Glossodynia in patients with nutritional deficiencies

Various types of nutritional deficiencies can produce glossodynia and associated signs of inflammation. Changes such as swelling of the tongue, papillary atrophy, and surface ulceration are possible in most of the deficiency states. To further complicate the clinical picture, the patient commonly will suffer from multiple nutritional deficiencies [29]. Therefore, it is not advisable to diagnose a specific nutritional deficiency on clinical impression alone. To establish iron, folate, or vitamin-B12 deficiency, a hematologic screening that includes complete blood count, red-cell, serum iron, B12, and folate levels should be performed [30]. Although they are rarely required, specific tests for suspected niacin, pyridoxine, and riboflavin deficiency are available. Although glossodynia related to nutritional deficiency is statistically uncommon, it is easily curable with replacement therapy. Identification of a vitamin deficiency through early oral symptoms can forestall development of serious and irreversible systemic and neurologic damage.     

Adenotonsillectomy in high risk patients: Hematologic abnormalities and COVID-19 considerations

Adenotonsillectomy is one of the most common surgical procedures performed by otolaryngologists. It is vital that surgeons are aware of the risks in performing this surgery especially during the COVID-19 pandemic and in children with hematologic disorders. In this review we describe common hematologic disorders often noted in pediatric patients undergoing this procedure, as well as proper screening and management of these patients. In addition, we also address the impact of the COVID-19 pandemic and some measures to help mitigate the risks of this procedure during this time.     

Parotid hypertrophy with bulimia: a report of surgical management

Benign hypertrophy of the salivary glands can occur in patients with anorexia nervosa. This enlargement has been related to nutritional deficiencies and bulimia, which is a form of episodic binge eating followed by vomiting. The surgical management of a patient with bulimia and benign bilateral parotid enlargement secondary to bulimia will be discussed. Superficial parotidectomy may be a useful adjunct in managing the cosmetic and psychological aspects of patients with anorexia nervosa and bulimia complicated by massive parotid hypertrophy intractable to medical management.     

Oral features of Wegener's granulomatosis

A review of the dental literature yielded ten cases of Wegener's granulomatosis manifesting in the oral cavity, but only one was found in the medical literature. The most common oral lesion is hyperplastic gingiva, which is red to purple, with many petechiae. Tooth mobility, loss of teeth, and failure of wounds to heal are also common manifestations. The disease may remain localized in the oral cavity for unusually long periods of time before multiorgan involvement occurs. Histologically, oral biopsy tissue does not exhibit the characteristic features of vasculitis and granulomas. There are, however, diagnostic histologic features that are consistently present, including pseudoepitheliomatous hyperplasia, epithelioid histiocytes, giant cells, and eosinophils. Failure to recognize these diagnostic clinical and histologic features resulted in a 24-month delay in the diagnosis and treatment of our patient.     

Plasmacytoma and upper airway obstruction.

Extramedullary plasmacytomas are hematologic malignancies that occur primarily in the head and neck region. They usually involve the submucosal lymphoid tissue of the nasopharynx or paranasal sinuses and present as soft tissue masses, but have not been previously reported to cause airway obstruction. In general, detection of plasmacytoma antedates the eventual development of the systemic hematologic malignancy, multiple myeloma, by months or years. We describe a unique case of acute upper respiratory tract obstruction secondary to compression by an extramedullary plasmacytoma occurring in the neck of a patient with history of long-standing multiple myeloma. Upper airway obstruction may be a manifestation of untreated plasmacytoma. It is imperative for otolaryngologists and head and neck surgeons to be familiar with this entity because total excision, as well as radiation therapy, for plasmacytomas can be curative in patients without underlying overt plasma cell dyscrasias.     

Plasma cell dyscrasias and amyloidosis

The plasma cell dyscrasias and amyloidosis are distinct clinical entities that may co-exist. Both disease processes may present with manifestations in the head and neck, making familiarity with these conditions by otolaryngologists essential. Prompt diagnosis and evaluation for systemic disease are crucial in proper treatment planning.     

