October 31, 2012 John Hanna, DO; Joseph Bee, DO; and Robert T. Sataloff, MD, DMA, FACS
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Abstract
Alendronate is commonly used in the treatment of osteoporosis and other bone diseases. Its drug profile includes many recognized side effects, and the literature includes case reports of esophageal irritation and ulceration. However, little has been published about laryngeal effects. We describe the case of a 77-year-old man who presented with hemoptysis secondary to laryngeal ulceration caused by the inadvertent misuse of alendronate. This case highlights the need for otolaryngologists to be familiar with alendronate and its side effects.
October 31, 2012 Taha Tahir Bekci, MD; Mesut Tezer, MD; Nurdogan Ata, MD; Levent Emre, MD
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Abstract
We describe 2 cases of obstructive sleep apnea syndrome (OSAS) that were found to be caused by the presence of laryngeal masses. Both patients presented with a long-standing history of snoring, gasping for air while sleeping, excessive daytime sleepiness, and morning headaches. In both patients, the lesions were discovered by fiberoptic nasopharyngoscopy. Patient 1, a 46-year-old man, declined surgery, and his lesions (and OSAS) resolved spontaneously in 4 months. Patient 2, a 39-year-old man, did undergo excision of his mass, and he also experienced an alleviation of OSAS.
October 31, 2012 Umit Taskin, MD; Omer Binay, MD; Cigdem Binay, MD; Ozgur Yigit, MD
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Abstract
Hyponatremia develops as a result of the inappropriate secretion of antidiuretic hormone. In rare cases, it develops as an iatrogenic complication. For example, acute iatrogenic post-tonsillectomy hyponatremia has been described in children following the infusion of hypo- or isotonic fluid. We report a case of rapidly developing post-tonsillectomy iatrogenic hyponatremia in a 5-year-old girl following an excessive infusion of hypotonic fluid. Her signs and symptoms began with nausea and vomiting and progressed to seizures and coma. We corrected the electrolyte disturbance by infusing a 3% sodium chloride solution until her neurologic manifestations disappeared, at which time her serum sodium concentration had risen back to 135 mEq/L. Otolaryngologists are not generally exposed to much information about hyponatremia, so we must be aware of its associated neurologic signs and symptoms.
October 8, 2012 Eliana Verghese, MD; Rima A. DeFatta, MD; Robert T. Sataloff, MD, DMA, FACS
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If voice therapy does not improve vocal fold atrophy and muscle tension dysphonia, then medialization laryngoplasty by injection or thyroplasty may be indicated.
October 8, 2012 Murat Ulusan, MD; Rasim Yilmazer, MD; Yasemin Ozluk, MD; Murat Enoz, MD; Yusufhan Suoglu, MD
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Abstract
Laryngeal osteosarcoma is an extremely rare disease. Only 23 cases have been published in the literature. Radiation-induced laryngeal osteosarcoma is even rarer; this is only the third such case to be reported. A 59-year-old man underwent radiotherapy for an in situ laryngeal squamous cell carcinoma at another institution. Five years later he developed a laryngeal osteosarcoma, and a total laryngectomy was performed. Although previous reports showed a poor prognosis, our patient was without disease at the 8-year follow-up. To the best of our knowledge, this is the longest disease-free follow-up to be reported in the literature. We also present a review of the world’s literature.
October 4, 2012 Neil Tanna, MD, MBA; Nisha Chadha, MD; Raman R. Sharma, BS; Joseph F. Goodman, MD; Nader Sadeghi, MD
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Abstract
Ossifying fibromyxoid tumor (OFMT) is a rare, recently described entity. As such, there is a paucity of information in the literature regarding this neoplasm. According to most reports, the tumor usually develops subcutaneously in the soft tissues of the extremities. Malignant forms of the tumor are far more rare than their benign counterparts. We present a new case of a malignant OFMT of the parapharyngeal space in a 33-year-old Pakistani man. The tumor was excised, and the patient did well with no complications. This case represents a rare occurrence of OFMT of the parapharyngeal space.
