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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.

The otolaryngology residency application problem

March 24, 2017     Robert T. Sataloff, MD, DMA, FACS

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

25 years of powered endoscopic maxillary antrostomy

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

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.

Instructions for Authors

March 24, 2017    

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

Presbyphonia: What can be done?

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

Facial trauma caused by electronic cigarette explosion

March 24, 2017     Brian Vaught, MD; Joseph Spellman, MD; Anil Shah, MD; Alexander Stewart, MD; David Mullin, MD


Electronic cigarettes are increasingly popular as a supposed safer alternative to tobacco cigarettes or a smoking cessation tool. Research and debate have focused primarily on possible adverse effects caused by the inhaled aerosol produced by electronic cigarettes and on smoking cessation efficacy. Few reports in the medical literature describe injuries secondary to device malfunction. We present a case of electronic cigarette explosion, with a projectile fracturing the patient's right naso-orbital-ethmoid complex and anterior and posterior frontal sinus tables, with frontal sinus outflow tract involvement. The patient underwent combined open and endoscopic repair, including open reduction internal fixation, with reconstitution and preservation of the frontal sinus and frontal sinus outflow tract. Additionally, we review the available data on electronic cigarette malfunction-including fires, explosions, associated injuries, and possible reasons for device malfunction-and discuss new 2016 U.S. Food and Drug Administration regulations pertaining to electronic cigarettes.

Evaluating the quality and readability of Internet information sources regarding the treatment of swallowing disorders

March 24, 2017     Ashley P. O'Connell Ferster, MD; Amanda Hu, MD, FRCSC


The Internet has become a popular resource for patient education. The information it provides, however, is rarely peer-reviewed, and its quality may be a concern. Since the average American reads at an 8th grade level, the American Medical Association and the National Institutes of Health have recommended that health information be written at a 4th to 6th grade level. We performed a study to assess the quality and readability of online information regarding the treatment of swallowing disorders. A Google search for “swallowing treatment” was conducted. We studied the first 50 websites that appeared on the search engine's results with the use of the DISCERN quality index tool, the Flesch Ease of Reading Score (FRES), and the Flesch-Kincaid Grade Level (FKGL) readability test. DISCERN is a validated 16-item questionnaire used to assess the quality of written health information; FRES and FKGL are used to assess readability. We classified the websites as either patient-targeted or professional-targeted sites, as well as either major or minor. The overall DISCERN score was 1.61 ± 0.61 (range: 1 to 5), the overall FRES was 39.1 ± 19.0 (range: 1 to 100), and the overall FKGL was 11.8 ± 3.4 (range: 3 to 12). As would be expected, patient-targeted websites had significantly higher FRES and significantly lower FKGL scores than did the professional-targeted websites (p = 0.01 and p = 0.04, respectively); there was no significant difference between the two in DISCERN scores. The major websites had significantly higher DISCERN scores than did the minor sites (p = 0.002); there were no significant differences in FRES and FKGL scores. We conclude that online information sources regarding the treatment of swallowing disorders were of suboptimal quality in that information was written at a level too difficult for the average American to easily understand. Also, the patient-targeted websites were written at a lower reading level, and the major websites contained a higher quality of information.

Metastatic chordoma of the tongue: Case report

March 24, 2017     Sultan Bişkin, MD; Rabiye Uslu Erdemir, MD; Sultan Şevik Eliçora, MD; Sevim Aydınlı, MD; Şükrü Oğuz Özdamar, MD


Chordomas are rare bone tumors that arise from notochord remnants. They most commonly occur in the sacrum, but they also can be seen in the skull base, cervical spine, and thoracolumbar vertebrae. Chordomas account for 1 to 4% of all primary skeletal tumors. They are usually indolent, locally growing tumors. Distant metastasis has been reported in 3 to 48% of cases. When metastasis occurs, it is usually observed in the lung, bone, and liver. To the best of our knowledge, no case of a chordoma metastasis to the tongue has been previously reported in the literature. We report such a case in a 61-year-old man.