Connection between changing the vitamin and immune status and the character of the throat microflora in patients with chronic tonsillitis

The author investigated 28 patients with chronic tonsillitis. The fungi sort Candida on the tonsils was discovered at 10 (35.72) patients, the bacterial flora was discovered at the other patients. There were more considerable decrease content of vitamins B2, C, methylnicotinamide and methylmalonic acid in the urine, vitamins B2 and methylnicotinamide in the saliva, vitamins A and B1 in the serum of the blood in the group of the patients with the fungus flora on the tonsils. It was discovered the decrease of numbers of lymphocytes CD8 and level of immunoglobulins G and M, disimmunoglobulinemia in this group. This decrease of the vitamins, cell and humoral immunity level leads to disbacteriosis, decompensation of the disease and development of the complications.     

Manifestations of gastroesophageal reflux in the otorhinolaryngology tract

BACKGROUND: Gastroesophageal reflux disease (GERD) is associated with a wide spectrum of otolaryngologic disorders and extraesophageal complications of the upper aerodigestive tract. Previous studies of patients diagnosed with GERD have reported symptoms such as asthma, chronic cough, pneumonia, laryngitis, but also other oral, rhinopharyngeal and laryngeal disorders, e.g. sore throat, globus sensation, and hoarseness. The objective of this study was to determine the incidence of gastroenterologic diseases in patients complaining of upper aerodigestive, pulmonary, laryngeal, pharyngeal, oral, and cervical disorders that are possibly attributable to GERD. PATIENTS: This study included 40 patients, who presented to the department of Otolaryngology with chronic complaints of at least one of the following symptoms or disorders during a minimum period of 3 months: dysphagia (n = 28), sensation of globus pharyngeus (n = 28), hoarseness (n = 20), odynophagia (n = 22), heartburn (n = 16), postnasal drip (n = 15), sore throat (n = 22), cough (n = 14), throat clearing (n = 11), laryngospasm (n = 6), and voice fatigue (n = 6). A complete examination of the head and neck was performed. Inflammatory disorders of the nose and the paranasal sinuses could not be confirmed by history, nasal endoscopy and Water's view x-ray or CT-scan of the paranasal sinuses in all patients. RESULTS: The main otorhinolaryngologic findings were laryngeal lesions (n = 38), including posterior laryngitis, erythema and edema of the interarytenoideal region, and chronic hyperplastic laryngitis. All patients were referred for gastroenterologic evaluation, where esophagogastroduodenoscopy was performed with histological examination of biopsy specimens. Different gastroenterologic diseases such as GERD, gastritis and hiatal hernia were confirmed in 30 of 40 cases, and appeared solely or in combination with each other. GERD was the most frequent gastroenterologic disease (48%), followed by hiatal hernia (45%) and Helicobacter pylori positive antrum gastritis (23%). Patients with GERD were treated with medical antireflux therapy, e.g. 20 mg to 40 mg of the proton pump inhibitor omeprazole daily. There was a remarkably good therapeutic outcome, since laryngeal disorders and findings as the result of gastroenterologic diseases resolved in 29 out of 30 patients. To date, these therapeutic results were maintained for the mean follow-up period of 8 months. CONCLUSIONS: It is concluded that in many patients, suffering from the above-mentioned otolaryngologic symptoms, occult gastroesophageal diseases are present. However, laryngoscopic findings are subtle and meticulous examination is mandatory. Medical antireflux treatment is effective for relief of symptoms and mucosal healing. Thus, extraesophageal otolaryngologic symptoms and laryngeal manifestations are to be considered as extragastrointestinal manifestations mainly of reflux disease.     

Anti-tumor effect of vitamin A and D on head and neck squamous cell carcinoma

Objectives: Vitamin A and D₃ have a very strong differentiation induction effect. Study design: We examined the anti tumor effect on head and neck squamous cell carcinoma (HNSCC) by treatment with several vitamins having strong differentiation induction effects in vitro. Methods: We used KB cell that an oral floor squamous cell carcinoma, vitamins as all-trans retinoic acid (ATRA), 4-[3,5-bis (trimethylsilyl) benzamido] benzoic acid (TAC-101), 1,25(OH)₂D₃ (calcitriol) and 22-oxa-1,25-(OH)₂D₃ (OCT). We determined receptors of vitamin A and D₃ using RT-PCR. Furthermore, we investigated the proliferation of tumor cells in concentration dependency using [³H]TdR uptake method, apoptosis and apoptosis related factors using TUNEL method and real-time PCR, cell cycle changes using flow cytometry, changing of the sensitivity of using MTT method, cytokine production and the angiogenesis factor using ELISA, by treatment with these vitamins. Results: The deficit of RAR-β was found in the KB cell. Each vitamin suppressed the cell proliferation, induced apoptosis, and cell cycle arrest, upregulated sensitivity of the chemotherapeutics drugs and downregulated several angiogenesis factors and an apoptotic factor; survivin. Conclusions: These results support the idea that vitamin A, D₃ and their derivatives are useful for preventing and/or treating patients with HNSCC.     