October 4, 2012 Elisa A. Illing, MD; Stacey L. Halum, MD
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Abstract
Rosai-Dorfman disease is a rare histiocyte disorder that is typically characterized by massive cervical lymphadenopathy. Isolated extranodal involvement is uncommon, and isolated laryngeal involvement is extremely rare. We report an unusual case of Rosai-Dorfman disease with isolated laryngeal involvement that led to recurrent dysphonia and airway obstruction. We discuss the challenges we faced in reaching a correct pathologic diagnosis and in deciding on an appropriate treatment regimen. Based on our experience, we believe that Rosai-Dorfman disease should be considered as a differential diagnosis in patients who present with a recurrent inflammatory (histiocytic) mass lesion of the larynx.
September 7, 2012 Jenna Briddell, MD; Andrew Mallon, DO; Rima A. DeFatta, MD; Farhad Chowdhury, DO; Matthew Nagorsky, MD, FACS
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Patients with an isolated cornu fracture can be asymptomatic in the acute setting, only to develop symptoms of chronic odynophagia and globus sensation months after the inciting injury.
September 7, 2012 Arturo Loaiza-Bonilla, MD; Flavia Rossi, MD; Bassel Alkhalil, MD
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Abstract
Primary tracheal carcinoid tumor is an extremely rare disorder that has been reported only occasionally in the medical literature. We report a case of a 36-year-old African American woman who presented to the emergency department complaining of persistent neck pain for the preceding week. She was 2 weeks postpartum and had no significant medical history. Laboratory workup was unremarkable. Computed tomography and magnetic resonance imaging showed a polypoid mass in the trachea. After bronchoscopy and laser ablation of the mass were performed, the final diagnosis of carcinoid tumor was made. To our knowledge this is the first reported case of this tumor in a postpartum patient. Further studies regarding the interactions between the natural history of carcinoid tumors and pregnancy are warranted. Their infrequency, clinical features, and pathophysiology make tracheal carcinoid tumors a formidable and interesting diagnostic challenge.
September 7, 2012 Edward E. Katime, MD; Jasvir S. Khurana, MD; Oneida A. Arosarena, MD
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Abstract
Prostate cancer, which is the most common cancer among men, rarely metastasizes to the neck. We report a case of prostatic carcinoma that metastasized to the larynx in a 71-year-old man who presented with hoarseness and shortness of breath. Computed tomography (CT) detected a 2.9 × 3.1 × 2.6-cm mass that extended from the cricoid and arytenoid cartilages into the superior trachea. Findings on histopathology and immunohistochemistry of the laryngeal tumor were consistent with a metastasis of the patient’s earlier prostate cancer. CT of the chest later detected a soft-tissue mass in the right paraspinal area and other thoracic pathology that represented metastatic disease. The patient was treated with palliative radiation therapy. As androgen deprivation therapy continues to increase the life expectancy of prostate cancer patients, detection of distant metastases will likely increase, as well. Urogenital cancer metastatic to the head and neck should be considered in the differential diagnosis of laryngeal masses.
September 7, 2012 Nicola A. Clayton, MScMed, BAppSc; Giselle D. Carnaby-Mann, MPH, PhD; Matthew J. Peters, MD; Alvin J. Ing, MBBS, MD
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Abstract
Patients with chronic obstructive pulmonary disease (COPD) may be at increased risk of aspiration secondary to impaired swallow function. One possible cause of this impairment is a reduction in laryngopharyngeal sensitivity. The relationship between COPD and laryngopharyngeal sensitivity has not been previously determined. We conducted a study to investigate the effect of COPD on laryngopharyngeal sensitivity by using laryngopharyngeal sensory discrimination testing (LPSDT). Our study population was made up of 20 adults (mean age: 71.7 yr) with clinically proven COPD and 11 healthy, age-matched controls. All 31 subjects underwent LPSDT with the use of an air-pulse stimulator via a nasendoscope. The threshold of laryngopharyngeal sensation was evaluated by measuring the amount of air pressure required to elicit the laryngeal adductor reflex (LAR). We found that the patients with COPD had a significantly higher LAR threshold than did the controls (p< 0.001). We conclude that patients with COPD have significantly less mechanosensitivity in the laryngopharynx. This sensory change may place patients with COPD at increased risk for aspiration.
August 10, 2012 Jonathan M. Bock, MD; John J. Petronovich, BS; Joel H. Blumin, MD
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Zenker diverticula rarely extend deep into the chest and induce severe dysphagia and aspiration pneumonia. In fact, only rare cases have been reported in the literature that exhibit such significant extension into the mediastinum.
