CT) of paranasal sinuses, (2) compare the radiation doses of different CT protocols with that of plain radiography, and (3) evaluate the reliability of low-dose CT in the detection of pathology and characterization of the detected pathology.Materials and methods: A head phantom was examined with different scan parameters to define a cutoff value to which the radiation dose can be reduced without negative impact on image quality. Kruskal-Wallis test and Wilcoxon W test were performed to compare the effective doses of the plain radiography in 30 patients with that of 3 different CT protocols in a total of 90 patients. The interobserver and intraobserver agreement in the detection of pathologic findings and in characterization of the pathology was estimated by calculating κ value.Results: The effective doses of plain radiography and low-dose CT were 0.098 and 0.045 mSv, respectively (P < .001). The effective dose of standard CT of sinuses (0.371 mSv) was 3.8 times higher than that of plain radiography and 8.2 times higher than that of low-dose CT (P < .001). The interobserver and intraobserver agreement on CT with regard to detection of pathology and pathology characterization was almost perfect (κ values 0.81–1) compared to fair (κ values 0.38–0.39) in plain radiography.Conclusions: The here proposed low-dose CT means significant dose reduction and is a reliable method in the investigation of the paranasal sinuses.

Surgical outcomes and histology findings after tonsillectomy in children with periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis syndrome - Corrected Proof

2009-09-14

Abstract: Purpose: This study aimed to evaluate (a) specific histologic findings in children with periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome who had tonsillectomy and (b) to assess any improvement of symptoms after tonsillectomy with or without adenoidectomy.Materials and Methods: This project is a retrospective study performed at “Aghia Sophia” Children's Hospital (Athens, Greece), between May 2007 and July 2008. Nine children were recruited into this study. Patients with defined diagnostic criteria for PFAPA syndrome till 14 years of age undergoing tonsillectomy with or without adenoidectomy were included in the study.Results: Nine children met our inclusion criteria in the PFAPA group, of which 5 were male (55.56%) and 4 were female (44.44%), with ages ranging between 2.5 and 5 years at the age of surgery (mean, 3.4 years). The length of follow-up ranged from 6 to 19 months. Eight (88.89%) of 9 patients had complete remission of symptoms immediately after surgery. The histologic and immunohistochemical examination showed features of chronic tonsillar inflammation.Conclusions: (a) No specific findings were observed in the tonsils of PFAPA patients; (b) we could not find any difference in tonsillar histology between PFAPA and chronic tonsillar inflammation; and (c) tonsillectomy is an effective treatment for PFAPA syndrome, improving patients and parental quality of life.

Shifting trends: mastoiditis from a surgical to a medical disease - Corrected Proof

2009-08-27

Abstract: Objective: The aim of this study is to review the outcome of pediatric patients suffering from acute mastoiditis treated conservatively and to correlate this to the evolution of our understanding of the shift in which mastoiditis has been transformed from a surgical to a medial disease.Methods: We perfomed a retrospective review patient files hospitalized in our tertiary-care center between 2005–2008. We examined the data concerning the infection which included: presenting signs/symptoms, prior otologic history, treatment (including both surgical and conservative) prior to hospitalization and during hospitalization, computed tomography (CT), hospital duration, complications and overall outcome. This data was analyzed and compared between different patients who underwent different treatment strategies.Results: Fifty-one patients were included in this retrospective review. Initially, forty-nine patients admitted to our hospital were treated conservatively. This treatment included intra-venous antibiotics, myringtomy and if needed subperiosteal abscess incision and drainage. Only 2 patients underwent CT scanning on admission. Further on, during hospitalization 4 additional patients underwent CT scanning due to continued fever or progression of local disease. All four CT scans showed no intra-cerebral complications, and so all continued with conservative treatment.Conclusion: Most cases of acute mastoidits may be treated with a conservative therapy regime. This regime, in our opinion, should include three branches: the first intravenous antibiotic therapy using a broad spectrum antibiotic. The second is myringotomy and the third branch is incision and drainage of subperiosteal abscess when needed.

Benign paroxysmal positional vertigo after decompression sickness: a first case report and review of the literature - Corrected Proof

2009-08-27

Abstract: Benign paroxysmal positional vertigo is a common cause of vertigo. We describe a previously unreported case of this clinical entity in a young, fit recreational water diver, having experienced decompression illness. Full recovery occurred after hyperbaric recompression therapy, and he remained symptom free on 6-week follow-up. We review the literature and discuss the pathogenesis of benign paroxysmal positional vertigo, proposing that semicircular canal nitrogen bubble formation could have been the primary etiological event leading to this condition.

