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Intramural esophageal hematoma mimicking a hypopharyngeal tumor

January 25, 2017  |  Chao-Jung Lin, MD; Bor-Hwang Kang, MD, PhD; Yueng-Hsiang Chu, MD, PhD; Chih-Hung Wang, MD, PhD

The common presentation of intramural esophageal hematoma is acute onset of retrosternal pain, typically accompanied by dysphagia, odynophagia, or hematemesis.

Mucous retention cyst of mastoid bone mimicking cholesteatoma

January 25, 2017  |  Nurdoğan Ata, MD; Suna Erkılıç, MD

Occlusion of mastoid cells and the aditus ad antrum caused by inflammatory diseases can result in poor ventilation and poor drainage of mastoid cells, which can in turn cause the formation of cysts.

Impact of exercise with TheraBite device on trismus and health-related quality of life: A prospective study

January 25, 2017  |  Charlotte Montalvo, MD; Caterina Finizia, MD, PhD; Nina Pauli, MD, PhD; Bodil Fagerberg-Mohlin, DDS; Paulin Andréll, MD, PhD

Abstract

Trismus is a common symptom in patients with head and neck cancer that affects many aspects of daily life negatively. The aim of this study was to investigate the impact of structured exercise with the jaw-mobilizing device TheraBite on trismus, trismus-related symptomatology, and health-related quality of life (HRQL) in patients with head and neck cancer. Fifteen patients with trismus (maximum interincisal opening [MIO] ≤35 mm) after oncologic treatment for head and neck cancer, underwent a 10-week exercise program with the TheraBite device and were followed regularly. Time between oncologic treatment and start of TheraBite exercise ranged from 0.7 to 14.8 years (average 6.2 years). MIO, trismus-related symptoms, and HRQL was assessed before and after exercise and after 6 months. A significant improvement in MIO was observed post-exercise (3.5 mm, 15.3%, p = 0.0002) and after 6-month of follow-up (4.7 mm, 22.1%, p = 0.0029). A statistically significant correlation was found between increased MIO and fewer trismus-related symptoms. In conclusion, exercise with TheraBite improved MIO and trismus-related symptoms in patients with trismus secondary to head and neck cancer. Structured exercise with the jaw-mobilizing device seems to be beneficial for patients with trismus independent of time since oncologic treatment.

Retropharyngeal and parapharyngeal abscesses: Factors in medical management failure

January 25, 2017  |  James Kosko, MD; Justin Casey, MD

Abstract

Retropharyngeal and parapharyngeal abscesses are the most common deep neck infections in the pediatric population. How best to treat these patients, be it intravenous antibiotics or immediate surgical incision and drainage, has long been debated. The purpose of this study was to evaluate patient and abscess characteristics associated with failure of medical treatment. We retrospectively examined 46 patients between 1999 and 2009 at Arnold Palmer Children's Hospital in Orlando. Patient charts were reviewed, and data collected included age, gender of the patient, size of the abscess, days of admission to the hospital, admission to the intensive care unit, and surgical intervention, if applicable. All patients first received 24 to 48 hours of IV antibiotics, at which point a clinical decision was made to proceed with surgery or continue conservative management. When comparing antibiotic treatment failure across age, gender, and abscess size, statistically significant correlation occurred only with the size of the abscess. Medical management was more likely to fail, and surgery needed, when abscesses were larger than 2 cm. Additionally, hospital stay was not statistically different between the medical and surgical groups. Our data demonstrate statistical significance for the ability to treat retro- and parapharyngeal abscesses 2 cm or less in diameter with IV antibiotics alone, without complications, and with a statistically similar average hospital stay compared with surgery. Abscesses larger than 2 cm may be managed medically, as well, but failure of antibiotic therapy alone is more likely, with surgical intervention more often required.

Evaluation of patient satisfaction with different hearing aids: A study of 107 patients

January 25, 2017  |  Seçkin Ulusoy, MD; Nuray Bayar Muluk, MD; Turhan San, MD; Cemal Cingi, MD

Abstract

We retrospectively investigated patient satisfaction with different types of hearing aids in 107 patients-60 males and 47 females, aged 8 to 84 years (mean: 53.8)-with unilateral or bilateral hearing loss, each of whom used two different hearing devices for at least 3 years per device. The International Outcome Inventory for Hearing Aids, Turkish edition (IOI-HA-TR) was used to evaluate satisfaction levels; we also calculated our own total individual subjective satisfaction (TISS) scores. We divided 16 different hearing devices into two types: device 1 and device 2; on average, device 2 had more channels, a lower minimum frequency, and a higher maximum frequency. We found that the IOI-HA-TR scores and TISS scores were higher and usage time was greater during device 2 use, and that there was a positive correlation between IOI-HA-TR and TISS scores. A total of 69 patients (64.5%) used device 2 for more than 8 hours per day, while 38 patients (35.5%) used it for 4 to 8 hours per day during the final 2 weeks of the trial. In contrast, 40 patients (37.4%) used device 1 for more than 8 hours, 50 (46.7%) used it for 4 to 8 hours, and the remaining 17 (15.9%) used it for less than 4 hours; the difference in the duration of use of the two devices was statistically significant (p < 0.001). Younger patients and patients with more education were more satisfied with their devices than were older patients and those who were not as well educated. We conclude that devices with good technologic features such as more channels, a lower minimum frequency, and a higher maximum frequency result in better hearing. Also, based on the age difference that we observed, we recommend that psychological support be provided to older patients with aided hearing to enhance their mental health and quality of life.

