Laryngeal findings and acoustic changes in light cigar smokers

June 4, 2015     Abdul-latif Hamdan, MD, FACS; Randa Al-Barazi, MD; Jihad Ashkar, MD; Sami Husseini, MD; Alexander Dowli, MD; Nabil Fuleihan, MD
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Abstract

The aim of this prospective study was to look at the laryngeal findings and acoustic changes in light cigar smokers in comparison to nonsmokers, in the setting of a voice clinic. A total of 22 cigar smokers and 19 nonsmokers used as controls were enrolled in the study. Demographic data included age, number of years smoking, number of cigars per week, history of allergy, and history of reflux. The confounding effects of allergy and reflux were accounted for in the control group. Subjects underwent laryngeal endoscopy and acoustic analysis. On laryngeal endoscopy, the most common laryngeal finding was thick mucus. There was no significant difference in the prevalence of any of the laryngeal findings in cigar smokers vs. controls. In comparison with the control group, both the fundamental frequency and habitual pitch were significantly lower in cigar smokers (p value = 0.034 and 0.004, respectively). We conclude that cigar smokers have lower fundamental frequency and habitual pitch compared to nonsmokers.

Sleep problems of adolescents: A detailed survey

June 4, 2015     Nuray Bayar Muluk, MD; Selda Fatma Bulbul, MD; Mahmut Turgut, MD; Gulsah Agirtas, MD
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Abstract

We investigated the sleep problems and sleep habits of adolescents at three public primary schools and two high schools. Our study included 428 Turkish school children (244 girls and 184 boys). We used a questionnaire to determine the time they went to sleep at night; waking time in the morning; incidence of nightmares, snoring, daytime sleepiness, and intrafamilial physical trauma; concentration difficulty in class; and school success. The students were divided into age-related groups (group 1 = 11 to 13 years of age; group 2 = 14 to 15 years; group 3 = 16 to 18 years). The time they went to sleep was mostly between 10 and 11 p.m. in groups 1 and 2, and 11 to 12 p.m. in group 3. Difficulty in falling asleep was reported by 16.8 to 19.6% of the students in the three groups. Difficulty in waking up in the morning was reported by 12.7% of group 1, 16.0% of group 2, and 16.8% of group 3. Snoring was present in 12.1% of females and 22.0% of males. The occurrence of one nightmare in the preceding 3 months was reported by 11.3% of the students; 17.9% of the students reported having nightmares several times. Daytime sleepiness was present in 65.1%, and concentration difficulty was present in 56.8% of the students. We conclude that difficulty in falling asleep, snoring, and daytime sleepiness may be seen in adolescents who are in both primary and high schools. Watching inappropriate programs and movies on television and intrafamilial physical trauma may cause nightmares and sleeping problems in these adolescents. Students and families should be educated about the importance of sleep in academic performance. Countries' public health policies should address sleep problems and related educational activities.

Introduction Sleep disorders are common, affecting about one-third of all people,1 and they can cause depression, impaired performance at school or work, and reduced quality of life and relationships. Despite our substantial knowledge about sleep problems, health professionals are still insufficiently trained in preventing, assessing, and...

ACE-inhibitor-related angioedema

June 4, 2015     Norman J. Chan, MD; Ahmed M.S. Soliman, MD
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There is debate regarding whether patients who experience ACE-inhibitor-related angioedema can be safely switched to angiotensin receptor blockers.

  Otolaryngologists are called upon frequently to care for patients with potentially life-threatening angioedema. This condition usually is associated with angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors are among the most commonly prescribed medications worldwide because they are indicated in the management of hypertension,...

Internal auditory canal osteoma: Case report and review of the literature

June 4, 2015     Sharon Ovnat Tamir, MD; Francoise Cyna-Gorse, MD; Olivier Sterkers, MD
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Abstract

We report a case of internal auditory canal osteoma and discuss this entity's etiology, natural history, and treatment options. The internal auditory canal osteoma is a rare entity with only a few reports published in the medical literature. Its diagnosis is based on two complementary imaging modalities: thin-slice computed tomography and magnetic resonance imaging. No consensus exists regarding the treatment of this entity, and treatment should be tailored to each patient depending on that patient's initial complaints, as well as his or her medical findings.

