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Speech perception and auditory performance following cochlear implantation in elderly Koreans

March 24, 2017  |  Sungsu Lee, MD, PhD; Hyong-Joo Park, MD; Hyong-Ho Cho, MD, PhD; Yong-Beom Cho, MD, PhD


The benefits of cochlear implantation (CI) in the elderly remain debatable in terms of sound and speech perception. Moreover, the results of CI may be affected by the intensity and pitch of spoken language. We conducted a retrospective study to evaluate surgical and hospitalization times, postoperative complications, and hearing outcomes after CI in elderly Koreans. Our study population was made up of 55 postlingually deafened adults who underwent unilateral CI. They were divided into two groups based on age; an older group consisted of 21 patients aged 65 years or older (mean 71.8) at the time of CI, and a comparison group was made up of 34 patients aged 18 to 64 years (mean: 47.5). The mean surgical and hospitalization times and the mean number of postoperative complications in the two groups were comparable. Auditory outcomes were quantified by the speech reception threshold (SRT), the speech discrimination test (SDT), scores on the Korean version of the Glendonald Auditory Screening Procedure (GASP-K), and categories of auditory performance (CAP) scores. The SDT and GASP-K values were significantly lower in the older group at 3 months, 1 year, and 2 years; there were no significant differences in mean SRT and CAP values. We conclude that elderly patients may obtain appreciable benefits from CI without experiencing serious surgical complications. Nevertheless, difficulties in speech perception should be taken into consideration in older patients.

Glomus faciale tumors: A report of 3 cases and literature review

March 24, 2017  |  Sahar Nadimi, MD; John P. Leonetti, MD; Sam J. Marzo, MD; Douglas E. Anderson, MD; Gulrez Mahmood, MD; Derek Bumgarner, MD


Our objectives in reporting this case series are to familiarize readers with the rare occurrence of paragangliomas originating along the facial nerve and to provide a literature review. We describe 3 such cases that occurred at our tertiary care academic medical center. Two women and 1 man presented with a tumor adjacent to the vertical segment of the facial nerve. The first patient, a 48-year-old woman, presented with what appeared to be a parotid tumor at the stylomastoid foramen; she underwent a parotidectomy, transmastoid facial nerve decompression, and a shave biopsy of the tumor. The second patient, a 66-year-old man, underwent surgery via a postauricular infratemporal fossa approach, and a complete tumor resection was achieved. The third patient, a 56-year-old woman, presented with a middle ear mass; she underwent complete tumor removal through a transmastoid transcanal approach. All 3 patients exhibited normal facial nerve function both before and after surgery. Paragangliomas of the facial nerve are extremely rare, and their signs and symptoms are unlike those of any other temporal bone glomus tumors. Management options include surgical resection, radiologic surveillance, and radiotherapy. The facial nerve can be spared in selected cases.

Submandibular salivary gland tumors: Clinical course and outcome of a 20-year multicenter study

March 24, 2017  |  Aviram Mizrachi, MD; Gideon Bachar, MD; Yaron Unger, MD; Ohad Hilly, MD; Dan M. Fliss, MD; Thomas Shpitzer, MD


The purpose of this retrospective chart review study was to review the nature and clinical course of benign and malignant submandibular gland tumors at 2 major university-affiliated tertiary medical centers. All patients who underwent submandibular salivary gland excision between 1990 and 2010 were included. Clinical and disease-related data were collected from the medical charts. One hundred ninety-three patients were identified, of whom 108 (56%) had non-neoplastic disorders (sialolithiasis and sialadenitis). The remaining 85 patients (44%) had a submandibular salivary gland tumor. The most common benign neoplasm was pleomorphic adenoma (53 patients). Twenty tumors (24%) were malignant: adenoid cystic carcinoma in 11 patients, mucoepidermoid carcinoma in 6 patients, and adenocarcinoma in 3 patients. Recurrence was noted in 7 patients with submandibular gland malignancy and in 2 patients with pleomorphic adenoma. The 5-year disease-free survival rate was 63%. Tumors of the submandibular gland are infrequently malignant. Recurrent submandibular salivary gland pleomorphic adenoma is rare compared with recurrences in the parotid gland.

Airway foreign body occurring during in-office vocal fold injection

March 24, 2017  |  Pamela Chia, MD; Aaron Jaworek, MD; Robert T. Sataloff, MD, DMA, FACS

Needle foreign bodies in the upper airway can result in life-threatening infections or hemorrhage from injury to the major vessels in the neck or chest.

