Case Reports in Otolaryngology最新文献

Background: Isolated congenital anosmia (ICA) traditionally represents an irreversible sensory disorder affecting 1 in 5,000-10,000 individuals. This case demonstrates rare partial olfactory recovery in childhood-onset anosmia following corticosteroid therapy, providing novel insights into olfactory neuroplasticity and therapeutic potential.

Case presentation: A 32-year-old woman with lifelong anosmia, diagnosed with ICA at age 20 using Sniffin' Sticks testing (2013), experienced first olfactory perceptions in 2014 following one week of oral corticosteroids and nine months of topical mometasone. MRI (2021) revealed barely visible olfactory bulbs, narrow olfactory clefts, minor ethmoid sinus inflammation, but normal-depth olfactory sulci and typical skull base morphology. Recent psychophysical testing (2025) demonstrated orthonasal hyposmia (TDI score 24) and retronasal hyposmia (11/20). Electrophysiological assessment detected preserved olfactory event-related potentials to hydrogen sulfide and phenyl ethyl alcohol, confirming functional neural circuitry. Recovery was complicated by parosmia, with foods like garlic, eggs and meat perceived as intensely unpleasant and faecal-smelling, leading to dietary modifications and preference for low-odour foods. Patient reported childhood social difficulties related to anosmia, with ongoing evolution of olfactory function over the past decade. Current treatment includes tapered systemic and topical corticosteroids, intranasal vitamin A drops (10,000 IU/day) and olfactory training, with recent improvements including tolerance of previously aversive foods.

Conclusions: This case challenges the irreversibility paradigm of childhood-onset anosmia and demonstrates that olfactory recovery is possible even after decades, potentially mediated by anti-inflammatory effects and neurogenic plasticity. The emergence of parosmia during recovery reflects maladaptive neuroplasticity during olfactory regeneration. Combined corticosteroid therapy, vitamin A supplementation and olfactory training may offer therapeutic hope for similar patients, warranting further investigation of inflammatory modulation and neuroregenerative approaches in congenital olfactory disorders.

One of the most challenging aspects regarding pediatric tracheostomy tube placement is the size selection, particularly in preterm infants. We present the first reported case of a makeshift tracheostomy tube using a 6-French suction catheter in a 31-week-old premature infant in an emergent situation. This approach holds promise as a potentially life-saving intervention for extremely small preterm infants. Furthermore, this case emphasizes the size discrepancy between the premature neonatal airway and the smallest tracheostomy tubes available. Further research is warranted to allow for more diverse clinical solutions that can accommodate similar cases in acute settings.

Tonsil stones or tonsilloliths are mineralised concretions in the crypts of palatine tonsils. They are usually small and asymptomatic. Sometimes, they can be recurrent, large in size and produce symptoms like a sense of foreign body in throat, mild pain and heaviness in throat and halitosis. In such cases, a surgical intervention may be required for permanent cure. We came across one such patient with massive tonsillolith which mimicked a peritonsillar abscess initially. Eventually, the large tonsillolith was surgically removed in toto. It measured 5.2 × 2.5 × 2.5 cm which makes it the largest tonsillar stone ever to be successfully removed till date.

Vestibular migraine (VM) requires a migraine history according to ICHD-3, but recurrent vertigo may also develop in secondary headache disorders. We report a 52-year-old man who experienced persistent headache and recurrent vertigo following a traffic accident. His headache fulfilled criteria for chronic posttraumatic headache and later medication-overuse headache. Vertigo attacks lasted minutes to 1 h and were accompanied by photophobia, phonophobia, and motion sensitivity, resembling VM despite no migraine history. Preventive therapy with amitriptyline and valproate reduced vertigo frequency and analgesic overuse. This case suggests that VM-like syndromes can occur with secondary headaches, where migraine-oriented prophylaxis may be useful.

