American Journal of Otolaryngology - Head and Neck Medicine and Surgery

Intracranial spread of chronic middle ear suppuration

Siba P. Dubey, Varqa Larawin, Charles P. Molumi — 2009-04-02

Abstract: Objective: The aim of the study was to review the pathogenesis and the result of management of the intracranial complications of chronic middle ear suppuration.Methods: This was a retrospective review of charts of 32 cases with intracranial complications due to chronic middle ear infection managed between 1993 and 2007. The symptoms, clinical findings, and medical and surgical management were reviewed and analyzed.Results: There were 10 (31.2%) patients in the age group of 0 to 10 years, 9 (28.1%) patients in the age group of 11 to 18 years, and 13 (40.6%) patients older than 18 years. Males were involved twice as much as females. Among the 32 patients, 18 (56.3%) had a single intracranial complication, whereas 14 (43.7%) had multiple intracranial complications. Among all the intracranial complications in the 32 patients, otitic meningitis was the commonest intracranial complication and was seen in 14 (43.7%) patients; it was followed by lateral sinus thrombosis in 10 (31.2%), cerebellar abscess in 6 (18.7%), epidural abscess in 7 (21.8%), and perisinus abscess in 5 (15.6%). Other less common but serious intracranial complications encountered were cerebral abscess and interhemispheric abscess in 2 (6.2%) each, and subdural abscess, otitic hydrocephalus, and otogenic cavernous sinus thrombosis in 1 (3.1%) each. Upon admission, all patients received a combination of parenteral antibiotics. Canal wall down mastoidectomy was performed in all but 1 patient. In addition, lateral sinus was explored in 13 (40.6%) and cerebellar abscesses were drained in 5 (15.6%) patients. The overall mortality rate of 31.2% was found in our series.Conclusion: The prognosis was worse with delayed presentation because of overwhelming intracranial infection due to multiple pathways of extension from chronic otitis media. Infected thrombus in the dural venous sinus should be removed to prevent dissemination of septic emboli.

Intratumoral delivery of docetaxel enhances antitumor activity of Ad-p53 in murine head and neck cancer xenograft model

2009-03-27

Abstract: Purpose: The aim of this study is to determine the ability of intratumorally delivered docetaxel to enhance the antitumor activity of adenovirus-mediated delivery of p53 (Ad-p53) in murine head and neck cancer xenograft model.Materials and methods: A xenograft head and neck squamous cell carcinoma mouse model was used. Mice were randomized into 4 groups of 6 mice receiving 6 weeks of biweekly intratumoral injection of (a) diluent, (b) Ad-p53 (1 × 1010 viral particles per injection), (c) docetaxel (1 mg/kg per injection), and (d) combination of Ad-p53 (1 × 1010 viral particles per injection) and docetaxel (1 mg/kg per injection). Tumor size, weight, toxicity, and overall and disease-free survival rates were determined.Results: Intratumoral treatments with either docetaxel alone or Ad-p53 alone resulted in statistically significant antitumor activity and improved survival compared with control group. Furthermore, combined delivery of Ad-p53 and docetaxel resulted in a statistically significant reduction in tumor weight when compared to treatment with either Ad-p53 or docetaxel alone.Conclusion: Intratumoral delivery of docetaxel enhanced the antitumor effect of Ad-p53 in murine head and neck cancer xenograft model. The result of this preclinical in vivo study is promising and supports further clinical testing to evaluate efficacy of combined intratumoral docetaxel and Ad-p53 in treatment of head and neck cancer.

Endonasal laser–assisted microscopic dacryocystorhinostomy: surgical technique and follow-up results

