Otolaryngology Commons^™

Eustachian Tube Foreign Body With Endoscopic-Assisted Surgical Removal, Phillip R. Purnell, Adam Bender Heine, Habib Zalzal, Abdul R. Tarabishy, Adam Casis

Faculty & Staff Scholarship

Abstract

Objectives. Foreign bodies of the external and middle ear are not uncommon; however, foreign bodies in the eustachian tube are rare. Here we describe the presentation, imaging, and endoscopic-assisted surgical management of a case of eustachian tube foreign body. Methods. A 34-year-old male was seen for evaluation of foreign body of the left eustachian tube while working with metal at a machine shop. Imaging and surgical management are highlighted and review of available literature regarding foreign bodies of the eustachian tube is presented. Results. A CT scan revealed a foreign body present approximately 1 cm into …

Improving Exposure For Transoral Oropharyngeal Surgery With The Floor Of Mouth Window: A Cadaveric Feasibility Study, Jefferson Chung, Adam Bender-Heine, H. Wayne Lambert

Faculty & Staff Scholarship

Background: Transoral robotic and laser surgery is rising in popularity due to the increasing incidence of Human Papilloma Virus (HPV) related oropharyngeal cancer. However, adequate exposure of the tongue base remains a major hurdle in many cases. This study introduces a novel surgical technique called the Floor of Mouth Window, which can be used to improve tongue base exposure at the time of transoral surgery. Methods: This is a preclinical anatomic cadaver study. Seven fresh cadavers were used for this study. Exposure of the tongue base was compared between conventional mouth gags – the Feyh-Kastenbauer and McIvor – and our …

Consistent Technique Limits Suspension Laryngoscopy Complications, Sean P. Larner, Rick A. Fornelli, Shane D. Griffith

Faculty & Staff Scholarship

ntroduction Suspension laryngoscopy (SL) is a commonly performed procedure among otolaryngologists. Several studies have shown that adverse effects occur regularly with SL.

Objective To evaluate the postoperative complications of SL, and to determine if protecting the dentition and the oral mucosa and limiting suspension times decrease the overall incidence of oral cavity and pharyngeal complications of SL.

Methods All of the cases of SL performed by 1 surgeon from November 2008 through September 2014 were retrospectively reviewed. A consistent technique for dental and mucosal protection was utilized, and suspension times were strictly limited to 30 consecutive minutes. The incidence of …

Can Symptoms Differentiate Between Chronic Adenoiditis And Chronic Rhinosinusitis In Pediatric Patients, Phillip R. Purnell, Jad H. Ramadan, Hassan H. Ramadan

Faculty & Staff Scholarship

The purpose of this article is to differentiate pediatric patients with chronic adenoiditis from those with chronic rhinosinusitis (CRS) based on presenting symptoms. A chart review from a tertiary care facility with pediatric patients who presented with suspected CRS from 2006 to 2014 was identified. We compared patient characteristics, clinical symptoms, duration of symptoms, and past medial history using univariate and multivariate logistic regression models. Based on recent literature, utilizing the computed tomography (CT) score, we identified those children with CRS versus those with chronic adenoiditis. Of the 99 pediatric patients included, 22 patients had diagnosis of adenoiditis and 77 …

Middle Ear Choristoma Presenting As Cholesteatoma With Conductive Hearing Loss, Phillip R. Purnell, Erik Interval, H James Williams, Adam M. Cassis

Faculty & Staff Scholarship

A 6-year-old male was seen for evaluation of middle ear polyp with associated hearing loss and otorrhea. CT scan revealed canal polyp with a stalk extending to the middle ear with malformation of the malleus and incus. The patient underwent exploratory tympanotomy which revealed a fistula from the bony-cartilaginous junction connecting to a middle ear mass which had eroded the incus. Intraoperative pathology suggested columnar epithelium without cholesteatoma or muscle. Final pathologic diagnosis reported dense fibrous tissue as well as ectopic salivary gland tissue, consistent with salivary gland choristoma. After removal of the mass, a partial prosthesis was successfully placed. …

Orofacial Granulomatosis In A Child, Reena Razdan, Maxwell D. Newby, Michele M. Carr

Faculty & Staff Scholarship

Orofacial granulomatosis (OFG) is a rare, idiopathic disorder of the orofacial region. It is clinically characterized by persistent and/or recurrent enlargement of the soft tissues of the oral and maxillofacial region, often manifesting as labial enlargement and swelling of intraoral sites such as the gingiva, tongue, and buccal mucosa. Full-thickness mucosal biopsy reveals noncaseating granulomatous inflammation, similar to Crohn’s disease and sarcoidosis. Thus, OFG must be distinguished from other chronic granulomatous disorders. We report a case of a young female patient who presented with labial and maxillary gingival enlargement without any identifiable systemic causes, with suggested involvement of environmental triggers.

