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A Case of Aspiration Pneumonia Caused by Cerebrospinal Fluid Leaks Associated with Delayed Identification of Iatrogenic Skull Base Injury during Endoscopic Sinus Surgery. 内窥镜鼻窦手术中因脑脊液漏致吸入性肺炎伴医源性颅底损伤的延迟诊断1例。
IF 0.6 Pub Date : 2021-04-08 eCollection Date: 2021-01-01 DOI: 10.1155/2021/5532194
Takashi Anzai, Akira Baba, Shin Ito, Yo Suzuki, Shori Tajima, Satoshi Hara, Yusuke Takata, Fumihiko Matsumoto, Katsuhisa Ikeda

Cerebrospinal fluid (CSF) leaks associated with endoscopic sinus surgery (ESS) are a rare complication affecting approximately 0.09% of patients. Although meningitis is a well-known complication of CSF leaks, the case we present is a rare and cautionary case of CSF leakage associated with ESS leading to aspiration pneumonia. A 43-year-old man with CSF leaks after ESS was referred to our hospital. After the operation, sometimes, he reported having a serous nasal discharge from the right side when he bent over, and he woke up choking on something every day. He also experienced headache, fever, fatigue, and cough. Interestingly, chest computed tomography (CT) showed a consolidation and ground-glass opacity in the posterior segments of the right upper lobes and superior segments of the bilateral lower lobes. These CT imaging findings were similar to those of aspiration pneumonia in bedridden patients who are always in a supine position. These findings suggest that CSF caused aspiration pneumonia. To the best of our knowledge, no case of aspiration pneumonia caused by CSF during endoscopic sinus surgery has been reported until now. If a patient with CSF leakage after ESS experiences fever, cough, or fatigue, physicians should consider aspiration pneumonia in addition to meningitis.

与内窥镜鼻窦手术(ESS)相关的脑脊液(CSF)泄漏是一种罕见的并发症,约占0.09%的患者。虽然脑膜炎是众所周知的脑脊液渗漏的并发症,我们提出的病例是一个罕见的和值得警惕的病例脑脊液渗漏与ESS导致吸入性肺炎。一名43岁男性因ESS后脑脊液渗漏被转介至我院。手术后,有时,他报告说,当他弯腰时,他有严重的右侧鼻分泌物,他每天醒来时都被什么东西噎住了。他还出现头痛、发烧、疲劳和咳嗽。有趣的是,胸部计算机断层扫描(CT)显示右上肺叶后段和双侧下肺叶上段有实变和磨玻璃影。这些CT影像表现与长期仰卧的卧床病人吸入性肺炎相似。这些结果提示CSF引起吸入性肺炎。据我们所知,目前尚未见鼻窦内窥镜手术中脑脊液引起吸入性肺炎的报道。如果ESS后出现脑脊液漏的患者出现发热、咳嗽或疲劳,除了脑膜炎外,医生还应考虑吸入性肺炎。
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引用次数: 0
Melanocytic Nevus in the External Auditory Canal with Keratin Accumulation. 外耳道黑色素细胞痣伴角蛋白积累。
IF 0.6 Pub Date : 2021-03-24 eCollection Date: 2021-01-01 DOI: 10.1155/2021/5539286
Junhui Jeong, Kyuin Lee, Hyun Seung Choi

Nevus is a benign melanocytic neoplasm and the most common type of skin tumor. It may occur anywhere on the skin, but it is rare in the external auditory canal (EAC). We present a case of melanocytic nevus in the EAC with keratin accumulation. In microscopic surgery, the mass was excised completely, and the wax and keratin material medial portion of the EAC behind the mass was removed. In this patient, a melanocytic nevus in the EAC caused symptoms of hearing loss and wax and keratin buildup. For melanocytic nevus in the EAC, excision and pathologic confirmation should be performed if there are symptoms or when malignant transformation is suspected.