Treatment success with titratable thermoplastic mandibular advancement devices for obstructive sleep apnea: A comparison of patient characteristics

March 24, 2017     Tang-Chuan Wang, MD; Yung-An Tsou, MD, MSc; Yi-Fan Wu, MD; Chia-Chang Huang, MD; Wesley Wen-Yang Lin, MSc; Yu-Fen Li, PhD, MPH; Michael Yuan-Chien Chen, MD; Chih-Jaan Tai, MD, MSc; Ming-Hsui Tsai, MD


A titratable thermoplastic mandibular advancement devices (MAD) is clearly an effective treatment option in some patients with obstructive sleep apnea (OSA). Determining which patients may be more likely to respond to treatment with thermoplastic MADs and to adhere to treatment would be of obvious clinical relevance. This was an experimental descriptive study (N = 60). Patients with OSA were instructed to wear a titratable thermoplastic MAD for 3 months. Treatment success was defined as a ≥50% reduction from baseline in the apnea-hypopnea index (AHI) or AHI <10 when wearing MAD. Adherence was defined as MAD use ≥5 nights/week. Treatment was successful in 66.7% of patients and 60.0% were adherent. All polysomnographic parameters and visual analogue scale scores (sleep quality, snoring, waking refreshed) were significantly improved after treatment. The patients in whom treatment failed had significantly higher neck circumferences (39.3 cm vs. 37.5 cm, p = 0.014), higher baseline AHI values (26.6 vs. 18.0, p = 0.016), and smaller AHI reduction (-31.8 vs -53.1, p < 0.001) than those in the group in whom treatment succeeded. There were no significant differences in polysomnographic, cephalometric, or visual analogue scale measures between patients for whom treatment was and was not successful, regardless of baseline values or the change rates after the MAD was placed. Titratable thermoplastic MADs can improve indicators of sleep quality, even in patients in whom treatment is considered to have failed.

Nasal, oral, and pharyngolaryngeal manifestations of pemphigus vulgaris: Endoscopic ororhinolaryngologic examination

March 24, 2017     Masafumi Ohki, MD; Shigeru Kikuchi, MD, PhD


Pemphigus vulgaris is an autoimmune blistering disorder that involves the skin and mucous membranes. Few reports have described nasal and oropharyngolaryngeal lesions in pemphigus vulgaris using an endoscopic ororhinolaryngologic examination. We retrospectively reviewed the clinical records of 11 patients with pemphigus vulgaris between 2001 and 2013 with respect to their symptoms, lesion sites, lesion features, and treatments received. All patients had undergone an endoscopic ororhinolaryngologic examination. Their mucosa-related symptoms were sore throat, oral pain, odynophagia, gingival bleeding, hoarseness, and epistaxis. The most frequent sites were the oral cavity (gingiva and buccal mucosa), larynx (epiglottis and vocal fold), oropharynx (soft palate), and nasal cavity (nasal septum). Lesions were typically characterized by erosion, erosion with a whitish exudate, and erythematous patches. Thus, our study findings reveal that pemphigus vulgaris involves both the nasal and oropharyngolaryngeal regions. Patients with pemphigus vulgaris should undergo an endoscopic ororhinolaryngologic examination to determine the range of their lesions.

Repair of the dilated earlobe

March 24, 2017     Akshay Sanan, MD; Ryan Heffelfinger, MD

The rising incidence of major salivary gland cancer in the United States

March 24, 2017     Anthony G. Del Signore, MD; Uchechukwu C. Megwalu, MD


We performed a population-based historical cohort study using the Surveillance, Epidemiology, and End Results (SEER) database to determine trends in the incidence of major salivary gland cancer and to evaluate the effect of sex, tumor size, histology, primary site, and extent of disease. Participants were men and women with major salivary gland cancer, diagnosed 1973-2009. The incidence of major salivary gland cancer increased from 10.4 per 1,000,000 in 1973 to 16 per 1,000,000 in 2009 (annual percent change [APC] 0.99; 95% confidence interval [CI] 0.78 to 1.20; p < 0.05). The incidence of parotid cancers increased (APC 1.13; 95% CI 0.88 to 1.39; p < 0.05) and paralleled the increase in major salivary gland cancer overall. There was an increase in the incidence of tumors measuring 0 to 2.0 cm (APC 1.99; 95% CI 0.61 to 3.38; p < 0.05), but no change in tumors measuring 2.1 to 4.0 cm (APC 1.02; 95% CI -0.46 to 2.52; p > 0.05) and tumors measuring > 4 cm (APC -0.52; 95% CI -1.72 to 0.69; p > 0.05). There was an increase in the incidence of regional (APC 0.77; 95% CI 0.32 to 1.23; p < 0.05) and distant (APC 2.43; 95% CI 1.43 to 3.45; p < 0.05) disease, but not localized disease (APC 0.35; 95% CI 0 to 0.71; p > 0.05). We conclude that the incidence of major salivary gland cancer is increasing, especially small parotid tumors. The incidence of tumors with regional and distant metastasis is also increasing. These findings highlight the need for further research on the etiology of salivary gland cancer, which may reveal opportunities for further public health efforts aimed at prevention.

Glomus jugulare manifesting as angiogenesis of the external ear canal

March 24, 2017     Sei Y. Chung, BS; James K. Liu, MD, FACS; Richard Chan Woo Park, MD, FACS; Robert W. Jyung, MD