Brian J. Baumgartner, MD; Tremaine Ladd, MD; Carlos Esquivel, MD
Abstract
Low-grade nasal cavity adenocarcinoma is an unusual neoplasm. When it does occur, it often appears in conjunction with a history of epistaxis and nasal obstruction that spans a period of a few weeks to several months. Most of these tumors arise in patients who are middle-aged or older. We report a case of low-grade nasal cavity adenocarcinoma that was unusual in that it occurred in an adolescent boy and that the presenting symptoms of chronic nasal obstruction and recurrent epistaxis had persisted for 7 years. The occurrence of this uncommon but recognized entity in such a young patient widens the age range of possible patients with this tumor, and a finding of such an extended duration of symptoms should raise clinical suspicion and encourage a thorough investigation in order to make the diagnosis.
A growing body of literature is suggesting that there is a link between head and neck cancer treated with radiation therapy and the development of obstructive sleep apnea/hypopnea syndrome (OSAHS). We describe the case of a 54-year-old man with a history of head and neck cancer whose OSAHS had gone undiagnosed for 3 years. After the diagnosis was made on the basis of sleep study data, we determined that the OSAHS was a long-term complication of cervical radiation therapy that had been delivered to treat the patient's laryngeal squamous cell carcinoma 3 years earlier. We also review the literature regarding the association between head and neck cancer and the development of OSAHS.
Can Alper Cagici, MD; Cem Ozer, MD; Ismail Yilmaz, MD; Filiz Aka Bolat, MD; Ozcan Cakmak, MD
Abstract
Cases of a solitary polyp of the nasal cavity are much less common than cases of massive polyposis. The most important factor in the formation of solitary polyps is the anatomic variations that result in mucosal contacts. We report the case of a patient who had bilateral solitary polyps of the uncinate process. Radiologic and clinical examinations revealed a medially bent uncinate process in the right nasal cavity and a bifid uncinate process in the left nasal cavity. These structures were the origins of the polyps.
Joni K. Doherty, MD, PhD; Mona Yong, MD; Dennis Maceri, MD
Abstract
Patients with an endolymphatic sac tumor (ELST) typically present with palsy of cranial nerves VII and/or VIII; other presenting symptoms include hearing loss, otalgia, occipital headaches, cranial nerve palsies, vertigo, gait ataxia, tinnitus, and otorrhea. ELSTs are extremely vascular, and they can invade and destroy temporal bone. Because of these characteristics, they are often mistaken for glomus tumors of the skull base. We describe the clinical presentation, evaluation, and management of ELSTs based on our review of the limited literature and our experience with 3 adults who presented to our tertiary care referral center with large ELSTs. Although these patients presented late in the course of their disease, their symptoms were relatively minor. Preoperative tumor embolization was performed, and a near-complete resection was achieved via an extended transotic approach in all 3 patients. The facial nerve was preserved without transposition in the first patient, the second patient underwent a primary nerve anastomosis, and the third required a cable graft of the facial nerve. Postoperative radiation therapy was administered to 2 of these patients. Follow-up by MRI detected no evidence of recurrence in any of the 3 patients.
Azhar M. Shaida, MA, FRCS; Matthew W. Yung, PhD, FRCS
Abstract
Neurofibromas are relatively common lesions of the nervous system, but only a few cases involving the pinna have been reported. The emphasis in most of these reports was on the cosmetic deformity; functional impairment in the form of hearing loss has been mentioned in only a few reports. We report a case of pinnal neurofibroma in which the primary complaint was otitis externa; hearing loss and cosmetic deformity were also present. Surgical excision resulted in an excellent functional and cosmetic outcome. This case demonstrates that neurofibroma of the pinna in the area of the external meatus can produce functional as well as cosmetic impairment, and surgery can produce a very satisfactory result.
