Infection

Endoscopic view of secretion transport in the maxillary sinus following a long-term inferior meatal antrostomy

August 10, 2012     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
article

It is important to remove any obstruction of the natural ostium of the maxillary sinus or the ethmoid infundibulum because maxillary sinus secretions will be transported toward the natural ostium even when a previously placed large and patent inferior meatal antrostomy is present.

Staphylococcus aureus cavernous sinus thrombosis mimicking complicated fungal sinusitis

July 5, 2012     Murat Songu, MD; Nazan Can, MD; Kazim Onal, MD; Secil Arslanoglu, MD; Nezahat Erdogan, MD; Aylin Kopar, MD; Ejder Ciger, MD
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Abstract

Septic cavernous sinus thrombosis is a rare and potentially life-threatening complication of infections involving the paranasal sinuses or the middle one-third of the face. We report a challenging case of cavernous sinus thrombosis to familiarize otolaryngologists with its clinical features, diagnosis, and management. The patient was a 45-year-old diabetic woman whose signs and symptoms mimicked those of complicated fungal sinusitis. She presentedwith fever, nausea without vomiting, frontal headache, bilateral ptosis and swelling, double vision, a partial loss of visual acuity in the left eye, and restricted lateral ocular movements. Her Snellen visual acuity had been reduced to 8/10 on the right and 6/10 on the left. Radiologic investigation revealed cavernous sinus extension of sphenoid sinusitis and a fungus-ball appearance in the sphenoid sinus. On the second day of her admission, the patient’s vision was further reduced to 6/10 on the right and 2/10 on the left. She then underwent urgent bilateral anterior and posterior ethmoidectomy and sphenoidectomy. At postoperative follow-up, her vision had stabilized at 10/10 bilaterally. At 2 months after discharge, she exhibited no evidence of abducens nerve palsy, and her ocular function had returned to normal. The diagnosis of cavernous sinus thrombosis requires a high index of suspicion and confirmation by imaging. The favorable outcome in our case was attributable to early diagnosis, prompt initiation of appropriate intravenous antibiotic therapy, and surgical drainage by the skillful surgical team.

Acute candidal pharyngolaryngitis

July 5, 2012     Andrew Mallon, DO; Rima A. DeFatta, MD; Robert T. Sataloff, MD, DMA, FACS
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Use of inhaled steroids has been identified as a risk factor for the development of laryngeal candidiasis. Therefore, if dysphonia, cough, and general laryngeal irritation occur in a patient using inhaled steroids, the possibility of laryngeal candidiasis should be considered.

Mycoplasma an unlikely cause of bullous myringitis

June 4, 2012     Lisa Cramer, BA; Dina M. Emara, MBBCh; Arun K. Gadre, MD, FACS
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Despite common belief, Mycoplasma pneumoniae is an extremely rare causative agent for bullous myringitis. Instead, it is caused by the same organisms responsible for acute otitis media.

A case of a giant submandibular gland calculus perforating the floor of the mouth

June 4, 2012     Raffaele Rauso, MD; Giulio Gherardini, MD, PhD; Paolo Biondi, MD; Gianpaolo Tartaro, MD; Giuseppe Colella, MD, DDS
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Abstract

Sialolithiasis is characterized by the obstruction of salivary gland secretion by a calculus. It is associated with swelling, pain, and infection of the affected gland. More than 80% of all salivary calculi occur in the submandibular gland. One reason for this is the makeup of the saliva in the submandibular gland, which includes a higher mucus content, a greater degree of alkalinity, and greater concentrations of calcium and phosphate salts compared with the saliva of the parotid and sublingual glands. Other factors are that its duct is longer and its saliva flows against gravity. Sialoliths that reach several centimeters in diameter (megaliths, or giant calculi) are rare. Perforation of the floor of the mouth by a giant calculus is extremely rare. We report such a case in a 56-year-old man who presented with a 2-day history of severe pain in the left sublingual area and painful swelling in the left submandibular area. Removal of the stone and the left submandibular gland was performed via an extraoral incision. On gross examination, the sialolith measured 5.6 cm.