痣是一种良性黑色素细胞肿瘤,是最常见的皮肤肿瘤类型。它可能发生在皮肤的任何地方,但在外耳道(EAC)是罕见的。我们报告一例黑色素细胞痣在EAC与角蛋白积累。在显微手术中,肿块被完全切除,肿块后面EAC内侧部分的蜡和角蛋白物质被去除。在这个病人,黑素细胞痣在EAC引起听力丧失和蜡和角蛋白堆积的症状。对于EAC的黑素细胞痣,如有症状或怀疑恶性转化时,应行手术切除和病理证实。
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引用次数: 0
Concomitant Obstructive Sleep Apnoea in Patients with Meniere's Disease: A Case Report and Literature Review. 梅尼埃病患者伴发阻塞性睡眠呼吸暂停1例报告及文献复习
IF 0.6 Pub Date : 2021-03-23 eCollection Date: 2021-01-01 DOI: 10.1155/2021/5592611
Wong Kein Low, Esther Jiayi Lim

Meniere's disease (MD) is a condition characterised by fluctuating and progressive hearing loss, aural fullness, tinnitus, and intermittent attacks of vertigo. The disabling vertigo symptoms can be controlled in most patients by lifestyle changes and medications such as diuretics. Should standard medical therapy fail, the patient may require surgery in order to control the disease, but such surgical procedures can be functionally destructive. Obstructive sleep apnoea syndrome (OSAS) is common, especially in people who are grossly overweight. Up to 15% of patients with MD may have concomitant OSA. Unless the OSA is well controlled, such patients may continue to experience MD symptoms despite receiving adequate standard medical therapy for MD. Moreover, MD patients may experience insomnia as a result of vertigo and/or tinnitus where sedatives are indicated. The use of sedatives with muscle relaxant properties may inadvertently further aggravate OSA resulting in a vicious cycle of symptoms. Symptoms suggestive of concomitant OSA must be proactively sought as these patients do not necessarily exhibit the obvious phenotypic features of OSA. This is especially so in Asians where OSAS is commonly observed in people who are not overly obese. We report a case of a female patient who presented with recalcitrant MD disease and was later found to have concomitant OSA. The relevant literature will be reviewed, and learning points will be discussed from the perspective of the otologist/neurotologist. The clinician must always be mindful of the existence of concomitant "silent" OSAS as this impacts the management of patients with MD.

梅尼埃氏病(MD)是一种以波动和进行性听力丧失、听觉充盈、耳鸣和间歇性眩晕为特征的疾病。大多数患者的致残性眩晕症状可以通过改变生活方式和服用利尿剂等药物来控制。如果标准的药物治疗失败,患者可能需要手术来控制疾病,但这种手术可能会对功能造成破坏。阻塞性睡眠呼吸暂停综合征(OSAS)很常见,尤其是在严重超重的人群中。高达15%的MD患者可能伴有OSA。除非OSA得到很好的控制,否则尽管接受了适当的MD标准药物治疗,这些患者仍可能继续出现MD症状。此外,MD患者可能因眩晕和/或耳鸣而失眠,这时需要使用镇静剂。使用具有肌肉松弛特性的镇静剂可能会在无意中进一步加重OSA,导致症状的恶性循环。由于这些患者不一定表现出OSA的明显表型特征,因此必须积极寻找提示合并OSA的症状。这在亚洲尤其如此,在亚洲,OSAS通常出现在不过度肥胖的人群中。我们报告一例女性患者谁提出顽固性MD疾病,后来发现有合并阻塞性睡眠呼吸暂停。回顾相关文献,并从耳科/神经科医生的角度讨论学习要点。临床医生必须时刻注意伴随的“隐性”OSAS的存在,因为这会影响MD患者的管理。
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引用次数: 0
An Uncommon Cause of Dysphagia: Postpneumonectomy Syndrome. 吞咽困难的一个不常见原因:肺切除术后综合征。
IF 0.6 Pub Date : 2021-03-08 eCollection Date: 2021-01-01 DOI: 10.1155/2021/6658690
Erica Rego, Ahmed Abdelmeguid, Yuqi Kevin Wang, Karuna Dewan

Objective: Dysphagia after pneumonectomy is uncommon but concerning. The purpose of this paper is to present a case of dysphonia secondary to postpneumonectomy syndrome. Case Report. A 66-year-old female with stage IIIa adenocarcinoma of the lung was treated with a left pneumonectomy. Three years later, she presented with severe dysphagia, dyspnea, and dysphonia. Esophagram demonstrated severely deviated esophagus to the left of midline, attributed to prior left-sided pneumonectomy, without clear evidence of any external compression. Chest CT scan showed associated leftward mediastinal shift. This patient was treated with voice therapy and an exclusion diet, as the patient elected not to have surgery.

