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Metal detection tests: Preventive tools for "Fiddler's Neck"

November 3, 2017     Brittanya A. Limone, MA, BS; Jacqueline Chen, BS; Sharon E. Jacob, MD

Markers of proliferation and cytokeratins in the differential diagnosis of jaw cysts

September 18, 2017     Nikola D. Zivkovic, PhD; Dragan S. Mihailovic, PhD; Milos S. Kostic, PhD; Ana S. Cvetanovic, MD; Zaklina Z. Mijovic, PhD; Maja V. Jovicic Milentijevic, PhD; Tijana V. Dencic, MD

Social media in otolaryngology-head and neck surgery

September 18, 2017     Modupe Oyewumi, MD; John Lee, MD, MSc, FRCSC; Allan Vescan, MD, FRCSC

Abstract

The objective of this study was to assess the current use of social media tools within Canadian otolaryngology-head and neck surgery (OHNS) programs and to assess the interest within these programs to integrate social media for networking, social, and educational programs. A prospective study from September 2013 to February 2014 was performed involving residents and faculty in Canadian OHNS programs. A 26-item questionnaire was created and sent to staff and resident physicians who met the study inclusion criteria using an online survey tool (surveymonkey.com). There were 101 respondents for a 10% response rate. More than half (58.4%) of respondents reported use of social media for personal and/or professional matters. Residents and junior faculty physicians 39 years and younger were more likely to have social media accounts and used them more frequently than their older counterparts. Among staff physicians, pediatric otolaryngologists had the highest rate of use, and otologists exhibited the lowest rate. Cellular phones were the most commonly used devices to access social media sites. Fewer than 35% of social media users failed to separate their personal and professional accounts. Although OHNS trainees and practicing physicians identified the potential benefits of social media tools in their specialty, most were unsure how to apply these tools to their practice. Ours is the first study to assess social media use in OHNS. Otolaryngologists are currently using social media; however, their application as a communication and educational tool in otolaryngology remains to be defined.

Long-standing, near total tympanic membrane perforation

September 18, 2017     J. Scott Greene, MD, FACS

Although most spontaneous perforations heal, repeated ruptures and chronic suppuration can lead to permanent perforations.

Congenital ear malformations: Effectively correcting cryptotia with neonatal ear molding

September 18, 2017     Collin Rozanski, BA; Joseph J. Rousso, MD

Cryptotia is a relatively common congenital ear malformation that can be difficult to correct with surgery. Treatment should be started before the first 6 weeks of life.

Ear fetal rhabdomyoma

September 18, 2017     Lester D. Thompson, MD

The soft tissues of the orbit, ear, and oral cavity are the most frequent sites of involvement, although adult-type rhabdomyomas are more common in the parapharyngeal and laryngeal spaces.

Hereditary hemorrhagic telangiectasia-laser treatment of epistaxis

September 18, 2017     Gorazd Poje, MD; Marcel Marjanovic Kavanagh, MD

Abstract

Hereditary hemorrhagic telangiectasia (HHT) is a rare, autosomal dominant disorder characterized by recurrent epistaxis, telangiectasias, and multiorgan vascular dysplasia. Various modalities exist for the treatment of HHT-related chronic epistaxis, although no method is preferred over another. The aim of this study was to review the effectiveness of diode laser photocoagulation in the treatment of epistaxis in patients with HHT. The study included 17 patients (7 men, 10 women) treated with diode laser photocoagulation from year 2008 to 2012. All patients met the Curaçao criteria for a diagnosis of HHT. Patients were followed for 1 year. Treatment success was assessed using a custom questionnaire and total blood counts. After laser photocoagulation, the frequency and intensity of bleeds were reduced significantly and average hemoglobin concentrations improved at the 4-month assessment. After laser treatment, no patient required septodermoplasty; therefore, we suggest that every patient with HHT should be treated with laser photocoagulation. Diode laser treatment is a simple and effective procedure that should be considered when treating HHT.

