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Infant with an unusual neck mass

April 30, 2016  |  Shiva Daram, MD; Ron B. Mitchell, MD

This case highlights the need to consider phlebectasias of the internal jugular vein when evaluating an infant with a compressible neck mass.

OK-432 injection therapy for cystadenocarcinoma of the parotid gland: A case report

April 30, 2016  |  Kiyoshi Makiyama, PhD, MD; Ryoji Hirai, PhD, MD; Fusako Iikuni, MD; Atsuo Ikeda, MD; Hirotaka Tomomatsu, MD

Abstract

OK-432 is an immunomodulator that has been reported to be efficacious as an injection therapy for cervical lymphomas and ranulas. We performed OK-432 injection therapy to treat a cystadenocarcinoma of the parotid gland in a 72-year-old man. The 50 x 46-mm tumor was located in the deep lobe of the gland. The tumor had compressed the glossopharyngeal, vagus, and hypoglossal nerves, causing neurally mediated syncope, hoarseness, dysphagia, and dysarthria. A concentration of 5 KE/2 ml of OK-432 was injected. Within 2 months, the cyst had disappeared; no recurrence was apparent during 59 months of follow-up. To the best of our knowledge, no previous report has described injection of OK-432 for malignant cystic disease. We describe the injection method, injection dose, and postinjection course in the hope that this information will prove useful for future applications against malignant cystic disease.

Endoscopic identification and powered removal of the uncinate process

April 30, 2016  |  Dewey A. Christmas, MD; Joseph P. Mirante, MD, MBA, FACS; Eiji Yanagisawa, MD, FACS

The identification and complete removal of the uncinate process results in a widened middle meatus and access to the ethmoid bulla, the frontal recess, and the outflow tract of the maxillary sinus.

Long-term effects of intracochlear electrical stimulation with looped patterns on tinnitus: A case study

April 30, 2016  |  Remo A. Arts, PhD; Erwin L. George, PhD; Andreas Griessner, PhD; Clemens Zierhofer, PhD; Robert J. Stokroos, PhD

Abstract

Electrical stimulation by cochlear implant (CI) has been proven to be a viable treatment option for tinnitus in many recent studies. In addition, intracochlear electrical stimulation independent of an acoustic input appears to suppress tinnitus, at least in the short term. We conducted a case study to investigate the long-term effects of both standard CI and intracochlear electrical stimulation independent of an acoustic input on tinnitus in a patient with single-sided deafness and tinnitus. We found no negative effects of intracochlear electrical stimulation independent of an acoustic input on speech perception in noise. Furthermore, the additional use of a standard CI was advantageous for speech discrimination in our patient. We conclude that long-term tinnitus suppression can be achieved via intracochlear electrical stimulation with looped patterns. Our findings in terms of speech discrimination in our patient were consistent with those reported in previous studies.

Gore-Tex extrusion following type I thyroplasty

April 30, 2016  |  Natalie A. Krane, MD; Amanda Hu, MD, FRCSC; Robert T. Sataloff, MD, DMA, FACS

Many different types of implants can be used for medialization thyroplasty, including Gore-Tex, Silastic, titanium, hydroxyapatite, and other materials.

Improved visualization of a dehiscent facial nerve with otoendoscopy

April 30, 2016  |  James G. Naples, MD; John W. House, MD; Benjamin J. Wycherly, MD

In middle ear surgery, endoscopy is a valuable instrument for second-look procedures in cholesteatoma.

A case of pediatric parapharyngeal space ganglioneuroma

April 30, 2016  |  Natalie Garzorz, MD; Gillian R. Diercks, MD; Harrison W. Lin, MD; William C. Faquin, MD, PhD; Laura V. Romo, MD; Christopher J. Hartnick, MD, MS

Abstract

Ganglioneuromas are rare, benign neoplasms derived from sympathetic neural crest progenitor cells. In the pediatric population, ganglioneuromas usually develop in the mediastinum or retroperitoneum. We report the case of a 3-year-old boy who presented with a painless enlarging neck mass, which was found to be a parapharyngeal space ganglioneuroma that extended to the skull base. We summarize the current principles regarding the diagnostic workup and treatment of these neoplasms, and we briefly review the literature.

Sympathetic hearing loss: A review of current understanding and report of 2 cases

April 30, 2016  |  Patrick F. Morgan, MD; Peter G. Volsky, MD; Barry Strasnick, MD, FACS

Abstract

Sympathetic hearing loss (SHL) is a rare complication that appears to occur when the immune system is primed against sequestered inner ear antigens. SHL has been implicated in delayed hearing loss after acoustic tumor removal, revision stapedectomy, and temporal bone fractures. We present 2 cases of suspected SHL after excision of skull base tumors during which the surgical approach had violated the otic capsule. Both patients experienced delayed contralateral sensorineural hearing loss. In comparing our cases with those previously reported, we hope to inspire others to do likewise and to develop an understanding of this clinical entity.

An extended toboggan technique for resection of substernal thyroid goiters

April 30, 2016  |  Catherine F. Sinclair, MD; Glenn E. Peters, MD; William R. Carroll, MD

Abstract

We describe our technique for the safe resection of substernal thyroid goiters. Early mobilization of the thyroid gland from tracheal attachments anteriorly and laterally facilitates extraction of the goiter from the mediastinum. Retrograde dissection through the ligament of Berry on the ipsilateral side can also facilitate identification of the recurrent laryngeal nerve and delivery of the substernal portion of the gland. We describe 2 representative cases in which we successfully used this technique.

If cytology of Warthin tumor is accurate, can management be conservative?

April 30, 2016  |  Alexander C. Vlantis, FCS(SA)ORL; Siu Kwan Ng, FRCSEd; Chi Keung Mak, MRCS(Ed); Jackie M. Cheung, MBChB; Amy B. Chan, FHKC Path; C. Andrew van Hasselt, MMed(Otol)

Abstract

We conducted a retrospective study to assess the accuracy of fine-needle aspiration cytology (FNAC) in the diagnosis of Warthin tumor and to evaluate the subsequent risk of conservative nonsurgical management. We reviewed the records of 75 patients (76 tumors) with a parotid mass that had been diagnosed as a Warthin tumor by FNAC. This patient population was made up of 64 men and 11 women, aged 46 to 93 years (mean: 67). Of the 76 tumors, 40 were treated with surgical excision and 36 with conservative measures. Histology of the 40 excised parotid masses revealed that 38 (95%) were indeed Warthin tumors, 1 (2.5%) was a low-grade adenocarcinoma, and 1 was benign-not otherwise specified. None of the 36 tumors underwent malignant transformation either clinically or on repeat FNAC (if performed) during a follow-up of 4 to 120 months (mean: 55.5 ± 32.2). We conclude that conservative management of Warthin tumors confidently diagnosed on FNAC may be an option for patients who are unwilling or unable to undergo surgical excision.

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