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Simultaneous occurrence of maxillary and sphenoid sinus fungus ball

March 16, 2016  |  Jae-Hoon Lee, MD; Ha-Min Jeong, MD

The maxillary sinus is the site most commonly affected by the fungus ball, followed by the ethmoid and sphenoid sinuses.

The effects of round window membrane injury and the use of a model electrode application on hearing in rats

March 16, 2016  |  Murat Koc, MD; Abdullah Dalgic, MD; Mehmet Ziya Ozuer, MD


We conducted an animal experiment to investigate the effects of mechanical trauma to the round window with the placement of a model electrode inserted into the scala tympani on the cochlear reserve, and to determine the efficacy of topical steroids in preventing hearing loss in such a situation. Our subjects included 21 male Wistar albino rats that were assigned into three groups of 7 each. In all three groups, an initial mechanical injury to the round window was created. At that point, group 1 received no further treatment, group 2 received a dexamethasone injection into the cochlea, and group 3 underwent implantation of a multichannel cochlear implant guide followed by dexamethasone administration. After a few minutes, the round window opening was obliterated with muscle, and the incision was sutured with 4-0 Vicryl Rapide polyglactin in all 3 groups. Distortion-product otoacoustic emissions were obtained before and immediately after the surgical injury, and again on postoperative day 7. Mean signal/noise ratios (S/Ns) obtained at 2, 3, and 4 kHz were calculated, and datasets were compared with nonparametric statistical tests. We found that the early postoperative mean S/N values were significantly lower than the preoperative values in groups 1 and 2, but there was no difference between the mean preoperative values and those obtained on postoperative day 7 in those two groups. In group 3, there were statistically significant differences among the mean preoperative, early postoperative, and postoperative day 7 S/N values. We observed that an electrode insertion into the cochlea via the round window subsequent to mechanical trauma seemed to cause a progressive hearing loss. Therefore, we conclude that special care must be taken to avoid injury to the round window membrane during placement of a cochlear implant electrode, as well as during surgery for chronic otitis media.

Respiratory epithelial adenomatoid hamartoma of the olfactory groove: A report of 4 cases and a review of the literature

March 16, 2016  |  William G. Albergotti, MD; Alkis J. Psaltis, MBBS (Hons), PhD; Rodney J. Schlosser, MD


Respiratory epithelial adenomatoid hamartoma (REAH) is a rare benign lesion that affects the nasal cavity and paranasal sinuses. We present 4 cases of REAH that involved the olfactory clefts; 1 case was bilateral. Each of the cases was treated surgically, and no recurrence was observed. Most reports have indicated that REAH occurs in the presence of sinonasal inflammation, particularly nasal polyposis, yet all 4 of our cases occurred in the absence of concurrent rhinosinusitis. This suggests that the etiology of REAH is multifactorial. In addition, we review the literature on REAH, and we discuss its presentation, differential diagnosis, radiology, histopathology, and underlying treatment principles.

Myxoinflammatory fibroblastic sarcoma of the nose: First reported case at an unusual location (nasal dorsum), with a review of the literature

March 16, 2016  |  Jura Numminen, PhD; Argyro Bizaki, MD; Jarno Kujansivu, MD; Sanna Huovinen, MD; Markus Rautiainen, MD, PhD


Myxoinflammatory fibroblastic sarcoma (MIFS) is a rare, low-grade, malignant, soft-tissue tumor that typically affects the distal extremities of middle-aged patients. In most cases, it presents as a painless, slowly growing mass within the subcutaneous tissue. It is associated with a low rate of metastasis but a high rate of local recurrence. In addition to the distal extremities, MIFS has been reported in the thigh, arm, forearm, groin, upper back, neck, and temporal area. As far as we know, no case has been previously reported in the nasal area. We report for the first time a case of MIFS presenting on the dorsum of the nose. The painless, 3.0-cm tumor was initially mistaken for reticular erythematous mucinosis, a benign skin condition that occurs when fibroblasts produce abnormally large amounts of mucopolysaccharides. The tumor was surgically removed in its entirety with surgical margins of 3 to 5 mm. During 4 years of follow-up, no clinical or radiologic evidence of a recurrence or metastasis was seen. We discuss the imaging and histologic features of MIFS, as well as its clinical management and follow-up, and we review related reports in the literature.

Medial orbital wall reconstruction with a porous polyethylene titan barrier implant

March 16, 2016  |  Alexander Ovchinsky, MD; Jeffrey P. Cranford, MD

When selecting an alloplastic implant for orbital reconstruction, it is important to consider the material properties of the implant.

Is the emergency department management of ENT foreign bodies successful? A tertiary care hospital experience in Australia

March 16, 2016  |  Ritesh Gupta, MBBS, MS(ENT); Rugare Percy Nyakunu, MBBS, BMedSci; Jorian Russell Kippax, MBChB, FACEM


We evaluated the role of the emergency department (ED) in the management of ear, nose, and throat foreign bodies in an Australian tertiary care hospital. We retrospectively reviewed all cases of ENT foreign-body presentations in the ED over a 2-year period. We identified 168 such cases, a large proportion of which involved pediatric patients. In addition to demographic factors, we also collected data on the nature of the foreign bodies, the specific sites involved, the rate of successful treatment by the ED staff, the seniority/rank of the treating clinician, and complications. Foreign bodies in the ear accounted for 49% of all cases, the nose for 43%, and the throat for 8%. The ED staff attempted to remove the foreign body in 89% of cases, while the rest were referred to the ENT team. The rate of successful removal of all foreign bodies attempted by the ED team was fairly high-78%; success rates were 86% for nasal foreign bodies, 72% for aural objects, and 67% for those lodged in the throat. No major complications occurred; minor bleeding episodes after removal occurred in 8% of cases. Most ENT foreign-body presentations were managed safely and entirely by the ED team; most of the ENT referrals were to outpatient clinics.