Hadi Ghanbari, MD; Mohammad Farhadi, MD; Ahmad Daneshi, MD
Abstract
We report an unusual case of unilateral rhinolith. The patient was a 21-year-old man who had a history of left-sided nasal obstruction and recurrent bouts of fetid, purulent rhinorrhea of several years' duration. The rhinolith, which had formed around an impacted foreign body, was extracted in several pieces under local anesthesia. Laboratory evaluation revealed that the foreign body was a hardened mixture of codeine and opium wrapped in a small sheet of nylon-what we called an "opioma."
James R. Tysome, MA, MRCS; Hesham A. Saleh, FRCS (ORL-HNS)
Abstract
A sphenochoanal polyp is a rare lesion that originates in the sphenoid sinus. It occurs most often in adolescents and young adults. We present what to the best of our knowledge is the first reported case of a sphenochoanal polyp associated with concomitant nasal polyps. The patient was a 54-year-old man who presented with bilateral nasal obstruction, possible obstructive sleep apnea, and an altered voice, all of which had likely been caused by the presence of a massive left sphenochoanal polyp and bilateral grade III anterior and posterior ethmoid polyps. Because the patient had dilated cardiomyopathy, he was not a good candidate for general anesthesia. Therefore, the polyps were removed endoscopically under local anesthesia. The sphenochoanal polyp measured 7.5 cm in its greatest dimension and weighed 41 g. The patient remained symptom-free at the 1-year follow-up. The presentation of a sphenochoanal polyp is similar to that of the more common antrochoanal polyp, but the two can usually be differentiated on computed tomography. Endoscopic sinus surgery allows for complete removal of the polyp, including its site of origin, which minimizes the risk of recurrence.
We conducted a study to determine if employment at a children's daycare facility increases an adult's risk of carrying Streptococcus pneumoniae in general and antibiotic-resistant S pneumoniae in particular. From January through March 2003, we obtained nasopharyngeal and oropharyngeal specimens from 63 adult workers at 6 daycare facilities and 65 similarly aged controls; all but 2 controls were nonclinical employees at our tertiary care center. Culture and sensitivity data were obtained from all specimens, and written questionnaires were used to gather information on each daycare worker, control, and daycare center. The vaccination records of children at 5 of the 6 daycare centers were reviewed. Odds ratios with 95% confidence intervals were calculated to compare the rates of colonization with S pneumoniae in the daycare workers and controls. Multinomial logistic regression analysis was used to compare different daycare centers and to identify risk factors for S pneumoniae carriage. Analysis of the results revealed that the prevalence of S pneumoniae colonization among daycare workers (3/63 [4.76%]) and controls (3/65 [4.62%]) was nearly identical. Whereas no S pneumoniae isolate from a daycare worker displayed multiple drug resistance, all 3 isolates from the controls did; however, this difference was not statistically significant. We conclude that employment at a children's daycare facility in our community did not increase an adult's risk of carrying S pneumoniae. In fact, daycare workers may be even less likely to carry antibiotic-resistant S pneumoniae because of the widespread and successful use of the heptavalent pneumococcal vaccine in young children.
Marcus W. Moody, MD; David H. Chi, MD; John C. Mason, MD; C. Douglas Phillips, MD; Charles W. Gross, MD; Rodney J. Schlosser, MD
Abstract
Tornwaldt's cyst is an uncommon type of nasopharyngeal cyst that may cause clinically significant symptoms. We reviewed reports of 31,855 computed tomography (CT) scans and 21,158 magnetic resonance imaging (MRI) scans to ascertain how many Tornwaldt's cysts were discovered incidentally. These images had been obtained between Jan. 1, 1994, and Dec. 31, 1999, at the University of Virginia Health Sciences Center. We found that 32 Tornwaldt's cysts had been incidentally detected in 20 women and 12 men. Four of these cysts had been found on CT (0.013%; mean size: 0.66 cm3) and 28 on MRI (0.13%; mean size: 0.58 cm3). The overall rate was 0.06% (32/53,013). The most common indications for imaging in these patients were headache, seizures, dizziness/vertigo, and pharyngeal symptoms. We also report the case of a patient with a symptomatic Tornwaldt's cyst whose symptoms resolved after treatment with endoscopic marsupialization. Tornwaldt's cyst should be remembered as an uncommon but potentially treatable cause of many symptoms seen in a typical otolaryngology practice.
