Ent-Ear Nose & Throat Journal最新文献

Objective: Prelacrimal recess approach can be used to access lesions of the anterior wall of the maxillary sinus (MS). Moreover, the longer the prelacrimal recess window distance (PLRWD), the easier it is to access the anterior wall. This study aimed to define the correlation between maxillary sinus pneumatization (MSP) and PLRWD, a previously defined anatomic factor predictive of the ease of prelacrimal recess approach (PLRA).

Methods: In total, 506 sides of 253 participants were studied. In the axial image, the PLRWD, the distance between the anterior wall of the MS and the lacrimal duct, was measured through radioanatomical analysis and classified as type I (<3 mm), type II (3-7 mm), or type III (>7 mm). On the coronal image, the distance between the nasal floor and the lower end of the MS was measured. When MSP did not reach the nasal floor, it was classified as grade I, as grade II when MSP reached the nasal floor, and grade III when the MS was pneumatized below the nasal floor.

Results: Type I included 115 sides (22.7%); type II, 277 sides (54.7%); and type III, 114 sides (22.5%). Grade I was observed in 58 sides (11.5%), grade II in 38 sides (7.5%), and grade III in 410 sides (81.0%). The mean PLRWD of grade I was 2.35 ± 2.41 mm, II was 3.37 ± 2.46 mm, and III was 5.55 ± 2.54 mm, showing a significant difference (P < .001). Post hoc analysis showed significant differences in the mean PLRWD among grades I, II, and III. Two anatomical factors, the MSP and PLRWD, were positively correlated (r = .507, P < .001).

Conclusions: This study demonstrates a correlation between the feasibility of MSP and PLRA. Both MSP and PLRWD are essential diagnostic parameters for preoperative planning and better surgical outcomes.

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 only documented cases of hearing loss following methamphetamine use in recent years. There is a paucity of literature regarding the mechanism causing acute SNHL secondary to methamphetamines. Proposed etiologies include neurotransmitter depletion or reduced cochlear blood flow as possible causes of ototoxicity.

Inflammatory myofibroblastic tumor (IMT) is a tumor composed of differentiated myofibroblastic spindle-shaped cells. It occurs in the soft tissues of the abdomen and lungs, and is very rare in the sphenoid sinus. The diagnosis depends on histopathology and immunohistochemistry, and is easily misdiagnosed. Although metastasis is rare, the recurrence rate is high. Surgical resection is the treatment of choice, and where complete resection is difficult, radiation therapy, hormonal therapy, or molecular targeted drug therapy can be administered. We report a rare case of IMT with a primary origin in the sphenoid sinus, which was entirely resected by nasal endoscopy and confirmed by histological examination.

This case involves a 30-year-old female who suffered extensive facial burns as an outcome of a horrific assault. The patient subsequently underwent 2 surgeries with the ultimate goal of reducing the cosmetic, physical, and thus mental burden the assault caused. The technique of choice was the novel trapezius fasciocutaneous flap for burn reconstruction of the neck. It is discussed that while this technique is still deemed a novel procedure, its unique characteristics make it an excellent choice for cases similar to this one. While this approach has not been widely popularized in the treatment of patients with burn contracture requiring reconstruction, the donor site characteristics and ideal functionality make the trapezius fasciocutaneous flap such an excellent choice. This particular type of graft yields a hidden donor site, contains rich vascularity with physical qualities similar to those of facial skin, specifically in regard to thickness, color, and texture, and ultimately produces the most ideal cometic outcome. Further, the wide arc of rotation unique to this flap allows for better manipulation and mobility at the transplanted location. While the anatomic implications are very relevant to head and neck surgery, this method also produces exemplary cosmetic outcomes when compared to other graft procedures.

Epithelial-myoepithelial carcinoma (EMC) is a rare tumor that occurs mainly in the major salivary glands. Cases occurring in the nasal cavity are rarely reported. The patient was a 48-year-old woman with a postoperative pathological diagnosis of EMC. The patient recovered well after surgery. We consulted and summarized all previous cases of nasal EMC. We also discuss the clinical presentation, treatment, and prognosis of EMC of the nasal cavity and paranasal sinuses.

As a variant of recurrent inferior laryngeal nerve (RILN), the nonrecurrent inferior laryngeal nerve (NRILN) is closely related to the occurrence of abnormal subclavian artery (ASA). The nonrecurrent inferior laryngeal nerve has been found in patients without arterial abnormalities, which is seen in the coexistence of NRILN and RILN, but it is easily confused with sympathetic-inferior laryngeal anastomosis branch (SILAB). We encountered 2 right NRILN patients without ASA during thyroid surgery. This article summarizes the characteristics of these cases and proposes methods to distinguish the coexistence of NRILN and RILN from SILAB. So far, 11 articles have reported 16 cases of NRILN without arterial abnormalities. In patients without artery abnormality, the vagus nerve could send out a descending branch NRILN at the bifurcation of the carotid artery and enter the larynx after anastomosis with RILN. Adequate dissection of the carotid sheath may avoid confusion with SILAB, and neural monitoring is also expected to provide a reference for the identification.

We describe a rare occurrence of unilateral vocal fold paralysis associated with a cervical osteophyte abutting the course of the recurrent laryngeal nerve. Trans-nasal laryngoscopy is vital in diagnosing vocal fold paralysis, but often does not provide insight into etiology. This case highlights the importance of radiographic imaging in newly diagnosed vocal fold paralysis, and underscores the principle that a diagnosis is not idiopathic until all sources have been ruled out.

Objective: To provide an updated evaluation of otolaryngology residency program websites during a socially distanced application cycle. Criteria were selected to evaluate for level of comprehensiveness, new content accommodating a virtual interview cycle, and stated commitment to diversity and inclusion.

Study design: Review of otolaryngology residency program websites.

Setting: Online websites between December 2020 and January 2021.

Methods: Otolaryngology residency program websites were evaluated for selected criteria. Programs were categorized by geographic location, size, and Doximity rankings. Differences between groups were analyzed using Student's t-test and analysis of variance with a significance level of P < .05.

Results: 118 otolaryngology residency program websites contained a mean (SD) of 16.3 (4.7) of 31 criteria (52.6%). Fewer than one third included virtual/video tours of facilities or the surrounding area. Only 33% had a stated commitment to diversity and inclusion. There was no difference in number of criteria included when categorized by geographic location (P = .22). Larger programs (17.9 vs 14.5, P < .001) and programs ranked in the top 50 by Doximity (17.7 vs 15.2, P = .003) included a significantly greater number of criteria.

Conclusion: While the comprehensiveness of otolaryngology residency program websites has improved, considerable room for improvement remains. Programs should strive to maintain updated websites that highlight training opportunities, program culture, and commitment to diversity and inclusion. Programs also should consider prioritizing the development of new online resources that may be especially useful to applicants during a virtual interview cycle.