Salivary gland biometry in female patients with eating disorders

High-resolution greyscale ultrasound is a generally accepted diagnostic tool for salivary gland enlargement, although no standard biometrical data for the sizes of unaffected parotid and submandibular glands exist. A lot of case reports describe non-inflammatory swelling of salivary glands as symptoms of eating disorders like anorexia nervosa or bulimia nervosa. They might be the only visible sign for the disease. With our prospective study we tried to quantify and compare biometrically the salivary gland in eating disordered patients, obese and normal-weight, healthy controls. A total of 70 females between 16 and 40 years of age were included of which 25 were healthy controls. All subjects underwent three-dimensional high resolution B-scan sonography of the parotid and submandibular gland. Gland volumes were calculated and a multiple regression analysis was done to investigate the influence of an eating disorder on salivary gland size. A significant difference in the size of the parotid glands was seen between our three study groups of adipose and eating disordered patients and healthy, normal-weight controls. The parotid gland volumes were seen in the subgroup bulimia nervosa (BN), (parotid volume = 63,708 mm(3)) where the mean value was more than twice as high as in the control group (31,059 mm(3)). By using body mass index and group characteristic the parotid gland volume as the dependent variable could be estimated with an r (2) of 0.327 in multiple regression analysis. Only the parotid glands were significantly enlarged, while the submandibular glands show no signs of enlargement. Eating disorders influence size of parotid glands, still the factors and the pathogenesis leading to this enlargement seem to be different in adiposity on the one and different types of eating disorders on the other hand. Standard gland volumes could be established, comparable to former initial reports. Submandibular gland remains unaffected by these alterations. We could show that high-resolution ultrasound assessment of parotid gland volume adds a complementary quantitative parameter of organ affection in eating disorders (anorexia/bulimia nervosa).     

Pediatric otolaryngologic manifestations of bleeding disorders

ObjectiveIn 1930, considering the diseases of the blood and lymphatic glands in relation to otolaryngology, Goldsmith and McGregor stated that “… the otolaryngologist has frequently to deal with bleeding from the nose and throat …”. After approximately 8 decades, in particular preoperatively, the use of universal coagulation screening in children is still controversial. Aim of the present review was to offer a concise but complete discussion of clotting disorders with pediatric otolaryngological interest recognizing: (i) vascular disorders, (ii) platelet disorders, (iii) disorders of coagulation, and (iv) thrombosis.MethodsAn exhaustive review of literature was performed to investigate available data and evidences regarding pediatric otolaryngologic manifestations of bleeding disorders.Results/ConclusionsModern otolaryngologists should be familiar with common bleeding disorders since many have head and neck manifestations. This knowledge allows the choice of appropriate pre-operative screening of surgical patients. The most important component of the preoperative assessment is the bleeding history that directs further laboratory evaluation. All otolaryngologic surgical procedures in children with bleeding disorders should be carried out with the close co-operation of the Haematology Department.     

Anti-neutrophil cytoplasmic antibody-associated mucocutaneous allergic vasculitis with oral manifestations caused by propylthiouracil.

A 49-year-old woman treated with increasing dosage of propylthiouracil (PTU) in order to control hyperthyroidism, developed progressive necrotic ulcers in the oral cavity, oropharynx and rhinopharynx and vasculitic ulcers on both auricular pinnae after a few days. The PTU treatment was immediately discontinued and the mucosal and skin manifestations resolved promptly. Laboratory findings, including anti-neutrophil cytoplasmic antibodies (ANCA), suggested allergic vasculitis. This is to our knowledge the first reported case of oral manifestations of PTU-induced allergic vasculitis.     

