Other ENT Topics

Tracheal bronchus in an 11-month-old infant

October 23, 2013     Robert Sprecher, MD, FACS, FAAP; Gary Josephson, MD, FACS, FAAP
article

The possibility of a tracheal bronchus should be entertained when a patient presents with recurrent right upper lobe pneumonia or right upper lobe collapse.

How closely related are allergic rhinitis, asthma, and chronic sinusitis?

September 18, 2013     Mahmoud Ghaderi, DO, FAOCO
article

Various triggers may have different presentations and thus create a clinically known diverse group of diseases that we have classically grouped as chronic rhinosinusitis.

Correction of the severely deviated septum: Extracorporeal septoplasty

September 18, 2013     Toby Steele, MD; Jamie L. Funamura, MD; Benjamin C. Marcus, MD; Travis T. Tollefson, MD, MPH
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Extracorporeal septoplasty represents a novel and evolving technique for the surgical correction of the severely deviated septum.

Comparison of clinical differences between patients with allergic rhinitis and nonallergic rhinitis

September 18, 2013     Mustafa Akarcay, MD; Murat C. Miman, MD; Tamer Erdem, MD; Semih Oncel, MD; Orhan Ozturan, MD; Erol Selimoglu, MD
article

Abstract

We conducted a retrospective study to investigate the clinical differences between subtypes of rhinitis patients. Our findings were based on a detailed history and nasal examination. The study population was made up of 910 patients who had at least two rhinitis symptoms. These patients were categorized into one of three rhinitis groups: nonallergic rhinitis (NAR), seasonal allergic rhinitis (SAR), and perennial allergic rhinitis (PAR); there were 212 patients (23.3%) in the NAR group, 473 (52.0%) in the SAR group, and 225 (24.7%) in the PAR group. In addition to demographic data, we compiled information on the season when each patient presented, specific symptoms and their triggers, parental history, associated allergic diseases (e.g., skin, lung, and eye allergies), and nasal examination findings. The SAR patients represented the youngest of the three groups. Most SAR patients presented in spring and summer, and this group had the highest incidence of eye itchiness, pharyngeal itchiness, eye redness, and palatal itchiness. In terms of triggering factors, a visit to a green area was significantly more common in the SAR patients, while detergent odor, sudden temperature change, and cold air were significantly more common in the NAR patients. On nasal examination, a pale nasal mucosa was significantly more common in the NAR group. In clinical practice, it is crucial to differentiate between allergic and nonallergic rhinitis. We conclude that relevant information from the history can predict allergic rhinitis. Future studies of prevalence should take into consideration the important findings of our study, including the significance of age and the seasonality of exacerbation of rhinitis symptoms.

The impact of pulmonary tuberculosis treatment on the prevalence of allergic rhinitis

August 21, 2013     Carren Teh Sui Lin, MBBS, MS(ORL-HNS); Gopala Krishnan, MBBS, FRSC(Ed); and Anura Michelle Manuel, MBBS, MS(ORL-HNS)
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Abstract

Atopy is a syndrome characterized by immediate hypersensitivity reactions to common environmental antigens. The “hygiene hypothesis” stipulates that childhood infections are associated with a lower risk of allergies. Not much has been published about the effects that the treatment of pulmonary tuberculosis (TB) has on allergies, specifically allergic rhinitis. We conducted a study to investigate the prevalence of allergic rhinitis in patients with pulmonary TB before and after treatment of their TB. Our initial study group was made up of 121 patients with confirmed pulmonary TB who were followed up by questionnaire. In addition to demographic data, they provided information about their personal and family history of atopy and their current status with regard to allergic rhinitis. After providing informed consent, all patients underwent skin-prick testing with Dermatophagoides pteronyssinus, Dermatophagoides farinae, and Blomia tropicalis allergens before and after TB treatment. Stool samples were obtained to identify patients with worm infestation, and they were excluded from the study. In all, 94 patients completed treatment and follow-up, and their data were included in the final analysis. Of this group, 31 patients (33.0%) exhibited symptoms of allergic rhinitis prior to TB treatment, and 26 (27.7%) had a positive skin-prick test. Following treatment, only 12 patients (12.8%) reported allergic rhinitis symptoms (p = 0.004), but there was no significant reduction in the number of patients with a positive skin-prick test (n = 20 [21.3%]; p = 0.555). We conclude that the treatment of pulmonary TB results in significant relief of atopy, particularly allergic rhinitis symptoms.