Maggot infestation of an ulcerated neck wound

June 4, 2015     Sidharth V. Puram, MD, PhD; Margaret S. Carter, MD; Daniel Deschler, MD, FACS
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The presence of maggots was hardly deliberate in this case, but these larvae successfully debrided a locally recurrent necrotic lymph node.

A 77-year-old man with a history of squamous cell carcinoma of the colon presented 13 months after he had undergone a partial glossectomy, bilateral neck dissections, and adjuvant chemoradiation therapy for a T3N2c metastasis to the oral tongue. He exhibited an 8 x 5-cm neck wound that was filled with maggots. Three days before presentation, he...

Intraductal infusion of steroids in patients with Sjogren syndrome to treat painful salivary swelling: Report of 2 cases

June 4, 2015     Henry R. Diggelmann, MD; Henry T. Hoffman, MD, MS, FACS
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Abstract

Painful salivary swelling in patients with Sjögren syndrome presents the clinician with a difficult-to-manage condition, and treatment options are limited. We report 2 cases that demonstrate the utility of a clinic-based intraductal corticosteroid infusion for the treatment of painful salivary swelling associated with Sjögren syndrome. Steroid infusion is a cost-effective, simple-to-perform, well-tolerated gland-sparing procedure that may yield good clinical results in selected patients.

Improvement in allergic and nonallergic rhinitis: A secondary benefit of adenoidectomy in children

June 4, 2015     Meir Warman, MD; Esther Granot, MD; Doron Halperin, MD, MHA
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Abstract

Chronic rhinitis (CR) is a common disorder in children. Allergic rhinitis (AR) is a risk factor for CR, and children with AR tend to suffer more from hypertrophic adenoids than do patients with nonallergic rhinitis (NAR). Few studies have addressed the issue of alleviating symptoms of pediatric CR or AR following adenoidectomy alone. We conducted a retrospective chart review to determine whether CR in children improves after adenoidectomy and whether children with AR will benefit more than those with NAR. Charts of 47 children who had undergone adenoidectomy for nasal obstruction and chronic middle ear effusion were reviewed. AR and NAR subgroups were classified based on symptoms, signs, blood IgE, and nasal smear (allergic criteria). Hypertrophic adenoids were graded using the adenoid-to-nasopharyngeal ratio (ANr >0.8). A questionnaire was used to assess the change in chronic rhinitis postoperatively. Improvement in CR was reported in 37 of 47 (79%) children. Patients with AR improved to a higher extent than those with NAR (12 of 14 [86%] vs. 25 of 33 [76%], respectively), but the difference was not statistically significant. A total of 41 lateral postoperative nasopharyngeal x-rays were obtained. The x-rays revealed that 20 of 26 (77%) of patients with ANr >0.8 had complete and 4 of 26 (15%) had partial resolution of symptoms of CR for a total resolution rate of 92%, compared to only a 53% resolution in the ANr <0.8 subgroup (6 of 15 and 2 of 15 patients, respectively [p <0.05]). The correlation between adenoid size and resolution of CR was not related to any of the AR/NAR subgroups. We conclude that symptoms of CR may improve after adenoidectomy in children who are experiencing nasal obstruction and chronic otitis media with effusion. Clinical improvement did not differ between AR and NAR patients, and was more prominent in children with hypertrophic adenoids (ANr >0.8).

Introduction Adenoidectomy is useful in relieving nasal obstruction in patients with hypertrophic, obstructing adenoids. In patients with small, chronically infected adenoids, adenoidectomy may be beneficial in otitis media with effusion by decreasing the efflux via the eustachian tube. Although adenoidectomy is one of the most common procedures...

