Trauma

Middle ear barotrauma with hyperbaric oxygen therapy: Incidence and the predictive value of the nine-step inflation/deflation test and otoscopy

December 1, 2008     Serdar Karahatay, MD, Yavuz Fuat Yilmaz, MD, Hakan Birkent, MD, Hakan Ay, MD, and Bulent Satar, MD
article

Abstract

We conducted a prospective study to determine the incidence of middle ear barotrauma in patients who were undergoing hyperbaric oxygen therapy (HBOT). We also investigated the value of the nine-step inflation/deflation test and otoscopic findings before and immediately after the initial HBOT session in predicting barotrauma in an attempt to establish some criteria for prophylaxis. The study was conducted on 36 ears of 18 adults who had no history of eustachian tube dysfunction. Patients were being treated with HBOT for sudden hearing loss, wound-healing complications, or complications of diabetes. After 7 days of HBOT, barotrauma was seen in 12 of the 18 patients (66.7%) and in 18 of the 36 ears (50.0%). The nine-step inflation/deflation tests, which were performed before and immediately after the initial HBOT session, were not predictive of barotrauma (p = 0.095 before and p = 0.099 after). However, otoscopic findings obtained immediately after the first session of HBOT were predictive of barotrauma, with a sensitivity and specificity of 83 and 100%, respectively. We conclude that patients with even minor positive pathologic findings on otoscopy immediately following HBOT are at increased risk of middle ear barotrauma if HBOT is to be continued without prophylaxis.

Eagle syndrome: Case report and review of the literature

October 31, 2008     Esther Kim, MD, Karla Hansen, MD, and James Frizzi, MD, FACS
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Abstract

Eagle syndrome, which is an uncommon sequela of elongation of the styloid process, can manifest as pain in the anterolateral neck, often with referred pain to the ear. In most cases, the elongation is an acquired condition, often occurring as a result of a traumatic incident, including tonsillectomy. We describe the case of a 57-year-old man who experienced unremitting right neck pain for several years following an accidental fall. A multidisciplinary investigation identified an elongated styloid process. Surgical shortening of the structure provided definitive relief of the patient's symptoms. We review the anatomy of the peristyloid structures and discuss the etiology, diagnosis, and treatment of Eagle syndrome.

Traumatic pseudoaneurysm of the occipital artery: Case report and review of the literature

October 31, 2008     Manish Patel, MD, Hisham Tchelepi, MD, and Dale H. Rice, MD
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Abstract

Only 3 cases of traumatic pseudoaneurysm of the occipital artery have been reported since 1644. We report a fourth case, which occurred in an 85-year-old woman who experienced a blunt trauma during a fall. The pseudoaneurysm resolved without surgical intervention. We also review the literature on traumatic pseudoaneurysms, as well as true aneurysms, of the external carotid system, with emphasis on current diagnostic and therapeutic options.

Mucosal tear

September 25, 2008     Mark A. Ginsburg, DO, Robert L. Eller, MD, and Robert T. Sataloff, MD, DMA
article

CSF rhinorrhea secondary to use of a Mayfield head clamp

June 30, 2008     Ioannis Moumoulidis, MD, MRCS and Helen Fernandes, FRCS; Ran De, FRCS
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Abstract

Various complications with use of a Mayfield head clamp have been reported, from minor skin necrosis and lacerations to the more significant extradural hematomas and meningitis. To the best of our knowledge, our report describes for the first time in the medical literature, the uncommon complication of frontal sinus fracture and cerebrospinal flu-id leak caused by a scalp pin of a head clamp used during a frontal craniotomy. The cerebrospinal fluid leak settled with conservative management, and no surgical intervention was necessary. Clinicians should appreciate the possibility of such a complication and assess preoperative scans for frontal sinuses that extend to a high level, as in our patient.

Palatal perforation from cocaine abuse

April 30, 2008     Marc Cohen, MD, Vishad Nabili, MD, and Dinesh K. Chhetri, MD
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Auricular injury with deformity following delivery by cesarean section

March 1, 2008     Sandeep P. Dave, MD and Steven D. Handler, MD
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True vocal fold pseudocyst

February 1, 2008     Mark A. Ginsburg, DO, Robert L. Eller, MD, and Robert T. Sataloff, MD, DMA
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Masticatory diplopia

January 1, 2008     Oleg Militsakh, MD and J. David Kriet, MD, FACS
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Abstract

We report a case of diplopia that was exacerbated by chewing in a patient who had sustained facial fractures in a motorcycle crash. The diplopia was corrected surgically 1 year following the accident. To the best of our knowledge, masticatory diplopia as a result of adhesion of the temporalis muscle to the periorbita secondary to facial trauma has not been previously reported.

Post-traumatic cervical chyloma

January 1, 2008     Juan Gomez, MD, Enrique Palacios, MD, FACR, and Jagan D. Gupta, MD
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Chondrodermatitis nodularis helicis

December 1, 2007     Lester D. R. Thompson, MD, FASCP
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Migration of cochlear implant magnets after head trauma in an adult and a child

September 30, 2007     Robert J. Stokroos, MD, PhD; Pim van Dijk, PhD
article
Abstract

Cochlear implantation is considered to be a safe and effective treatment for severe to profound sensorineural hearing loss. Device failures are rare. We report the cases of 2 patients-a 44-year-old woman and a 3-year-old boy-with cochlear implants who were referred to our tertiary cochlear implant center for treatment of magnet migration secondary to mild head trauma. The migra-tion had led to device failure in both cases. Surgical re- exploration was performed with nonmagnetic instruments, and both magnets were easily returned to their proper place. Postoperatively, implant function was restored to previous levels, and wound healing was uncomplicated. The incidence of magnet migration in cochlear implant patients is unknown. A few cases have been reported in children, but to the best of our knowledge, ours is the first report of magnet migration in an adult.

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