Otolaryngology Commons^™

Definitive Radiation Therapy For Schneiderian Inverted Papilloma Of The Soft Palate And Uvula., Rahul Sinha, Arianne J Abreu, Christopher E Fundakowski, Robert T Sataloff

Otolaryngology (ENT) Resident Research

Schneiderian inverted papilloma is a benign, locally aggressive tumor that typically arises in the respiratory mucosa of the nasal cavity and paranasal sinuses. These tumors are often asymptomatic but can cause unilateral nasal obstruction, discharge, hyposmia and epistaxis. They warrant attention particularly due to the potential for malignant transformation. They are treated most often with surgical excision. This case report describes a patient with Schneiderian inverted papilloma arising outside its usual location and managed with definitive radiation therapy instead of surgical excision due to concerns for functional impairment. Remission was obtained with radiation therapy, although the patient experienced treatment-related side …

Esophageal Innominate Artery Fistula After Delayed Recognition Of Esophageal Foreign Body., Arianne J Abreu, Rahul Sinha, Robert T Sataloff

Otolaryngology (ENT) Resident Research

Esophageal innominate artery fistula (EIF) is a rare cause of life-threatening gastrointestinal hemorrhage. This condition occurs most often secondary to an aneurysm, tumor, or esophageal foreign body. After stabilization of airway and circulation, the management options vary from open to endoscopic and endovascular repair. The initial presentation, diagnosis and management of EIF in the literature focuses on adults primarily. In this case report, the clinical presentation of EIF in a pediatric patient, secondary to delayed recognition of a foreign body, highlights management considerations in this population.

Bilateral Vocal Process Avulsion: A Rare Complication Of Laryngeal Trauma., Hye Rhee Chi, Omar Ramadan, Robert T Sataloff

Otolaryngology (ENT) Resident Research

Vocal process avulsion is a rare and often overlooked complication of laryngeal trauma, most commonly associated with endotracheal intubation. It involves detachment of the vocal process from the body of the arytenoid cartilage, leading to dysphonia, dysphagia, voice fatigue, and/or aspiration. While strobovideolaryngoscopy and laryngeal electromyography may suggest underlying structural disruption, diagnosis can be challenging when findings are subtle or imaging is inconclusive. Definitive diagnosis and management typically involves surgical evaluation and repair to restore vocal fold tension and glottic competence. We present the first documented case of bilateral vocal process avulsion following endotracheal intubation.

Case Report: Suspected Rupture Of A Papillary Thyroid Tumor In A Patient With Graves' Disease Who Experienced Airway Narrowing Without Respiratory Distress., Daniel Goodman, Samuel Bosco, Bradford Davison Smith

Otolaryngology (ENT) Resident Research

This case report describes a 55-year-old woman presenting with acute dysphagia and neck swelling after a "popping" sensation in her neck. CT and MRI revealed a large retropharyngeal cystic mass and a left thyroid lobe mass, causing airway displacement. Despite significant effacement of the oropharyngeal and supraglottic airway on flexible nasopharyngolaryngoscopy, the patient remained asymptomatic regarding respiratory distress. Subsequent ultrasound-guided fine needle aspiration biopsy diagnosed malignant papillary thyroid carcinoma. Concurrently, previously undiagnosed Graves' disease was identified. The clinical presentation was attributed to suspected rupture or hemorrhage of the malignant thyroid tumor, leading to a serosanguineous fluid collection and inflammatory edema. …

Anterior Vocal Fold Scar., Arianne J Abreu, Omar Ramadan, Robert T Sataloff

Otolaryngology (ENT) Resident Research

No abstract available

Time To Measure: A Proposed Theoretical Model For Head And Neck Cancer Intervals Of Care, Mary Jue Xu, Hannah Decker, Arianne Abreu, Rolvix H. Patterson, Hirwa Nteyumwete, Pier-Luc Beaudoin, David W. Hamilton, Aslam Nkya, Willybroad Massawe, Nicholas Correia, Furahini Yoram Paulo, Katherine Van Loon, Susan D. Emmett, Christina Reaves, Samuel Okerosi