Study of factors responsible for recidivism in allergic fungal rhinosinusitis

September 18, 2017     Bipin Kishore Prasad, MS

Abstract

Patients with allergic fungal rhinosinusitis (AFRS) are typically atopic and immunocompetent. Despite combined modality treatment based on surgery and immunomodulation, the potential for recidivism is well recognized. A study was conducted in a military hospital in India to identify the factors responsible for recidivism in AFRS and to suggest measures to overcome it. Sixty patients with AFRS (42 new cases and 18 cases that required revision surgery) were managed between January 2009 and July 2013. Patients underwent endoscopic, radiologic, and laboratory evaluation for AFRS followed by functional endoscopic sinus surgery. Each patient received oral prednisolone, 1 mg/kg/day, for 1 week preoperatively and 0.5 mg/kg/day for 4 weeks postoperatively. A randomly selected group of 30 patients (group A) received oral prednisolone 0.4 mg/kg/day for the next 4 weeks, tapered to 0.2 mg/kg/day for the next 2 months and to 0.1 mg/kg/day for the last 2 months. The drug was stopped after 6 months. In the remaining 30 patients (group B), oral prednisolone was tapered within 2 months. Topical steroid sprays were advised in all patients. Recidivism was observed in 12 of 42 (28.6%) patients presenting for the first time with AFRS: 9 patients from group B (30%) and 3 patients from group A (10%). Besides inadequate postoperative oral steroid therapy, suboptimal functional endoscopic sinus surgery, noncompliance with intranasal sprays, nonadherence to Kupferberg staging, inadequate follow-up, failure of surgeons to impart health education to patients, and unavailability of ENT consultation in rural belts were found to be factors causing recidivism.

Maxillary sinus mucoceles and other side effects of external-beam radiation in the pediatric patient: A cautionary tale

September 18, 2017     Anthony Sheyn, MD; Tate Naylor, MD; Felicity Lenes-Voit, MD; Eric Berg, MD

Abstract

A sinonasal mucocele can develop after the obstruction of a sinus ostium, which can occur secondary to trauma, infection, a neoplasm, or an iatrogenic cause. These mucoceles typically arise in the frontal and ethmoid sinuses. Sinonasal mucoceles are epithelium-lined cysts that can gradually expand to fill a paranasal sinus. They can present with ophthalmologic, rhinologic, and neurologic symptoms. There are reports in the literature of sinonasal mucocele development after radiation for nasopharyngeal carcinoma. However, these cases are rare; when they do occur, they tend to arise in the sphenoid sinus. We describe the case of a 21-year-old man who had undergone external-beam radiotherapy for a right maxillary sinus rhabdomyosarcoma at the age of 4 years and who subsequently developed bilateral maxillary sinus mucoceles and multiple other known complications of radiation therapy. To the best of our knowledge, this is the first case of postirradiation bilateral maxillary sinus mucoceles to be reported in the literature.

Management decisions for Zenker diverticulum in the elderly

September 18, 2017     Karen Kost, MD, FRCSC; Kourosh Parham, MD

Zenker diverticulum is primarily a geriatric condition, usually requiring surgical management.

Endoscopy-assisted Coblation for nasopharyngeal stenosis: A report of 2 cases

September 18, 2017     Omer Karakoc, MD; Bahtiyar Polat, MD; M. Timur Akcam, MD; Mustafa Gerek, MD

Abstract

Acquired nasopharyngeal stenosis, the standard treatments for which carry a high risk of restenosis, is an uncommon complication of both velopharyngeal surgery and radiotherapy to the nasopharynx. We present the cases of 2 men, aged 41 and 52 years, who underwent surgical treatment for nasopharyngeal stenosis with endoscopy-assisted Coblation. The two surgeries lasted 23 and 18 minutes, respectively. Neither patient experienced any surgical complication, and a nasopharyngeal stent was not needed in either case. At follow-up 12 months postoperatively, both patients exhibited a patent nasopharyngeal passage. Endoscopy-assisted Coblation appears to be a safe, effective, and less painful option for the treatment of nasopharyngeal stenosis.

Intracapsular tonsillectomy for keratosis pharyngeous: A pilot study of postoperative recovery and surgical efficacy

September 18, 2017     Philip A. Gaudreau, MD; Eric M. Gessler, MD

Abstract

Our objective was to perform a pilot study comparing intracapsular radiofrequency ablation tonsillectomy with subcapsular tonsillectomy in adult patients with keratosis pharyngeous. Patients diagnosed with keratosis pharyngeous between December 2010 and February 2013 were randomized to undergo either intracapsular or subcapsular tonsillectomy using radiofrequency ablation. Postoperative pain scores and amount of pain medication taken were recorded for 2 weeks. A 6-month follow-up questionnaire was used to assess efficacy of the procedure. Twenty-two patients completed the initial 2-week questionnaire. Eighteen completed the 6-month follow-up questionnaire. The amount of pain medication consumed on postoperative days 8 (p = 0.0293), 9 (p = 0.0146), and 10 (p = 0.035) was significantly less in the intracapsular group. Risk of recurrence of tonsilloliths was significantly greater at the 6-month follow-up in the intracapsular cohort (p = 0.0291). Based on these findings, in patients undergoing tonsillectomy for keratosis pharyngeous, intracapsular radiofrequency ablation tonsillectomy may result in decreased pain medication consumption compared with subcapsular tonsillectomy. Intracapsular tonsillectomy, however, resulted in a higher rate of recurrence of tonsilloliths. The benefit of decreased pain medication may be offset by the greater likelihood for symptoms to recur. Larger studies are needed to confirm these findings.

