The association of secondary tonsillar and laryngeal tuberculosis: a case report and literature review

Tonsillar and laryngeal tuberculosis are rare diseases. We report a case with a tonsillar and laryngeal lesion. Histopathological and bacteriological examinations established the diagnosis of tonsillar and laryngeal tuberculosis associated with asymptomatic pulmonary focus.     

Fine needle non-aspiration cytology for the diagnosis of cervical lymph node tuberculosis: a single center experience

IntroductionThe fine-needle cytology is being used as a first line of investigation in the diagnosis of head and neck swellings, as it is simple, cost effective and less invasive as compared to biopsy.ObjectiveThe aims of this study were to evaluate the results of the fine-needle non-aspiration cytology of cervical lymphadenopathy and to study the factors influencing the rate of non-diagnosis results.MethodsThis retrospective study was conducted on selected patients with cervical lymphadenopathy that had undergone a fine-needle non-aspiration cytology followed by a histological biopsy. The sensitivity, specificity, positive predictive value and negative predictive value of fine-needle non-aspiration cytology for diagnosing tuberculosis were estimated. The risk factors of non-diagnosis results were evaluated.ResultsThe sensitivity, specificity, positive predictive value rates of fine-needle non-aspiration cytology for tuberculosis were 83.3%, 83.3%, 78.9% and 86.9% respectively. In total, 47 out of the 131 samples (35.8%) were considered non-diagnosis. Of the non-diagnosis samples, 84.2% (38 out of 47) were benign mostly due to tuberculosis (30 cases). Among the studied factors, only tuberculosis (confirmed by histopathological examination) was significantly associated with non-diagnosis cytology (p = 0.02, Odds-Ratio = 2.35).ConclusionTuberculosis is currently the commonest cause of cervical lymphadenopathy in North Africa. Fine-needle non-aspiration cytology is safe and accurate in the diagnosis of cervical tuberculous lymph node that is associated with the risk of non-diagnosis cytology.     

Protective effect of N-acetylcysteine against cisplatin ototoxicity in rats: a study with hearing tests and scanning electron microscopy

IntroductionOtotoxicity is a health problem appearing after powerful treatments in serious health conditions. It is sometimes inevitable when treatment of the serious disease is required. Cisplatin is an antineoplastic agent which was investigated previously to reveal increased nitrogen and reactive oxygen radicals that damages hair cells, resulting in ototoxicity. N-acetylcysteine, previously shown to decrease ototoxicity caused by different agents, is known to be a powerful in vitro antioxidant. Probably N-acetylcysteine, in addition to its antioxidant effect, blocks a cascade where reactive oxygen species result in apoptosis in the cochlea.ObjectivesThe possible preventive effect of N-acetylcysteine in cisplatin ototoxicity was studied with auditory brain stem responses, otoacoustic emissions, and histopathological investigation of the cochlea in a scanning electron microscopy.MethodsThis study was conducted on 21 Wistar Albino rats in four groups. 1 mL/kg/day three times in total intraperitoneal (i.p.) Saline (n = 5), 500 mg/kg/day i.p. three times in total N-acetylcysteine (n = 5), i.p. 15 mg/kg cisplatin alone (single dose) (n = 5) and i.p. 15 mg/kg cisplatin plus 500 mg/kg/day N-acetylcysteine (n = 6) were administered. The rats were anesthetized to study the hearing tests before and after the experiment. The rats were sacrificed to investigate the cochleas by scanning electron microscopy.ResultsAuditory brain stem responses and otoacoustic emissions values were attenuated in the cisplatin group. The group that received N-acetylcysteine in addition to cisplatin had better auditory brain stem responses thresholds and otoacoustic emissions. The samples obtained from the cisplatin group showed surface irregularities, degeneration areas, and total or partial severe stereocilia losses. The changes were milder in the cisplatin + N-acetylcysteine group.ConclusionCisplatin ototoxicity can be detected by auditory brain stem responses and otoacoustic emissions testing in rats. N-acetylcysteine may protect the cochlear cells from histopathological changes. We concluded that N-acetylcysteine given 4 h after cisplatin injection has a potential otoprotective effect against cisplatin ototoxicity. which suggests it could be used in clinical trials.     