We describe an unusual case in which a 35-year-old man presented with skull base mucormycosis with osteomyelitis secondary to squamous cell carcinoma of the temporal bone. We also review the literature on the clinical characteristics, diagnosis, and treatment of mucormycosis.
Cystadenocarcinoma is a rare malignant neoplasm of the salivary gland. Treatment involves local excision; neck dissection and postoperative radiation therapy are used for clinically positive neck metastases. The prognosis varies according to the clinical stage and grade of the tumor.
Joseph Donzelli, MD; Susan Brady, MS, CCC-SLP; Michele Wesling, MA, CCC-SLP; Melissa Theisen, MS, CCC-SLP
Abstract
We conducted a prospective, descriptive study of 40 tracheotomized patients to investigate the relationships between (1) levels of accumulated oropharyngeal secretions and laryngeal penetration/aspiration status, (2) secretion levels and tube-occlusion status, and (3) tube-occlusion status and aspiration status. Assessments of secretion status were quantified with the use of a 5-point rating scale. All evaluations were made by fiberoptic endoscopic evaluation of swallowing. We found that patients with higher secretion levels were more likely to aspirate than were patients with lower secretion levels. Also, patients who tolerated placement of a tube cap had the lowest mean secretion level, and those who tolerated only light finger occlusion had the highest; likewise, most patients with normal secretion levels tolerated a capped tube, and a plurality of patients with profound secretion levels tolerated only light finger occlusion. Finally, no significant differences were observed with respect to occlusion status and aspiration rates.
Olawale A. Lasisi, MBChB; Babatunde L. Salako, MBBS; Solomon Kadiri, MBBS; Ayo Arije, MBBS; Richard Oko-Jaja, MBBS; Arinola Ipadeola, MBBS; Fatai Olatoke, MBBS
Abstract
The etiology of sensorineural hearing loss (SNHL) associated with renal failure and hemodialysis is controversial. Possible mechanisms include a shared antigenicity between the kidney and the labyrinths, osmotic alteration caused by hemodialysis, and the ototoxic effect of diuretics. We present 2 cases of SNHL associated with renal failure and its treatment. One patient was a 35-year-old man who developed profound SNHL after 5 sessions of hemodialysis, and the other was a 36-year-old woman who developed severe to profound SNHL after 7 sessions. It is our impression that both hearing losses might have been attributable to osmotic disequilibrium in the labyrinth or to an acute labyrinthine injury caused by contamination of the blood by the degraded product of an old cellulose acetate hemodialyzer membrane; the hemodialyzer had been in use for 15 years.
Derek K. Hewitt, MD, MPH; William C. Kinney, MD, MHA
Abstract
Epidermoid cysts or tumors are uncommon. When they do occur, they are usually large at presentation, and the initial symptoms usually involve the cranial nerves. Congenital epidermoids are believed to arise as a result of cellular dysfunction during embryogenesis, which leads to an abnormal migration of ectodermal cells. We present 2 cases of epidermoids that were identified incidentally at our institution during radiologic evaluations of head trauma; one was found in the sphenoid sinus and the other in the temporal bone. Both patients were treated surgically. We review the pathogenesis, diagnosis, and imaging characteristics of these epidermoids.
Daniel D. Charous, MD; Matthew T. Charous, MD; Mary F. Cunnane, MD; Joseph R. Spiegel, MD
Abstract Anomalies of the branchial apparatus occur with some frequency in the adult and pediatric populations. Branchial anomalies are most often derivatives of the first or second pouch. Branchial anomalies involving the third pouch may present as cysts, sinuses, fistulas, and ectopic glands. They are relatively rare, and they respond well to surgical removal. We report the case of a 53-year-old woman who was referred to us for evaluation of a persistent left upper neck mass. The patient had no history of a cervical mass as a child or young adult. The mass was excised uneventfully, and the final pathology revealed a normocellular parathyroid gland and thymic tissue.
