The causes of the development of cicatrical stenosis of the larynx and trachea in the patients presenting with Guillain-Barré syndrome

The problem of rehabilitation of the patients presenting with post-intubation stenosis of the larynx and trachea remains unresolved despite the development of new methods for the diagnostics and treatment of this condition. One of the indications for long-term artificial lung ventilation is the severe form of Guillaine-Barret syndrome associated with paralysis of breathing muscles, development of bulbar symptoms, and disturbances of trophic process in the skin and mucous membranes. However, prolonged (mean 26 days) artificial lung ventilation may result in the formation of many-layer stenosis of the larynx and trachea whereas disturbed trophic processes in the skin and mucous membranes coupled to inadequate innervation complicate the postoperative conditions of the patients and promote restenosis of the tracheal lumen.     

Miller Fisher variant of Guillain-Barré syndrome masquerading as acute sphenoid sinusitis with orbital apex syndrome

Miller Fisher syndrome (MFS), a variant of Guillain-Barré syndrome, is a rare disorder typically characterized by a triad of ataxia, areflexia, and ophthalmoplegia, which may have a highly variable clinical presentation. We report a case of MFS in a 45-year-old female presenting with sphenoid sinusitis and sixth nerve palsy. She underwent endoscopic sphenoid sinusotomy without improvement, had postoperative deterioration, was diagnosed with MFS, and was treated with intravenous immunoglobulin with complete response. Because of the potential severity of Guillain-Barré syndrome, great vigilance should be taken when examining sixth nerve palsies to prevent misdiagnosis and delay in treatment of the MFS variant of this disease.     

Reconstruction of the upper lip,columella and premaxilla with an extended Abbé flap: report of a case

The resection of malignant tumours affecting the upper lip, columella, premaxilla and/or caudal septum requires reconstructive surgery, which does not always produce satisfactory results-either aesthetic or functional. We have designed a modification of the Abbé flap consisting of the extension of the distal portion of the latter over the chin, and the inclusion of a fragment of rib cartilage in this portion of the flap. The columella is reconstructed in this way, and the cartilage serves to buttress the pyramid tip and prevent its collapse. A case is reported, with good aesthetic and functional results. Other surgical procedures are discussed, analysing their advantages and inconveniences.     

The anatomical basis of the Abbé flap

OBJECTIVES: Objective of the study were 1) to determine the course, including specific relationship to the vermilion border, free margin of the lip, and orbicularis oris and number of the superior and inferior labial arteries, and 2) to discuss the relevance of this anatomy to design of the Abbé flap. STUDY DESIGN: Detailed anatomical dissections of the mid and lower face of injected cadaver heads. METHODS: Sixteen superior labial arteries and 15 inferior labial arteries in 9 adult cadaver heads ranging in age from 41 to 90 years were studied. RESULTS: The superior labial artery was a single vessel in all cases. At the oral commissure the vessel was superior to the vermilion border in 94% of the dissections. At the midline the vessel was within the vermilion border in 75% of dissections. The vessel was found within the orbicularis oris in 19% of dissections and between the mucosa and the orbicularis oris in 81% of dissections. The inferior labial artery was a single vessel in all dissections. Its course was variable in position relative to the vermilion border and to its take-off from the facial artery. In the central portion of the lip the vessel was found within the orbicularis oris in 13% of dissections and between the mucosa and the orbicularis oris in 87% of dissections. CONCLUSIONS: The superior labial artery is found within 10 mm of the free margin of the upper lip. The inferior labial artery is variable in its course, varying up to 15 mm from the free margin of the lower lip.     

vocal cord paralysis following section of rami communicans vagoglossopharyngeal for pharyngalgia and otalgia

A 46-year-old man experienced severe lancinating pain in the throat that radiated to the left ear. The pain, which was exacerbated by swallowing or coughing, had lasted for 2 years. The findings of the patient's neurological examination were normal. Computed tomographic and magnetic resonance imaging scans of the brain and nasopharynx did not show any abnormality. A diagnosis of idiopathic vagoglossopharyngeal neuralgia was made. In surgery, both the glossopharyngeal and the rami communicans between the vagal and grssopharyngeal nerves were sectioned. The patient was free of pain following the surgery, but complained of hoarseness in voice. Examination showed paralyzed left vocal cord at a paramedian position. In the 12 months following the surgery, the hoarseness has gradually improved and eventually disappeared.     