Aural tuberculosis at the start of the 21st century. Literature review according to SWiM guidelines. Part 1: Clinical and diagnostic data

ObjectivesReview of the scientific literature dedicated to clinical data and diagnosis modalities for aural tuberculosis published since the start of the 21st century.Material and methodsSearch of the Medline, Cochrane and Embase databases for the period 2000–2020. Selection of articles in English, French and Spanish devoted to clinical cases and series documenting clinical data and diagnosis for aural tuberculosis of articles by two authors. Analysis performed according to SWiM guidelines. Extraction of data on pre-established files documenting clinical and diagnostic data.ResultsIn total, 173 articles: 163 case reports (228 patients) and 10 cohorts (177 patients) from 49 countries were analyzed. Female/male sex ratio was 1.05, with ages ranging from less than 1 month to 87 years. Tuberculosis involved another site in 35.1% of cases. Aural involvement was bilateral in 19.7% of cases. Clinical presentation corresponded to otitis media (prior antibiotic treatment and auricular surgery in 41.4% and 10.1% of cases, respectively) without any pathognomonic symptoms or signs. Associated severe locoregional complications were seen in 32% of cases, with 23.2% and 13% incidence of peripheral facial palsy and severe intracranial complications, respectively. Time to diagnosis ranged from less than 1 month to 384 months, and was longer than 12 months in 26.5% of case reports, without significant correlation (P = 0.29) with severe revelatory locoregional complications. Incidence of Mycobacterium tuberculosis detection ranged from 33.4% of documented cases in auricular secretions to 64.6% in polyps, granulomas, and/or biopsies. In the case reports, diagnosis with certainty was done in 58.3% of cases, while it was based on involvement of another site and on indirect criteria or positive clinical progression after treatment in the other 10.1% and 31.6%, respectively.ConclusionAural tuberculous must always be considered in case of unfavorable progression of otitis. Definitive diagnosis is based on multiple auricular sample sites, polymerase chain reaction, and γ interferon blood assay.     

Combined external and endoscopic frontal sinusotomy with stent placement: a retrospective review

OBJECTIVES: To examine the long-term results of combined external and endoscopic frontal sinusotomy using frontal sinus stents and to compare our results with those reported for the endoscopic Lothrop procedure. STUDY DESIGN: We performed a retrospective review of 40 patients with chronic frontal sinusitis refractory to medical management who underwent a total of 62 combined external and endoscopic frontal sinusotomies with stent placement. All procedures were performed by the senior author at Vanderbilt University Medical Center. MAIN OUTCOME MEASURES: Postoperative nasofrontal duct patency and subjective patient improvement based on the last clinical examination. RESULTS: The overall patency rate of the nasofrontal duct was 79% (95% confidence interval [CI] of +/-10%.) The overall subjective patient improvement rate was 78% (95% CI of +/-14%.). The average length of stent placement was 5 weeks. The mean patient follow-up time was 12 months. There were no surgical complications. The nasofrontal duct patency rate and patient improvement rate from our study did not differ statistically from results reported by other authors using the endoscopic Lothrop procedure. CONCLUSION: We have found endoscopic frontal sinusotomy, in conjunction with external frontal sinusotomy and placement of frontal sinus stents, to be as effective in obtaining frontal sinus patency rates and overall patient improvement rates as the endoscopic Lothrop procedure.     

Outpatient parotidectomy with or without the use of a post-operative drain: A retrospective bi-institutional study

Objective

Parotid surgery is historically performed as an inpatient procedure and suctions drains are predominantly used during surgery. Recent literature provides evidence that outpatient parotid surgery is safe and effective. Our study aims to describe the results of drainless outpatient parotidectomy and outpatient parotidectomy with drain placement and compare their outcomes.

Design

Retrospective cohort study.

Setting

Bi-institutional retrospective cohort study.

Participants

Patients that underwent outpatient drain-less parotidectomy and patients that underwent outpatient parotidectomy with post-operative drain placement.