Infected sublingual hematoma: A rare complication of frenulectomy

July 21, 2013     Amal Isaiah, MD, DPhil; Kevin D. Pereira, MD, MS
article

Given the spectrum of potential poor outcomes, some consensus has emerged in favor of early surgical management of significant ankyloglossia.

Inferior vestibular neuritis in a fighter pilot: A case report

June 11, 2013     Xie Su Jiang, MD, PhD; Jia Hong Bo, PhD; Xu Po, MS; and Zheng Ying Juan, BSC
article

Abstract

Spatial disorientation in airplane pilots is a leading factor in many fatal flying accidents. Spatial orientation is the product of integrative inputs from the proprioceptive, vestibular, and visual systems. One condition that can lead to sudden pilot incapacitation in flight is vestibular neuritis. Vestibular neuritis is commonly diagnosed by a finding of unilateral vestibular failure, such as a loss of caloric response. However, because caloric response testing reflects the function of only the superior part of the vestibular nerve, it cannot detect cases of neuritis in only the inferior part of the nerve. We describe the case of a Chinese naval command fighter pilot who exhibited symptoms suggestive of vestibular neuritis but whose caloric response test results were normal. Further testing showed a unilateral loss of vestibular evoked myogenic potentials (VEMPs). We believe that this pilot had pure inferior nerve vestibular neuritis. VEMP testing plays a major role in the diagnosis of inferior nerve vestibular neuritis in pilots. We also discuss this issue in terms of aeromedical concerns.

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
article

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.

Intrapharyngeal schwannoma in a pediatric patient

June 11, 2013     Nader Nassif, MD; Mariaelisabetta Cottelli, MD; Davide Farina, MD; and Marco Berlucchi, MD
article

Abstract

Schwannomas are benign peripheral nerve neoplasms that arise from Schwann cells. They usually occur in the adult population. The most common site in the head and neck region is the parapharyngeal space. Intrapharyngeal schwannomas are extremely rare, and those that have been reported all occurred in adults. We report what to the best of our knowledge is the first case of an intrapharyngeal schwannoma in a pediatric patient. The patient, a 15-year-old boy, was treated successfully with surgical excision.

Laryngeal plexiform neurofibroma in a child

June 11, 2013     Fikret Kasapoglu, MD; Talip Ozdemircan, MD; and Levent Erisen, MD
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Abstract

Neurofibromatosis (NF) is a genetically inherited, autosomal dominant disease, characterized by multiple cafe au lait spots, cutaneous neurofibromas and “Lisch nodules.” Neurofibromatosis can develop from a neural source at any age. However, neurofibroma of the larynx is extremely rare and is usually manifested by obstructive airway symptoms. We encountered a 5-year-old child presenting with stridor and dyspnea, who had a diagnosis of laryngeal plexiform neurofibroma. The purpose of our report is the consideration of laryngeal NF in the differential diagnosis of dyspnea in infants and children.

Airway management in an infant with alobar holoprosencephaly and cebocephaly associated with maternal diabetes mellitus

April 17, 2013     Rajanya S. Petersson, MD; William A. Carey, MD; Dana M. Thompson, MD
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Abstract

We report a case of alobar holoprosencephaly (HPE) and cebocephaly associated with uncontrolled maternal type 1 (insulin-dependent) diabetes mellitus. Alobar HPE is the most severe form of HPE. Patients with cebocephaly have ocular hypotelorism and a proboscis with a single, blind-ended nostril. Shortly after our patient was born, we were consulted for airway management, as the parents' goal was to bring their child home. A tracheostomy tube was placed, and choanal atresia repair was eventually performed. The infant was never decannulated, however, and she died at the age of 9 months of acute respiratory distress syndrome secondary to an upper respiratory infection. To the best of our knowledge, this case represents the longest reported survival of an infant with alobar HPE and cebocephaly. Decisions regarding the care of these infants should be made in a collaborative, multidisciplinary fashion, with special attention paid to the primary caregivers' goals of care.

Congenital cholesteatoma in a 3-year-old

April 17, 2013     Danielle M. Blake, BA; Senja Tomovic, MD; Robert W. Jyung, MD
article

 When a congenital cholesteatoma is diagnosed early as a localized circumscribed mass, it can be resected with a very low risk of recurrence.

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