Is Susac syndrome (microangiopathy of the inner ear, retina, and central nervous system) an underdiagnosed cause of sensorineural hearing loss?

Susac syndrome is a rare disorder caused by the development of microangiopathic lesions in the inner ear, retina, and central nervous system. Although relatively few cases have been reported in the literature, this diagnosis is becoming more frequent as physician awareness increases. A high index of suspicion is needed to make the diagnosis because the signs and symptoms of Susac syndrome are those of a wide range of differential diagnoses. Otolaryngologists should be familiar with this syndrome because hearing loss may be the initial presenting symptom. We describe a new case of Susac syndrome to further promote physician awareness, and we discuss the options for diagnosis and treatment.     

Gradenigo's syndrome: Is fusobacterium different? Two cases and review of the literature

Gradenigo's syndrome is a rare but life threatening complication of acute otitis media (AOM), which includes a classic triad of otitis media, deep facial pain and ipsilateral abducens nerve paralysis. The incidence of Fusobacterium necrophorum infections has increased in recent years. We describe two cases of Gradenigo's syndrome caused by F. necrophorum. Additional four cases were identified in a review of the literature. Gradenigo's syndrome as well as other neurologic complications should be considered in cases of complicated acute otitis media. F. necrophorum should be empirically treated while awaiting culture results.     

Ear, nose, and throat manifestations of Sjögren's syndrome: retrospective review of a multidisciplinary clinic

OBJECTIVE: To assess the otolaryngologic manifestations of S?gren's syndrome (SS). DESIGN: A retrospective case study. SETTING: The Toronto Hospital. METHOD: Case note review of 196 patients evaluated in a multidisciplinary clinic for this disease. Patients were retrospectively classified according to the revised international classification. MAIN OUTCOME MEASURES: The prevalence of subjective and objective audiologic and otorhinolaryngologic abnormalities. RESULTS: One hundred eleven patients were diagnosed with primary and 26 with secondary SS, leaving 60 with unclassified sicca syndrome. There was minimal otologic pathology. There was a mildly increased prevalence of sensorineural deafness in secondary SS (41-60 years, 36%; 61-80 years, 70%). Approximately 50% of patients in each group complained of nasal symptoms, but only 20% had abnormal findings on rhinoscopy. Similarly, 60 to 70% in each group complained of throat symptoms, but only 20% had abnormal findings on indirect laryngoscopy. Thirty-eight percent of primary patients had parotid gland symptoms, and 25% had abnormally swollen glands, with eight subsequently diagnosed with lymphoma. No patients in the other two groups had abnormal parotid glands. CONCLUSIONS: SS does not appear to be associated with increased otologic or audiologic disease, except perhaps in conjunction with systemic autoimmunity. Nose and throat symptoms are common in SS, but the complications of mucosal dryness on examination are unusual (approximately 20%). Primary SS can cause serious parotid morbidity secondary to inflammation and infection. There is also a significant risk of lymphomas that often present as parotid masses, necessitating long-term follow-up.     

Prognostic value of the blink reflex test in Bell’s palsy and Ramsay-Hunt syndrome

Objective

This study was designed to evaluate the prognostic value of the blink reflex (BR) test in patients with Bell’s palsy (BP) or Ramsay Hunt syndrome (RHS).