During rhinoplasty surgery, tiny bone spicules (BSs) can form, particularly if blunt tools are used. If these BSs are not noticed and removed intraoperatively, they can cause cosmetic problems and nasal swelling postoperatively. A patient who underwent open rhinoplasty 2 years ago presented with a painless swelling causing cosmetic problems near the left medial canthus. A BS was detected by paranasal sinus computerized tomography and removed using an endonasal endoscopic approach (EEA). At 13 months of postoperative follow-up, the patient reported no complaints. The use of sharpened osteotomes or powered instruments, capable of creating the precise and desired osteotomies, is crucial to prevent the formation of BS. Detecting these BS intraoperatively is also desirable. Administering intravenous corticosteroids, such as prednisolone (1 mg/kg), maintaining hypotensive anesthesia, applying ice packs, and elevating the head 30° during surgery can help reduce edema and aid in the identification of BS. Saline irrigation and surgical field aspiration can facilitate the removal of BS. Final inspection and palpation of the nose from different angles under proper lighting are essential. In cases where BSs are overlooked, an EEA with minimal dissection and no skin scar may be preferred for their extraction. EEA is a minimally invasive, practical, and successful treatment option for BS extraction.

Introduction: Nasal chondromesenchymal hamartoma (NCMH) is a rare cause of nasal mass in infants and children. It was first described in 1998, and since then, only 63 previous cases have been reported.

Case report: Here, we report a case of a 4-day-old neonate with a right-sided nasal mass presenting with respiratory distress since birth. MRI was suggestive of chondromesenchymal hamartoma, for which endoscopic excision was done with complete removal of the tumor. The patient was diagnosed and successfully managed in our setup.

Discussion: NCMH is a rare cause of nasal obstruction in neonates, with a similar clinical presentation to other known nasal masses. Physical examination, imaging, histopathology, and molecular tests are combined to diagnose such cases. The curative management currently recommended is surgery.

Conclusion: It is always prudent to consider all possible differentials in neonates presenting with a nasal mass. Our report focuses on the role of proper examination, imaging techniques, and histologic evaluation for proper diagnosis and follow-up in a resource-limited setup.

Osteomas of the external ear canal are rare but benign bony growths. We present a case report of an external auditory canal osteoma in a 74-year-old female that spontaneously extruded from the ear. The patient was evaluated after the lesion dislodged from her ear canal without physical manipulation or operative intervention, and she presented the specimen intact. The diagnosis of osteoma was made clinically, radiographically, and pathologically. We propose that certain external ear canal osteomas may resolve spontaneously or be amenable to in-office removal.

"Rhinophyma" comes from the Greek words "rhis," meaning nose, and "phyma," meaning growth, which reflects its clinical presentation; overgrowth of sebaceous glands results in disfigurement or even nasal obstruction, in more severe cases. Nonsurgical treatments are the standard care, with dermabrasion, laser therapy, and ablative treatments being the most commonly preferred options. For advanced or recurrent cases, surgical intervention is the gold standard. Various surgical techniques have been described, including skin grafts, flaps, and skin substitutes. Surprisingly, there are only a few case reports in the literature regarding the surgical management of rhinophyma. We present two cases of severe and recurrent rhinophyma treated surgically in one stage procedure under local anesthesia by two different surgical techniques, one flap reconstruction and one dermal substitute and split-thickness skin graft reconstruction. Both patients had breathing difficulties, which were resolved after the surgical intervention. No major complications were detected during the 2 years of follow-up. Patients were satisfied with the aesthetic and functional outcomes. The surgical approach of rhinophyma should be the standard of care for recurrent cases or cases with nasal obstruction. Different surgical techniques have been described. As long as surgical planning is concerned, it is essential to consider practical and clinical factors such as patient's preferences, one or more stages of reconstruction, healing time, safety, and recurrence rates.

A 35-year-old man with uncontrolled human immunodeficiency virus (HIV) infection presented with a pharyngeal plaque-like lesion after recommencing antiretroviral treatment (ART). Rapid localized growth of the lesion paralleled his rising CD4+ T-cell count, suggesting immune reconstitution-mediated deterioration. The diagnosis of the lesion as angiolymphoid hyperplasia with eosinophilia was made more challenging by the atypical immune response that accompanies the HIV-associated immune reconstitution inflammatory syndrome.

Cricotracheostomy is a modified tracheostomy technique that involves partial resection of the anterior cricoid cartilage, which enables high-level airway access while minimizing the risk of subglottic stenosis. This report describes two adult cases of congenital scoliosis with complex skeletal deformities, including tracheal deviation and restricted neck extension, wherein conventional tracheostomy was challenging. In both cases, cricotracheostomy successfully provided stable airway access without complications such as granulation tissue formation, infection, or subglottic stenosis during follow-up. This report supports the utility of cricotracheostomy as the primary surgical approach in patients with severe skeletal deformities.