Otolaryngology (ENT) Resident Research

Head and neck cancer care delays are challenging, given the complexity of cancer care pathways, which leads to delays throughout the patient journey, from the symptom onset to treatment completion. Current models and literature addressing cancer care are limited by heterogeneous definitions of care intervals, a focus on specific aspects of the patient journey instead of the whole care continuum, and limited use of implementation science to target gaps in implementing evidence-based interventions. Here, we propose the Head and Neck Cancer TImely aCess TO Care Model as an approach to conceptualize, measure, and address delays in diverse health systems.

Prolonged Ulcerative Laryngitis., Sugosh M Anur, Lauren E Melley, Robert T Sataloff

Otolaryngology (ENT) Resident Research

Ulcerative vocal fold lesions occupy the vibratory margins of the musculomembranous portion of the vocal folds and cause dysphonia. Symptoms may exist for several weeks to months before improvement occurs. Lesions observed on strobovideolaryngoscopy may resemble malignant leukoplakia and tempt physicians to obtain biopsy. Biopsy can cause permanent dysphonia and should be performed only when necessary. Therefore, it is important to identify prolonged ulcerative laryngitis and provide appropriate management.

Dynamic Obstruction Of The Subglottis: A Subglottic Stenosis Mimic., Razmig Garabet, Lauren E Melley, Omar Ramadan, Robert T Sataloff

Otolaryngology (ENT) Resident Research

Laryngomalacia is characterized by dynamic obstruction of the upper airway. Early detection using dynamic observation across the respiratory cycle helps assume accurate diagnosis and effective management. We present a case of laryngomalacia that mimicked characteristics of subglottic stenosis which could have resulted in unnecessary surgery.

Laryngeal Granuloma Reduction Following Treatment With High-Dose Oral Steroids., Jordan A Higgs, Lauren E Melley, Omar Ramadan, Robert T Sataloff

Otolaryngology (ENT) Resident Research

No abstract available

Laryngeal Cancer Presenting As An Anterior Glottic Web., Razmig Garabet, Lauren E Melley, Omar Ramadan, Robert T Sataloff

Otolaryngology (ENT) Resident Research

No abstract available

Retracted Publications In Otolaryngology-Head And Neck Surgery: What Mistakes Are Being Made?, Hannaan S Choudhry, Sugosh M Anur, Hassan S Choudhry, Emily M Kokush, Aman M Patel, Christina H Fang

Otolaryngology (ENT) Resident Research

OBJECTIVES: Retraction of publications is critical to maintaining scientific integrity, yet there is a lack of research on its occurrence in Otolaryngology. This study investigates characteristics, trends, and reasons for retraction of publications in otolaryngology journals.

STUDY DESIGN: Bibliometric analysis.

SETTING: PubMed, Scopus, Web of Science.

METHODS: A PubMed search for publications retracted during 1990 to 2022 from the top 60 journals with the subject "Otorhinolaryngology" using Scopus' CiteScore was performed. Publications were excluded if they were not in English, had missing information or did not have available abstracts or full-text. Publication and retraction dates, journal, country of origin, citation …

Vocal Fold Paresis And Bilateral Anterior Laryngeal Saccular Cysts In A Singer., Ryan Witcher, Lauren E Melley, Omar Ramadan, Robert T Sataloff

Otolaryngology (ENT) Resident Research

No abstract available

Acquired Anterior Laryngeal Web Following Laryngeal Inhalation Injury., Lauren E Melley, Omar Ramadan, Robert T Sataloff

Otolaryngology (ENT) Resident Research

No abstract available

Perioperative Opioids And Survival Outcomes In Resectable Head And Neck Cancer: A Systematic Review., Eric V Mastrolonardo, Derek S Mann, Harleen K. Sethi, Bo H Yun, Elliott M Sina, Maria Armache, Brooke Worster, Christopher E Fundakowski, Leila J Mady

Otolaryngology (ENT) Resident Research

BACKGROUND: Opioids are a mainstay in pain control for oncologic surgery. The objective of this systematic review is to evaluate the associations of perioperative opioid use with overall survival (OS) and disease-free survival (DFS) in patients with resectable head and neck cancer (HNC).

