Infection

Dengue fever: A primer for the otolaryngologist

July 21, 2013     Demetri Arnaoutakis, MD; Tapan A. Padhya, MD
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Abstract

It has been estimated that more than 50 million cases of dengue occur worldwide each year, mostly in the tropics. In light of recent cases appearing in central and southern Florida, dengue has reemerged as a public health issue in the United States with respect to infection control and prevention. We review the course of dengue infection and its clinical presentation from the perspective of the practicing otolaryngologist, and we outline tactics for prevention and management.

Laryngotracheal rhinosporidiosis

July 21, 2013     J. Madana, MS; Deeke Yolmo, MS; S. Gopalakrishnan, MS; Sunil K. Saxena, MS
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Abstract

Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi. It usually affects mucous membranes of the nose, nasopharynx, and ocular conjunctiva. Cutaneous, laryngeal, tracheal, genital, and bony dissemination is rare. Laryngotracheal involvement poses many diagnostic and therapeutic challenges. A 45-year-old South Indian man presented with complaints of a mass in both nostrils for 2 years, associated with progressive hoarseness of voice and difficulty in breathing for 6 months. Rhinosporidial lesions were seen bilaterally in the nasal cavity. Telescopic and fiberoptic laryngoscopic examinations showed reddish, strawberry-like masses with whitish spots on their surface involving the larynx and trachea. Computed tomography of the head and neck revealed soft-tissue mass lesions involving the bilateral nasal cavities and nasopharynx, extending to the oropharynx and involving the larynx and trachea. A preliminary tracheostomy was performed, followed by direct laryngoscopic excision of the laryngeal lesions and rigid-bronchoscopy-guided excision of the tracheal lesions. The patient was prescribed dapsone and advised to take it for 2 years. At 2 years of follow-up, there was no recurrence.

Oral hairy leukoplakia in an HIV- negative patient

June 11, 2013     Evan M. Graboyes, MD; Clint T. Allen, MD; Rebecca D. Chernock, MD; and Jason A. Diaz, MD
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Abstract

We report the case of a 31-year-old woman with systemic lupus erythematosus who was found to have oral hairy leukoplakia (OHL). She was on immunosuppressive therapy but was human immunodeficiency virus (HIV)-negative. OHL has been previously reported in HIV-negative patients who were immunosuppressed for other reasons, such as solid organ or hematopoietic stem cell transplantation, hematologic malignancies, or systemic diseases. To the best of our knowledge, this is the first case of OHL in an HIV-negative patient reported in the otolaryngology literature. It adds to the growing list of cases of OHL in HIV-negative patients and serves as a reminder to physicians to include OHL in the differential diagnosis for oral cavity lesions in all immunosuppressed patients. The article also summarizes the current state of knowledge about the pathogenesis of OHL, its relation to the Epstein-Barr virus, and the treatment options.

Methicillin-resistant Staphylococcus aureus as a cause of neonatal suppurative parotitis: A report of two cases and review of the literature

June 11, 2013     Sean T. Donovan, MD; Grant T. Rohman, MD; John P. Selph, MD; Roy Rajan, MD; Rosemary M. Stocks, MD; and Jerome W. Thompson, MD, MBA
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Abstract

Suppurative parotitis is an uncommon entity identified in newborns. While Staphylococcus aureus has been frequently identified as the causative pathogen among the few patients diagnosed with neonatal suppurative parotitis (NSP), there has only been one prior case described in the literature that was due to methicillin-resistant Staphylococcus aureus (MRSA). Because of its virulence, MRSA presents new and substantial challenges for the surgeon; we describe two cases of NSP caused by MRSA and the subsequent surgical intervention necessitated for cure. We also include a review of all cases of NSP described in the English-language literature.

Letters to the Editor

June 11, 2013    
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Does tonsillectomy affect the outcome of drug treatment for the eradication of gastric H pylori infection? A pilot study

March 24, 2013     Ozan Seymen Sezen, MD; Utku Kubilay, MD; Yusuf Erzin, MD; Murat Tuncer, MD; Seref Unver, MD
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Abstract

Eradication of Helicobacter pylori, which is associated with diverse gastroduodenal pathologies of varying severity, is sometimes challenging. We conducted a prospective study to determine the effect of tonsillectomy on the eradication of H pylori from the gastrointestinal tract. Our study population was made up of 46 patients-32 females and 14 males, aged 14 to 58 years (mean: 28.84 ± 9.65)-who had chronic tonsillitis and concomitant dyspepsia. An initial gastrointestinal endoscopy was performed to obtain specimens for histology and a rapid urease test. These gastroscopies revealed that 32 patients were H pylori-positive (69.6%) and 14 were H pylori-negative (30.4%); these groups were designated A and B, respectively. The 32 H pylori-positive patients were divided into three subgroups based on the sequence in which they underwent drug therapy and tonsillectomy. All 3 subgroups received the same 14-day combination-drug regimen for eradication of gastric H pylori. The patients in group A1 (n = 12) underwent tonsillectomy prior to receiving drug treatment; 2 months after the cessation of drug therapy, they underwent a second gastroscopy. The patients in group A2 (n = 10) received drug treatment first followed by tonsillectomy; 2 months later, they underwent their second gastroscopy. The patients in group A3 (n = 10) received drug treatment first, then they underwent a second gastroscopy, and then they were taken for tonsillectomy. The success or failure of H pylori eradication was determined by the second gastroscopy. Also, analyses were performed after tonsillectomy to look for H pylori infection in tonsillar specimens. Eradication of gastric H pylori was achieved in 9 of the 12 group A1 patients (75.0%), 8 of the 10 group A2 patients (80.0%), and 7 of the 10 group A3 patients (70.0%); there were no statistically significant differences among the three groups. Likewise, there were no significant differences between any subgroups or combination of subgroups in terms of tonsillar positivity. As far as we know, this is the first study to investigate the effect of tonsillectomy on the outcome of H pylori eradication treatment. In light of our findings, we may speculate that tonsillar tissue does not seem to be a reservoir for H pylori infection. Although tonsillectomy had no significant effect on gastric H pylori eradication in our study, our results might have been skewed by the relatively small size of our sample.