Shahrokh Farzampour, Ehsan Fayazzadeh, Ebrahim Mikaniki — 2009-03-31

Abstract: Purpose: Endonasal dacryocystorhinostomy is known as an increasingly attractive and effective approach for the surgical treatment of nasal duct obstruction with minimal complications and best cosmetic consequences. In a relatively large-scale case-series study over a 5-year period, we describe the surgical technique and 12-month follow-up results of microscopic laser dacryocystorhinostomy with particular regard to the effect of various pre-/postoperational factors (ie, patients' sex, age, symptoms chronicity, previous interventions, duration of silicone intubation) on the surgical outcome.Materials and methods: A total of 162 cases in 151 patients with chronic epiphora, mucocele, or recurrent episodes of dacryocystitis were included in the study. Endonasal laser dacryocystorhinostomy was performed using a surgical microscope with transcanalicular lacrimal sac illumination. The laser types used were potassium-titanyl-phosphate and neodymium:yttrium-aluminum-garnet for ablation of nasal mucosa and application to bone, respectively. Patients were evaluated 6 months and 1 year later. Data were analyzed by χ2 tests.Results: There were no major complications during or after the operations. Complete cure occurred in 89.5% (after 6 months) and 74.2% (after 1 year) of the cases. Anatomical patency was shown by lacrimal system irrigation with fluorescein in 81.5% of the cases after the 12-month follow-up. It was found that patients younger than 55 years, with symptoms lasting less than 1 year, and without history of nasal problems, had significantly higher surgical success rates (P < .05). Moreover, rates of failure were significantly lower in cases whose canaliculi were intubated for 5 to 6 months (P < .05).Conclusions: Endonasal microscopic laser dacryocystorhinostomy is a safe and minimally invasive procedure with reasonable results. It has many advantages over external or other conventional approaches. Successful results could be further enhanced by more wisely selecting the patients and by silicone extubation after 6 months.

Difference in outcome of botulinum toxin treatment of essential palatal tremor in children and adults

Eike Krause, Florian Heinen, Robert Gürkov — 2009-03-31

Abstract: Purpose: The objective of this clinical study was to investigate the history and clinical findings in 10 patients having an essential palatal tremor. Furthermore, a botulinum toxin A (BTA) therapy in 5 cases was carried out, and the outcome was analyzed.Materials and Methods: Seven adult and 3 pediatric patients with essential palatal tremor were examined at presentation, before and after start of treatment, and every 3 months or when symptoms recurred. Findings were documented by endoscopic video recordings, electromyography, tympanometry, and ear canal microphone recording. The BTA injections were performed in local or general anesthesia, under elecromyographic guidance.Results: The BTA therapy in all 5 patients was successful. Surprisingly, 2 of these patients, aged 10 and 6 years, remained in remission for several years after a single successful injection.Conclusion: Botulinum toxin therapy is a safe and effective treatment of essential palatal tremor and seems to be especially useful in pediatric patients. The long lasting effect in children hints toward a pathophysiologic difference between pediatric and adult essential palatal tremor.

Tympanometry in infants with middle ear effusion having been identified using spiral computerized tomography

Liu Zhiqi, Yang Kun, Huang Zhiwu — 2009-03-31

Abstract: Purpose: This study was carried out to evaluate the diagnostic value of 226 and 1000 Hz probe-tone tympanometry in infants with effusion in the middle ear.Methods: For this study, we recruited 52 infants with ages 42 days to 6 months as clinical subjects in a hearing-ability screening program. After a spiral computerized tomography (CT) scan of the patients, we tested their hearing using tympanometry of 2 probe-tone frequencies: 226 and 1000 Hz. The patients were divided into 2 groups according to the results of the CT scan: group 1 patients had normal middle ears without fluid, and group 2 patients had ears with fluid. We recorded the tympanograms and their percentage of every type and compared the tympanometric results with CT to get the concordance rate between tympanometry and CT diagnose while obtaining the normal values of 1000 Hz tympanometric measures.Results: The 226 Hz probe-tone tympanograms of middle ears with fluid differed greatly from those without. At 226 Hz, their tympanograms were single-peaked tympanograms (51.06%), double-peaked tympanograms (44.68%), flat tympanograms (2.13%), and negative-pressure tympanograms (2.13%) for the group with normal middle ears, but single-peaked tympanograms (77.19%), double-peaked tympanograms (19.30%), and flat tympanograms (3.51%) for the group with middle ear effusion. The 1000 Hz probe-tone tympanograms included single-peaked or flat-type tympanograms in both the normal middle ear group and the group with middle ear effusion. The group with normal middle ears was identified by spiral CT, and its tympanograms mostly had a single peak (97.87%) during 1000 Hz tympanometry. Tympanograms of the middle ear effusion group mostly had a flat curve (98.25%). When the Liden/Jerger classification system was used to evaluate the tympanograms, normal tympanograms were single-peaked, and flat tympanograms indicated middle ear effusion. According to this standard, the concordance rate between the 1000 Hz tympanometry (98.08%) and CT diagnosis was higher than when 226 Hz tympanometry (25%) (P < .05) was performed, and the value of κ was equal to 0.961 between 1000 Hz tympanometry and CT diagnosis.Conclusions: In clinical practice, 1000 Hz tympanometry, not 226 Hz, is recommended to determine the presence of middle ear fluid in infants younger than 6 months.