Conclusion: This is the first reported case of dysphonia accompanying severe dysphagia following left pneumonectomy. While postpneumonectomy syndrome is rare, a high degree of clinical suspicion is recommended when treating patients with history of pneumonectomy.

目的:肺切除术后吞咽困难虽不常见,但值得关注。本文的目的是报告一个继发于肺切除术后综合征的发声障碍病例。病例报告。一例66岁女性IIIa期肺腺癌患者行左侧全肺切除术。三年后,她出现严重的吞咽困难、呼吸困难和发音困难。食管造影显示食管严重偏斜至中线左侧,归因于先前的左侧全肺切除术,无任何明显的外部压迫证据。胸部CT显示左侧纵隔移位。这名患者接受了语音治疗和排他饮食,因为患者选择不做手术。结论:这是首次报道的左侧全肺切除术后伴有严重吞咽困难的吞咽障碍病例。虽然肺切除术后综合征是罕见的,但在治疗有肺切除术史的患者时,建议高度怀疑。
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引用次数: 1
Nasopharyngeal Carcinoma Ex Pleomorphic Adenoma: Case Report and Comprehensive Literature Review. 鼻咽癌多形性腺瘤1例报告及综合文献复习。
IF 0.6 Pub Date : 2021-02-26 eCollection Date: 2021-01-01 DOI: 10.1155/2021/8892280
Ellen L Tokarz, Adian A Ong, Mark S Burke

Carcinoma ex pleomorphic adenoma (CXPA) is an epithelial malignancy that transforms from benign pleomorphic adenomas (PA) at a rate of 1.5% after 5 years and 10% after 15 years. The average age of reported nasopharyngeal CXPA is 56.7 years. However, the present case describes a 19-year-old making this case exceptionally rare. Standard treatment is wide local excision with adjuvant treatment. We report the demographics, presentation, treatment, and outcomes of 8 cases of nasopharyngeal CXPA. While surgical excision is the mainstay of treatment, negative margins can be difficult to obtain at the skull base, and we report a recurrence rate of 50% in nasopharyngeal primaries. Due to the aggressive nature of the disease and high rate of recurrence, the majority of patients in our review received adjuvant radiation with some receiving adjuvant chemotherapy in addition.

癌前多形性腺瘤(CXPA)是一种由良性多形性腺瘤(PA)转变而来的上皮性恶性肿瘤,5年后发病率为1.5%,15年后发病率为10%。报告的鼻咽部CXPA的平均年龄为56.7岁。然而,本病例描述了一名19岁的患者,使得这种情况非常罕见。标准治疗是局部广泛切除配合辅助治疗。我们报告8例鼻咽炎的人口统计学、表现、治疗和结果。虽然手术切除是主要的治疗方法,但在颅底很难获得阴性切缘,我们报告鼻咽部原发的复发率为50%。由于疾病的侵袭性和高复发率,在我们的综述中,大多数患者接受辅助放疗,一些患者还接受辅助化疗。
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引用次数: 0
Exuberant Intratracheal Granuloma. 气管内大量肉芽肿。
IF 0.6 Pub Date : 2021-02-22 eCollection Date: 2021-01-01 DOI: 10.1155/2021/6697478
Emelia Stuart, Michael Armaneous, David Bracken, Kayva Crawford, Andrew M Vahabzadeh-Hagh