Experience With Key Indicator Cases Among Otolaryngology Residents, Daniel C. O'Brien, Brian Kellermeyer, Jeffson Chung, Michele M. Carr

Faculty & Staff Scholarship

Objective

To describe the resident experience with respect to key indicator cases for each year of training.

Study Design

Multi‐institution, cross‐sectional assessment.

Methods

Using an electronic survey, current otolaryngology residents were solicited to complete a survey regarding their experiences with the key indicator cases to that point. The survey was sent to this cohort in the winter of 2017–2018.

Results

Three hundred and three residents responded, with 293 completing the survey. Twenty‐three percent were PGY1, 19% PGY2, 21% PGY3, 18% PGY4, and 19% PGY5 or higher. The majority of residents progress from resident assistant as a PGY2, to resident surgeon …

Isolated Inferior Rectus Muscle Entrapment Following Endoscopic Sinus Surgery, Scott Shapiro, Jamie L. Schaefer, Sumeet Gupta, John Nguyen, Brian Kellerymeyer

Faculty & Staff Scholarship

Orbital complications are known risks of endoscopic sinus surgery (ESS). The lamina papyracea and medial rectus muscle are the most commonly injured structures during ESS. Inferior rectus injury is more rare, with only one reported case of isolated inferior rectus injury in the literature. Guidelines for managing ESS-induced inferior rectus injury do not exist, and delayed intervention and management of adjacent sinuses may affect long-term outcomes such as persistent diplopia and disfigurement. In this report, we present a case of a 67-year-old man with diplopia due to isolated left inferior rectus muscle entrapment and injury from violation of the orbital …

Remarkable Presentation: Anaplastic Thyroid Carcinoma Arising From Chronic Hyperthyroidism, Habib G. Zalzal, Jeffson Chung, Jessica A. Perini

Faculty & Staff Scholarship

Background. Undifferentiated anaplastic carcinoma rarely develops from chronic hyperthyroidism. Although acute hyperthy- roidism can develop prior to anaplastic transformation, chronic hyperthyroidism was thought to be a protective measure against thyroid malignancy. Methods. A 79-year-old female presented acutely to the hospital with dyspnea. She had been taking methimazole for chronic hyperthyroidism due to toxic thyroid nodules, previously biopsied as benign. Upon admission, imaging showed tracheal compression, requiring a total thyroidectomy with tracheostomy for airway management. Results. Pathology demonstrated undifferentiated anaplastic thyroid carcinoma. The patient passed away shortly after hospital discharge. Despite treatment with methimazole for many years, abrupt enlargement of her …

Tracheocutaneous Sinus Following Tracheocutaneous Fistula Repair: Management Strategies In A Pediatric Patient, Adam Bender-Heine, Habib G. Zalzal, Nainika Nanda, Hassan Ramadan

Faculty & Staff Scholarship

Objective. To present a rare case of a pediatric tracheocutaneous sinus years after repair of a tracheocutaneous fistula and to review management strategies. Background. A tracheocutaneous fistula is a common sequela of pediatric tracheostomy and can occur in as many as one in three pediatric patients. There is debate in the literature regarding optimal surgical management. Case Presentation. An 8-year-old girl presented to the emergency department with swelling and erythema over the anterior neck. Clinical exam and diagnostic imaging revealed an underlying tracheocutaneous sinus. Discussion. Complications following pediatric tracheostomy are common and range in complexity from stomal granulation to tracheocutaneous …

Palatine Tonsil Stenting Of The Airway As Determined By Drug-Induced Sleep Endoscopy, Habib G. Zalzal, Steven Coutras

Faculty & Staff Scholarship

Objective. To demonstrate lateral pharyngeal wall collapse and increased apnea-hypopnea index in a child posttonsillectomy. Background. Some children have worsening of their sleep symptoms after tonsillectomy for obstructive sleep apnea. This case report demonstrates an open airway on drug-induced sleep endoscopy (DISE) in a child with tonsillar hypertrophy followed by more pronounced airway obstruction related to lateral pharyngeal wall collapse after tonsillectomy. Case Presentation. A 7-year- old boy presented with obstructive sleep apnea and underwent workup with DISE. Following adenotonsillectomy and subsequent lingual tonsillectomy with epiglottopexy, the patient’s sleep apnea symptoms and polysomnogram results worsened. Subsequent DISE showed a more …