The dilemma of midline destructive lesions: a case series and diagnostic review

2009-03-31

Abstract: Background: Midline destructive lesions (MDLs) of the nose are a diagnostic dilemma due to an extensive differential diagnosis and vague presenting signs and symptoms. Etiologies may be neoplastic, autoimmune, traumatic, infectious, or unknown.Study Design: Case series and review of the literature were done.Methods: Medical records of 8 patients presenting with an MDL were reviewed.Results: Each patient received nasal endoscopy, computed tomography scan of the sinuses, laboratory workup, culture (aerobes, anaerobes, fungus, and acid-fast bacilli), and biopsy with flow cytometry. Laboratory tests included complete blood count, basic metabolic panel, erythrocyte sedimentation rate, angiotensin-converting enzyme, antineutrophil antibodies, rheumatoid factor, anti-Ro and anti-La antibodies, Epstein-Barr virus antibodies, coccidiomycosis serology, HIV antibodies, fluorescent treponemal antibody absorption, classic antineutrophil cytoplasmic antibodies, perinuclear antineutrophil cytoplasmic antibody, proteinase 3, and myeloperoxidase. Choice of diagnostic study was individualized for each patient. Two patients were diagnosed with natural killer/T-cell lymphoma, 2 were diagnosed with Wegener's granulomatosis, and 4 remained idiopathic, despite the extensive workup. A diagnostic algorithm to aid in the approach to MDLs is presented.Conclusions: The diagnosis of MDLs remains difficult but is aided by a systematic approach and familiarity with multiple diagnostic techniques. It is imperative to take multiple tissue specimens from various sites, send them fresh, and communicate suspicion of lymphoma. Despite diagnostic advances and improved understanding of the diseases underlying MDLs, an etiology is often not identified.

Complications in pediatric cochlear implants

Jonathan McJunkin, Anita Jeyakumar — 2009-03-31

Abstract: Objective: The purpose of this study is to retrospectively review the complications of pediatric patients undergoing cochlear implantation at a tertiary referral center.Method: Institutional review board permission was obtained. A retrospective analysis of all pediatric patients (younger than 18 years) who underwent primary cochlear implantation was performed from January 2001 to December 2005. The patients were reviewed for demographic information, type of hearing loss, cochlear implant device, and complications including implant failure, meningitis, hematoma, implant extrusion, cerebrospinal fluid leak, facial palsy, and wound infection.Results: One hundred sixty-five patient records were reviewed. Twenty-nine patients were lost to follow-up or were revision cases; therefore, 136 records were analyzed. Of the patients, 53.5% were male. The most common etiology of hearing loss was nonsyndromic, nongenetic, congenital sensorineural hearing loss (60.6%). Other less common etiology of hearing loss included TORCH (toxoplasmosis, other infections, rubella, cytomegalovirus, herpes simplex virus) (8.3%), connexin mutation (5.8%), and enlarged vestibular aqueduct (6.5%). All patients had a follow-up of 3 years. There were no intraoperative complications. The most common complications were flap infections (2.6%) and immediate postoperative hematomas (1.9%). Flap problems mostly occurred within 2 weeks of implantation. Within the study period, there was only one device failure (0.7%).Conclusions: Cochlear implantation in children continues to be reliable and safe in experienced hands, with a low percentage of severe complications. The patients should have a lifetime follow-up.

