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Is there an association between migraine and allergic rhinitis?

June 20, 2017  |  Isil Adadan Guvenc, MD; Mustafa Acar, MD; Nuray Bayar Muluk, MD; Nagehan Erdogmus Kucukcan, MD; Cemal Cingi, MD

Abstract

We conducted a prospective study to evaluate nasal signs and symptoms and to perform allergen-specific immunoglobulin E (IgE) testing to investigate the relationship between migraine and allergic rhinitis. Our study group consisted of 40 patients diagnosed with migraine-22 men and 18 women, aged 21 to 38 years (mean: 25.7). We compared their findings with a control group of 40 healthy adults-15 men and 25 women, aged 19 to 36 years (mean: 25.1). Allergen-specific IgE measurements were obtained with six groups of allergens: fungi, grass pollens, tree pollens, wild herbs, house dust mite 1, and house dust mite 2. We found no significant difference between the migraine patients and the controls in the incidence of nasal signs and symptoms (i.e., discharge, congestion, itching, and sneezing) or inferior turbinate signs (i.e., color and edema). According to the IgE assays, 14 migraine patients (35.0%) were sensitized to one or more allergens, compared with 11 of the controls (27.5%); the difference was not statistically significant. Sensitization was highest for the grass pollens panel in both groups. Even though we did not find an association between migraine and allergic rhinitis, the recent literature supports a correlation between migraine and atopy. The two conditions share common neural pathways and common mediators, and they can be linked statistically in patients and their families. A pathophysiologic association between the two conditions seems more likely than an etiologic association. In this regard, future efforts could be focused on the determination of atopy in migraine patients and the therapeutic implications of this diagnosis.

A comparison of tonsillar surface swabbing, fine-needle aspiration core sampling, and dissected tonsillar core biopsy culture in children with recurrent tonsillitis

June 20, 2017  |  Saurav Sarkar, MBBS, MS, FACS; Abheek Sil, MBBS; Soma Sarkar, MBBS, MD; Biswajit Sikder, MBBS, MS

Abstract

In recurrent tonsillitis, the pathogenic bacteria are harbored in the tonsil core, and therefore cultures of superficial swab samples are not particularly accurate in identifying specific types of core bacteria. On the other hand, the results of fine-needle aspiration (FNA) cultures of core samples have been closely correlated with the findings of core cultures in excised tonsils, and both methods are far superior to surface swabbing. We conducted a prospective study to compare the accuracy of culture findings from tonsillar tissue obtained by surface swabbing, FNA sampling of the tonsil core in situ, and core sampling of the excised tonsil in children with recurrent tonsillitis. Our patient population was made up of 54 children-22 boys and 32 girls, aged 4 to 14 years (mean: 10.7)-who were undergoing elective tonsillectomy during a 1-year period. On the day of surgery, a surface swab, core FNA sample, and dissected core sample were obtained from each patient and sent for culture. Culture showed that the three methods were in agreement in 34 cases (63.0%). In 9 cases (16.7%) the surface swab culture grew different pathogens from those of the two core cultures, and in 3 other cases (5.6%) the surface swab culture was negative while the two core cultures were positive for the same pathogens. In all, the results of core FNA culture and dissected core culture were in agreement in 46 cases (85.2%); in only 4 cases (7.4%) did the core FNA culture fail to accurately identify the causative pathogens. Overall, the sensitivity and specificity of core FNA sampling were 100 and 50% respectively, compared with 82.9 and 30.8% for the superficial tonsillar swab. We conclude that routine culture of surface swab specimens in patients with chronic or recurrent tonsillitis is neither reliable nor valid. We recommend that core FNA sampling be considered the diagnostic method of choice since it can be done on an outpatient basis, it would reliably allow for culture-directed antibiotic therapy, and it could obviate the need for elective tonsillectomy in many cases. However, its feasibility as an office procedure in children remains to be determined.

