Tracheal amyloidosis-an unusual cause of stridor

April 30, 2009     Emer E. Lang, FRCS(ORL), Eimear Phelan, AFRCSI, and Helena Rowley, FRCS(ORL)


Amyloidosis confined to the trachea is an exceedingly rare entity. We describe the case of a 63-year-old man who presented with a history of dysphonia and stridor. Rigid bronchoscopy revealed a segment of abnormal tissue at the midtracheal level, resembling granulation tissue. A stent was placed in an attempt to secure the patient's airway, which was >50% narrowed. Although the patient's stridor disappeared completely, 5 days postoperatively it recurred, worsening within hours. Emergency bronchoscopy revealed that the tracheal stent was almost completely obstructed with amyloid and granulation tissue, despite high-dose steroid therapy, and had to be removed. Tracheostomy was performed to bypass the diseased trachea. We also highlight some of the problems encountered with tracheal stenting in benign tracheal disease.

Ehlers-Danlos syndrome presenting as dysphonia and manifesting as tongue hypermobility: Report of 2 cases

February 1, 2009     Jeremy D. Richmon, MD, Jessica Wang-Rodriguez, MD, and Apurva A. Thekdi, MD


Ehlers-Danlos syndrome (EDS) comprises a group of related hereditary connective tissue diseases. EDS manifests as joint hypermobility, tissue elasticity, and easy bruising. Although affected patients typically present to primary care physicians, orthopedists, and rheumatologists, some head and neck symptoms (e.g., dysphonia, dysphagia, and/or temporomandibular joint complaints) may direct some to an otolaryngologist. We describe the cases of 2 patients who presented to our otolaryngology clinic for evaluation of dysphonia. On physical examination, both exhibited tongue hypermobility, and both were subsequently diagnosed with EDS. We also review the results of our comprehensive literature search, in which we found only 3 articles that specifically described tongue hypermobility; in each case, the hypermobility was related to EDS. Finally, we discuss presentations of EDS that otolaryngologists might encounter.

A rare cause of dysphonia

July 31, 2008     Iman Naseri, MD, Sarah K. Wise, MD, and Adam M. Klein, MD


Although dysphonia is a common complaint among patients seen in an otolaryngology clinic, an autoimmune cause of the problem is less common. Autoimmune disease can be the source of various laryngologic manifestations, but diagnosis depends on a high index of suspicion, careful patient evaluation and testing, and videolaryngoscopy (videostroboscopy if available) to uncover specific identifying findings. This report describes a patient presenting with upper-range vocal difficulties who was found to have early systemic lupus erythematosus.

Recurrent respiratory papillomatosis

January 1, 2008     Soham Roy, MD and Richard J. Vivero, MD

Laryngeal amyloidosis: A case of 'Adidas-stripes' larynx

June 30, 2007     Gauthier Desuter, MD, MS; Marc Hamoir, MD; Christophe Van Geem, MD; Donatienne Boucquey, MS

Teflon granuloma

March 1, 2007     James R. Tate, MD; Peter C. Belafsky, MD, PhD; Kristen Vandewalker, MD

Asymmetric Reinke's edema

February 1, 2007     Robert Eller, MD; Mary Hawkshaw, BSN, RN, CORLN; Robert T. Sataloff, MD, DMA

The 'sentinel clot' sign in spontaneous retropharyngeal hematoma secondary to parathyroid apoplexy

August 31, 2006     George Koulouris, FRANZCR; Marcus Pianta, MBBS; Stephen Stuckey, FRANZCR
Spontaneous retropharyngeal hemorrhage from a cervical parathyroid adenoma is a rare complication of primary hyperparathyroidism. Because of its rarity, it has seldom been documented in the radiologic or ENT literature. Patients may present with a variety of manifestations, ranging from dysphagia to dysphonia to life-threatening dyspnea or hemorrhage. Awareness of a possible thyroid or parathyroid etiology may expedite treatment and prevent unnecessary interventions. We present a case of spontaneous retropharyngeal hemorrhage in which the "sentinel clot" sign enabled us to identify the lesion of origin.

Herpes simplex virus infection presenting as a piriform sinus mass

June 30, 2006     Laurie A. Brigandi, DO; Paul V. Lanfranchi, DO; Edward D. Scheiner, DO, FOCOO; Scott L. Busch, DO, FACS
Evidence is accumulating that herpes simplex virus (HSV) infection is implicated in oncogenesis. HSV antigens have been observed in some oral cancers. We present the case of a 62-year-old man who presented with dysphagia, odyno-phagia, and dysphonia and who was found on computed tomography (CT) to have a mass in his piriform sinus. We suspected a malignancy, but histopathology of biopsy specimens revealed that the mass exhibited the classic signs of the HSV cytopathic effect, including the presence of intranuclear inclusion bodies, ballooning degeneration of epithelial cells, and a ground-glass appearance of some nuclei. The patient responded well to antiviral therapy, and posttherapy CT revealed that the mass had resolved completely. To the best of our knowledge, this is the first report in the literature of a case of HSV infection presenting as a piriform sinus mass.

The paresis podule

September 30, 2005     Stacey L. Halum, MD; Jamie A. Koufman, MD

Pediatric vocal fold cysts: Acute dysphonia

April 1, 2005     Adam Rubin, MD; Johnathan B. Sataloff; Robert T. Sataloff, MD, DMA

Hemorrhagic polyp following intubation

July 31, 2004     Adam D. Rubin, MD; Robert T. Sataloff, MD, DMA
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