Novel Epstein-Barr virus immunoglobulin G–based approach for the specific detection of nasopharyngeal carcinoma - Corrected Proof

Ahmed S. Abdulamir, Rand R. Hafidh, Fatimah Abu Bakar, Kassim Abbas — 2009-08-27

Abstract: Purpose: This study was designed to find a reliable Epstein-Barr virus (EBV) immunoglobulin (Ig) G–based diagnostic/screening test for nasopharyngeal carcinoma (NPC) able to demarcate between the NPC-related seropositivity of EBV IgG antibodies and that of other head and neck cancer (HNCA) and control groups. The NPC-associated immunosuppression affects EBV IgA much more than IgG, leading to inconsistent detection of NPC using EBV IgA antibodies.Materials and methods: One hundred twenty-two HNCA patients, 42 NPC, 66 laryngeal carcinoma, and 14 hypopharyngeal carcinoma and 3 groups of 100 control subjects were enrolled in this study. Enzyme-linked immunosorbent assay (ELISA) was used to find a specific cutoff value for the NPC-related seropositivity of EBV IgG antibodies.Results: NPC group showed higher serum level of EBV IgG antibodies than control and other HNCA groups (P < .05). However, the traditional cutoff value, mean + 2 SDs of control subjects, failed to demarcate the seropositives of NPC patients from those of healthy population (P > .05). The new cutoff value, mean + 2 SDs of the seropositives group of control subjects who had already been grouped by the traditional cutoff value, proved successful. It succeeded to demarcate between the NPC-related EBV IgG seropositivity and that issued from the persistent, latent, or reactivated EBV infection in the population (P < .05). The sensitivity/specificity of NPC detection by the new cutoff-based ELISA kit, 76.19% and 86%, was close or higher than that of EBV IgA antibodies.Conclusion: EBV IgG-based ELISA could be used for the diagnosis of NPC using a new cutoff threshold that excludes the population baseline of EBV IgG seropositivity.

Spurious decline in intraoperative parathyroid hormone: false positives in parathyroid surgery - Corrected Proof

Doug Sidell, John Wang, Joel Sercarz — 2009-08-27

Abstract: Objectives: The aims of this study were to (1) describe a false-positive result using a highly sensitive intraoperative parathyroid hormone (PTH) assay in an adult patient with primary hyperparathyroidism and (2) discuss the potential pitfalls of revision parathyroid surgery and the implication of various localization techniques described in the literature.Methods: A case report is described from a tertiary care university hospital. A literature review detailing diagnostic tools used to improve outcomes in parathyroid surgery is presented. The potential inaccuracies of intraoperative PTH assays are discussed.Results: We present a 71-year-old woman with primary hyperparathyroidism who was referred to our institution for revision surgery. The patient had preoperative sestamibi imaging that localized a right inferior parathyroid lesion. Intraoperatively, a specimen consistent with parathyroid tissue was removed and sent for frozen section. The intraoperative PTH levels were noted to decrease from 154 pg/mL (preincision) to 28 pg/mL (20 minutes postexcision). The frozen section results were consistent with a lymph node. This stimulated a 4-gland exploration, which confirmed normal left superior and inferior parathyroid glands. A 1.5-cm right retroesophageal parathyroid was subsequently discovered and excised. Final intraoperative PTH levels were 20 pg/mL.Conclusion: Rapid PTH assays have become the mainstay of parathyroid surgery at many institutions; however, despite their accuracy, false-positive results are known to occur. We present a case of an inaccurate decline in intraoperative PTH and use this case report as a means to highlight some potential pitfalls of the test.

Perineural invasion detected by high-field 3.0-T magnetic resonance imaging - Corrected Proof

Renee Penn, Elliot Abemayor, Vishad Nabili, Sunita Bhuta, Claudia Kirsch — 2009-08-27

Abstract: The presence of perineural invasion (PNI) with cutaneous squamous cell carcinoma portends a poor prognosis. PNI may be detected radiographically or clinically, with motor or sensory deficits, and is confirmed by histologic evaluation. Recent interest has grown regarding the role of imaging in determining the presence of PNI and its preoperative implications. We report on a patient with cutaneous squamous cell carcinoma invading the parotid gland with clinical evidence of facial nerve weakness. On standard 1.5 Tesla (T) magnetic resonance imaging (MRI), bilateral parotid glands were symmetric; however, a second high-field 3-T MRI revealed asymmetric enhancement of the left facial nerve at the stylomastoid foramen and extending throughout the left parotid gland. PNI was later confirmed on histopathology. The presurgical determination of PNI was essential in our mapping the exact tumor location and in our surgical planning.

