Vertigo in elderly patients: A review of 164 cases in Brazil

August 27, 2014     Pedro Luiz Mangabeira Albernaz, MD, PhD


The author conducted a study to identify and categorize those vestibular disorders that were the most common among elderly patients at his private clinic over a 20-year period. He reviewed the records of 735 patients aged 65 to 90 years. The most common diagnosis was vertigo and/or disequilibrium, which occurred in 164 patients (22.3%). Of this group, 121 patients (73.8%) had a peripheral vestibular disorder and 43 (26.2%) had a central vestibular disorder. The characteristics of these cases are discussed.

A study of mucosal melanoma of the oral cavity in India: A rare tumor

August 27, 2014     Pankaj Chaturvedi, MS; Sandeep Lerra, MS(ENT); Piyush Gupta, MS; Prathamesh S. Pai, MS(ENT), DNB; Devendra A. Chaukar, MS, DNB; Jai Prakash Agarwal, MD; Anil K. D'Cruz, MS, DNB


Malignant melanomas involving the mucosa are rare and aggressive lesions. Their rarity has made the formulation of staging and treatment protocols very difficult, as most of the available information comes from case reports and small case series. We conducted a retrospective study to analyze the behavior of melanomas of the oral mucosa in patients who were treated at Tata Memorial Hospital in Mumbai, a tertiary care referral center for malignancies and one of the largest cancer centers on the Indian subcontinent. During the 22-year period from January 1986 through December 2007, we found only 13 such cases, which had occurred in 8 men and 5 women, aged 26 to 70 years (mean: 37.5). All patients had been offered surgery with curative intent. Mucosal melanomas have exhibited a greater tendency for distant recurrence than for local treatment failure, which is why adjuvant radiation therapy has not been shown to confer any consistent benefit. In our study, only 3 of the 13 patients (23.1%) remained alive 2 years after diagnosis, despite aggressive treatment. Tumor staging, optimal treatment, and prognostic factors for oral mucosal melanoma are far from clear, and further research is needed. Despite the small number of patients in this study, it still represents one of the largest series of oral mucosal melanoma patients in India.

Introduction Malignant melanomas are aggressive tumors that usually occur on the skin. Skin melanomas have been studied extensively, and clear-cut staging, treatment, and prognostic information is available. However, melanomas occurring in the mucous membranes, which are relentlessly malignant, are very uncommon, and the available information on...

In reference to “The value of resident presentations at scientific meetings”*

August 27, 2014     Jean Anderson Eloy, MD, FACS; Peter F. Svider, MD; Adam J. Folbe, MD; Michael Setzen, MD, FACS; Soly Baredes, MD, FACS

Regardless of what level of training one is at, we strongly agree with, support, and praise the editors' valuable point that supporting current trainees in scholarly pursuits is crucial for the continued advancement of our specialty

Dear Editor: We would like to thank the editors of major otolaryngology journals for their insightful editorial entitled “The Value of Resident Presentations at Scientific Meetings,” published in The Laryngoscope and other prominent oto-laryngologic journals.1-14 We strongly agree on the importance of encouraging research among...

An unusual cause of dyspnea in a pregnant woman: Supraglottic hemangioma

August 27, 2014     Zehra Kurdoglu, MD; Mertihan Kurdoglu, MD; Hakan Cankaya, MD


Dyspnea is a common complaint among pregnant women; upper airway obstruction is a rare cause of it. We report a case of supraglottic hemangioma in a 20-year-old pregnant woman who presented with increasing dyspnea and hoarseness at 40 weeks of gestation. She gave birth to a healthy 3,100-g girl by caesarean delivery under epidural anesthesia. She was able to breathe easily during the postpartum period. This case represents a rare instance of dyspnea caused by a supraglottic hemangioma in a pregnant woman.

Introduction Dyspnea is a common symptom during pregnancy. It may develop as a result of decreasing lung capacity, anemia, preeclampsia, or cardiac hypertrophy.1,2 Gestational dyspnea as a result of supraglottic laryngeal hemangioma is very rare. Hemangiomas are benign vascular lesions that can occur in the head and neck. Hemangiomas of the...

Arytenoid cartilage chondroma

August 27, 2014     Joel E. Portnoy, MD; Johnathan B. Sataloff; Mary J. Hawkshaw, BSN, RN, CORLN; Robert T. Sataloff, MD, DMA, FACS

Strobovideolaryngoscopy revealed a mass along the medial aspect of the left arytenoid cartilage.

A 33-year-old woman presented with a 3.5-week history of dysphonia. Her voice was constantly weak, breathy, and strained, and she had voice fatigue. She also complained of frequent throat clearing, a globus sensation, and mild dysphagia. In addition to signs of laryngopharyngeal reflux, strobovideolaryngoscopy revealed a mass along the medial...

Neopharyngeal diverticulum

August 27, 2014     Rebecca J. Howell, MD; Gregory N. Postma, MD

Endoscopic examination showed no distal stricture or cricopharyngeus muscle.