Main Outcome Measures

Complication rates, unplanned post-operative visits, unplanned prolonged stay.

Results

Three hundred eighty patients underwent outpatient parotidectomy with drain placement and 31 patients underwent outpatient drainless parotidectomy in two different hospitals. The incidence of haematoma (drain: 3.1% vs. drainless: 0%, p = 1), infection (drain: 14.3% vs. drainless: 13.8%, p = 1) and salivary fistula (drain: 5.6% vs. drainless: 3.4, p = 1) were comparable between both groups. Seroma or sialocele was more frequently seen in the drain-less group (27.6% vs. 6.2%, p < .001), but were all managed conservatively. Within 10 days after surgery, unplanned visits seemed more frequent in the drain group, although the difference was not statistically significant (14.9% vs. 3.4%, p = .16).

Conclusions

Outpatient parotid surgery with or without the use of a post-operative drain is safe, practical and feasible. Same-day discharge with and without drain placement yield comparable outcomes. However, the results need to be interpreted cautiously as this study was limited by a small cohort of parotidectomies without drain placement. Future studies should further compare both approaches.     

Comparison of therapeutic results in sudden sensorineural hearing loss with/without additional hyperbaric oxygen therapy: a retrospective review of 465 audiologically controlled cases

Clin. Otolaryngol. 2011, 36 , 121–128 Objective: To investigate the necessity of routine application of hyperbaric oxygen therapy for sudden sensorineural hearing loss. Design/setting and participants: A retrospective chart review looked at 465 patients, with 353 of them receiving pharmacologic treatments alone. Among these patients, 76 underwent systemic steroid treatment only (steroid group) and 277 received systemic steroids and dextran (steroid–dextran group). The remaining 112 patients were treated with hyperbaric oxygen in addition to pharmacologic agents (steroid–dextran–hyperbaric oxygen group). Main outcome measures: The outcome was determined by comparing the difference of pure‐tone thresholds and absolute hearing gains after treatment calculated at each audiometric octave frequency or grouped frequencies of audiograms. On the basis of the severity of initial hearing loss, patients were classified at three scales of hearing impairments measured in decibels hearing level (dBHL): ≦70 dBHL, less severe; 71–90 dBHL, severe; and ≧91 dBHL, profound. The outcomes of their hearing recovery were classified into three recovery grades: good, fair and poor. Results: In those patients with initial hearing loss >90 dBHL, the addition of hyperbaric oxygen to steroid–dextran gave a significant hearing gain difference (P = 0.030) by showing a greater hearing gain of 24.5 ± 2.7 dB compared with steroid only (12.9 ± 3.7 dB) or steroid–dextran (15.6 ± 2.7 dB). This outcome was confirmed when we compared the outcome using the recovery grading; steroid–dextran–hyperbaric oxygen group showed that more patients with initial profound (≧91 dBHL) hearing loss responded to hyperbaric oxygen treatment by exhibiting good and fair recoveries (2% and 70%) as compared with steroid only (0% and 42%) or steroid–dextran (8% and 46%) groups (P = 0.043), while the patients with initial severe (71–90 dBHL) and less severe (≦70 dBHL) hearing loss responded to the addition of hyperbaric oxygen treatment with less favourable recoveries. Furthermore, the addition of dextran in steroid–dextran group showed no significant benefit compared with the steroid group (P =0.435). Conclusions: When applied as an adjuvant to pharmacologic agents, hyperbaric oxygen benefits patients with initial profound sudden sensorineural hearing loss. Therefore, we recommend the routine application of hyperbaric oxygen in conjunction with pharmacologic agents for those patients. The addition of dextran to steroid has no benefit and cannot be recommended.     

The impact of arterial sclerosis on hearing with and without occupational noise exposure: A population-based aging study in males

Objectives

Arterial sclerosis contributes to inadequate blood supply to multiple organs, suggesting that general atherosclerosis may play an important role in the inner ear. Since noise is a major etiology for hearing loss, the aim of this study was to evaluate both the respective and the combined effects of arterial sclerosis and occupational noise exposure on hearing after accounting for age in middle-aged and elderly men.