Spectrum of paranasal sinus mycoses in coastal India

June 4, 2012     Jyoti R. Kini, MD; Spoorthy S. Shetty, MBBS; Hema Kini, MD
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Abstract

Fungal infections of the nose and paranasal sinuses are uncommon, and the disease they cause can be identified from their histopathologic appearance. The aim of this study was to assess the incidence of fungal infection and histopathologic changes in specimens sent for evaluation of chronic sinusitis and correlate with culture findings wherever possible. The records of 200 consecutive cases coded as paranasal sinuses over a period of 3 years were retrieved from the Department of Pathology, Kasturba Medical College, Mangalore, India. Twenty nine out of a total of 200 specimens (14.5%) were positive for fungal elements on histopathologic examination. The most common etiologic agents in our study were Aspergillus spp (37.9%); only 1 culture (3.4%) was positive for a Candida species. Eight of 29 patients with fungal sinusitis (27.6%) had diabetes, and 1 patient was being treated for rheumatoid arthritis. Eight of the 29 patients had allergic fungal sinusitis, 8 had chronic granulomatous sinusitis, and 1 had acute fulminant invasive sinusitis. Fungi have been increasingly recognized as an important pathogen in chronic sinusitis. It is imperative for patient management not only that paranasal sinus mycoses be diagnosed but also that the specific histologic category be identified.

Huge middle ear adenoma with delayed facial nerve paralysis

June 4, 2012     Seung Ho Lee, MD; Hoseok Choi, MD, PhD; Young Chae Chu, MD; Young Hyo Kim, MD; Kyu-Sung Kim, MD, PhD
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Abstract

Middle ear adenoma is a rare disease that arises from the mucosa of the middle ear. Only a few cases of associated facial nerve paralysis have been reported. Facial nerve involvement is most likely related to nerve compression rather than tumor invasion of the nerve. We describe a case of a huge middle ear adenoma in a 63-year-old man. He presented with a 1-month history of right-sided otalgia, otorrhea, and facial palsy; he also had a 10-year history of right-sided hearing loss. A tympanomastoidectomy was performed. Intraoperatively, the tumor was found to fill the middle ear cavity as well as the entire diameter of the external auditory canal. The tumor had eroded the wall of the facial canal at the second genu, and it was tightly adherent to the epineurium. Focal inflammation around the tumor was observed at the exposed facial nerve. The tumor was removed and the facial nerve was decompressed. Immediately after surgery, the patient’s aural symptoms resolved. The final pathology evaluation established the diagnosis of a middle ear adenoma. At the 3-year follow-up, the ear cavity was completely healed and facial nerve function was improved.

Streptococcus milleri head and neck abscesses: A case series

June 4, 2012     Christopher Robert Foxton, MA(Oxon); Smariti Kapila, MBBS; Justin Kong, MBBS; Neil John Thomson, FRACS
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Abstract

Streptococcus milleri infections and abscesses in the head and neck region have been previously reported, but there is still a dearth of clinical literature on this topic. To add to the available reports and to promote a better understanding and awareness of this clinically important entity, we present this retrospective review of 7 cases of head and neck abscess caused by S milleri infection. We have placed particular emphasis on antibiotic sensitivity patterns. These patients—6 men and 1 woman, aged 28 to 73 years (mean: 42.7)—had been seen at a district general hospital in Gosford, Australia, over a 6-month period. All patients had undergone surgical intervention and had been treated with intravenous antibiotics. All the S millericultures were sensitive to penicillin G, cephalexin, and erythromycin. Six of these patients experienced a resolution of their abscess, while 1 patient died from overwhelming sepsis. We believe that the initiation of penicillin G, cephalexin, or erythromycin is a good starting point for empiric therapy. S milleri should be considered as a causative organism in a patient who presents with a head and neck abscess, especially in the presence of a dental infection. Such a patient should be monitored closely for airway obstruction and distal infective sequelae. Also in this article, we compare our findings with those reported in two other published series.

