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Simultaneous binaural bithermal caloric testing: Clinical value

January 25, 2017  |  Robert T. Sataloff, MD, DMA, FACS; Meghan L. Pavlick, AuD, FAAA; James (Drew) McCaffrey, MD; John M. Davis, MD; Shannon M. Stewart, AudD

Abstract

The aim of this retrospective review was to determine the clinical value of simultaneous binaural bithermal caloric testing (SBT) versus alternate binaural bithermal caloric testing (ABB) in the setting of a tertiary care neurotology clinic. Charts of 131 adults who had presented with otologic complaints and had undergone both SBT and ABB examinations were included in the study. The main outcome measure was the identification of peripheral hypofunction. One hundred two patients had a normal ABB caloric examination; 86 of those 102 patients (84.3%) had normal ABB examinations but abnormal SBT results. We conclude that SBT is a more sensitive measure of peripheral pathology than the traditional ABB examination. If peripheral pathology is suspected but not confirmed by ABB, SBT appears useful for detecting mildly reduced vestibular response.

Extraosseous Ewing sarcoma: Expanding the differential diagnosis of supraclavicular fossa tumors

January 25, 2017  |  Julio Rama-López, MD, PhD; Rafael Ramos Asensio, MD; Cesar García-Garza, MD; Pablo Luna Fra, MD; Maria del Carmen Gassent Balaguer, MD; José Fuster Salva, MD

Abstract

A broad spectrum of diseases can be included in the differential diagnosis of neck masses. We report a case of extraosseous Ewing sarcoma that presented as a neck mass in a 70-year-old man. To the best of our knowledge, this is the first reported case of extraosseous Ewing sarcoma of the supraclavicular fossa. Published cases of extraosseous Ewing sarcoma in the neck have been described in other age groups, but those tumors were confined to the parapharyngeal space. Also, there have been reported cases in patients older than 70 years in which Ewing sarcoma affected other structures such as the larynx and the pelvis, but none in the soft tissues of the neck. This case adds extraosseous Ewing sarcoma as a possible diagnosis to consider when evaluating a neck mass in the supraclavicular fossa.

Endoscopic view of balloon dilation for excision of a sphenoid cyst

January 25, 2017  |  Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS

The sphenoid sinus can be opened for ventilation, inspection, or biopsy from a transethmoid or transnasal approach after identifying its ostium.

Obstructing in utero oropharyngeal mass: Case report of a lymphatic malformation arising within an oropharyngeal teratoma

January 25, 2017  |  Todd J. Wannemuehler, MD; Christopher R. Deig, BA; Brandon P. Brown, MD; Stuart A. Morgenstein, DO

Abstract

An ex utero intrapartum treatment procedure was performed to deliver a fetus with a multiseptated, entirely cystic, 4.5 x 5.0 x 4.0-cm mass occupying the oropharynx and oral cavity with protrusion from the mouth. Surgical excision was performed, and final pathologic diagnosis revealed a lymphatic malformation arising within a cystic oropharyngeal teratoma. Lymphatic malformations are virtually indistinguishable radiologically from rare, purely cystic teratomata, and efforts have been made to distinguish between the two in utero because of differing available treatment modalities. This represents the first documented case in the literature of a lymphatic malformation arising from within an oropharyngeal teratoma.

Anomalous stapes in Down syndrome

January 25, 2017  |  Daniel T. Ginat, MD, MS

It is important to consider the presence of inner ear anomalies in Down syndrome, which occur in up to approximately 75% of this population

Intramural esophageal hematoma mimicking a hypopharyngeal tumor

January 25, 2017  |  Chao-Jung Lin, MD; Bor-Hwang Kang, MD, PhD; Yueng-Hsiang Chu, MD, PhD; Chih-Hung Wang, MD, PhD

The common presentation of intramural esophageal hematoma is acute onset of retrosternal pain, typically accompanied by dysphagia, odynophagia, or hematemesis.

Mucous retention cyst of mastoid bone mimicking cholesteatoma

January 25, 2017  |  Nurdoğan Ata, MD; Suna Erkılıç, MD

Occlusion of mastoid cells and the aditus ad antrum caused by inflammatory diseases can result in poor ventilation and poor drainage of mastoid cells, which can in turn cause the formation of cysts.

