Rhinolith from a long-ago insertion of a bead into the nasal cavity

September 20, 2015     Hung-Che Lin, MD; Chih-Hung Wang, MD, PhD; Hsin-Chien Chen, MD, PhD

CT may be used to assess the calcification deposits and the number and size of rhinoliths.

A 37-year-old woman was referred to our hospital for evaluation of a mass in the left nasal cavity. The mass had been discovered incidentally by an otolaryngologist during a workup for a common cold. The patient had no previous history of nasal complaints.

Adult-onset familial vocal fold paralysis

September 20, 2015     Ida Amir, MRCS, DOHNS; Yanick J. Crow, MBBS, PhD, MRCP; Pradeep Morar, MD, FRCS(ORL-HNS)


We describe the cases of 2 brothers in their early 50s, born to consanguineous parents, who presented with acute stridor as a result of adult-onset bilateral abductor vocal fold paralysis. Both patients had a history of adult-onset asthma. No other associated symptoms were evident, and findings on neurologic examination and all other investigations were normal. Both patients required emergency surgical tracheostomy. Another brother with a similar history had died of an airway problem when he was 53 years of age; 2 other younger brothers and 3 younger sisters were currently unaffected. To the best of our knowledge, this is the first report of adult-onset familial bilateral vocal fold paralysis in the absence of associated features. The parents' consanguinity suggested an autosomal recessive basis to this disorder. In addition to describing the features of this case, we review the literature relating to adult-onset familial vocal fold paralysis.

Sensorineural hearing loss after ossicular manipulation and drill- generated acoustic trauma in type I tympanoplasty with and without mastoidectomy: A series of 51 cases

September 20, 2015     K. Cagdas Kazikdas, MD; Kazim Onal, MD; Nadir Yildirim, MD


Recognized causes of high-frequency sensorineural hearing loss (SNHL) after tympanoplasty with and without mastoidectomy include acoustic trauma from manipulation of the ossicles, the noise generated by suctioning and, in the case of mastoidectomy, the noise generated by temporal bone drilling. We conducted a retrospective study to identify the effects of ossicular manipulation and mastoid drilling on high-frequency SNHL. Our study population was made up of 51 patients-20 males and 31 females, aged 10 to 59 years (mean: 28.5). Of this group, 26 patients had undergone a unilateral over-under tympanoplasty only (tympanoplasty group) and 25 had undergone a unilateral tympanoplasty plus additional mastoid surgery (mastoidectomy group). Bone-conduction audiograms were obtained pre- and postoperatively; the latter were obtained within 24 hours after surgery and again at 6 months of follow-up. In the tympanoplasty group, a significant SNHL, primarily at 2 kHz, was seen in 6 patients (23%) at 24 hours, but at 6 months there was no depression of bone-conduction thresholds. In the mastoidectomy group, a significant SNHL, primarily at 2 and 4 kHz, occurred in 12 patients (48%) at 24 hours, and bone-conduction deterioration was still present in 4 patients (16%) 6 months after surgery. The difference between the preoperative audiograms and the 6-month audiograms in both groups was statistically significant (p = 0.034). We conclude that (1) over-under tympanoplasty, which requires significant manipulation of the ossicles, can cause temporary SNHL after surgery, and (2) prolonged exposure to the noise generated by mastoid drilling can result in permanent SNHL.

Introduction The loudness of noise and the length of time a patient is exposed to such noise determine whether a patient will experience a noise-induced hearing loss. Sounds louder than 80 dB are considered to be potentially damaging to the ear by causing cochlear injury. Noise exposure can result in a transient hearing deficit (temporary...

A large laryngeal pleomorphic leiomyosarcoma arising from a small pedicle without mucosal invasion: Case report

September 20, 2015     Napadon Tangjaturonrasme, MD


Laryngeal leiomyosarcoma is a rare mesenchymal malignancy of the head and neck region. The author presents a case of an atypical laryngeal leiomyosarcoma that featured a large pedunculated lesion without mucosal invasion. This feature has not been previously described in the English-language literature. The diagnosis, treatment, and outcome are also discussed.

Management of venous pulsatile tinnitus with normal otoscopic findings

September 20, 2015     Lei Jin, MD; Yucheng Wang, PhD


We conducted a retrospective study to analyze the therapeutic effects of ligation of the internal jugular vein in a series of adults with pulsatile tinnitus of venous origin. Our study group was made up of 12 patients-all women, aged 27 to 61 years (mean: 40 ± 6.1)-who had been diagnosed with venous pulsatile tinnitus and who were treated with jugular vein ligation. Follow-up had been conducted by telephone interviews for 1 to 6 years postoperatively to assess tinnitus status over the long term. Seven patients achieved complete relief of their tinnitus immediately after surgery, but 5 of them experienced a recurrence within 2 years. The remaining 5 patients received no relief from surgery, including 1 patient who actually experienced a worsening of her tinnitus to the point that it became an intolerable roar. We conclude that treatment of pulsatile tinnitus of venous origin by ligation of the internal jugular vein should be avoided because of poor outcomes and in view of the possibility of complications. In addition to our study findings, we discuss 2 of our cases in more detail.