Lidocaine spray vs tetracaine solution for transnasal fiber-optic laryngoscopy

2009-03-31

Abstract: Statement of problem: The aim of this study was to evaluate the efficacy of lidocaine spray 10%, compared with tetracaine 2% solution, as a local anesthetic for patients undergoing transnasal fiber-optic laryngoscopy.Method of study: A prospective study was conducted on patients undergoing transnasal fiber-optic laryngoscopy. Microsurgical sponges were applied in each side of the nose for 10 minutes before laryngoscopy. Patients were randomly classified into group A and group B, in which tetracaine 2% solution and lidocaine spray 10% were used, respectively. Patients were asked to evaluate the severity of pain during the procedure by a visual analog scale. Patients data, pain score, and potential complications were placed in a database and statistically assessed.Main results: Our series consisted of 48 patients. Statistical analysis showed significant lower mean nasal discomfort score in favor of the tetracaine group (2.29 vs 3.04 [P < .001]). No tetracaine complications or side effects occurred.Principal conclusion: Neurosurgical sponge application of tetracaine 2% solution is an easy, safe, inexpensive, and effective analgesia for transnasal fiber-optic laryngoscopy.

Ludwig's angina as an extremely unusual complication for direct microlaryngoscopy

Andrés Coca Pelaz, José L. Llorente Pendás, Carlos Suárez Nieto — 2009-03-27

Abstract: Background: An extremely rare case that to our knowledge has not been reported before is described, in which a patient had a Ludwig's angina as a complication of direct microlaryngoscopy.Methods: We report a Ludwig's angina after a direct microlaryngoscopy for a Reinke's edema, due to erosion on the internal face of the mandible produced by compression of the laryngoscope.Results: The patient underwent placement of 2 drainages, intraoral and cervical, and several incisions on the floor of the mouth, with intravenous corticosteroids and antibiotics and with resolution of the illness without performing tracheostomy.Conclusions: Ludwig's angina is an extremely rare complication of microlaryngoscopy, but it is potentially life-threatening. Early diagnosis and treatment resulted in survival of the patient without complications.

Novel presentation of a fourth branchial cleft anomaly in a male infant

Seth H. Evans, Mark Marinello, Kelley M. Dodson — 2009-03-27

Abstract: Fourth branchial cleft anomalies are rare congenital disorders of the neck. We describe a case involving a unique presentation of this entity as well as a review of the literature concerning its management.

An unusual case of ingestion of a moth cocoon in a 14-month-old girl

Paul A. Tripi, Richard Lee, Joe B. Keiper, Andrew W. Jones, James E. Arnold — 2009-03-27

Abstract: We present a case report of a 14-month-old girl who ingested a moth cocoon, which resulted in dramatic symptoms of irritability, drooling, and anorexia. Direct laryngoscopy, bronchoscopy, and esophagoscopy under general anesthesia revealed copious, tenaciously adherent, barbed hairs embedded in her tongue and buccal mucosa. Removal of the hairs with irrigation, suction, and brushing was unsuccessful and was eventually abandoned. In the following 48 hours, the girl recovered uneventfully with supportive care. The hairs were subsequently identified as coming from the hickory tussock moth (Lepidoptera: Arctiidae: Lophocampa caryae), which is ubiquitously distributed throughout much of North America. This is the first detailed case report of ingestion of an L caryae cocoon.

Necrotizing fasciitis secondary to bisphosphonate-induced osteonecrosis of the jaw

Dhave Setabutr, Nathan W. Hales, Greg A. Krempl — 2009-03-27

Abstract: Osteonecrosis of the jaw is an uncommon consequence of biphosphonate therapy. This has most commonly been a bone complication with little if any soft tissue involvement. An unusual case of necrotizing fasciitis with extensive soft tissue infection stemming from a prolonged case of osteonecrosis of the jaw presented. The management of this patient (aggressive surgical debridement and prolonged wound care) is reviewed as well as the review of the underlying processes.

Localized amyloidosis of the nasal and paranasal mucosa: a rare pathology

2009-03-16

Amyloidosis is a rare condition characterized by the deposition of abnormal protein filaments into extracellular tissue. We present a patient with localized amyloidosis of the nasal and paranasal sinus mucosa and discuss the diagnostic challenges related to making the correct diagnosis.