Synchronous lesions of the right accessory parotid gland and left main parotid gland

June 20, 2017  |  Ba D. Nguyen, MD

Tumoral involvement of parotid glands is usually solitary; multifocality is rare

Correlation among external auditory canal anomaly, temporal bone malformation, and hearing levels in patients with microtia

June 20, 2017  |  Kun Chen, MS; Liu Liu, MS; Runjie Shi, MD; Peihua Wang, MD; Dong Chen, MD; Hua Xiao, MD

Abstract

We conducted a retrospective study to evaluate the relationship between external auditory canal (EAC) anomaly, temporal bone abnormality, and hearing levels using objective scoring systems in Chinese patients with microtia. The study population consisted of 106 ears of 94 Chinese patients (67 male and 27 female) aged 5 to 45 years (mean: 12.6) with microtia. The EAC abnormalities were classified into 4 types according to Schuknecht's criteria: type A, type B, type C, and type D. Developmental anomalies of the temporal bone were evaluated by Jahrsdoerfer computed tomography (CT) scoring system using high-resolution CT scans of the temporal bone. Temporal bone malformation parameters were divided into 4 subgroups: ossicular chain development, windows connected to the cochlea, aeration development of the middle ear, and facial nerve aberration. Hearing levels (air conduction and bone conduction) were examined. Outcomes parameters included correlation coefficients (r) and a number of other variables. The total points (10 points) and subtotal points related to ossicles (4 points), windows (2 points), aeration (2 points), and facial nerve (1 point) correlated inversely with the EAC abnormalities. The hearing levels (air conduction, r = 0.396, p <0.01; bone conduction, r = 0.21, p = 0.03) correlated significantly with the EAC abnormalities of Schuknecht's classification. We conclude that the better developed the external auditory canal, the better developed the temporal bone and the better developed the external auditory canal, the better hearing level. The hearing level also can serve as an indicator to determine whether a patient will be suitable for reconstructive surgery.

The protective effect of intratympanic dexamethasone on streptomycin ototoxicity in rats

June 20, 2017  |  Aylin Gul, MD; Engin Sengul, MD; Beyhan Yilmaz, MD; Fazil Emre Ozkurt, MD; Mehmet Akdag, MD; Aysenur Keles, MD; Ismail Topcu, MD

Abstract

The purpose of this experimental study was to investigate the protective role of intratympanically administered dexamethasone on the inner ears of rats that were exposed to streptomycin ototoxicity. Twenty-four adult Wistar albino rats were separated into 4 groups: Group 1 (only streptomycin), Group 2 (only intratympanic dexamethasone), Group 3 (streptomycin and intratympanic dexamethasone), and Group 4 (streptomycin and intratympanic saline). All rats were evaluated with distortion product otoacoustic emissions (DPOAE) tests before the start of treatment and on the day it ended. On the 45th day, after the final DPOAE tests, animals of all groups were sacrificed under general anesthesia. The differences between the amplitudes of DPOAE results were determined, and hearing results were statistically analyzed. Also, the cochleas of each rat were histopathologically evaluated under a light microscope with hematoxylin and eosin staining. In the intratympanic dexamethasone group it was observed that cochlear hair cells were mostly protected. No significant difference was seen between the DPOAE results before and after treatment (p >0.05). On the other hand, loss was observed in the hearing functions and hair cells of the rats that received streptomycin and streptomycin plus intratympanic saline (p <0.05). In the streptomycin plus intratympanic dexamethasone group, the cochlear hair cells were partially protected. A significant difference was observed when the DPOAE results (DP-grams) of the streptomycin plus intratypmanic dexamethasone group were compared to those of the streptomycin plus intratympanic saline group (p <0.05). After the experimental study, ototoxic effects of the administration of streptomycin and intratympanic dexamethasone were observed on the rats' cochlear hair cells. We conclude that intratympanic dexamethasone has protective effects against this cochlear damage in rats.

Is computed tomography perfusion a useful method for distinguishing between benign and malignant neck masses?