Impact of exercise with TheraBite device on trismus and health-related quality of life: A prospective study

January 25, 2017  |  Charlotte Montalvo, MD; Caterina Finizia, MD, PhD; Nina Pauli, MD, PhD; Bodil Fagerberg-Mohlin, DDS; Paulin Andréll, MD, PhD

Abstract

Trismus is a common symptom in patients with head and neck cancer that affects many aspects of daily life negatively. The aim of this study was to investigate the impact of structured exercise with the jaw-mobilizing device TheraBite on trismus, trismus-related symptomatology, and health-related quality of life (HRQL) in patients with head and neck cancer. Fifteen patients with trismus (maximum interincisal opening [MIO] ≤35 mm) after oncologic treatment for head and neck cancer, underwent a 10-week exercise program with the TheraBite device and were followed regularly. Time between oncologic treatment and start of TheraBite exercise ranged from 0.7 to 14.8 years (average 6.2 years). MIO, trismus-related symptoms, and HRQL was assessed before and after exercise and after 6 months. A significant improvement in MIO was observed post-exercise (3.5 mm, 15.3%, p = 0.0002) and after 6-month of follow-up (4.7 mm, 22.1%, p = 0.0029). A statistically significant correlation was found between increased MIO and fewer trismus-related symptoms. In conclusion, exercise with TheraBite improved MIO and trismus-related symptoms in patients with trismus secondary to head and neck cancer. Structured exercise with the jaw-mobilizing device seems to be beneficial for patients with trismus independent of time since oncologic treatment.

Retropharyngeal and parapharyngeal abscesses: Factors in medical management failure

January 25, 2017  |  James Kosko, MD; Justin Casey, MD

Abstract

Retropharyngeal and parapharyngeal abscesses are the most common deep neck infections in the pediatric population. How best to treat these patients, be it intravenous antibiotics or immediate surgical incision and drainage, has long been debated. The purpose of this study was to evaluate patient and abscess characteristics associated with failure of medical treatment. We retrospectively examined 46 patients between 1999 and 2009 at Arnold Palmer Children's Hospital in Orlando. Patient charts were reviewed, and data collected included age, gender of the patient, size of the abscess, days of admission to the hospital, admission to the intensive care unit, and surgical intervention, if applicable. All patients first received 24 to 48 hours of IV antibiotics, at which point a clinical decision was made to proceed with surgery or continue conservative management. When comparing antibiotic treatment failure across age, gender, and abscess size, statistically significant correlation occurred only with the size of the abscess. Medical management was more likely to fail, and surgery needed, when abscesses were larger than 2 cm. Additionally, hospital stay was not statistically different between the medical and surgical groups. Our data demonstrate statistical significance for the ability to treat retro- and parapharyngeal abscesses 2 cm or less in diameter with IV antibiotics alone, without complications, and with a statistically similar average hospital stay compared with surgery. Abscesses larger than 2 cm may be managed medically, as well, but failure of antibiotic therapy alone is more likely, with surgical intervention more often required.

Evaluation of patient satisfaction with different hearing aids: A study of 107 patients

January 25, 2017  |  Seçkin Ulusoy, MD; Nuray Bayar Muluk, MD; Turhan San, MD; Cemal Cingi, MD

Abstract

We retrospectively investigated patient satisfaction with different types of hearing aids in 107 patients-60 males and 47 females, aged 8 to 84 years (mean: 53.8)-with unilateral or bilateral hearing loss, each of whom used two different hearing devices for at least 3 years per device. The International Outcome Inventory for Hearing Aids, Turkish edition (IOI-HA-TR) was used to evaluate satisfaction levels; we also calculated our own total individual subjective satisfaction (TISS) scores. We divided 16 different hearing devices into two types: device 1 and device 2; on average, device 2 had more channels, a lower minimum frequency, and a higher maximum frequency. We found that the IOI-HA-TR scores and TISS scores were higher and usage time was greater during device 2 use, and that there was a positive correlation between IOI-HA-TR and TISS scores. A total of 69 patients (64.5%) used device 2 for more than 8 hours per day, while 38 patients (35.5%) used it for 4 to 8 hours per day during the final 2 weeks of the trial. In contrast, 40 patients (37.4%) used device 1 for more than 8 hours, 50 (46.7%) used it for 4 to 8 hours, and the remaining 17 (15.9%) used it for less than 4 hours; the difference in the duration of use of the two devices was statistically significant (p < 0.001). Younger patients and patients with more education were more satisfied with their devices than were older patients and those who were not as well educated. We conclude that devices with good technologic features such as more channels, a lower minimum frequency, and a higher maximum frequency result in better hearing. Also, based on the age difference that we observed, we recommend that psychological support be provided to older patients with aided hearing to enhance their mental health and quality of life.