METHODS: A systematic review of PubMed, SCOPUS, and CINAHL between 2000 and 2022 was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies investigating perioperative opioid use for patients with HNC undergoing surgical resection and its association with OS and DFS were included.

RESULTS: Three thousand three hundred seventy-eight studies met initial inclusion …

Bcor-Rearranged Sarcoma Of The Tonsil., Samuel Bosco, Tanner Lyons, Melanie Shpigel, Corrado Minimo, Rehka Bhat, Seth Zwillenberg, Amit Bhojwani

Otolaryngology (ENT) Resident Research

A tonsillar mass in a young patient with no medical issues routinely presents as an infectious process. Practitioners must maintain a broad differential if diagnostic testing does not support an infection. Neoplasm must be excluded. Otolaryngologists must consider malignancies other than squamous cell carcinoma, the most common oropharyngeal malignancy, and lymphoma. Rare tumors, such as sarcomas, must also be considered. Otolaryngologists must be familiar with the proper management of rare oropharyngeal malignancies.

Endolymphatic Sac Tumor, Tanner P. Lyons, Laura Barry, Robert T Sataloff

Otolaryngology (ENT) Resident Research

Masses occupying the retrolabyrinthine space are uncommon and most often represent paragangliomas, choroid plexus papilloma, endolymphatic sac tumors (ELSTs) or distant metastasis. ELSTs are rare, locally invasive tumors of the inner ear, with less than 300 cases reported in the literature. ELSTs are associated with von-Hippel Lindau (VHL) disease. Patients diagnosed with an ELST should undergo genetic testing for VHL disease, and individuals with confirmed VHL disease should be screened for ELST(s).

Oncocytic Papillary Cystadenoma Of The Larynx: A Rare And Masquerading Entity., Samuel Bosco, James Ding, Christopher Fundakowski

Otolaryngology (ENT) Resident Research

We cared for a 59-year-old female smoker who presented with a supraglottic lesion mimicking a laryngeal saccular cyst. The lesion was found to be a oncocytic papillary cystadenoma. This is a rare, benign neoplasm that accounts for 2–4.7% of minor salivary gland neoplasms. Oncocytic papillary cystadenoma of the larynx is even more rare, compromising less than 1% of all benign laryngeal neoplasms. This case highlights the importance of comprehensive differential diagnosis for cystic laryngeal lesions.

Unresectable Primary Tracheal Synovial Sarcoma, Joann M. Butkus, Mackenzie Kramer, Daniel Eichorn, Ali Raza R. Shaikh, Rajesh R. Patel

Otolaryngology (ENT) Resident Research

Synovial sarcoma (SS) comprises less than 1% of head and neck cancers, and less than five cases of adult primary tracheal SS have been described. This case describes a patient encountered at a community-based academic hospital, and retrospective chart review was performed for data collection. A woman in her forties presented with shortness of breath due to a superior mediastinal mass found to be an unresectable primary tracheal SS. Primary treatment resorted to curative-intent radiation therapy. Subsequent metastasis required systemic chemotherapy with pazopanib. To the best of our knowledge, this is the first reported case of this nature and adds …

A Unique Case Of Metastatic Prostate Carcinoma To The Subglottis, Samuel Bosco, Kristen Prijs, Jordan Licata, Sandra A Schwartz, Raymond Lesser