June 20, 2017  |  Fatih Duzgun, MD; Serdar Tarhan, MD; Gulgun Yilmaz Ovali, MD; Gorkem Eskiizmir, MD; Yuksel Pabuscu, MD

Abstract

Evaluation of neck masses is frequent in ear, nose, and throat clinics. Successful outcomes associated with neck mass are directly related to rapid diagnosis and accurate treatment for each patient. Late diagnosis of a malignant mass increases the magnitude of morbidity and the rate of mortality of the disease. Although magnetic resonance imaging and computed tomography (CT) examinations are important tools for evaluating head and neck pathologies, they do not allow functional evaluation. For this reason, CT perfusion (CTP) as a method of functional evaluation for distinguishing benign from malignant masses is gaining attention. The utility of CTP for distinguishing between benign and malignant mass lesions was investigated in 35 patients with masses in the neck (11 benign, 24 malignant). CTP was shown to be a useful method for identifying head and neck tumors and blood volume values to enable the differential diagnosis of benign and malignant head and neck tumors.

Impact of a pediatric anesthesiologist on operating room efficiency during pediatric tonsillectomies and adenotonsillectomies

June 20, 2017  |  Nicholas A. Dewyer, MD; Yoseph A. Kram, MD; Stephen Long, MD; Marika D. Russell, MD, FACS

Abstract

We conducted a retrospective case review to determine if the presence of an Accreditation Council for Graduate Medical Education (ACGME) fellowship-trained pediatric anesthesiologist improves efficiency during pediatric tonsillectomies and adenotonsillectomies in hospitals that do not have dedicated pediatric operating rooms and, if so, to determine which specific anesthesia practices might account for such a difference. We reviewed the charts of all patients aged 12 years and younger who had undergone a tonsillectomy or adenotonsillectomy from Jan. 1, 2008, through Aug. 1, 2013, at San Francisco General Hospital. A total of 75 cases met our eligibility criteria. We compiled information on patient demographics, surgical time, anesthesia time, and anesthesia practices. Our primary study outcome was the amount of anesthesia-controlled time (ACT), which is the sum of time spent in induction and emergence. Cases were grouped according to whether the operation was staffed by an ACGME fellowship-trained pediatric anesthesiologist or a general anesthesiologist. Data were analyzed for 1 pediatric anesthesiologist and 23 general anesthesiologists. We found that ACT was significantly shorter during the cases staffed by the ACGME fellowship-trained pediatric anesthesiologist, although there were no major differences in anesthesia practices between the types of anesthesiologist. We suggest that staffing pediatric tonsillectomy operations with a fellowship-trained pediatric anesthesiologist may be an effective strategy for increasing operating room efficiency.

Parathyroid carcinoma in a patient with three prior parathyroid adenomas

June 20, 2017  |  Michael Goldenberg, MA; Henry Crist, MD; Darrin V. Bann, MD, PhD

Fine-needle aspiration is contraindicated because of its inability to distinguish parathyroid carcinoma from benign disease and the risk of seeding tumor along the biopsy tract.

Idiopathic pretracheal deep neck space infection with mediastinal extension: A series of 3 cases and review of the literature

June 20, 2017  |  Samuel Roberts, BMed; Lyndon Chan, MBBS (Hons); Robert Eisenberg, MBBS, FRACS

Abstract

Idiopathic pretracheal deep neck space infection is an extremely rare condition with potentially devastating complications. We present a series of 3 cases of pretracheal deep neck space infection that arose in the absence of trauma or a congenital lesion and that exhibited mediastinal spread. To the best of our knowledge, these cases represent the first reported series of this rare condition to be published in the English-language literature. All cultures grew Streptococcus milleri, and all patients had a favorable outcome. A high index of suspicion for a deep neck space infection is warranted in view of the devastating complications of this condition. Computed tomography is the investigation of choice. Treatment with intravenous antibiotics and surgical drainage, particularly when mediastinitis is present, is recommended. This rare presentation warrants a thorough investigation to identify the source of infection.

Massive auricular cutaneous horn

June 20, 2017  |  Christopher P. Nyte, DO

The importance of preoperative histologic examination of the horn base with a suitable shave or punch biopsy cannot be overstated given the risk of underlying malignancy.

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