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Long-term follow-up of KTP laser turbinate reduction for the treatment of obstructive rhinopathy

April 30, 2017  |  Hemal Raja, FRCS, ORL-HNS; Scott Mitchell, MBChB, MRCS, DOHNS; George Barrett, MRCS, DOHNS; Ashish Sharma, MBBS, MA, MRCS, MRCP; Derek W. Skinner, FRCS, ORL-HNS


We investigated the subjective, long-term, patient-reported symptom control after endoscopic potassium titanyl phosphate (KTP) laser reduction of the inferior turbinates. Symptoms were listed preoperatively and patients were asked, via telephone interview, the status of their symptoms. Chi-square analysis was used to assess statistical significance of the surgical intervention. Thirty-six patients (male:female ratio: 5:4) aged 13 to 80 years (mean: 37.2) were available for follow-up. The mean follow-up time was 68.47 months (range: 44 to 92). The principal symptom patients experienced was nasal obstruction (94.4%); postoperative improvement in this symptom at 44 months and beyond was reported by 85.3% of patients (chi-square 16.94, p < 0.001). Other symptoms, such as rhinorrhea and sneezing, showed no significant improvement at long-term follow-up. This study adds evidence to the long-term improvements in obstructive nasal symptoms using KTP laser reduction of the turbinates.

The role of hypertonic saline in monopolar tonsillectomy in adult patients

April 30, 2017  |  Jian Ma, MD; Mei Zheng, MS; Jun-Wei Mu, MD; Peng Cui, MD


This study's objective was to look for a simple and inexpensive method to reduce patients' pain during tonsillectomy. Bilateral tonsillectomy patients were enrolled and placed into different groups based on their admission numbers. Patients with odd numbers had electrical tonsillectomy on the right side with hypertonic saline injection into the tonsillar capsule (group A) or electrical tonsillectomy on the left side with normal saline injection (group B). Those with even numbers had electrical tonsillectomy on the left side with hypertonic saline injection into the tonsillar capsule (group A) or electrical tonsillectomy on the right side with normal saline injection (group B). Pain, operative bleeding, postoperative bleeding, and operation time were evaluated. Injecting hypertonic saline into the tonsillar capsule reduced pain caused by electrical tonsillectomy but did not impact the operative or postoperative bleeding and operation time. While simple and economic, monopolar electrical tonsillectomy with the help of hypertonic saline injected into the tonsillar capsule can effectively relieve patients' pain when compared to surgeries with normal saline injection.

Quality-of-life outcomes in Graves disease patients after total thyroidectomy

April 30, 2017  |  Lukas H. Kus, MD; Wilma M. Hopman, MA; Ian J. Witterick, MD; Jeremy L. Freeman, MD


Historically, research into surgical treatment of Graves disease has assessed subtotal rather than total thyroidectomy. Most clinicians now recommend total thyroidectomy, but little information is available regarding quality-of-life (QOL) outcomes for this procedure. Our aim was to assess QOL after total thyroidectomy. This is a retrospective, pilot study of patients with Graves disease who underwent total thyroidectomy from 1991 to 2007 at a high-volume tertiary referral center in Toronto, Canada. Questionnaires addressing disease-specific symptoms and global QOL concerns were sent to 54 patients. Analyses included parametric and nonparametric tests to assess the differences between perception of symptoms and global QOL before and after surgery. Forty patients responded (response rate: 74%) at a median of 4.8 years postoperatively. On a 10-point scale, overall wellness improved from 4.1 preoperatively to 8.7 postoperatively (p < 0.001). Patients recalled missing less work or school after surgery (7.8 vs. 1.1 days/year; p = 0.001). Overall satisfaction with the procedure was high. On average, symptoms improved within 32 days of surgery, and all symptoms showed substantial improvement. This is the first North American study to assess QOL outcomes of patients with Graves disease after total thyroidectomy. Patients experienced marked and rapid improvement in QOL postoperatively. These findings suggest that total thyroidectomy is a safe and effective treatment.