Otolaryngology (ENT) Resident Research

An 85-year-old male presented to an otolaryngology office with hoarseness, stridor, and shortness of breath. He had been evaluated by 2 outside otolaryngologists for a 4-year history of hoarseness. He was referred for consideration for speech therapy regarding hoarseness, vocal fold edema, and a questionable right vocal fold polyp. The patient reported that his symptoms had worsened progressively over the prior 6-12 months. He had no history of head and neck cancer, recent intubation, autoimmune conditions, head and neck trauma, or smoking. The patient had a history of prostate carcinoma treated with radical prostatectomy, radiation therapy, and hormone therapy 18 …

Examination Of Care Processes And Treatment Optimization For Head And Neck Cancer Patients In A Community Setting “Hub And Hub” Model, Harleen K. Sethi, Elijah Walker, Travis Weinsheim, Matthew J. Brennan, Christopher E. Fundakowski

Otolaryngology (ENT) Resident Research

Objective

To examine referral pattern, the timing of diagnostic/staging processes, and treatment initiation for new head and neck cancer patients in a community setting.

Methods

Patients with a newly diagnosed previously untreated diagnosis of head neck cancer managed at Asplundh Cancer Pavilion/Abington Memorial Hospital from October 2018 to March 2020. Source of referral and preceding workup were examined as well as intervals between initial head and neck consult and various timepoints of treatment initiation.

Results

One hundred and five patients were included in the study. The primary referral sources were external general otolaryngology (56.3%). Oral surgery and dermatology obtained tissue …

Exuberant Arytenoid Edema Following Gore-Tex Thyroplasty, Mopileola Tomi Adewumi, Eli Bress, Robert T Sataloff

Otolaryngology (ENT) Resident Research

Arytenoid edema is not a well-described complication of thyroplasty. We report a case of exuberant arytenoid edema following thyroplasty in a 33-year-old female. The diagnosis was made post-operative day 1, the patient was immediately started on a 6-day course of methylprednisone with voice rest. The arytenoid edema completely resolved within 1 week.

Cartilaginous Choristoma Of The External Auditory Canal., Harleen K Sethi, Melanie Shpigel, Ghiath Alnouri, Jing Zhou, Robert T Sataloff

Otolaryngology (ENT) Resident Research

Cartilaginous choristoma is a rare benign lesion of the external auditory canal, generally found incidentally on physical exam in an asymptomatic patient. Our patient had the largest cartilaginous choristomas described in the literature to date. Additionally, this reviews the nomenclature and differential diagnoses of masses within the external auditory canal.

Hereditary Angioedema., Helen Lesser, Jason E Cohn

Otolaryngology (ENT) Resident Research

A 14-year-old African American female presented to the emergency department with spontaneous, sudden-onset lip swelling for 1 h. On examination, there was significant water-bag edema of the upper lip extending to the philtrum and premaxilla. Nasopharyngeal laryngoscopy revealed a patent airway without edema. She was initiated on intravenous dexamethasone, famotidine, and diphenhydramine, after which her edema improved but did not resolve. She was subsequently transferred to a local pediatric hospital and upon further testing she was found to have a C1 esterase inhibitor de novo gene mutation. Angioedema causes localized, non-pitting edema of the dermis, subcutaneous and submucosal tissue, and …

Bilateral Sensorineural Hearing Loss In The Setting Of Acute Methamphetamine Overdose, Jeremy Reich, Harleen Sethi, Robert Sataloff

Otolaryngology (ENT) Resident Research

Substance abuse is a rare but known cause of sensorineural hearing loss (SNHL). We report a case of acute SNHL in a 28-year-old man following an overdose of methamphetamine and incidental ingestion of fentanyl. On initial encounter, he had moderate-to-severe hearing loss in the right ear and severe-to-profound hearing loss in the left ear in addition to acute kidney injury, liver failure, and lactic acidosis. The patient was treated with a two-week course of high-dose steroids and expressed a subjective improvement in hearing. This case highlights the importance of auditory testing following a drug overdose and is one of the …

Perichondritis: Inspect The Lobule, Eli Bress, Jason E Cohn

Otolaryngology (ENT) Resident Research

CASE PRESENTATION: This is a brief report of a 57-year-old Caucasian female presented with a 4-day history of worsening left ear pain. Her symptoms began with left otalgia and otorrhea which progressed to helical erythema, prompting a visit to the emergency department. She was noted to have erythema of the left auricle and swelling of the left auditory meatus. Our otolaryngology service observed erythema of the auricle with sparing of the lobule.