Chronic discharging sinus in the parotid: Are we missing something?

January 25, 2017  |  Mainak Dutta, MS; Indranil Chatterjee, MS, DNB, MCh(Pediatric Surgery); Mitrajit Mallik, MS, MCh(Pediatric Surgery)

A foreign body in the parotid substance/duct once diagnosed must be removed surgically, which often might require superficial parotidectomy.

Acetylcysteine in the treatment of subacute sinusitis: A double-blind placebo-controlled clinical trial

January 25, 2017  |  Mehrzad Bahtouee, MD; Gholamhosein Monavarsadegh, MD; Mohammadjavad Ahmadipour, MD; Mazyar Motieilangroodi, MD; Niloofar Motamed, MD; Jamshid Saberifard, MD; Seyyedsajjad Eghbali, MD; Hooman Adibi, MD; Hesam Maneshi, MD; Hasan Malekizadeh, MD

Abstract

Sinusitis is a common disease with harmful effects on the health and finances of patients and the economy of the community. It is easily treated in most of its acute stages but is associated with some management difficulties as it goes toward chronicity. Therefore, we tried to improve the treatment of subacute sinusitis by using acetylcysteine, which is a safe mucolytic and antioxidant agent. Thirty-nine adult patients with subacute sinusitis proved by computed tomography (CT) were enrolled in a double-blind, placebo-controlled trial. They received oral amoxicillin-clavulanic acid and normal saline nasal drops for 10 days and oral pseudoephedrine for 7 days. In addition, the patients received acetylcysteine (600 mg orally, once daily) in the intervention group or placebo in the control group for 10 days. A paranasal CT scan was taken at baseline and 30 days after patients finished the treatment and was evaluated quantitatively by Lund-Mackay (LM) score. Symptoms and some aspects of quality of life also were assessed at baseline and 14 days after initiation and 30 days after termination of the treatment via the Sino-Nasal Outcome Test questionnaire. The groups showed no significant difference in LM score after treatment. A positive correlation was observed between the LM and SNOT-20 scores. We concluded that adding oral acetylcysteine to amoxicillin-clavulanic acid, pseudoephedrine, and intranasal normal saline has no benefit for the treatment of subacute sinusitis.

Locoregional control of tongue base adenoid cystic carcinoma with primary resection and radial forearm free flap reconstruction

January 25, 2017  |  Bharat B. Yarlagadda, MD; Josh C. Meier, MD; Derrick T. Lin, MD; Kevin S. Emerick, MD; Daniel G. Deschler, MD

Abstract

Adenoid cystic carcinoma of the minor salivary glands can be challenging and marked by high rates of local recurrence despite appropriate surgical resection. Management of this pathology in the base of the tongue is particularly difficult given the poor functional outcomes traditionally associated with an aggressive surgical approach. This article presents a case series of patients who underwent up-front surgical resection followed by free tissue transfer reconstruction. A retrospective analysis was performed of patients with adenoid cystic carcinoma of the base of the tongue who underwent composite resection and reconstruction with a radial forearm free flap. Three patients met inclusion criteria and underwent analysis. All patients achieved locoregional control after at least 4 years of surveillance. In addition, all patients were decannulated and were swallowing without the need for gastrostomy tube feeding. This series demonstrates that for select patients with adenoid cystic carcinoma of the base of the tongue, excellent locoregional control can be achieved with acceptable functional outcomes and prolonged survival when appropriate reconstructive measures are employed.

The role of surgery in necrotizing otitis externa

January 25, 2017  |  Maayan Gruber, MD; Eyal Sela, MD; Ilana Doweck, MD; Ariel Roitman, MD; Nechama Uri, MD; Samer Srouji, MD; Raanan Cohen-Kerem, MD

Abstract

This retrospective case review describes a subset of 5 patients with necrotizing otitis externa (NOE) with a refractory disease course who underwent surgery as part of their management plan between 2008 and 2013. Surgery promoted the cure of 4 of the 5 patients, and a fungal pathogen was recovered in 4 of 5 surgical samples. We conclude that surgery may be a necessary diagnostic and treatment adjunct in selective cases of NOE, especially in patients with a refractory disease course or with a suspected fungal etiology.

Effect of renal failure on voice

January 25, 2017  |  Walid A. Mudawwar, MD; Elie S. Alam, MD; Doja S. Sarieddine, BS; Zaahir A. Turfe, MD; Abdul-Latif H. Hamdan, MD, EMBA, FACS

Abstract

The objective of this case-control study was to assess the impact of dysphonia on quality of life and to report the perceptual and acoustic findings in patients with chronic renal failure. A total of 22 patients with chronic renal failure and 18 healthy controls were recruited. Patients were asked to complete the Voice Handicap Index (VHI)-10 to assess the impact of dysphonia on quality of life. Perceptual evaluation of patients' voice recordings using the GRBAS classification was performed. Acoustic analysis was also conducted. Fundamental frequency, habitual pitch, shimmer, relative average perturbation, harmonic-to-noise ratio, voice turbulence index, and the maximum phonation time were reported. The mean scores of the VHI-10 were within normative values, with no significant difference between groups. There was also no significant difference in any of the acoustic parameters or in the mean score of any of the perceptual parameters between patients and controls. We conclude that patients with renal failure do not have dysphonia with a significant impact on quality of life, as evident by the normative values of the VHI-10. There were neither perceptual nor acoustic differences between patients and controls.

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