Methods

The evaluation was conducted using 773 subjects from a population-based sample of 1189 men, aged 40–83 years. The impact of carotid atherosclerosis (CA) or retinal arteriolosclerosis (RA) on hearing was assessed according to history of occupational noise exposure (Noise) obtained in a questionnaire. Differences in the mean pure-tone thresholds at each frequency, between the CA (+) and CA (−) groups or between the RA (+) and RA (−) groups, based on noise exposure were compared using the general linear model (GLM) Procedure in SAS, with adjustments for age. Then, the main effect of CA or RA, and the interactive effect of noise and either CA or RA on pure-tone threshold at seven frequencies were analyzed using an analysis of covariance (ANCOVA), after adjusting for age.

Results

In the Noise (+) group, a statistically significant deterioration in hearing was found in the CA (+) group compared with the CA (−) group at 500 and 1000 Hz. The results in RA were significant at even lower frequencies than in CA. In the results from ANCOVA, the significant main effect of CA was shown in the pure-tone threshold at 8000 Hz, but not in the analysis of RA. A significant interactive effect of either CA or RA and Noise was observed in hearing at the range from 125 to 1000 Hz.

Conclusions

The present study suggests that the impact of arterial sclerosis on hearing is limited but significantly hazardous in middle-aged and elderly men, and that arterial sclerosis exacerbates the deleterious effects of noise on hearing. Early recognition of arterial sclerosis might be contributory to the hearing prognosis after middle age, especially for noise-exposed men.     

Cricotracheal separation: a review and a case with bilateral recovery of recurrent laryngeal nerve function

Cricotracheal separation (CTS) is an uncommon injury, with a high index of suspicion required to establish the diagnosis. Computerized tomography (CT) plays a role in diagnosis but cannot necessarily be relied upon. Bilateral recurrent laryngeal nerve (RLN) palsies are usually associated with this type of injury. We recently treated a patient with CTS in whom one RLN was intact from the time of the injury and the other nerve recovered within three months. Computed tomography was inconclusive. Early open repair of the injury and frequent follow-up examinations led to successful decannulation after six weeks and excellent short-term voice and airway outcomes. A detailed discussion of this unusual case is followed by a review of the current literature on CTS, with particular emphasis on significant management dilemmas and controversies. Clinical suspicion remains more sensitive than investigations in diagnosing CTS. Permanent bilateral RLN palsies are not inevitable following these injuries.     

Usage of personal music players in adolescents and its association with noise-induced hearing loss: A cross-sectional analysis of Ohrkan cohort study data

Objective: To describe personal music player (PMP) usage among adolescents, sociodemographic determinants and association with audiometric notches. Design: Audiometric evaluation to assess hearing status, and standardized questionnaires to evaluate PMP listening behaviors, leisure noise exposures and self-reported hearing loss symptoms. Sociodemographic information was collected using a parent questionnaire. Noise exposure by PMP usage equivalent for a 40?h week was estimated based on self-reported volume and duration of use. Study sample: A total of 2143 students (54% females) attending 9th grade in Regensburg, Germany, during 2009 to 2011. Results: Overall, 85% of the students reported using PMPs. Exposure level exceeded 80?dB(A) in approximately one third, and 85?dB(A) in one quarter, of those who used PMP. An audiometric notch was found in 2.3% of participants, but was not significantly associated with higher PMP exposure. Conclusions: PMP exposure above the occupational limits of 80 and 85?dB(A) set by the Directive 2003/10/EC may be a risk factor for developing noise-induced hearing loss. Educational measures to ameliorate high risk behaviors in PMP usage are needed, particularly for socially disadvantaged groups.     