Introduction Pulsatile tinnitus in a patient with normal findings on otoscopic examination often poses a diagnostic challenge to the otolaryngologist. The causes of pulsatile tinnitus can be divided into vascular and nonvascular factors. Characteristically, pulsation is temporarily muted or even eliminated by relatively gentle compression of the...

Using ultrasonic preoperative thyroid volume to determine incision length for minimally invasive thyroid surgery

August 26, 2015     Austin P. Daly, MD; Massi Romanelli-Gobbi, MD; Jeffrey L. Miller, MD; David Rosen, MD; David M. Cognetti, MD; Edmund A. Pribitkin, MD


The determination of the volume of a diseased thyroid lobe or an entire gland by preoperative ultrasonography may enable surgeons to select candidates for a minimally invasive approach to thyroid lobectomy or total thyroidectomy. We retrospectively reviewed the charts of 71 adults who had undergone minimally invasive nonendoscopic thyroid surgery at our hospital from January 2007 through May 2009. We compiled data on ultrasonic preoperative thyroid volumes and operative incision lengths. Of the 71 patients, 40 had undergone lobectomy and 31 had undergone total thyroidectomy. The lobectomy group was evenly subdivided into two groups based on the median volume of the affected lobe; 20 patients had a volume of <28.32 ml and 20 had a volume of >28.32 ml. The incision length ranged from 2.0 to 3.8 cm (mean: 3.1 ± 0.53) in the smaller-volume lobectomy group and from 2.5 to 5.0 cm (mean: 3.7 cm ± 0.71) in the larger-volume lobectomy group; the difference was statistically significant (p < 0.01). The 31 patients in the total thyroidectomy group were subdivided on the basis of the median volume of the entire thyroid gland; 16 patients had a volume of <49.24 ml and 15 had a total volume of >49.24 ml. The incision length in those two groups ranged from 2.5 to 4.0 cm (mean: 3.4 ± 0.53) and 3.6 to 6.0 (mean: 5.1 ± 0.99), respectively; again, the difference was statistically significant (p < 0.001). The findings of our study suggest that preoperative ultrasonographic thyroid lobe volume or total thyroid gland volume can be used to determine the appropriate minimum length for the surgical incision.

Can vinegar be used in treating Pseudomonas ear infections in a patient with a perforated eardrum?

August 26, 2015     Muhamed Aslam Khan, MS, MRCSEd; Nazneen Khan, MBBS, DGO, DRCOG


Chronic Pseudomonas ear infections are difficult to treat, particularly in immunodeficient patients. Vinegar therapy is a time-tested measure for the treatment of these infections. It is inexpensive, simple, easy to administer, and very effective. However, some physicians are reluctant to use it in immunocompromised patients or in the setting of a perforated tympanic membrane. We describe our successful use of vinegar therapy in a 32-year-old man with both of these conditions. His Pseudomonas ear infection had persisted for more than 5 years despite conventional drug treatment. Eventually, we treated him with instillations of topical vinegar, and his infection cleared in 3 weeks.

Introduction Chronic Pseudomonas infection of the ear in humans is difficult to treat, especially in immunodeficient patients. This infection has remained resistant to many modalities of treatment, leading to frustration for patients and physicians alike. Pseudomonas organisms can be killed in an acidic environment, which can be created with...

Supraglottoplasty in a 39-year-old woman

August 26, 2015     Hilary M. Caruso Sales, DO; Amanda Hu, MD, FRCSC; Robert T. Sataloff, MD, DMA, FACS

In this case, the patient's larynx was diffusely erythematous and edematous, with thick secretions and severe posterior “cobblestoning.”

A 39-year-old woman presented with hoarseness of 3 months' duration. The hoarseness had started after an upper respiratory infection. She developed associated symptoms of odynophagia, postnasal drip, dyspnea, and the sensation that her throat was closing. Treatment with antibiotics, cough medications, and nebulizers had not improved her...

Base of tongue schwannoma

August 26, 2015     Gautam Bir Singh, MS; Rubeena Arora, MS; Sunil Garg, MS, DNB; Kiran Aggarwal, MD

On T1-weighted MRI, these lesions appear hypointense or isointense relative to the tongue muscle.

A 29-year-old man presented to the ENT outpatient department of our tertiary care teaching hospital with the chief complaint of swelling of the tongue for the previous 3 years. The swelling had increased over time, and now the patient had an intense foreign body sensation in the tongue, as well as an obvious cosmetic deformity. Interestingly, the...

Hybrid frontal sinus surgery with balloon dilation and microdebrider resection

August 26, 2015     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS

In cases with polyps obstructing the sinus ostia, if a hybrid procedure employing both microdebrider resection and balloon dilation is performed, a satisfactory sinus outflow tract can be obtained.

A 47-year-old man was referred because of a 2-year history of recurring frontal pain with intermittent frontal sinusitis treated medically on numerous occasions. Computed tomography (CT) of the sinuses showed bilateral frontal sinusitis (figure 1, A). Nasal telescopic evaluation revealed middle meatal and frontal recess polyps with thick...
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