If only it were that simple

September 18, 2017     Brian J. McKinnon, MD, MPH, MBA, FACS

Older siblings are at increased risk for foreign bodies

September 18, 2017     Laura H. Swibel Rosenthal, MD; Matthew R. Bartindale, MD; Zachary C. Fridirici, MD; Natalie A. Papillon, BS

Abstract

A prospective, case-control study was performed to describe the role that siblings play in foreign bodies of the head and neck and to recognize situations in which children are most at risk for foreign bodies. Any child or adolescent (0 to 17 years old) with a foreign body removed from the head or neck was included. The data collected included location of the foreign body, location of acquisition (e.g., home), and the number of and ages of siblings. Controls were matched by age, sex, and location of removal (clinic, operating room, or emergency department). Thirty-four patients were enrolled (20 male, 14 female). The average age was 5.25 years (range: 10 months to 15 years). The average age of patients with foreign bodies in the ear was 5.98 years (n = 23), esophagus 4.34 years (n = 6), and nose 2.97 years (n = 5). Nineteen (56%) of the foreign bodies were acquired at home and 17 (50%) under supervision by parents. Children with a younger sibling have a significantly increased risk of acquiring a foreign body compared with children without a younger sibling (odds ratio = 4.00, p = 0.04). We conclude that although acquisition of foreign bodies should become less common as children mature, older siblings (i.e., children who have a younger sibling) are at increased risk for foreign body acquisition. Most foreign bodies are acquired at home under supervision by parents. Increased awareness of this finding may help prevent foreign bodies in the head and neck.

Bacterial cellulose as a new graft model for the Turkish delight technique in rhinoplasty: An experiment in 20 rats

September 18, 2017     Sevim Aydinli, MD; Sultan Biskin, MD; Aykut Erdem Dinc, MD; Yusuf Orhan Ucal, MD; Nilufer Kandemir, MD; Ishak Ozel Tekin, MD

Abstract

We conducted an experiment to investigate the effectiveness of bacterial cellulose, a new graft material, in correcting and preventing dorsal nasal disorder in rhinoplasty. The experiment was performed on 20 Wistar albino rats. The rats were evenly divided into two groups: a fascia group and a cellulose group. In the fascia group, grafts from the conchal cartilage were removed, shredded, and then wrapped in temporal muscle fascia. In the cellulose group, shredded cartilage was wrapped in the bacterial cellulose. These shredded gristle grafts, which were also placed in a subcutaneous area at the back of the rats, were excised after 60 days. We then performed histopathology to compare the health and integrity of the cartilage and the degree of vascularization, fibrosis, and chronic inflammation in the two groups. We found a significantly greater degree of vascularization (p = 0.004) and fibrosis (p = 0.005) in the fascia group and a significantly greater degree of chronic inflammation (p = 0.023) in the cellulose group. We found no statistically significant difference between the two groups in terms of cartilage health and integrity. Our results suggest that bacterial cellulose grafting may play a role as an alternative to fascia grafting for the wrapping of shredded cartilages in Turkish delight grafting, but further investigation is needed.

Surgical trainees and powered-drill use do not affect type I tympanoplasty hearing outcomes

September 18, 2017     David T. Kent, MD; David H. Chi, MD; Dennis J. Kitsko, DO

Abstract

The purposes of this study were to determine if use of a powered drill or trainee involvement during tympanoplasty is associated with a decline in sensorineural hearing, as well as to examine whether trainee involvement affected tympanic membrane (TM) closure rates. This study was a chart review (February 2006 to October 2011) of 172 pediatric otolaryngology patients undergoing type I tympanoplasty for TM perforation of any etiology at a tertiary-care pediatric otolaryngology practice. Data collected included air conduction (AC) at 250 to 8,000 Hz, speech reception thresholds, bone conduction (BC) at 500 to 4,000 Hz, and air-bone gap (ABG) at 500 to 4,000 Hz. Rates of surgical success did not change significantly if a trainee assisted during surgery (69.6% with an assistant vs. 77.4% without; p = 0.297). AC hearing was not found to be significantly different between the two groups preoperatively or postoperatively at 250, 500, 1,000, 2,000, 4,000, or 8,000 Hz (p > 0.05). There were no significant differences in AC hearing outcomes between patients in whom a surgical drill was used and those in whom no drill was used (p > 0.05). BC and ABG did not change significantly at any frequency (p > 0.05). In conclusion, no correlation between high-frequency hearing loss and use of a powered drill for canalplasty during type I tympanoplasty was found in this pediatric population. No significant difference was found in surgical success rates or AC hearing outcomes when a surgical trainee was present.