Issue: November 2006 Category: Original Articles
Editorial Issue: November 2006 Category: Departments
Abstract We report the case of a 14-year-old girl who was referred to us with a 2-year history of abnormal panoramic dental x-rays. Computed tomography of the paranasal sinuses demonstrated a left unilateral maxillary sinus opacification that had been produced by an ectopic molar. The tooth was removed via an endoscopic approach rather than with a traditional Caldwell-Luc procedure. A nasal endoscope was used to create a middle meatal antrostomy and deliver the tooth and its cystic contents. The patient recovered without complications, and she exhibited no signs of recurrence at the 2-year follow-up.
Abstract Fungal sinusitis secondary to Pseudallescheria boydii is rare, as only 25 cases have been previously reported in the literature. Although P boydii resembles Aspergillus on pathologic examination, it is typically resistant to amphotericin B. Therefore, culture is necessary to differentiate the two. Patients with P boydii sinusitis should generally be treated with a combination of surgery and antifungal therapy. Combination treatment is particularly important for immunocompromised patients with fungal invasion because mortality among these patients is high. The prognosis is better for immunocompetent patients, even those with fungal invasion. We describe a new case of invasive fungal sinusitis secondary to P boydii infection, and we review the literature on this emerging pathogen.
Robert Todd Adelson, MD; Robert J. DeFatta, MD, PhD; D.J. Verret, MD; Yuenan Shen, MD
Abstract Liposarcoma is the most common soft-tissue malignancy in adults, but the appearance of a liposarcoma in the head and neck region is distinctly unusual. Intraoral liposarcomas represent a particularly interesting subset of this tumor in that (1) they are exceedingly rare and (2) affected patients tend to have a better prognosis than do patients with a similar lesion located elsewhere in the head and neck. An understanding of the histologic subtypes and corresponding clinical behavior of liposarcomas will assist physicians in appropriately managing these patients. Most of these tumors can be effectively treated with conservative surgery. We report the rare case of a well-differentiated liposarcoma arising in the tongue of a 55-year-old man. We also discuss the typical pathologic findings in these malignancies and review the diagnosis, associated controversies, management, and prognosis.
John M. Lasak, MD; Mark Van Ess, DO; Thomas C. Kryzer, MD; Richard J. Cummings, MD
Abstract We performed a retrospective review of 44 patients with middle ear injury incurred through the external auditory canal. Twenty-two of the 44 patients had presented to our center within 1 month of their injury (early group), and 22 presented later (delayed group); the mean interval from the time of the trauma to presentation was 6 days in the early group and 7 years in the delayed group. The causes of injury were penetrating trauma (70% of cases), thermal insults (20%), and explosive and nonexplosive blasts (9%). Purulent otorrhea, cholesteatoma, and ossicular discontinuity were more common in the delayed group. Otologic surgery was required in 9 early-group patients (41%) and in all 22 delayed-group patients (100%). Two patients in the early group developed a dead ear. The mean pure-tone averages (PTAs) at presentation were 30.7 and 52.2 dB in the early and delayed groups, respectively; after management, the corresponding mean PTAs were 21.0 and 42.5 dB. The respective mean air-bone gaps in the two groups were 14.6 and 28.2 dB at presentation and 8.0 and 17.2 dB after management. We conclude that middle ear injury incurred as a result of trauma sustained through the external auditory canal is associated with considerable morbidity. Patients who present in a delayed fashion have significantly poorer hearing at presentation and after management. Patients who do not develop a dead ear generally derive benefit from reconstruction of the middle ear sound-conduction mechanism.
Pediatric Otolaryngology Clinic