Epiglottis reconstruction with free radial forearm flap after supraglottic laryngectomy

Hung-Tao Hsiao, Yi-Shing Leu, Kwang-Yi Tung — 2009-03-27

Abstract: A bilobed free radial forearm flap was designed to reconstruct a defect in the epiglottis and tongue base in 2 patients who underwent supraglottic laryngectomy. The flap was initially sutured in the shape of the epiglottis to prevent aspiration during deglutition. Six months after surgery, after a full course of radiation therapy, the flap had flattened and underwent atrophy, but the patients still had good voice production and were able to swallow well without any aspiration. Regardless of the final shape of the reconstructed epiglottis, it will suffice to prevent aspiration if the flap is large enough to occlude the tracheal outlet.

Oculocardiac reflex during the endoscopic sinus surgery

Hong In Baek, Byung Cheol Park, Wee Hwang Kim, Won Sang Son — 2009-03-27

Abstract: The oculocardiac reflex is developed by surgical or nonsurgical stimulations to the eyeball including manipulation of extraocular muscles. The authors came across a case of severe arrhythmia due to oculocardiac reflex caused by the stimulation of orbital tissue from the injury of lamina papyracea during endoscopic sinus surgery. Previous heart evaluations of the patient of this case suggested no abnormalities in the heart. This case shows that the oculocardiac reflex can occur during endoscopic sinus surgery but is not limited as the complication from ocular surgery.

Schwannoma of the hard palate

2009-03-31

Abstract: Schwannomas are rare, benign neoplasms that can arise from any cranial, peripheral, or autonomic nerve that contains Schwann cells. Approximately 25% to 45% of all schwannomas occur in the head and neck. They occur most commonly in the eighth cranial nerve, but it has been reported that 20% to 58% arise in the oral cavity, with approximately 10% of these located on the hard palate. We report a case of schwannoma of the hard palate, present important pathologic considerations for diagnosis, and provide a review of the literature regarding extracranial schwannomas.

Endoscopic above and below approach with frontal septotomy in a patient with frontal mucocele: a contralateral bypass drainage procedure through the frontal septum

Seok Hyun Cho, Yong Seop Lee, Jin Hyeok Jeong, Kyung Rae Kim — 2009-03-31

Abstract: Frontal sinus has complex anatomy and is the most difficult sinus to dissect under the nasal endoscope. In case of difficult accessibility through the frontal recess, we can make a detour to more invasive and external procedures to treat chronic or intractable frontal sinus diseases. However, these approaches usually need advanced surgical skills and sometimes can result in minor and/or major complications. Therefore, we developed a new surgical technique to treat frontal mucocele in a patient with severe new bone formation at the frontal recess and presented our experiences with literature review.

Editorial Board

2010-03-01

Guidelines for Contributing Authors

2010-03-01

American Journal of Otolaryngology - Head and Neck Medicine and Surgery

Intracranial spread of chronic middle ear suppuration

Intratumoral delivery of docetaxel enhances antitumor activity of Ad-p53 in murine head and neck cancer xenograft model

Endonasal laser–assisted microscopic dacryocystorhinostomy: surgical technique and follow-up results

Difference in outcome of botulinum toxin treatment of essential palatal tremor in children and adults

Tympanometry in infants with middle ear effusion having been identified using spiral computerized tomography

The dilemma of midline destructive lesions: a case series and diagnostic review

Complications in pediatric cochlear implants

Lidocaine spray vs tetracaine solution for transnasal fiber-optic laryngoscopy

Ludwig's angina as an extremely unusual complication for direct microlaryngoscopy

Novel presentation of a fourth branchial cleft anomaly in a male infant

An unusual case of ingestion of a moth cocoon in a 14-month-old girl

Necrotizing fasciitis secondary to bisphosphonate-induced osteonecrosis of the jaw

Localized amyloidosis of the nasal and paranasal mucosa: a rare pathology

Epiglottis reconstruction with free radial forearm flap after supraglottic laryngectomy

Oculocardiac reflex during the endoscopic sinus surgery

Schwannoma of the hard palate

Endoscopic above and below approach with frontal septotomy in a patient with frontal mucocele: a contralateral bypass drainage procedure through the frontal septum

Editorial Board

Contents

Guidelines for Contributing Authors