Pediatric tracheal tumor masked by a history of travel: Case report and literature review

A previously healthy 10‐year‐old female reported a 1‐month history of wheezing and hemoptysis. Initial evaluation and treatment were focused on refractory reactive airway disease and infectious etiologies prompted by her recent travels in Africa. Worsening respiratory distress prompted emergent evaluation with imaging and endoscopy. Bronchoscopy diagnosed a distal tracheal tumor; pathology of this tumor was benign fibrous histiocytoma. Successful management of this condition included imaging, rigid bronchoscopy with biopsy, and tracheal resection to surgically excise the lesion. Although rare, tracheal tumors should be considered when presentation of asthma is atypical and nonresponsive to medical interventions. Laryngoscope, 125:1004–1007, 2015     

Empiric treatment of laryngopharyngeal reflux with proton pump inhibitors: a systematic review

OBJECTIVE: The objective of this study was to define the outcome of empiric treatment of suspected laryngopharyngeal reflux (LPR) symptoms with proton pump inhibitors (PPIs). DESIGN: The authors conducted a systematic review of the English and foreign literature. Studies that used PPIs as an empiric treatment modality for suspected LPR, whether alone or in combination with other acid suppressants and/or placebo, were included. Studies that did not include PPIs as a treatment option were excluded. MAIN OUTCOME MEASURES: A lack of common outcome measures was evident in the uncontrolled studies. In the randomized, controlled trials, outcome measures included symptom questionnaires and videolaryngoscopy. Only one study used computerized voice analysis. RESULTS: Fourteen uncontrolled studies together with one unblinded, nonrandomized study with a control group of healthy volunteers and six double-blind, placebo-controlled randomized trials were identified from 1994 to 2004. Selection bias, blinding of the results, and lack of common outcome measures were some of the problems preventing a formal metaanalysis. Although uncontrolled series reported positive results, randomized, controlled trials demonstrated no statistically significant differences for changes in severity or frequency of symptoms associated with suspected reflux between PPIs and placebo. CONCLUSIONS: Recommendations for empiric treatment of suspected LPR with PPIs, by far the most common ear, nose and throat practice in the United Kingdom, are based on poor levels of evidence from uncontrolled studies. The few randomized, controlled trials have failed to demonstrate superiority of PPIs over placebo for treatment of suspected LPR.     

Brains tern Electric Response Audiometry: Estimation of the Amount of Conductive Hearing Loss with and without Use of the Response Threshold

Three aspects of brainstem response audiometry were investigated in the present study. (1) The brainstem response threshold was compared with the pure-tone audio-gram in 40 patients with conductive hearing loss. The brainstem response threshold has a one-to-one relationship with the mean of the pure-tone thresholds at 2 and 4 kHz. The correlation coefficient in this comparison is 0.84 and the standard error of the estimate is 8.3 dB. Taking into account corresponding results in cochlear hearing loss [Drift et al.: Audiology 26: 1-10, 1987] it is concluded that the brainstem response threshold provides a good estimate of the amount of peripheral hearing loss, independent of the type of hearing loss. (2) It was shown [Drift et al.: Audiology 27: 260-270, 1988] that different types of peripheral hearing loss can be distinguished reliably with brainstem response audiometry. Parameters relevant for this distinction were the horizontal shift of the latency-level curve (1(L) curve), that of its derivative and the response threshold. In the clinical situation measurement of the response threshold is not always possible due to restlessness of the patient. To simulate this situation we randomly truncated the lower parts of the 1(L) curves of quiet patients. The test group consisted of 22 adult normally hearing subjects, 79 patients with cochlear hearing loss, 40 with conductive hearing loss and 22 with mixed hearing loss. Linear discriminant analysis was applied to the horizontal shift of the 1(L) curve and of its derivative. The brainstem diagnosis 'normal hearing' correctly excludes a conductive hearing loss in 98% of the cases and the brainstem diagnosis 'cochlear hearing loss' does so in 79%. The brainstem diagnosis 'conductive hearing loss' correctly predicts a conductive component of hearing loss in 94% of the cases and the brainstem diagnosis 'mixed hearing loss' does so in 90%. The distinction between cochlear hearing loss and normal hearing is not reliable, neither is the distinction between conductive and mixed hearing loss. (3) The amount of the conductive component of hearing loss can be estimated by the horizontal shift of the 1(L) curve. Statistical comparison with the mean of the air-bone gaps at 2 and 4 kHz gave a correlation coefficient of 0.77, a standard error of the estimate of 9.7 dB, and a slope of the regression line of 0.93. An overestimation of about 7 dB has to be taken into account in case of mixed hearing loss.     

