Pharynx

Proton pump inhibitors: Adverse effects

December 17, 2010     Robert T. Sataloff, MD, DMA, FACS, Editor-in-Chief
article
Most otolaryngologists are now aware of the importance and high incidence of laryngopharyngeal reflux (LPR), especially in patients with voice complaints. Although many controversies remain regarding optimal diagnosis and treatment, long-term therapy with acid suppression is used commonly.

Hypopharyngeal diverticulum formation following anterior discectomy and fusion: Case series

October 31, 2010     Terah J. Allis, MD, Nazaneen N. Grant, MD, and Bruce J. Davidson
article

Abstract

Pharyngoesophageal diverticulum is a rare complication following anterior cervical discectomy and fusion (ACDF). Dysphagia is a well-documented complication associated with ACDF. It may result postoperatively from a variety of etiologies, including hardware displacement, pharyngeal edema, or vocal fold paresis. One rare cause of persistent dysphagia is the formation of a hypopharyngeal diverticulum, reported in the literature in 9 previous cases. Such diverticula after ACDF surgery may have pathogenesis that is distinct from that of typical Zenker diverticula. We report 3 new cases of hypopharyngeal diverticula in patients who underwent revision ACDFs. Variables assessed included age, sex, level of fusion, ACDF-related complications, and diverticulum management. Two patients underwent successful open surgical diverticulectomy and cricopharyngeal myotomy. In the third case, the patient had a small diverticulum close to the surgical hardware and minimal symptoms and was managed conservatively. Our cases, combined with the 9 previous cases, demonstrate commonalities, particularly with regard to the risk of revision spinal surgery and infection and subsequent hypopharyngeal diverticula development. Hypopharyngeal diverticulum can occur as a complication of ACDF and should be considered in patients with persistent dysphagia after surgery. In this patient population, open resection and cricopharyngeal myotomy are recommended.

Effects of chlorhexidine/benzydamine mouth spray on pain and quality of life in acute viral pharyngitis: A prospective, randomized, double-blind, placebo-controlled, multicenter study

October 31, 2010     Cemal Cingi, MD, Murat Songu, MD, Ahmet Ural, MD, Muzeyyen Yildirim, MD, Nagehan Erdogmus, MD, and Cengiz Bal, MD
article

Abstract

We conducted a prospective, randomized, double-blind, placebo-controlled, multicenter study to assess the efficacy of chlorhexidine gluconate/benzydamine HCl mouth spray for reducing pain and improving quality of life in patients with acute viral pharyngitis. Prior to treatment, patients rated the intensity of their pain on a visual analog scale and evaluated their quality of life on the 36-Item Short-Form Health Survey. Patients were then randomized to receive either paracetamol (acetaminophen) plus chlorhexidine/benzydamine or paracetamol plus placebo for 7 days. On days 3 and 7 of treatment, the participants again rated the intensity of their pain, and on day 7, they again rated their quality of life. A total of 164 patients were evaluable at study's end-80 in the chlorhexidine/benzydamine group and 84 in the control group. A comparison of self-evaluations revealed that the active treatment group reported less pain on both day 3 (p < 0.001) and day 7 (p = 0.002). Likewise, the chlorhexidine/benzydamine group reported a significantly better quality of life on day 7 (p < 0.001). Chlorhexidine/benzydamine was well tolerated, and no serious adverse events were observed.

Nasopharyngeal glioma causing respiratory distress in a neonate: Transoral endoscopic excision

April 30, 2010     Young Hak Park, MD, Sung Won Kim, MD, PhD, Seung Ho Cho, MD, and Yong Woo Choi, MD
article

Abstract

Nasal gliomas are rare, benign, congenital midline tumors made up of heterotopic neuroglial tissue. They have the potential for intracranial extension. They are commonly seen in newborns and children, and rarely in adults. Preoperative diagnostic imaging is essential to delineate the exact location, limits, and extensions of the tumor and thus to determine the appropriate surgical approach. Endoscopic surgery is considered appropriate for the removal of an intranasal glioma without intracranial extension. We describe a rare case of nasopharyngeal glioma in a newborn who presented with early respiratory distress, and we include a review of the literature.

Sensitivity and specificity of rapid antigen detection testing for diagnosing pharyngitis in the emergency department

March 31, 2010     Sezgin Sarikaya, MD, Can Akta&scedil;, MD, Didem Ay, MD, Asli Çetin, MD, and Ferudun Celikmen, MD
article

Abstract

Acute pharyngitis in adults is primarily a viral infection; only about 10% of cases are of bacterial etiology. Most cases of bacterial pharyngitis are caused by group A beta-hemolytic streptococci (GABHS). One laboratory method for the diagnosis of GABHS is rapid antigen diagnostic testing (RADT), which can be processed during an emergency department visit and which has become a popular alternative to throat swab cultures. We conducted a study to define the sensitivity and specificity of RADT, using throat culture results as the gold standard, in 100 emergency department patients who presented with symptoms consistent with streptococcal pharyngitis. We found that RADT had a sensitivity of 68.2% (15 of 22), a specificity of 89.7% (70 of 78), a positive predictive value of 65.2% (15 of 23), and a negative predictive value of 90.9% (70 of 77). We conclude that RADT is useful in the emergency department when the clinical suspicion is GABHS, but results should be confirmed with a throat culture in patients whose RADT results are negative.

