Ear, Nose & Throat Journal Skip to content Skip to navigation

Novel terms for laser-assisted surgery of the upper aero-digestive tract providing more specificity to surgical interventions

May 23, 2018  |  A consensus statement of the European Laryngological Society

TLM is the most used acronym for endoscopic transoral pharynx surgery using the CO2 laser and microscope. TLM is not limited to a rigid approach. ELS adopted nomenclature to categorize additional approaches including flexible endoscopy and robotics.

 

Computational analysis of swallowing mechanics after surgery for obstructive sleep apnea

April 30, 2018  |  Mark A. Ellis, MD; Mariah B. Pate, MD; Hugh D. Dorris, BA; William G. Pearson Jr., PhD; Jimmy J. Brown, DDS, MD

Abstract

Multilevel upper airway surgery for obstructive sleep apnea (OSA) has been shown to cause clinically significant dysphagia in some patients. We describe the cases of 2 adults with OSA who developed persistent dysphagia after multilevel upper airway surgery. Patient-specific computational analysis of swallowing mechanics (CASM) revealed absent pharyngeal shortening and aberrant tongue base retraction in both patients. These findings are consistent with the OSA surgical goal of enlarging the hypopharyngeal airway but likely contributed to our patients' dysphagia. Patient-specific CASM allows for sensitive identification of swallowing mechanical dysfunction that might otherwise be overlooked, and it may be utilized in future head and neck surgery patients to analyze swallowing dysfunction associated with treatment.

Screening and management of postoperative hypoparathyroidism-induced hypocalcemia in thyroidectomized patients in the endocrine ward compared with the surgical ward

April 30, 2018  |  Nina Sauer, MD; Anne Lautenbach, MD; Katharina Pohl, MD; Gerhard Schon, MD; Hans-Peter Brose, MD; Clarissa Alexandra Schulze zur Wiesch, MD; Jens Carsten Aberle, MD

Abstract

Transient hypoparathyroid-associated hypocalcemia is a common side effect after thyroidectomy. Not only may it be life-threatening, but it also can distinctly affect length of hospital stay and treatment costs. Screening and treatment practices are suspected to differ between clinicians in endocrine and surgical wards. We therefore compared discipline-related differences in screening and treatment of hypocalcemia as well as the length of hospital stay of patients after thyroidectomy. Data from 170 patients treated with total thyroidectomy in the Department of Otolaryngology (n = 29), General Surgery (n = 49) and Endocrinology (n = 92) were analyzed, and measurements of postoperative calcium and parathyroid hormone, calcium at time of discharge, percentage of discharge with a calcium level <1.9 mmol/L (defined as severe hypocalcemia), treatment of hypocalcemia, and duration of hospitalization were compared between disciplines. Postoperative calcium levels were measured in 97.8% of patients in endocrine wards compared with 83.3% in surgical departments (p = 0.001), and discharge with a calcium level <1.9 mmol/L was statistically more frequent in surgical vs. endocrine wards. Additional to calcium supplementation, active vitamin D was administered in 95% of patients treated in endocrine wards vs. 35% in surgical wards. Length of hospitalization was 8.12 (±6.62) days (endocrinology) to 10.55 (±9.39) days (surgical wards) (p = 0.05). Monitoring of calcium levels is an important indicator of the quality of postoperative care after thyroidectomy. To prevent postoperative hypocalcemia-induced complications and to reduce the length of hospital stay, an interdisciplinary approach for the management of hypocalcemia after thyroidectomy might be a promising model for future treatment concepts.

Horizontal (vs. vertical) closure of the neo-pharynx is associated with superior postoperative swallowing after total laryngectomy

April 30, 2018  |  Giannis Thrasyvoulou, MD, PGCert Med, PhD; Petros V. Vlastarakos, MD, MSc, PhD; Michael Thrasyvoulou, BSc(Math); Aristides Sismanis, MD, FACS

Abstract

We conducted a cross-sectional study to compare the horizontal and vertical methods used in the surgical closure of the neo-pharynx after total laryngectomy in terms of their effect on swallowing function, swallowing-related quality of life (QOL), and overall QOL. We also assessed the potential influence of age (≤64 vs. ≥65 yr) and the type of treatment modality (primary, salvage, or total laryngectomy with radiotherapy) on outcomes. Our final study population was made up of 34 patients-31 men and 3 women, aged 49 to 89 years (mean: 66.8)-who had undergone a total laryngectomy. One year after surgery, all patients were asked to complete the M.D. Anderson dysphagia inventory (MDADI), which quantifies swallowing function and swallowing-related QOL, and the University of Washington quality-of-life questionnaire (UW-QOL), which quantifies overall QOL. Of the 34 patients, 16 had undergone a horizontal surgical closure of their neo-pharynx and 18 a vertical closure. According to the MDADI, patients in the horizontal group experienced significantly better swallowing function/QOL; the mean composite MDADI scores were 91.5 in the horizontal group and 68.3 in the vertical group (p = 0.005). We found no significant difference in terms of overall QOL, as the respective mean UW-QOL scores were 81.0 and 80.8 (p = 0.93). The population correlation coefficient was positive in both groups, but more so in the horizontal group (ρhorizontal = 0.876 and ρvertical = 0.676). Neither age nor the type of treatment modality employed influenced swallowing function/QOL (page = 0.10, ptreatment modality = 0.78) or overall QOL (page = 0.08, ptreatment modality = 0.59). We conclude that horizontal closure of the neo-pharynx is superior to vertical closure in terms postoperative swallowing function/QOL but not overall QOL.