A novel method for reconstruction of severe caudal nasal septal deviation: Marionette septoplasty

June 4, 2015     Gurkan Kayabasoglu, MD; Alpen Nacar, MS; Mahmut Sinan Yilmaz, MD; Aytug Altundag, MD; Mehmet Guven, MD
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Abstract

We conducted a retrospective study to compare open and endonasal (closed) approaches to extracorporeal reconstruction of severe caudal septal deviations. From January 1, 2010, through December 31, 2013, 78 patients with severe caudal septal deviation underwent corrective surgery at our hospital. Of this group, 33 patients (mean age: 32 yr) underwent extracorporeal septoplasty via an open approach, and 45 patients (mean age: 35 yr) underwent treatment with a new procedure that we developed: subtotal extracorporeal septoplasty through a closed approach, which we call “marionette septoplasty.” In addition to demographic data, we compiled information on surgical time, the duration of postoperative edema, the degree of postoperative pain, and differences between pre- and postoperative nasal function and tip support in both groups. We found that our marionette septoplasty procedure required significantly less surgical time and resulted in a significantly shorter duration of postoperative edema than did open septoplasty, while there was no statistically significant difference between the two procedures in the degree of pain. Following surgery, nasal function in both groups improved significantly, without any significant difference between the two. Finally, we documented improved tip support in all 78 patients. Our results show that marionette septoplasty produces the same functional results as does open septoplasty while requiring less surgical time and shortening the healing period.

Th1 and Th2 cytokine gene expression in atopic and nonatopic patients with nasal polyposis

June 4, 2015     Mohammad Farhadi, MD; Mitra Barati, MPH; Azardokht Tabatabaii, MS; Mehdi Shekarabi, PhD; Samileh Noorbakhsh, MD; Shima Javadinia, MD
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Abstract

The pathogenesis of nasal polyps has been debated for many years. The lymphocytes that infiltrate nasal polyps have been identified as predominantly memory T cells in an activated state, and these cells produce a mixed cytokine pattern of T1 helper (Th1) and T2 helper (Th2) cells. We conducted a prospective study to compare the expression levels of some Th1 and Th2 cytokines in atopic and nonatopic patients. Our study population consisted of 75 adults-42 men and 33 women (mean age: 38 yr)-with nasal polyposis. Patients with an allergy were distinguished from those without an allergy on the basis of the history, the results of skin-prick testing, and measurement of total IgE serum concentrations. Based on these criteria, patients were divided into two groups: atopic (n = 38) and nonatopic (n = 37). Levels of cytokine gene expression in the atopic patients were compared with those of the nonatopic patients by real-time polymerase chain reaction. Statistical analysis found no significant differences in the rate of interleukin (IL) 10 and IL-12 gene expression between the allergic and nonallergic patients. On the other hand, rates of interferon gamma and IL-4 gene expression were significantly higher in the atopic patients (p = 0.03 and p = 0.02, respectively). Our research suggests that an imbalance of Th1 and Th2 cells plays an important role in the pathophysiology of nasal polyps. Although nasal polyposis is a multifactorial disease associated with several different etiologic factors, chronic persistent inflammation is undoubtedly a major factor, regardless of the specific etiology.

Introduction The prevalence of nasal polyps is 4.3%.1 Nasal polyps are often linked to systemic disease, but their pathogenesis is for the most part unknown. Allergic fungal sinusitis, asthma, aspirin sensitivity, and cystic fibrosis have all been found to cause severe polyposis.

Unexpected cholesteatoma in a very young child with a congenital aural duplication anomaly

April 27, 2015     Moo Kyun Park, MD
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Cholesteatoma can develop in very young children with congenital aural stenosis and a duplication anomaly, and physicians should consider this condition in affected children with otalgia and otorrhea.

Congenital aural stenosis is defined as an external auditory canal less than 4 mm across. Cholesteatoma is far more likely in a bony ear canal opening of 2 mm or less, but regardless of the degree of stenosis, the incidence of cholesteatoma is very low in patients younger than 3 years. Therefore, surgery is usually delayed until later in...
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