Large pediatric maxillary dentigerous cysts presenting with sinonasal and orbital symptoms: A case series

April 30, 2017  |  Shakil Ahmed Nagori, MDS; Anson Jose, MDS; Ongkila Bhutia, MDS; Ajoy Roychoudhury, MDS


Dentigerous cysts are benign odontogenic cysts associated with the crowns of unerupted, embedded, or impacted teeth. Most of them are associated with mandibular third molars, followed by maxillary third molars and canines. They are usually asymptomatic, and rarely do they grow extensively and compress the adjacent anatomic structures. We report 5 cases of extensive maxillary dentigerous cysts presenting with sinonasal and orbital symptoms. A literature review for similar presentations of dentigerous cysts has demonstrated 21 cases. Recognition of the extensive growth potential of the dentigerous cyst, diagnosing it with its unusual presentation, and appropriate management are discussed in this article.

Medially displaced common and internal carotid arteries presenting as a pulsatile mass: Clinicoradiologic analysis of 62 cases

April 30, 2017  |  Ilker Burak Arslan, MD; Yildiz Arslan, MD; Erhan Demirhan, MD; Selahattin Genc, MD; Yeliz Pekcevik, MD; Levent Altin, MD; Zahide Yilmaz, MD; Ibrahim Cukurova, MD


We conducted a prospective study to analyze the medially displaced courses of the common carotid artery (CCA) and the cervical segment of the internal carotid artery (ICA) in patients who were diagnosed with a pulsatile mass on nasopharyngolaryngoscopy and by clinicoradiologic findings. Our study group was made up of 62 patients-40 women and 22 men, aged 30 to 88 years (mean: 63.7)-who presented with a submucosal pseudomass or a bulging mass on the pharyngeal wall with obvious pulsation. For comparison purposes, we recruited a control group of 62 consecutively presenting patients who had been admitted to our Neurology Department with acute severe headache and who had undergone CT angiography based on a suspicion of an aneurysm or a vertebral or carotid artery dissection. A medially displaced carotid artery was identified in all patients in the study group. Two main course abnormalities were observed: (1) a pharyngeal superficial placement (PSP), consisting of a bulging or placement immediately adjacent to the naso-orohypopharyngeal lumen, and (2) a retropharyngeal midline placement (RMP), which entailed medialization of the carotid arteries to the midline. A PSP was observed in 11 patients, an RMP was found in 17 patients, and both were seen in 34 patients. The distance from the aberrant carotid artery to the pharyngeal wall and to the retropharyngeal midline of the retropharynx was measured at four levels: nasopharyngeal, retropalatal, retroglossal, and retroepiglottic in both groups. The mean distance was significantly shorter in the study group than in the control group at all four levels (p < 0.002). We conclude that the most likely diagnosis of a pulsatile mass detected on nasopharyngolaryngoscopy is an aberrant CCA or cervical ICA.

Linear IgA dermatosis limited to the mucosal membranes as a rare cause of dysphagia

April 30, 2017  |  Victoria M. Bones, MD; Lyndsay L. Madden, DO

Stapes-pyramidal fixation by a bony bar

April 30, 2017  |  N. Wendell Todd Jr., MD, MPH; Kai-Chieh Chan, MD

The treatment of otorrhea in children with cleft palate: An institutional review

April 30, 2017  |  Stephen Nogan, MD; Katie Phillips, MD; Jonathan Grischkan, MD


We conducted a retrospective observational chart review to characterize otorrhea in patients with cleft palate (CP) after tympanostomy tube placement in terms of the bacteria profile, treatment effectiveness, and overall disease burden. A total of 157 patients over 6 years were reviewed. Fifty of the 157 patients (31.8%) experienced postoperative otorrhea. Of the 50 patients with otorrhea, all received topical antibiotics, 30 received oral antibiotics, and 12 received povidone-iodine irrigations. The average duration of otorrhea was 5.2 months for patients with povidone-iodine irrigations and 8.5 months for those without povidone-iodine irrigations. Methicillin-resistant Staphylococcus aureus was the most commonly cultured microorganism. The average number of total healthcare visits over a 12-month period was 13.6 per patient. We conclude that postoperative otorrhea is a common problem after tympanostomy tube placement in children with CP and places a significant burden on these patients and the healthcare system. The bacteriologic profile may be different in this population compared with the non-CP population with otorrhea after tympanostomy, and a search for more effective treatment options is warranted, including further investigation into povidone-iodine irrigations.

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.