Stapediovestibular ankylosis in an HIV/HCV-copositive patient

March 16, 2016  |  Stephan Radoslavov Lolov, MD, PhD, DSc


To the best of the author's knowledge, no case of a patient with stapediovestibular ankylosis who was also coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) has been previously described in the literature. This report describes the case of a 36-year-old woman who was diagnosed with all three conditions. The clinical diagnosis of stapes fixation was based on otoscopic, audiometric, tympanometric, and surgical findings. Stapedectomy was performed, and perilymph and serum samples were obtained and tested for anti-HIV and anti-HCV antibodies. While the titers of anti-HCV antibodies in the serum and perilymph were of similar magnitude, there were almost 16 times more anti-HIV antibodies in the serum than in the perilymph. This case offered a unique opportunity to study the titers of anti-HIV/HCV antibodies in both the blood serum and perilymph. Data relating to these titers may provide new insights into the mechanisms of stapediovestibular ankylosis and inner ear immunology.

Helicobacter pylori in lacrimal secretions

March 16, 2016  |  Aysegul Batioglu-Karaaltin, MD; Ozlem Saatci, MD; Meltem Akpinar, MD; Melih Ozgur Celik, PhD; Omer Develioglu, MD; Ozgur Yigit, MD; Mehmet Kulekci, MD; Alper Tunga Akarsubasi, PhD


The aim of this study was to investigate the presence of Helicobacter pylori in human lacrimal and nasal secretions. Eighty patients with complaints of dyspepsia who had undergone endoscopies and gastric antrum biopsies were included in the study. A total of five specimens, including 2 lacrimal secretion samples, 2 nasal mucosal swab samples, and 1 gastric antrum biopsy, were collected from each patient and investigated with polymerase chain reaction (PCR) methods consisting of the urease enzyme coding gene GlmM (UreC) and the H pylori-specific 16S rRNA coding gene. The Reflux Symptom Index and ophthalmologic complaints of the patients were recorded. The detected positivity rates of the H pylori 16S rRNA coding gene in gastric biopsies and nasal mucous and lacrimal secretions were 55, 11.2, and 20%, respectively. The patients were grouped as gastric-antrum-biopsy-negative (Group I [n = 36]) and -positive (Group II [n = 44). In Group II, H pylori positivity in the lacrimal and nasal mucous secretions was 36.3 and 18%, respectively. A comparison between the groups in terms of H pylori presence in nasal mucous and lacrimal secretions yielded statistically significant differences (p = 0.0001, p = 0.003). The simultaneous presence of H pylori in nasal mucous and lacrimal secretions was 13.6% in Group II. H pylori positivity in nasal mucous and lacrimal secretions had a positive moderate correlation (r = 0.40; p = 0.0003). The present study is the first report on the presence of H pylori in lacrimal secretions through nested PCR, which suggested the presence of a number of mechanisms for H pylori transmission to lacrimal secretions.

A case of minocycline-induced black thyroid associated with papillary carcinoma

March 16, 2016  |  Kohei Nishimoto, MD, PhD; Yoshihiko Kumai, MD, PhD; Daizo Murakami, MD, PhD; Eiji Yumoto, MD, PhD


We report a rare case of black thyroid accompanied by papillary carcinoma in a patient with an extended history of minocycline treatment. A 78-year-old man was referred to our outpatient clinic with swelling in his neck. He had been taking minocycline for the previous 2 years and 7 months to treat chronic perianal pyoderma. Neck ultrasonography and computed tomography demonstrated a 3.5 x 3.7 x 5.0-cm nodule in the left thyroid lobe, and fine-needle aspiration cytology identified it as a papillary carcinoma. The patient underwent a total thyroidectomy and neck dissection. During the procedure, a distinct black discoloration of the thyroid parenchyma was observed. Histopathology confirmed both the black thyroid and the papillary carcinoma. Based on the thyroid gland's discoloration and the history of minocycline use, the patient was diagnosed with minocycline-induced black thyroid. He was symptom-free 20 months after surgery.

Surgical treatment of superior laryngeal neuralgia: A case report and review of the literature

March 16, 2016  |  Richard Salzman, MD, PhD; Tomáš Gabrhelík, MD, PhD; Ivo Stárek, MD, PhD


Superior laryngeal (SL) neuralgia is paroxysmal pain above the thyrohyoid membrane. We present a case of SL neuralgia that was resistant to conservative treatment and eventually required surgical intervention. The patient was a 39-year-old woman with a 5-year history of debilitating pain above the thyroid cartilage. After having undergone different imaging scans with negative results, she tried various treatments (e.g., antibiotics, analgesics, stellate ganglion block, radiofrequency SL neurotomy, and stereotactic radiosurgery), all of which were ineffective. Finally, she underwent bilateral surgical SL neurotomy. Postoperatively, she immediately noticed a significant alleviation of her pain. Her postoperative course was completely uneventful, as she experienced no dysphagia or dysphonia, even transiently. One month later, she no longer required regular painkillers, and at 14 months, she remained essentially pain-free. While medical management remains the treatment of choice for SL neuralgia, we recommend that refractory cases be treated initially with a neural block with local anesthesia. Patients who do not respond are candidates for surgery. We consider selective peripheral SL neurotomy to be safe and effective when performed by experienced hands. We also discuss the difficulties of managing SL neuralgia.