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

Association of Meniere disease with human leukocyte antigen in Taiwanese population

December 10, 2018  |  Kai-Chieh Chan, MD; Che-Ming Wu, MD; Wan-Ling Ho, MD, PhD; Ping-Chin Lai, MD, PhD


The etiology of Ménière disease (MD) is multifactorial; genetic factors seem to play an important role. The associations between MD and human leukocyte antigen (HLA) status have been studied previously in several populations and have shown that the HLA alleles imparting susceptibility varied. In the present study, we explored HLA status in Taiwanese patients with definitive MD. HLA was typed via polymerase chain reaction, sequence-specific oligonucleotide genotyping in 35 patients with MD diagnosed using the criteria of the American Academy of Otolaryngology-Head and Neck Surgery and 70 unrelated healthy controls. HLA allele association tests were used to evaluate differences in allelic frequencies between the patients and controls. The allelic frequency of HLA-A*11 was significantly greater in MD patients than in controls (52.9 vs. 31.4%, odds ratio: 2.45, 95% confidence interval: 1.4 to 4.4, p = 0.004, p corrected = 0.03). Thus, A*11 may be a useful HLA biomarker in Taiwanese patients with MD. Further larger-scale studies are required.

Destructive lesion of the temporomandibular joint: A case of tophaceous pseudogout

December 10, 2018  |  Jessica B. Howell, MD; Yula A. Indeyeva, MD; Stephanie E. Ambrose, MD; Evan R. Reiter, MD


Tophaceous pseudogout of the temporomandibular joint is a rare entity that clinically and radiographically mimics neoplastic or infectious conditions. Diagnosis requires histopathologic examination. Given the rarity of this condition, there is a paucity of information pertaining to the surgical approach, reconstructive options, and postoperative outcomes.

The root cause of physician burnout cannot be solved with resilience efforts

December 10, 2018  |  Michael M. Johns, MD, III

The burnout problem can be traced largely to loss of physician autonomy and marginalization of physicians in decision making.

Aggressive fibromatosis of the parotid gland

December 10, 2018  |  Vishaal Patel, MD; Virginia Falvello, MD; Marion Hughes, MD; Barry Schaitkin, MD


Extra-abdominal fibromatosis (EAF) is a rare, locally aggressive tumor that originates in fascial structures. It accounts for less than 0.3% of all tumors diagnosed. Head and neck tumors account for only 7% of those, and only a few cases occurring in the parotid gland have been previously reported. We describe the case of a 34-year-old woman who presented with a painful parotid mass. She was found to have an EAF of her right parotid gland. Medical management with antibiotics and immunosuppression therapy was unsuccessful. Surgical resection was required for both a definitive diagnosis and management. Preoperative findings on computed tomography, magnetic resonance imaging, and both fine-needle aspiration biopsy and surgical biopsy were nonspecific, as is typical in EAF cases.

Laryngeal hereditary hemorrhagic telangiectasia

December 10, 2018  |  Jerome R. Lechien, MD, PHD, MS; Camille Finck, MD, PhD

Laryngeal telengiectasia involving the vocal folds is known to cause hemorrhages, which are often difficult to control given the vascular wall fragility.

Stapes footplate defect as a source of CSF leak and otogenic meningitis in a patient with a cochlear implant

December 10, 2018  |  Maria Vartanyan, MD; Fiona Hill, MBBS; Kumiko Orimoto, MD, PhD; Stephen O'Leary, PhD, FRACS, FAHMS

Clinicians should be proactive in ensuring that cochlear implant patients have received comprehensive immunization.

Evaluation of bendable surgical suction devices made of shape-memory alloy for the endonasal transsphenoid removal of pituitary tumors

December 10, 2018  |  Ronny Grunert, PhD; Sandra Klietz, BEng; Paul A. Gardner, MD; Juan C. Fernandez-Miranda, MD; Carl H. Snyderman, MD, MBA


In minimally invasive surgeries, it can be difficult to reach desired anatomic areas with rigid instruments, especially when obstacles are present in the surgical corridor (e.g., during transnasal pituitary surgery). We developed a new kind of suction device constructed of the shape-memory alloy Nitinol (nickel titanium), which is adaptable to a patient's specific anatomy. Use of this device minimizes surgical risks by allowing physicians to use an endonasal transsphenoid approach. The suction device, which is equipped with a cannula made of the shape-memory alloy, was planned and manufactured with three different handpiece designs. Experienced pituitary surgeons tested the prototypes in human cadaver skulls and rated the devices on specific questionnaires. The results of their evaluation indicate that this device is a suitable tool for improving the surgical procedure. Its potential benefits include a more effective surgery and reductions in the risk of injury, the duration of surgery, and costs.

An unusual presentation of papillary thyroid carcinoma in a pediatric patient: A case report

December 10, 2018  |  Matthew G. Cravens, BS, BA; Tyson J. Nielsen, MD; Erynne A. Faucett, MD; Audrey B. Erman, MD


Cystic neck masses in the pediatric population are common but rarely concerning for malignancy. Given this typically benign nature, they are frequently managed conservatively. Here we present an unusual case of a waxing and waning cystic neck mass in a pediatric patient. After surgical removal, the mass was found to be metastatic papillary thyroid cancer. This is a unique presentation in the pediatric age group that has not yet been described. Based on this case, we suggest an expanded differential in any workup for a cystic neck mass to include papillary thyroid carcinoma, regardless of the patient's age.

A fistulating oropharyngeal lesion

December 10, 2018  |  Richard Heyes, MBChB (Hons), MRCS DO-HNS; Courtney M. Tomblinson, MD; David G. Lott, MD


Post-transplant lymphoproliferative disorder (PTLD) is a unifying term for a spectrum of lymphoid expansion entities brought about by immunosuppression. It can present throughout the head and neck, and tonsillar involvement is not limited to children. We report the case of a 67-year-old woman who developed odynophagia associated with putrid halitosis 4 months after she had undergone renal transplantation. Direct visualization of the oropharynx revealed multiple sites of severe ulceration and erythema, with erosion of both the anterior and posterior right tonsillar pillars and a necrotic ulceration fistulating deeply. Biopsy analysis led to a diagnosis of PTLD. The patient underwent rituximab monotherapy and responded well. However, after the cessation of therapy, she experienced a recurrence that necessitated chemotherapy, which resulted in a lasting remission. At follow-up 5 years later, she remained PTLD-free with stable stage 4 chronic kidney disease.

Huge neck lymphangioma removed in toto with minimal access

December 10, 2018  |  Vikas Malhotra, MBBS, MS(ENT), DNB; Nikhil Arora, MBBS, MS(ENT), DNB; Pankhuri Mittal, MBBS, MS(ENT), DNB

Treatment selection should be based on the size, depth, and location of the lesion, as well as potential morbidity and surgical complications.