TNF-Alpha inhibitor as a cause of refractory suppurative laryngitis and rhinosinusitis

September 18, 2017     Sevtap Akbulut, MD; Lyndsay L. Madden, DO; Berrylin J. Ferguson, MD, FACS; Clark A. Rosen, MD, FACS

Discontinuation of TNF-α inhibitors is recommended in patients with bacterial infections requiring antibiotic therapy or those with severe upper respiratory infection.

Surgicel use in control of primary postadenoidectomy bleeding

September 18, 2017     Mohammad Waheed El-Anwar, MD; Ahmad Abdel Fattah Nofal, MD; Ashraf Elmalt, MD

Abstract

Although postadenoidectomy bleeding is a rare complication, it is serious and potentially fatal. Postnasal packing and cautery of the adenoid bed are the most popular methods of controlling postadenoidectomy bleeding. Many hazards and complications may arise from traditional nasopharyngeal packing and nasopharyngeal cautery. In this case series, oxidized regenerated cellulose (Surgicel Nu-Knit; Ethicon; Somerville, N.J) was inserted and used as postnasal packing to control primary postadenoidectomy bleeding in 9 cases after conventional curettage adenoidectomy. All patients underwent nasophayngoscopic examination with a 0° rigid telescope to re-curette if any remnant was still present, and were repacked with appropriate size ribbon gauzes for at least 15 minutes before applying Surgicel. Surgicel succeeded in controlling primary postadenoidectomy bleeding in all cases, with no need for any further intervention. At the 1-month follow-up, no complications were reported. We conclude that Surgicel postnasal pack effectively controls primary postadenoidectomy bleeding. Its many advantages make it superior to other traditionally used material. It is readily available, tolerable, relatively inexpensive, hemostatic, adhesive, freely reshaped, bactericidal, causes no granulation reaction, has no need to be removed, and the patient does not need to be in the ICU or sedated.

Comparison of clinical outcomes using a Piezosurgery device vs. a conventional osteotome for lateral osteotomy in rhinoplasty

August 24, 2017     Bulent Koc, MD; Eltaf Ayca Ozbal Koc, MD; Selim Erbek, MD

Abstract

Our aim for this study was to evaluate and compare the clinical outcomes in patients who underwent lateral osteotomy with a Piezosurgery device or a conventional osteotome in open-technique rhinoplasty. This cohort trial involved 65 patients (36 women and 29 men; average age: 23.6 ± 5.71 yr) who underwent surgery between May 2015 and January 2016. Piezosurgery was used for lateral osteotomy in 32 patients, whereas 33 patients underwent conventional external osteotomy. These 2 groups were compared for duration of surgery, perioperative bleeding, postoperative edema, ecchymosis, pain, and patient satisfaction on the first and seventh postoperative days. The Piezosurgery group revealed significantly more favorable outcomes in terms of edema, ecchymosis, and hemorrhage on the first day postoperatively (p < 0.001 for all). Similarly, edema (p = 0.005) and ecchymosis (p < 0.001) on the seventh postoperative day also were better in the Piezosurgery group. Hemorrhage was similar in both groups on the seventh postoperative day (p = 0.67). The Piezosurgery group not only experienced less pain on the first postoperative day (p < 0.001), but these patients also were more satisfied with their results on both the first and seventh postoperative days. Results of the present study imply that Piezosurgery may be a promising, safe, and effective method for lateral osteotomy, a critical step in rhinoplasty. The time interval necessary for the learning curve is counteracted by the comfort and satisfaction of both patients and surgeons.

Use of sialendoscopy as an aid to identify a large retained foreign body

August 24, 2017     Christopher J. Britt, MD; David Hyman, MD; Gregory K. Hartig, MD

Abstract

We describe the novel use of sialendoscopy in a 51-year-old man to identify a large and long-standing foreign body (wood) within the facial soft tissues that had eluded detection on previous imaging and surgical exploration. The identification of this foreign body was elusive on both computed tomography and magnetic resonance imaging, illustrating the limitations of imaging in identifying vegetable matter within soft tissues.

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