Background: Upper airway granulomas are commonly encountered benign masses and are a result of pronounced tissue reactivity to localized respiratory mucosal trauma. The mechanism of injury to respiratory epithelium is most commonly iatrogenic and associated with intubation or indwelling tracheostomy. Case Report. A 40-year-old obese female with a history of multiple intubations, poorly controlled diabetes mellitus type II, and history of tracheal stenosis presented with sudden onset respiratory distress requiring intubation at an outside hospital. Direct laryngoscopy revealed a rapidly forming transglottic tissue mass, measuring 5.0 × 2.2 × 0.8 cm. The following case represents an unusual exception to our experience with granulomas given its rapidity of onset and migration of tissue around the endotracheal tube. Discussion. Laryngeal erythema and granulation formation are expected postintubation findings in most patients; however, the large size of granuloma tissue and rapid onset of symptoms in this case make it remarkable. Our patient had multiple risk factors for postintubation stenosis: female sex, poorly controlled diabetes, hypertension, obesity, and multiple prior intubations for periods lasting longer than forty-eight hours.

Conclusion: Our case highlights a rare laryngeal finding of a large granulation tissue mass causing sudden onset airway obstruction.

背景:上呼吸道肉芽肿是常见的良性肿块,是组织对局部呼吸道粘膜损伤的明显反应性的结果。呼吸道上皮损伤的机制通常是医源性的,与气管插管或留置气管切开术有关。病例报告。一名40岁肥胖女性,有多次插管史,控制不良的II型糖尿病,气管狭窄史,出现突发性呼吸窘迫,需要在医院外插管。直接喉镜检查发现快速形成的跨声门组织肿块,尺寸为5.0 × 2.2 × 0.8 cm。以下病例代表了我们对肉芽肿的一个不寻常的例外,因为它的发病速度快,气管内管周围的组织迁移。讨论。喉部红斑和肉芽形成是大多数患者插管后的预期结果;然而,在这种情况下,肉芽肿组织的大尺寸和快速发作的症状是值得注意的。我们的患者有多种插管后狭窄的危险因素:女性,控制不良的糖尿病,高血压,肥胖,多次插管持续时间超过48小时。结论:我们的病例突出了一个罕见的喉部发现,一个巨大的肉芽组织团块引起突发性气道阻塞。
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引用次数: 0
A Case Report of Complete Resolution of Auricular Mucormycosis in an 18-Month-Old Diabetic Child. 18月龄糖尿病患儿耳毛霉菌病完全治愈1例报告。
IF 0.6 Pub Date : 2021-02-20 eCollection Date: 2021-01-01 DOI: 10.1155/2021/6618191
Mariam Aljehani, Hatem Alahmadi, Mansour Alshamani

Background: One of the most rare but deadly types of infectious fungal infection is Mucormycosis. All the cases reported with this type of infection are immunocompromised individuals. The challenge of early detection and intervention makes it one of the high mortality rates among other infectious diseases. Case Report. We report an 18-month-old girl with undiagnosed diabetes presented with a very aggressive form of necrotic infection of the ear auricle with facial nerve palsy. Using a series of magnetic resonance imaging, antibiotics, and high clinical suspicion, a diagnosis was established, and the patient was sent to the operation theatre for surgical debridement. Monthly follow-ups showed improvement of the facial palsy, and a plan for artificial auricle is set to occur in the following months before the age of five. Discussion. Mucormycosis is considered a very fatal and aggressive infection that has a very high mortality rate in immunocompromised patients. Early detection of such cases with an array of magnetic resonance imaging (MRI) and computed tomography (CT) is crucial in early treatment. Early aggressive surgical debridement and empirical coverage of bacterial, viral, and fungal infections can also alleviate the chances of preventing any secondary infection to develop in such cases.

Conclusion: A combination of antifungal, antibiotic, and antiviral with timely surgical intervention improved the patient with complete resolution of the facial nerve palsy and no further recurrence of the infection.