Giant retropharyngeal abscess in an adult as a complication of acute tonsillitis: Case report

October 31, 2009     Cem Ozbek, MD, Safak Dagli, MD, E. Evrim Unsal Tuna, MD, Onur Ciftci, MD, and Cafer Ozdem, MD
article

Abstract

Retropharyngeal abscess is an uncommon entity that can have severe and even fatal complications if it is not identified and treated early. Clinical and radiologic findings must be considered together prior to surgical drainage of a suspected retropharyngeal abscess. Airway obstruction may require emergent surgical management with tracheotomy. We describe the case of a 22-year-old man with a massive retropharyngeal abscess that was caused by inadequate treatment of acute tonsillitis. He responded well to surgical drainage and empiric antibiotic therapy.

Bean sprout impaction in the pharynx: Two cases of this unusual foreign body

August 31, 2009     Dulani Mendis, DOHNS, MRCS and Simon Thorne, DLO, MRCSEd
article

Abstract

We report 2 cases of bean sprout impaction in the pharynx. To the best of our knowledge, pharyngeal impaction of a bean sprout has not been previously described in the literature. We also comment on the theoretical infective risks associated with the long-term impaction of organic foreign bodies and the validity of a thorough ENT examination, even when the foreign body appears to be insignificant.

Nontraumatic retropharyngeal abscess complicated by cervical osteomyelitis and epidural abscess in post-Katrina New Orleans: Four cases

June 30, 2009     Sabeen Faruqui, MS, Enrique Palacios, MD, Paul Friedlander, MD, Miguel Melgar, MD, PhD, Jorge Alvernia, MD, and Phillip Vaughan Parry, MD
article

Abstract

Most retropharyngeal abscesses, including iatrogenic cases, are caused by trauma. Nontraumatic retropharyngeal abscesses usually occur secondary to infection of the retropharyngeal lymph nodes. Because these particular nodes usually disappear by the age of 4 or 5 years, a nontraumatic retropharyngeal abscess in an adult is extremely rare. When they do occur in adults, they are generally seen in immunocompromised patients and in intravenous drug abusers. Left untreated, a retropharyngeal abscess can lead to rare and fatal complications such as cervical osteomyelitis, epidural abscess, and discitis. Retropharyngeal abscesses can be diagnosed with a thorough history of risk factors, an examination for neurologic deficits, and radiologic studies, particularly magnetic resonance imaging. Treatment involves intravenous antibiotic therapy and surgical drainage. During follow-up, it is important to closely monitor the results of clinical neurologic examinations and weekly determinations of the C-reactive protein level and erythrocyte sedimentation rate in order to assess the response to therapy. We report 4 cases of nontraumatic retropharyngeal abscess complicated by cervical osteomyelitis and epidural abscess that were seen in New Orleans within 3 years of Hurricane Katrina, which struck the U.S. Gulf Coast in August 2005.

Malignant rhabdoid tumor of the parapharyngeal space

March 1, 2009     Anthony Sparano, MD, Portia Kreiger, MD, and Ken Kazahaya, MD
article

Abstract

Malignant rhabdoid tumor has been a somewhat controversial entity since it was first described in 1978 as a possible sarcomatous variant of Wilms tumor. Eventually, however, it was found to be a distinct neoplastic tumor with histologic characteristics similar to those of rhabdomyosarcoma. Malignant rhabdoid tumors affect children. Clinically, they occur primarily in the kidney, and they behave aggressively. Associated mortality is significant, even with combined-modality treatment regimens. We describe the case of a large extrarenal malignant rhabdoid tumor of the parapharyngeal space with extension to the infratemporal fossa and skull base in a previously healthy 2-year-old girl who had presented with a cervical mass and ipsilateral Horner syndrome. The patient underwent complete surgical extirpation of the lesion and received adjunctive cisplatin chemotherapy and radiation therapy, and she remained disease-free at 9 months of follow-up. Given the age group of the patients that these neoplasms most commonly affect and given the neoplasms' resemblance to rhabdomyosarcoma and other small round-cell tumors of the head and neck, discussion of the associated clinical pathology, imaging characteristics, histopathologic features, and mode of management are of particular importance, especially so in view of the uncommon location of the tumor in this specific case. Such a discussion may help lead to minimization of misdiagnosis and maximization of therapeutic benefit.

Smooth-muscle tumor of the parapharyngeal space

February 1, 2009     Sofia Avitia, MD, Jason Hamilton, MD, and Ryan F. Osborne, MD, FACS
article

Viral supraglottitis in an adult

February 1, 2009     Ali Lotfizadeh, MD and Dinesh K. Chhetri, MD
article

Intravascular papillary endothelial hyperplasia (Masson lesion) of the hypopharynx and larynx

December 1, 2008     M. Güven Güvenç, MD, Levent Dereköylü, MD, Nazim Korkut, MD, Ferhan Öz, MD, and Büge Öz, MD
article

Abstract

Masson lesion is characterized by a benign intravascular papillary hyperplasia and subsequent thrombosis. Clinically, this lesion can be misdiagnosed as mucocele, hemangioma, Kaposi sarcoma, angiosarcoma, pyogenic granuloma, and several other lesions. In this article, we report a case of intravascular papillary endothelial hyperplasia of the hypopharynx and larynx, which caused dysphagia in an 18-year-old female patient. The lesion was excised entirely via a lateral pharyngotomy approach. We discuss the clinical and histopathologic features, differential diagnosis, and treatment of this uncommon entity.

PreviousPage
of 5Next