Cochlear implantation in late-implanted adults with prelingual deafness - Corrected Proof

Tova Most, Hadas Shrem, Ilana Duvdevani — 2009-08-24

Abstract: Purpose: The purpose of this study was to examine the effect of cochlear implantation (CI) on prelingually deafened participants who were implanted as adults. The effect of the CI was examined with regard to the following variables: communication, family, social skills, education, and work satisfaction with one's life, loneliness, and self-esteem.Materials and methods: Thirty-eight adults participated. Four self-report questionnaires were used at 2 points in time: before and after CI.Results: The research findings show significant differences in the reports of most variables before and after implantation. The participants felt better with regard to communication, social skills, education, and work and satisfaction with one's life after implantation in comparison to their feelings before implantation. Furthermore, they felt less lonely after implantation. However, there were no significant differences before and after implantation regarding their feelings within the family and regarding their self-esteem.Conclusions: The results demonstrated the need to evaluate the benefits resulting from the CI not only with traditional clinical measures but with additional measures as well. Furthermore, they demonstrated the benefit of the CI on the positive psychosociological implications of prelingually deafened adults.

Expression of the receptor activator for nuclear factor-κB ligand and osteoprotegerin in chronic otitis media - Corrected Proof

Jerzy Kuczkowski, Monika Sakowicz-Burkiewicz, Ewa Iżycka-Świeszewska — 2009-08-10

Abstract: Background: The receptor activator for nuclear factor-κB ligand (RANKL) and osteoprotegerin (OPG) are the key factors controlling the osteoclast and osteoblast action in the bone.Purpose: The study objective was to investigate the expression level of RANKL and OPG in cholesteatoma and granulation tissue, and to assess the relationship between their expression levels and osteolysis.Material and methods: Patients with chronic otitis media with cholesteatoma (n = 28) and without cholesteatoma (n = 24) treated surgically at the Department of Otolaryngology of the Medical University of Gdańsk were included in the study. RANKL and OPG expressions were analyzed by immunohistochemistry and Western blot.Results: RANKL and OPG were expressed in all cholesteatoma and granulation tissues. RANKL expression was mainly observed in cholesteatoma subepithelial stroma, whereas OPG-positive cells originated from the epithelium. The number of OPG-positive cells in the normal skin was significantly higher than in cholesteatoma tissues. The RANKL protein level in cholesteatoma tissues was 1.8- and 1.5-fold higher than in the auditory canal skin and granulation tissues, respectively. The number of RANKL-positive cells in cholesteatoma tissues was significantly higher than in the normal skin. No substantial differences were found in average OPG protein levels between cholesteatoma tissues and the normal auditory canal skin. The ratio of RANKL/OPG was significantly higher in cholesteatoma tissues (2.93 ± 0.79) than in the skin samples (1.36 ± 0.34).Conclusions: Altered ratio of RANKL/OPG protein level in cholesteatoma tissues suggests that these proteins might be somehow involved in the pathogenesis of cholesteatoma. However, to resolve this issue a study on a larger group of patients should be conducted.

A randomized prospective study of oral levofloxacin vs intravenous flomoxef prophylaxis in postoperative infection after endoscopic sinus surgery - Corrected Proof

2009-07-30

Abstract: Objective: The clinical efficacy and cost effectiveness of oral antimicrobial prophylaxis with levofloxacin (LVFX) on endoscopic sinus surgery (ESS) was evaluated.Materials and methods: Ninety-three patients undergoing ESS were prospectively enrolled in the present study. The patients were randomly divided into 2 groups, LVFX and flomoxef (FMOX). Two hundred milligrams of LVFX was orally given 2 hours before the start of surgery and 6 hours after the end of surgery, which was followed by the administration of 200 mg every 12 hours for 2 days. One gram of FMOX was dissolved in 100 ml of physiological saline and given intravenously at the induction of anesthesia and 6 hours after the end of surgery, followed by infusion twice daily for 2 days.Results: There were no statistically significant differences between 2 groups in terms of age, sex, systemic complications, surgical procedures, the duration of the operation, the length of hospitalization, the amount of blood loss, body temperature, or the number of white blood cells or C-reactive protein. Although no statistical significance was observed in the bacterial resistance between the two antibiotics, LVFX seems to show a low rate of resistance pattern change as compared to FMOX. The present study demonstrated that no patients treated with LVFX or FMOX were afflicted with postsurgical infection.Conclusion: Oral administration of LVFX is a simple, cost-effective and safe alternative to intravenous prophylaxis in ESS based on clinical efficacy and bacteriological study.