背景:毛霉病是最罕见但致命的感染性真菌感染之一。所有报告的这类感染病例都是免疫功能低下的个体。早期发现和干预的挑战使其成为其他传染病中死亡率很高的疾病之一。病例报告。我们报告一个18个月大的女孩与未确诊的糖尿病提出了一个非常积极的形式坏死性感染的耳廓面神经麻痹。通过一系列磁共振成像,抗生素和临床高度怀疑,诊断成立,并将患者送往手术室进行手术清创。每月的随访显示面瘫有所改善,并计划在5岁前的几个月内进行人工耳廓手术。讨论。毛霉病被认为是一种非常致命的侵袭性感染,在免疫功能低下的患者中具有很高的死亡率。用一系列磁共振成像(MRI)和计算机断层扫描(CT)早期发现这些病例对于早期治疗至关重要。早期积极的手术清创和细菌、病毒和真菌感染的经验覆盖也可以减少在这种情况下预防任何继发感染的机会。结论:联合应用抗真菌药、抗生素和抗病毒药物,及时手术治疗,可使面神经麻痹患者完全康复,不再发生感染。
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引用次数: 4
A Case of Epistaxis as the First Sign of Acute Idiopathic Thrombocytopenic Purpura. 鼻出血为急性特发性血小板减少性紫癜的先兆1例。
IF 0.6 Pub Date : 2021-02-06 eCollection Date: 2021-01-01 DOI: 10.1155/2021/6612939
Shori Tajima, Fumihiko Matsumoto, Takashi Anzai, Satoshi Hara, Yo Suzuki, Katsuhisa Ikeda

Idiopathic thrombocytopenic purpura (ITP) is an acquired thrombocytopenia caused by the action of autoantibodies against platelet antigens. It is traditionally defined by a platelet count of less than 10 × 104/μL. Most patients with ITP are asymptomatic; however, symptoms have been confirmed in some cases. Conversely, it is very rare to find epistaxis as the first sign of ITP. We report the case of an 84-year-old man who came to the ear, nose, and throat department with severe and repeated epistaxis. We decided to keep him hospitalized as it was very difficult to stop the nasal bleeding. A full blood count showed a platelet level of only 1000/μL. Hematologic results confirmed the diagnosis of ITP. The patient underwent treatment with intravenous gamma-globulin, platelet transfusions, and romiplostim with a favorable response.

特发性血小板减少性紫癜(ITP)是一种获得性血小板减少症,由自身抗体对血小板抗原的作用引起。传统的定义是血小板计数小于10 × 104/μL。大多数ITP患者无症状;然而,在某些情况下,症状已得到证实。相反,很少发现鼻出血是ITP的第一个征兆。我们报告的情况下,84岁的男子谁来到耳鼻喉部严重和反复鼻出血。我们决定让他住院治疗,因为鼻血很难止住。全血细胞计数显示血小板水平仅为1000/μL。血液学结果证实ITP的诊断。患者接受静脉注射γ -球蛋白、血小板输注和罗米普罗stim治疗,反应良好。
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引用次数: 1
Malignant Transformation of Temporal Bone Schneiderian Papilloma Associated with HPV-6. 与HPV-6相关的颞骨施耐德乳头状瘤恶变
IF 0.4 Q4 OTORHINOLARYNGOLOGY Pub Date : 2021-01-25 eCollection Date: 2021-01-01 DOI: 10.1155/2021/6684254
O Marzouk, F Brasch, I Todt, P K C Goon, H Sudhoff

Introduction: Temporal bone Schneiderian papillomas (TBSPs) rarely present as a primary tumors arising from the middle ear and mastoid process. The clinical findings and imaging of TBSPs are not specific. Therefore, diagnosis can only reliably be definitively established by histopathology.

Objective: To report a novel case of a malignant transformation of TBSP associated with HPV-6 and to present its management. Case Report. A 68-year-old woman presented with conductive hearing loss and recurrent right-sided otorrhoea. Initially, we performed a lateral temporal bone resection and obliteration with abdomen fat. Early histology described TBSP associated with HPV-6. Follow-up detected malignant transformation of the Schneiderian papillomatous variant. Postoperative radiotherapy combined with extended temporal bone resection resulted in a disease-free 17-month period of follow-up. Discussion. TBSPs are not very specific, and the diagnosis can only reliably be established by histopathology. There is a risk of malignant transformation, and due to the absence of reliable prognostic markers, strict postoperative follow-up is mandatory and should consist of regular otoscopy, nasal endoscopy, and imaging. This case also supports the importance of extended temporal bone resections as salvage surgery, combining radical surgery with radiotherapy for improved survival rates.