An undulating vallecular cyst

April 30, 2018  |  Yu-Hsuan Lin, MD; Ming-Yee Lin, MD, PhD

Most vallecular cysts are indolent, but they carry the potential for airway obstruction if they become enlarged.

Balloon catheter dilation of a septated frontal sinus

April 30, 2018  |  Joseph P. Mirante, MD, MBA, FACS; Dewey A. Christmas, MD; Eiji Yanagisawa, MD, FACS

Balloon catheter dilation has been associated with symptomatic relief comparable to that associated with traditional endoscopic sinus surgery, but with less tissue destruction.

Wireless mobile ultrasonography-assisted parotid duct stone removal

April 30, 2018  |  Na Rae Oh, MD; Joo Hyun Woo, MD, PhD; Dong Young Kim, MD, PhD; Min Kwan Baek, MD, PhD

Abstract

Ultrasonography is highly sensitive for the diagnosis of sialoliths. Recently, wireless mobile ultrasonography was developed. We describe the case of a 49-year-old man who presented with painful postprandial left cheek swelling. Computed tomography detected a solitary 5-mm parotid duct stone with infection at the anterior portion of the left masseter muscle. Transoral stone removal was planned, although difficulty was expected in view of the surrounding infection. Surgery was performed under the guidance of mobile ultrasonography, and the stone was removed safely.

Anxiety, depression, and hopelessness in patients before and after treatment for peripheral facial paralysis

April 30, 2018  |  Fatih Arslan, MD; Mert Cemal Gokgoz, MD; Murat Binar, MD; Emre Aydemir, MD; Abdullah Durmaz, MD

Abstract

We conducted a prospective study to investigate the effectiveness of pharmacologic treatment on alleviating facial paralysis, as well as the anxiety and depression that are associated with it. Our study population was made up of 105 patients-59 men and 46 women, aged 18 to 60 years (mean: 38.2)-who had acute idiopathic peripheral facial paralysis. Before treatment, paralysis was classified as House-Brackmann grade II or III in 44 patients (41.9%) and grade IV to VI in the remaining 61 (58.1%). After treatment, 73 patients (69.5%) improved to grade I, 29 (27.6%) were at grade II or III, and only 3 (2.9%) remained at grade IV or higher. Mean scores on the Beck anxiety inventory, the Beck depression inventory, and the Beck hopelessness scale were 20.30, 19.75, and 7.57, respectively, before treatment and 5.72, 5.68, and 2.85 afterward; the difference in all three measures was statistically significant (p < 0.001). We found no correlation between the degree of facial paralysis and anxiety levels (r = 0.094, p = 0.338) or depression levels (r = 0.181, p = 0.064). Clinicians should consider asking patients with peripheral facial paralysis about their feelings of anxiety, depression, and hopelessness and refer them for a psychiatric consultation if necessary.

Surgical treatment of symptomatic subglottic stenosis during the third trimester of pregnancy

April 30, 2018  |  Erin R. Hamersley, DO, LT MC USN; Angel J. Perez, MD, LCDR MC USN; Michele P. Morrison, DO, CDR MC USN, FACS; Halton W. Beumer, MD, MAJ MC USAF

Abstract

Subglottic stenosis is a narrowing of the airway distal to the glottis. Airway narrowing can be severe and, when coupled with pregnancy, can pose a significant threat to the mother and fetus. There is sparse literature describing treatment of these critical patients, posing a challenge for management. We describe our experience with a 31-year-old woman with idiopathic subglottic stenosis who became symptomatic during her pregnancy, requiring surgical intervention early in her third trimester. The following case report describes this patient's presentation and management, in which an awake dilation technique was used. We also include a literature review on the management of subglottic stenosis in pregnancy.

Esthesioneuroblastoma with widespread distant metastasis: Case report and literature review

April 30, 2018  |  Manraj Khosla, MD; Cristina Pecci, DO; Annie Do, MD; Lee McGhan, MD; Mahesh Seetharam, MD; Richard Sue, MD

Abstract

Esthesioneuroblastoma (ENB) is an uncommon sinonasal tract tumor, and it is even more uncommon among all neoplasms. Literature regarding the incidence and spread of the disease is limited. The prognosis of metastatic disease is poor. In this report, we present a case of recurrent ENB in a young woman involving metastasis to the neck, lungs, and ovary. Metastasis to the cervical lymph nodes is relatively common, but metastasis to the lungs is rare. Furthermore, to our knowledge, no cases of ovarian metastases of ENB have been reported. This case highlights the potential for widespread metastatic disease, suggesting the need for more frequent and thorough surveillance of patients diagnosed with recurrences of this tumor.