Oscillopsia in labyrinthine defective patients: comparison of objective and subjective measures - Corrected Proof

Carlo Badaracco, Francesca Sylos Labini, Annalisa Meli, Davide Tufarelli — 2009-07-30

Abstract: Objective: To compare the oscillopsia sensation in vestibular defective patients, using a specific handicap questionnaire and a specific Visual Analog Scale, with objective measure of the vertical vestibulo-ocular reflex efficiency in the pitch plane, using the computerized Dynamic Visual Acuity (DVA) test and Gaze Stabilization Test (GST).Design: Controlled retrospective study.Setting: Day hospital in ENT Rehabilitation Unit.Subjects: Sixty-five subjects: 35 controls (12 men and 23 women; mean age, 50.77 ± 13.39 years) and 30 patients with chronic dizziness: 18 with unilateral vestibular hypofunction (7 men and 11 women; mean age, 55.50 ± 12.72 years) and 12 with bilateral hypofunction (7 men and 5 women; mean age, 57.25 ± 9.18 years).Main measures: Computerize vertical DVA and GST; subjective Visual Analog Scale, Oscillopsia Score questionnaire.Results: Instrumental tests had different means between subject groups; vertical DVA results and subjective measures were significantly correlated.Conclusions: Vertical DVA and GST test in up and down direction are able to separate healthy and vestibular patients. Moreover, the DVA test in down direction differentiates patients with unilateral vestibular hypofunction and with bilateral vestibular hypofunction. These results show that vertical DVA test can be used for the assessment of the visual field instability referred to as disabling.

Airway implications of congenital sternal agenesis - Corrected Proof

Richard J. Vivero, Alexander Fort, Jose W. Ruiz, Soham Roy — 2009-07-16

Abstract: Congenital agenesis of the sternum is an extremely unusual malformation rarely encountered by the practicing Otolaryngologist. It typically arises in conjunction with other midline ventral congenital anomalies, including abdominal, diaphragmatic, and cardiac malformations. We report a case series of two patients managed with tracheotomy placement due to prolonged intubation. The first patient was a 63-day-old infant born at 34 weeks gestation with dysmorphic features, cleft lip and palate, and skeletal dysplasia, including absence of the sternum. The second patient was a 31-day-old infant born with ectopic cordis and diaphragmatic hernia. The inadequate closure of the anterior chest wall secondary to manubrium malformation or a variant contributes significantly to a child's inability to generate adequate ventilatory pressures. As a result, airway management must be considered not only to ensure airway patency but also an appropriate physiological environment to allow for adequate air exchange in the lungs.

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

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.

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

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.

Deep neck abscess due to Acinetobacter baumannii infection - Corrected Proof

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.

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

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.

Device-related risk of fire in oropharyngeal surgery: a mechanical model - Corrected Proof

Soham Roy, Lee P. Smith — 2009-07-06

Abstract: Objective: The aim of this study was to evaluate the fire risk for an electrosurgical device (Bovie) as compared with a bipolar radiofrequency ablation wand (Coblator) in a mechanical model of oropharyngeal surgery.Methods: An endotracheal tube was inserted into the cranial end of a degutted, whole raw chicken through which 100% oxygen was piped at 10 L/min. An electrosurgical device (15 W, coagulate mode) and bipolar radiofrequency ablation wand (9, 7, and 3 in ablate mode; 5 and 3 in coagulate mode) were activated in the central cavity. All experimental conditions were tested for 4 minutes, or until a positive result was achieved. All trials were repeated to ensure accuracy.Results: Ignition was obtained with a sustained fire when using the electrosurgical device for between 25 and 80 seconds. Under all 5 experimental conditions, no ignition or sustained fire could be produced using the radiofrequency ablation wand. After 20 sustained minutes of continuous plasma ablation in the chicken cavity without ignition, the electrosurgical device was able to ignite a fire in 25 seconds in the same cavity.Conclusions: Although electrosurgical devices present a significant risk of fire during open cavity surgery in oxygen-enriched environments, that risk seems to be eliminated with bipolar radiofrequency plasma ablation.