“Sitting-up vertigo as an expression of posterior semicircular canal heavy cupula and posterior semicircular canal short arm canalolithiasis”

BackgroundVestibular symptoms on sitting-up are frequent on patients seen by vestibular specialists. Recently, a benign paroxysmal positional vertigo (BPPV) variant which elicits vestibular symptoms with oculomotor evidence of posterior semicircular canal (P-SCC) cupula stimulation on sitting-up was described and named sitting-up vertigo BPPV. A periampullar restricted P-SCC canalolithiasis was proposed as a causal mechanism.ObjectiveTo describe new mechanisms of action for the sitting-up vertigo BPPV variant.MethodsEighteen patients with sitting-up vertigo BPPV were examined with a pre-established set of positional maneuvers and follow-up until they resolved their symptoms and clinical findings.ResultsAll patients showed up-beating torsional nystagmus (UBTN) and vestibular symptoms on coming up from either Dix-Hallpike (DHM) or straight head-hanging maneuver. Sixteen out of 18 patients presented a sustained UBTN with an ipsitorsional component to the tested side on half-Hallpike maneuver (HH). A slower persistent contratorsional down-beating nystagmus was found in eleven out 18 patients tested on nose down position (ND).ConclusionsPersistent direction changing positional nystagmus on HH and ND positions indicative of P-SCC heavy cupula was found in 11 patients. A sustained UBTN on HH with the absence of findings on ND, which is suggestive of the presence of P-SCC short arm canalolithiasis, was found on 5 patients. All patients were treated with canalith repositioning maneuvers without success, but they resolved their findings by means of Brandt-Daroff exercises. We propose P-SCC heavy cupula and P-SCC short arm canalolithiasis as two new putative mechanisms for the sitting-up vertigo BPPV variant.     

Inflammatory focal myositis of the sternomastoid muscle: is there an absolute indication for biopsy? A case report and review of the literature

bstract Focal myositis is a localised inflammatory process affecting skeletal muscles belonging to the pathological group of inflammatory pseudo tumours of soft tissue that includes myositis ossificans, proliferative myositis and nodular pseudosarcomatous fasciitis. Very rarely, it may affect one of the neck muscles and present as a neck lump, in which case both the clinical and pathological picture can mimic a sarcoma. We describe a case of focal myositis of the sternocleidomastoid muscle, present a review of this rare condition and debate the necessity of biopsy.     

Study of the prevalence of impaired hearing and its determinants in the city of Itajaí, Santa Catarina State,Brazil

The number of people with impaired hearing is increasing; knowing its magnitude is essential for public health.ObjectiveTo study the prevalence and determinants of impaired hearing in Itajaí/SC.MethodsA population-based survey based on a World Health Organization protocol. Field research was carried out from July 2008 to 2011. Procedures for evaluating hearing in households: questionnaire, measurement of noise, otoscopy, pure tone audiometry at 1000, 2000, and 4000 Hz, tympanometry, and acoustic reflexes: individuals above 4 years; children under 4 years: evoked otoacoustic emissions (OAE), cocleo-palpebral reflex(CPR), tympanometry, and acoustic reflexes. In the elderly population a questionnaire of perception of hearing loss was applied.ResultsThe study sample consisted of 379 individuals – 45.38% were males and 54.62% were females. Age-range: 11.34% up to 10 years; 64.39% 10 to 60 years, 24.27% over 60 years. Evaluation of the best hearing ear showed that 74.1% of residents had normal hearing, 18.9% had mild hearing loss, 5.1% had moderate hearing loss, 1.9% had severe hearing loss. Disabling impaired hearing was detected in 26 subjects: one child (otitis media); four adults (one otitis, one noise-induced, two idiopathic); 21 elderlies (presbyacusis). Of eight children under 4 years all presented CPR, three were normal examinations, two had absent OAE bilaterally, one had absent OAE in the right ear and one in the left ear.ConclusionThe prevalence of disabling impaired hearing in Itajaí was 7%; the highest prevalence was in the 50-year and above age group – the main cause was presbyacusis.