Necrotizing cervical fasciitis: Prognosis based on a new grading system

March 24, 2013     Jagdeep Singh Thakur, MS; Neeti Verma, MS; Anamika Thakur, MD; Dev Raj Sharma, MS; Narinder Kumar Mohindroo, MS, DORL
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Abstract

We conducted a 10-year retrospective study to determine the prognosis of necrotizing cervical fasciitis (NCF). Our study population included 38 patients-32 males and 6 females, aged 10 months to 70 years (mean: 55 yr)-who had presented for management of NCF at our tertiary care hospital between Jan. 1, 2000, and Dec. 31, 2009. We classified each case into four categories based on the duration of disease prior to presentation, the severity of disease, and other factors that influence outcomes. We found that the most important factor in determining prognosis was the time interval between the onset of NCF and subsequent presentation for specialist or surgical intervention. Patients with a higher grade of NCF had longer hospital stays. Although aggressive surgical and medical intervention is the gold standard for the management of NCF, many of our patients presented with a relatively healthy appearing wound, which could mislead the evaluating clinician and delay prompt management. We believe that our new grading system will help obviate this problem and make clinicians more vigilant when faced with a new case of necrotizing fasciitis.

Recurrent post-tympanostomy tube otorrhea secondary to aerobic endospore-forming bacilli: A case report and brief literature review

February 25, 2013     James J. Jaber, MD, PhD; Matthew L. Kircher, MD; Eric Thorpe, MD; Ryan G. Porter Sr., MD; John P. Leonetti, MD; Sam J. Marzo, MD
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Abstract

We report a unique case in which a 57-year-old man with an 8-year history of late recurrent post-tympanostomy tube otorrhea (PTTO) was found to harbor Bacillus subtilis, an aerobic endospore-forming bacillus that is typically resistant to chemical and physical agents because of its unique life cycle. Removal of the patient's tympanostomy tube resulted in complete resolution of his long-standing otorrhea. We also review the etiologies of and treatment strategies for early, late, chronic, and recurrent PTTO. We conclude that regardless of the etiology, a patient with persistent or recurrent PTTO should consider undergoing removal of the ventilation tube.

Hyperplastic epiglottis caused by chronic inflammation

January 24, 2013     Mark D. Wilkie, MBChB; Samuel C. Leong, MPhil; Alessandro Panarese, FRCS; Arnab Banerjee, FRCS
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Due to the development of Hib vaccines, the epidemiology of epiglottitis has shifted dramatically back toward adult presentations, with a marked decline in the incidence among children.

Middle ear atelectasis

October 31, 2012     Min-Tsan Shu, MD; Kang-Chao Wu, MD; Yu-Chun Chen, MD
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Tympanic membrane retraction caused by long-term eustachian tube dysfunction may lead to erosion of the ossicles and cholesteatoma.

Chromobacterium violaceum necrotizing fasciitis: A case report and review of the literature

October 31, 2012     Jonathan K. Seigel, MD; Michael E. Stadler, MD; Jennifer L. Lombrano, DDS; Jeffrey S. Almony, MD, DDS; Marion E. Couch, MD, PhD; and Thomas H. Belhorn, MD, PhD
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Abstract

Necrotizing fasciitis is a severe, rapidly progressive infection of the subcutaneous tissue that causes significant destruction. It is rarely encountered in the pediatric population. We describe the case of a 14-year-old boy who was diagnosed with Chromobacterium violaceum necrotizing fasciitis and subsequently found to have autosomal recessive chronic granulomatous disease.

Otogenic pneumocephalus as a complication of multiple myeloma

September 7, 2012     Melissa J. Maguire, MD; Uma Nath, MD; Guiseppe E. Bignardi, MD
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Abstract

We report a case of otogenic pneumocephalus in an 80-year-old woman with multiple myeloma. The pneumocephalus was associated with Haemophilus influenzae otitis media and reactive meningitis in the absence of an intracranial brain abscess. Myeloma causes thinning of bone trabeculae and destructive lytic bone lesions. This can predispose to a risk of pathologic fractures and, in patients with skull vault involvement, to the rare complication of pneumocephalus. Therefore, pneumocephalus should be considered in the differential diagnosis of acute headache in patients with multiple myeloma, especially those with skull vault involvement. Prompt computed tomography and liaison between the otolaryngology and neurology teams may assist in making an early diagnosis and preventing life-threatening intracranial complications.

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