Paranasal sinus bony structures and sinus functioning during viral colds in subjects with and without a history of recurrent sinusitis

OBJECTIVES/HYPOTHESIS: The objective was to assess the impact of ostial obstruction and anatomical variations on paranasal sinus functioning during viral colds with computed tomography (CT) in subjects with and without a history of sinusitis. STUDY DESIGN: Cross-sectional study. METHODS: Twenty-three volunteers with a history of recurrent sinusitis and 25 subjects without such history who had an early (symptoms for 2-4 d) natural cold were examined by taking viral specimens and CT scans and recording symptoms. The pathological sinus changes in the CT scans were scored, and several paranasal bony anatomical variations recorded. RESULTS: Viral origin of the cold was identified in 32 (67%) subjects, similarly in the two groups. Ostiomeatal obstruction and anatomical variations were equally frequent in the subjects with and without a sinusitis history (17 of 23 vs. 17 of 25 for ostial obstruction and 17 of 23 vs. 20 of 25 for at least one variation, respectively). However, in the case of ostiomeatal obstruction the combined CT score of ethmoidal and maxillary sinuses was significantly higher in the subjects with a sinusitis history than in those without (mean +/- SD, 3.0 +/- 0.9 vs. 2.3 +/- 1.2 [P =.05, t test]). In the sinusitis-prone subjects, several variations were associated significantly with various pathological sinus CT changes (septal deviation, horizontally situated processus uncinatus, large concha bullosa, and laterally concave concha media), whereas in the control subjects, only the presence of Haller cells was related to sphenoidal sinus disease. CONCLUSION: Ostiomeatal complex obstruction and bony anatomical variations seem to have a greater impact on the functioning of paranasal sinuses during viral colds in sinusitis-prone subjects than in subjects without a sinusitis history. These differences may be associated with the increased risk of bacterial sinusitis.     

Angioedema: 5 years' experience, with a review of the disorder's presentation and treatment.

Angioedema is a problem that the otolaryngologist-head and neck surgeon is often asked to treat. This report concerns 17 patients admitted for care during a 5-year period. At their initial presentation, 94% of these patients manifested signs and symptoms of angioedema in the head and neck; three of them required urgent tracheotomy or intubation. As treatment of complement-mediated angioedema is distinct, an etiology-specific diagnostic and treatment protocol is presented. Of the patients, 35% had recent initiation of angiotensin-converting enzyme (ACE) inhibitor therapy for hypertension, and 6% demonstrated classic hereditary angioedema. However, the majority of them (59%) had unclear etiologies for their symptoms. Since angioedema is the final result of several possible abnormalities, a thorough knowledge of the differential diagnosis and clinical presentation is vital to patient management.     

Osteonecrosis of the jaws: a review and update in etiology and treatment

Introduction

Osteonecrosis of the jaws can result either from radiation, used in radiotherapy for treatment of malignant tumors, or medications used for bone remodeling and anti-angiogenesis such as bisphosphonates. These conditions can be associated with triggering factors such as infection, trauma and decreased vascularity. The management of patients with osteonecrosis of the jaws requires caution since there is no specific treatment that acts isolated and decidedly. However, different treatment modalities can be employed in an associated manner to control and stabilize lesions.

电针疗法联合手法灸治疗Meige综合征1例并文献复习

目的 观察电针疗法联合手法灸治疗Meige综合征的疗效及优势。方法 整理1例Meige综合征患者资料,辨证取穴,针刺得气后连接电针仪。留针30 min后出针施以手法灸10～15 min。1次/d, 7 d为1疗程,5个疗程结束后观察患者症状改善情况。结果 5个疗程结束后患者症状基本消失,无复发。结论 电针联合手法灸治疗Meige综合征疗效及优势显著。