简介颞骨施耐德乳头状瘤(TBSPs)很少作为原发性肿瘤出现在中耳和乳突。颞骨施奈德乳头状瘤的临床表现和影像学检查并不具有特异性。因此,只有通过组织病理学检查才能明确诊断:报告一例与 HPV-6 相关的 TBSP 恶性转化的新病例,并介绍其治疗方法。病例报告。一名 68 岁的女性患者出现传导性听力损失和反复右侧耳鸣。起初,我们进行了颞骨外侧切除术,并用腹部脂肪进行阻塞。早期组织学描述为与 HPV-6 相关的 TBSP。随访发现,施奈德乳头状瘤变体发生了恶性转化。术后放疗结合扩大的颞骨切除术使患者在 17 个月的随访中无疾病发生。讨论。TBSP的特异性不强,只有通过组织病理学才能可靠确诊。由于缺乏可靠的预后指标,术后必须进行严格的随访,包括定期进行耳镜检查、鼻内镜检查和影像学检查。本病例也证明了扩大颞骨切除术作为挽救手术的重要性,将根治性手术与放疗相结合可提高存活率。
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引用次数: 0
Kimura's Disease: A Rare Cause of Unilateral Tonsillar Enlargement. 木村病:单侧扁桃体肿大的罕见病因。
IF 0.6 Pub Date : 2021-01-07 eCollection Date: 2021-01-01 DOI: 10.1155/2021/8815317
Prakash Khanal, Agya Shrestha

Introduction: Kimura's disease is a rare inflammatory disorder of unknown cause, commonly seen in young Asian males. Case Report. A 61-year-old male patient presented with a history of right tonsillar mass and cervical lymphadenopathy. The patient underwent hematological investigation and imaging followed by resection of tonsillar mass. Based on histopathological and subsequent immunohistochemistry reports, the case was diagnosed as Kimura's disease of the tonsil. Discussion. Kimura's disease commonly presents as painless subcutaneous masses in the head and neck region or cervical lymphadenopathy. Kimura's disease presenting as a tonsillar mass is a very rare condition. Patients usually have peripheral eosinophilia and elevated levels of serum IgE. The diagnosis is based on the clinical and histopathologic findings in a biopsy of the mass and/or lymph node along with elevated peripheral eosinophil and serum IgE level.

Conclusion: The clinical presentation of Kimura's disease is highly variable. Kimura's disease should be considered as a differential diagnosis in patients presenting with a tonsillar mass. A high index of suspicion along with histopathological examination helps in the early diagnosis and management. Surgical excision is the treatment of choice.

木村氏病是一种病因不明的罕见炎症性疾病,常见于亚洲年轻男性。病例报告。男性,61岁,以右侧扁桃体肿块及颈淋巴肿大病史为主诉。患者接受血液学检查和影像学检查,并切除扁桃体肿块。根据组织病理学和随后的免疫组织化学报告,该病例被诊断为扁桃体木村病。讨论。木村病通常表现为头颈部无痛皮下肿块或颈部淋巴结病。木村氏病表现为扁桃体肿块是一种非常罕见的疾病。患者通常有外周血嗜酸性粒细胞增多和血清IgE水平升高。诊断是基于肿块和/或淋巴结活检的临床和组织病理学结果,以及外周血嗜酸性粒细胞和血清IgE水平升高。结论:木村病的临床表现多变性。当患者出现扁桃体肿块时,木村氏病应被视为鉴别诊断。高怀疑指数和组织病理学检查有助于早期诊断和治疗。手术切除是治疗的首选。
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引用次数: 0
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Case Reports in Otolaryngology
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