Velopharyngeal insufficiency and articulation impairment in velo-cardio-facial syndrome: the influence of adenoids on phonemic development

Velo-cardio-facial syndrome is the most common contiguous gene disorder in humans and constitutes 8% of patients with clefts of the secondary palate. Speech disorders, including severe hypernasality and articulation impairment have been documented as among the most common clinical manifestations of the disorder. A series of 36 consecutive patients with VCFS ranging in age from 3 to 14 years, all confirmed to have a 22q11.2 deletion, were studied to determine specific risk factors associated with VPI and articulation impairment. Factors studied included palatal clefting, hypotonia, platybasia, and adenoid size. The factor that correlated most strongly with speech disorders was adenoid hypoplasia or absence, a common manifestation in the syndrome. It is hypothesized that early identification of the absence or hypoplasia of the adenoids can result in the implementation of appropriate therapy plans to avoid severe disorders of speech intelligibility.     

Dietary antioxidant intake in patients at risk for second primary cancer

OBJECTIVES: To analyze dietary antioxidant intake for head and neck cancer patients at risk for development of second primary cancers. STUDY DESIGN: Prospective observational study. METHODS: Twenty-four patients underwent three random, unscheduled, 24-hour dietary recalls over a 15-day period within 6 to 60 months after successful treatment for stage I or II oral cavity squamous cell carcinoma. RESULTS: The study sample had a lower mean daily dietary intake of fruits and vegetables and antioxidant nutrients, including vitamins A, C, E, and total carotenes than age- and sex-matched historic control subjects (all P <.05 except vitamin A). A positive linear correlation was noted between daily servings of F&V and dietary intake of vitamins A, C, E, and total carotenoids (all P <.05 except vitamin A). Compared to current recommendations, the study sample had lower mean daily dietary intake of vitamins A, C, and E (P =.81,.06, and <.01) and servings of fruits and vegetables (P <.01). When vitamin supplements were included in the analysis, mean daily intake exceeded recommended dietary allowance (RDA) for vitamins A, C, and E (all P <.05). CONCLUSION: This study suggests that patients treated for early-stage oral cavity carcinoma, at risk for second primary cancers, have a statistically significant deficiency in dietary (food) sources of antioxidant nutrients when compared with both historic control subjects and current recommendations. Vitamin supplementation significantly exceeded current RDAs. Because increased fruit and vegetable intake, but not vitamin supplementation exceeding RDA, is associated with reduced cancer risk, physicians may consider recommending at least five daily servings of fruits and vegetables as an alternative to vitamin supplementation.     

The recognition and management of the otolaryngological manifestations of AIDS

Between October 1984 and December 1987, 219 patients who fulfilled the criteria for Acquired Immune Deficiency Syndrome (AIDS), as set out by the Centers for Disease Control, Georgia, were seen at St. Mary's Hospital, London. The most common otolaryngological manifestations of the disease in these patients were oral candidiasis (60%), oesophageal candidiasis (16%), persistent generalized lymphadenopathy (27%) and Kaposi's sarcoma (26%). Our management of the patients is described.     

Use of laboratory evaluation and radiologic imaging in the diagnostic evaluation of children with sensorineural hearing loss.

OBJECTIVE: Laboratory testing and radiologic imaging are commonly used to delineate syndromic from nonsyndromic sensorineural HL (SNHL). The aim of this study was to examine the yield of laboratory tests and radiologic imaging commonly used in the diagnostic evaluation of SNHL in children. STUDY DESIGN: Retrospective analysis of 114 (54 female, 60 male) consecutively investigated children with SNHL between 1998 and 2000 at a tertiary-care university hospital. METHODS: Results of routine laboratory testing to assess autoimmunity, blood dyscrasias, endocrine abnormalities, renal function, infection, and cardiac testing were reviewed. Results of radiologic evaluation were also reviewed. In general, computed tomography (CT) was obtained in patients with symmetric SNHL, whereas magnetic resonance imaging (MRI) with or without CT was obtained in asymmetric SNHL. RESULTS: Laboratory evaluation of the blood did not yield the etiology of SNHL in any patient. Blood tests for autoimmune disease were often positive but did not correlate with clinical disease. Nonspecific elevation of erythrocyte sedimentation rate (ESR) and antinuclear antibody (ANA) was present in 22% of cases. An abnormal electrocardiogram with a prolonged QT interval resulted in the diagnosis of Jervall and Lange-Nielsen syndrome. In the 97 patients who underwent radiologic studies, abnormalities were present in 38 of 97 studies (39%). Isolated inner ear malformations were twice as common as multiple abnormalities with large vestibular aqueducts as the most common isolated finding. CONCLUSION: In the evaluation of children with unexplained SNHL, routine laboratory evaluation should be reconsidered given its low diagnostic yield. However, radiologic abnormalities of the inner ear are common. Identification of inner ear malformations has direct impact on management of these children, suggesting that all children should undergo radiologic imaging as an integral component of evaluation of SNHL.     