Transoral robotic surgery and oropharyngeal cancer: A literature review

August 27, 2014     Paraig O'Leary, MD; Thomas Kjaergaard, MD, PhD


The incidence of head and neck squamous cell carcinoma has risen steadily over the past decade due to the increase in cancers associated with the human papillomavirus (HPV). The prognosis for the treatment of this type of cancer with radiotherapy and chemoradiotherapy is good. However, because these treatments can have detrimental effects on organ function and quality of life, researchers are looking into transoral robotic surgery (TORS) as a possible alternate therapy. TORS might have a positive effect on postoperative function and quality of life for cancer survivors. The aim of this review is to report on the current situation regarding the treatment of oropharyngeal cancer with TORS, with a focus on the long-term oncologic and functional outcomes of this strategy. The articles cited in this review were selected from the PubMed and MEDLINE database. They contain study results pertaining to TORS implementation, complications, oncologic and functional outcomes, and the implications of HPV-associated cancer. We found that while TORS has some clear advantages and strengths and almost certainly a permanent place in future treatment, further research is necessary to correctly evaluate the role it will play in the complete management of oropharyngeal cancer.

Introduction The incidence of head and neck squamous cell carcinoma, including oropharyngeal cancer, has increased steadily over the past decade.1 With traditional exposition factors such as tobacco use and alcohol abuse in decline, the increase in oropharyngeal cancer has been associated with human papillomavirus (HPV) infection.2 In Sweden, for...

Postoperative management in laryngeal cancer with subglottic extension and histologically negative nodes: Which patients need adjuvant radiotherapy?

August 27, 2014     Federico Ampil, MD; Cherie-Ann O. Nathan, MD; Timothy Lian, MD; Roxana Baluna, MD, PhD; Edward Milligan, MD; Gloria Caldito, PhD


We conducted a study of 19 patients who had laryngeal cancer with subglottic extension (LCSE) and pathologically negative lymph nodes (pN0) following total laryngectomy and neck dissection (TLND). These patients had undergone surgery during a 17-year period from 1986 through 2002. Of this group, 9 did not receive postoperative radiotherapy (non-RT group) and 10 did (RT group). Adjuvant irradiation had been administered to those with additional histopathologic risk factors for recurrence. We found that recurrence rates in the neck were 44% in the non-RT group and 11% in the RT group (1 of 9 evaluable patients), and the corresponding 5-year disease-free survival rates were 51 and 89%. While both of these differences were clinically significant, neither was statistically significant (p = 0.29 and p = 0.14, respectively). The presence of LCSE was not known prior to or during TLND in 4 non-RT patients and in 7 RT patients; their corresponding neck recurrence rates were 50 and 0%. Two of 8 patients (25%) whose ipsilateral lobe of the thyroid gland was not removed experienced a stomal recurrence. We conclude that three factors can be used to identify patients with pN0 LCSE who may be candidates for adjuvant postoperative radiotherapy: (1) a failure to remove the ipsilateral thyroid gland lobe during TLND, (2) a failure to examine the level VI lymph node for metastatic disease status, and (3) unfavorable histopathologic findings.

Introduction Laryngeal cancer with subglottic extension (LCSE) and metastasis-free cervical lymph nodes (pN0) observed after total laryngectomy and neck dissection (TLND) presents a treatment dilemma that demands consideration of the potential danger of undertreatment and the unnecessary morbidity of overtreatment.

Saccular cyst as a complication of medialization laryngoplasty: A case report

August 27, 2014     Brent J. Benscoter, MD; Lee M. Akst, MD


We report the case of a 54-year-old woman who presented for evaluation of deterioration in her voice and swallowing function, which had begun after she had undergone a medialization laryngoplasty for unilateral vocal fold paralysis. Findings on examination and imaging revealed that a mass had developed adjacent to the Silastic implant that had been placed during the laryngoplasty. The superior extent of the implant reached above the laryngeal ventricle. Endolaryngeal surgical resection of the mass was accomplished without the need to remove the implant. Pathologic analysis identified the mass as a laryngeal saccular cyst. Although laryngeal saccular cysts are uncommon, medialization laryngoplasties are not. This case represents a rare complication of medialization laryngoplasty in which an implant compressed the laryngeal saccule and led to formation of the cyst.

Introduction Laryngeal saccular cysts are uncommon lesions that are believed to arise from either atresia of the orifice of the laryngeal saccule or retention of mucus in the collecting ducts of the submucosal glands around the laryngeal ventricle.1 The incidence of carcinoma associated with saccular cysts and laryngoceles is reported to range...

Balloon sinus dilation in the office setting

August 27, 2014     Joseph P. Mirante, MD, FACS; Michael A. Munier, MD, FACS; Dewey A. Christmas Jr., MD; Eiji Yanagisawa, MD, FACS

The ability to complete operative procedures in the office setting avoids the time and cost of working in a hospital or outpatient surgical center operating room.

One of the basic tenets of surgical treatment of chronic rhinosinusitis has been the creation of an opening into the diseased sinus cavity to provide drainage and aeration. Initial efforts date back to the early twentieth century, with such reports as Loeb's drainage of the maxillary sinus by extraction of a carious tooth in 1914.1 Over time...
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