DIAGNOSIS: The diagnosis to be otitis externa with perichondritis was established, and we recommended otic ciprofloxacin-hydrocortisone, IV vancomycin, and ciprofloxacin. The patient had marked improvement and was discharged …

Congenital Pulmonary Airway Malformation (Cpam): An Interesting Ent Consultation., James Ding, Lauren E Melley, Alexander Manteghi

Otolaryngology (ENT) Resident Research

A 13-month-old boy was referred to the emergency department from the pediatrician’s office for increased shortness of breath. A 2-view chest X-ray was ordered revealing right hemithorax hyperlucency, minimal lung markings, and leftward mediastinal shift.

Nasal Bone Fractures: Differences Amongst Sub-Specialty Consultants, Jason E. Cohn, Sammy Othman, Michael Toscano, Tom Shokri, Jason D Bloom, Seth Zwillenberg

Otolaryngology (ENT) Resident Research

BACKGROUND: Nasal fractures constitute the largest proportion of facial trauma each year, however, there is no consensus management. In this study, we investingated the role of the consultant and the functional and aesthetic outcomes of procedures performed to address nasal bone fractures.

METHODS: A retrospective chart review of patients who sustained nasal bone fractures was conducted from 8/1/14 through 1/23/18. Categorical variables were analyzed using chi-squared testing and Fisher's exact test, where appropriate, while continuous variables were compared using Mann-Whitney U testing.

RESULTS: During the study period, 136 patients met inclusion criteria for full analysis. The mean age of this …

To Balloon Or Not To Balloon, The Current State Of Management Of Eustachian Tube Dysfunction., David J. Lafferty, Brian J Mckinnon

Otolaryngology (ENT) Resident Research

While otologic complaints are a common reason for patients to present to an otolaryngologist, Eustachian tube dysfunction (ETD) remains a poorly understood disease whose management is unclear. Among the general population in the United States, ETD has a prevalence of 4.6% among adults and 6.1% among children. Eustachian tube dysfunction is not just a common diagnosis for otolaryngologists, ETD accounted for 2 million visits for patients less than 20 years old to primary care providers and over 2 million visits for patients older than 20 years old between 2005 and 2012. Despite the commonality of ETD, opinions differ wildly among …

Eagle Syndrome Masquerading As A Chicken Bone, Jason E. Cohn, Sammy Othman, Karima Sajadi-Ernazarova

Otolaryngology (ENT) Resident Research

This is a brief report of a 17-year-old male who presented to the emergency department with odynophagia and a foreign body sensation in the throat after choking on a chicken wing. A soft tissue neck radiograph was performed which revealed a 4.6-cm linear object in the vallecula read by the radiology department as a chicken bone. The otolaryngology team was consulted and performed a nasopharyngeal laryngoscopy which did not reveal a foreign body in the upper aerodigestive tract. On physical examination, the right tonsillar fossa was tender to palpation. Upon further review of the radiograph, the right stylohyoid ligament was …

An Unusual Presentation Of Subglottic Stenosis Necessitating Urgent Tracheostomy, Jacob Burdett, Alexander Manteghi

Otolaryngology (ENT) Resident Research

By definition, the subglottis is the area of the larynx immediately below the vocal folds extending to the level of the inferior border of the cricoid cartilage. This area represents the narrowest portion of the pediatric airway and is the most common site of iatrogenic stenosis. This stenosis is generally secondary to increased rates of intubation in infants of prematurity. Evaluation and treatment for subglottic stenosis represents one of the most common airway consultations within pediatric otolaryngology. Goals of therapy include securing a safe airway and restoring subglottic patency. In this clinical case, we present a unique pattern and presentation …