25 years of powered endoscopic maxillary antrostomy

March 24, 2017  |  Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS

Powered endoscopic maxillary antrostomy has continued to be a useful procedure during the past 25 years.

Breast cancer metastases to the head and neck: Case series and literature review

March 24, 2017  |  Jeremiah C. Tracy, MD; Nicholas R. Mildenhall, MD; Richard O. Wein, MD; Miriam A. O'Leary, MD


Breast cancer is the most common cancer in women and is the second most common cause of cancer-related death. Despite the relatively high prevalence of this disease, breast cancer manifestations in the head and neck are relatively rare. Supraclavicular lymphadenopathy and bony metastases to the mandible and maxilla are the most common manifestation of breast cancer in the head and neck. Head and neck metastases are the first presentation of distant disease in approximately one-third of cases. The prognosis of breast cancer with distant metastases to the head and neck is generally poor, and the management of these lesions is controversial. Overall extent of disease and individual patient prognosis must guide treatment decisions. Atypical cases including maxillary sinus mass, jugular foramen mass, and dermal metastases are presented. Metastatic breast cancer is a rare diagnosis in the head and neck, yet metastatic disease from an infraclavicular primary deserves inclusion on any comprehensive differential diagnosis list. In women, breast carcinoma is the most common infraclavicular primary to metastasize to the head and neck.

Laryngoceles: Concepts of diagnosis and management

March 24, 2017  |  Mohammad Kamal Mobashir, PhD, MD; Waleed M. Basha, PhD, MD; Abd ElRaof Said Mohamed, MD; Mostafa Hassaan, MD; Ahmed M. Anany, MD


A laryngocele is an abnormal dilatation of the laryngeal saccule. It is a rare benign lesion of the larynx. Various modalities of treatment have been advocated for its management. We present our treatment results and outcomes of a series of cases of laryngoceles and discuss the concepts of their management. This study included patients with different laryngocele types. Patients with an internal laryngocele underwent endoscopic CO2 laser resection, while those with a combined laryngocele underwent resection via a V-shaped lateral thyrotomy approach. Seven patients had an internal laryngocele, and 4 patients had a combined laryngocele. Hoarseness and neck swelling were the most common symptoms. The mean follow-up period was 8.5 months. None of the patients needed a tracheostomy either preoperatively or postoperatively, or had recurrence of laryngocele. We advocate the lateral thyrotomy approach for combined laryngoceles as it provides safe, precise, and complete resection under direct visualization via a single approach, while we favor the endoscopic laser approach for the internal ones as it allows resection of the entire lesion with minimal laryngeal trauma, less operative time, and a shorter hospital stay.

Validation of olfactory threshold testing methods

March 24, 2017  |  Alan Hirsch, MD; Alexander Roussos, MS; Sally Freels, PhD


In patients with chemosensory complaints, a head-to-head comparison of unilateral olfaction threshold testing with the Phenyl Ethyl Alcohol Smell Threshold Test (PEA) and the OLFACT-RL Odor Threshold Test (OLFACT-RL) was undertaken. The charts of 23 consecutive patients presenting with chemosensory complaints seen at the Smell and Taste Treatment and Research Foundation were reviewed and information extracted per Institutional Review Board guidelines. All patients had undergone olfactory testing with the PEA test and the OLFACT-RL test in accordance with their published administration manuals. Using Spearman correlation coefficients to measure the statistical correlation between tests, we found evidence of a correlation between PEA and OLFACT-RL values on the left side only, overall (r = 0.49, p = 0.0184); in those who had hyposmia and did not have anosmia (r = 0.42, p = 0.0668); in those who did not have burning mouth syndrome (r = 0.46, p = 0.0304); and in those who did not have dysosmia (r = 0.47, p = 0.0553). There is no evidence of a correlation on the right side. The correlation for the left nostril suggests that these tests may be interchangeable. However, lack of correlation with the right nostril requires further investigation.

Unusual case of chronic maxillary rhinosinusitis

March 24, 2017  |  Jérôme R. Lechien, MD, MSc; Julien W. Hsieh, MD; Sven Saussez, MD, PhD

Although maxillary rhinosinusitis due to migration of a distractor is rare, it must be suspected in all patients with a history of dysmorphism surgery and unilateral rhinosinusitis.

Presbyphonia: What can be done?

March 24, 2017  |  Karen Kost, MD, FRCSC; Kourosh Parham, MS, PhD, FACS

In assessing elderly patients with dysphonia, it is important to recognize that prespyphonia is a diagnosis of exclusion, and it may coexist with other vocal disorders.