Mycobacterial tuberculosis superimposed on a Warthin tumor

April 30, 2012     Kang-Chao Wu, MD; Bo-Nien Chen, MD
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Abstract

The concomitant occurrence of tuberculosis infection within a Warthin tumor is extremely rare, as only 6 cases have been previously reported in the English-language literature. We report a new case in a 92-year-old man, who presented with a 20-year history of a painless swelling in the right infra-auricular area that had recently become painful and larger. The patient had no history of tuberculosis, weight loss, or chronic cough. The fluctuant mass was aspirated, but histopathology and routine culture were negative. Computed tomography identified a 5-cm, heterogeneous, enhancing mass with multiple, variably sized, low-density areas without surrounding edema in the area of the right parotid gland. Complete excision was performed to relieve the patient's symptoms. Histopathology diagnosed an acid-fast bacillus infection within a Warthin tumor. On polymerase chain reaction testing, formalin-fixed, paraffin-embedded tissue was negative for tuberculosis, but subsequent culture identified Mycobacterium tuberculosis. Initially, the patient refused antituberculosis therapy, but he relented when miliary pulmonary tuberculosis was diagnosed 11 weeks postoperatively.

Otomycosis in immunocompetent and immunocompromised patients: Comparative study and literature review

March 1, 2012     Borlingegowda Viswanatha, MS, DLO, Dadarao Sumatha, MBBS, and Maliyappanahalli Siddappa Vijayashree, MBBS, MS
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Abstract

A comparative clinical study was carried out that included 50 cases of otomycosis in immunocompetent patients and 50 cases of otomycosis in immunocompromised patients. Clinical presentation, predisposing factors, mycologic profile, and treatment outcomes were compared. Aspergillus spp were the most commonly isolated fungi in the immunocompetent group, and Candida albicans in the immunocompromised group. Bilateral involvement was more common in the immunocompromised group. All the patients were treated with topical clotrimazole ear drops. Four patients in the immunocompromised group did not respond to treatment with clotrimazole but were treated successfully with fluconazole ear drops. Three patients had a small tympanic membrane perforation due to otomycosis.

The association between Helicobacter pylori and laryngopharyngeal reflux in laryngeal pathologies

March 1, 2012     Engin Çekin, MD, Mustafa Ozyurt, PhD, Evren Erkul, MD, Koray Ergunay, MD, Hakan Cincik, MD, Burak Kapucu, MD, and Atila Gungor, MD
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Abstract

We conducted a study to determine the presence or absence of Helicobacter pylori and laryngopharyngeal reflux (LPR) in 43 previously untreated patients who had presented with a laryngeal lesion. Our aim was to determine if there was any association among H pylori, LPR, and laryngeal lesions. H pylori status was determined by real-time polymerase chain reaction (PCR) assays of biopsy tissue obtained during direct laryngoscopy. The presence or absence of LPR was determined on the basis of patients' reflux symptom index (RSI) and reflux finding score (RFS), which were based on their questionnaire responses and findings on endoscopic examination of the larynx, respectively. Patients with an RSI of 14 or more and/or an RFS of 8 or more were considered to have LPR. H pylori was present in 24 patients (55.8%) and absent in 19 (44.2%)-not a statistically significant difference. The prevalence of LPR was higher than the prevalence of H pylori; it was present in 30 patients (69.8%) and absent in 13 (30.2%). The difference was statistically significant (p = 0.01). We found no association between H pylori status and LPR status. Additionally, we analyzed two subgroups based on whether their lesions were benign or malignant/premalignant and found a significant relationship between LPR positivity and the presence of malignant/premalignant laryngeal lesions (p = 0.03). We found no association between H pylori status and either of the two subgroup categories.

Acquired toxoplasmosis of the buccal area with extranodular involvement: Report of an unusual case

December 1, 2009     Serap Köybasi, MD, Ahmet Emre Süslü,w, MD, Beyhan Yigit, MD, and Cetin Boran, MD
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Abstract

Acquired toxoplasmosis is a common parasitic infection in humans. It can be caused by ingestion of infected meat or other food that has been contaminated by the feces of infected cats. Approximately 90% of immunocompetent patients with acquired toxoplasmosis are asymptomatic and undiagnosed; in the other 10%, toxoplasmosis manifests as a nonspecific, self-limited illness that usually does not require treatment. In symptomatic cases, cervical lymphadenopathy is one of the most common clinical findings. We report the case of a 33-year-old woman who experienced unilateral facial swelling secondary to toxoplasmosis. In addition to the atypical location of her disease (i.e., the buccal area), the atypical histopathologic findings in this case (e.g., extranodular involvement) constituted a very unusual presentation of toxoplasmosis.

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