Foudroyanter Verlauf einer therapierefrakt?ren Wegener Granulomatose bei negativen c-ANCA

BACKGROUND: Wegener's Granulomatosis is a rare systemic disease characterized by the triad of necrotizing granulomas of blood vessels, upper respiratory tract, and kidneys. Diagnosis depends on clinical symptoms (ACR-criteria), detection of serum circulating antineutrophil cytoplasmic antibodies (c-ANCA) and bioptical histopathology. CASE-REPORT: A 34-year-old patient presented with intraoral ulcerating, necrotizing inflammations of the palate and the gingiva. Chest radiograph (nodules, infiltrates), urin analysis (red blood cell casts) being inconspicuous Wegener's granulomatosis was diagnosed by histopathology of an intraoral incisional biopsy. Conventional therapy with corticosteroids and cyclophosphamide relapsed while the disease was taking a progressive course (pulmonary infiltrates, necrotizing vasculitides all over the common integument). The patient died of cardiac decompensation three months after diagnosis. c-ANCAs were not present at any time of disease. CONCLUSIONS: 1. Symptoms of the head and neck are manifest in up to 95% of Wegener's granulomatosis. So knowledge of the disease is important for dentists and oral and maxillofacial surgeons in spite of its low prevalence. 2. c-ANCA-titers do not reflect disease activity. Negative c-ANCAs do not exclude Wegener's granulomatosis. 3. Wegener's granulomatosis can take a progressive, therapy resistent course.     

Red cell rheology in patients with purulent-inflammatory diseases of the nose and paranasal sinuses

The study of rheological properties of red cells from peripheral blood in 61 patients with pyoinflammatory diseases of the nasal and paranasal sinuses has revealed defective red cell deformability, augmentation of their aggregation, alterations in their shape and volume. The severity of rheological disorders directly correlated with severity of intoxication and inflammation. Pathogenetic grounds are provided validating correction of hemorheological abnormalities.     

Idiopathic sudden hearing loss and disturbance of iron metabolism. A clinical survey of 426 cases.

The role of disturbances of the iron metabolism (DIM) in idiopathic sudden hearing loss (ISHL) was investigated in 426 patients with ISHL who received iron therapy, anti-DIM medication, vitamins, and a combined regimen in a randomized study which was stratified by stages and groups. Low concentrations of haemoglobin, serum iron, serum ferritin, and red cell basic ferritin as well as abnormal circadian variations in the serum iron level were observed. The results were significantly better in patients receiving iron therapy than in those receiving anti-DIM medication, vitamins, and the combined regimen. Hearing improvement was achieved in 53.26% of the patients whose treatment started later than 3 months after the onset of the disease. The clinical association of DIM and ISHL is discussed.     

Impacts of different methylprednisolone administration routes in patients with sudden hearing loss or Meniere’s disease

BackgroundEvidence suggests that glucocorticoids are important in the treatment of sudden hearing loss (SHL) and Meniere’s disease (MD). However, different glucocorticoid administration methods may have a significant impact on treatment outcomes.ObjectiveThis study aimed to investigate effects of different glucocorticoid administration methods on sudden hearing loss and Meniere’s disease.MethodsIn this study, glucocorticoids were administered orally in 18 patients, by retroauricular injection in 15 patients and by intratympanic injection in 15 patients. White blood cell (WBC) count, serum K⁺, fasting plasma glucose (FPG), body temperature, heart rate and blood pressure were used to evaluate effects of glucocorticoids on patients with hearing loss. Visual analog scale (VAS) of pain and sleep disorders were also surveyed, and pure tone audiometry (PTA) results were compared among groups to evaluate efficacy of different glucocorticoids administration methods.ResultWBC count, heart rate and blood pressure were higher in patients taking oral glucocorticoids, while body temperature, serum K⁺ and FPG levels did not change in all three groups. However, patients who received intratympanic injection of glucocorticoids experienced more pain, while those taking oral glucocorticoids reported more sleep impairment. Treatment efficacy on hearing loss was not significantly different among the three groups.ConclusionThese findings suggest that systemic glucocorticoid administration can result in greater whole body responses than local administration, but with similar hearing treatment efficacy.