Ent-Ear Nose & Throat Journal最新文献

Rhabdomyosarcoma (RMS) is a rare and aggressive cancerous tumor that arises from embryonal mesenchymal cells with skeletal muscle differentiation, and it is exceedingly rare that occurs specifically in the larynx. To date, only 22 instances of laryngeal pleomorphic RMSs have been documented in adults. Consequently, there is limited information available to assist healthcare professionals in effectively handling RMS in the larynx of adult patients. Here, we present an uncommon occurrence involving a 45-year-old man who experienced progressive hoarseness and received a diagnosis of pleomorphic RMS affecting the larynx. Pleomorphic RMS had been pathologically diagnosed after a vertical hemilaryngectomy. Following the surgical intervention, the patient underwent chemotherapy and radiation therapy. As of now, there have been no indications of tumor recurrence.

Sialolithiasis is one of the most common diseases of salivary glands. More than 80% of the sialoliths occur in the submandibular gland. While most of the calculi are less than 10 mm in size, 7.6% are larger than 15 mm and are classified as giant sialoliths. We demonstrate a rare case of asymptomatic giant sialolith in the left Wharton's duct with a total atrophy of the left submandibular salivary gland. A 48-year-old female patient presented with lumping sensation for 1 month. A left mouth floor mass was found accidentally during examination and was later revealed to be a painless sialolithiasis. Image study revealed a giant sialolith in the left Wharton's duct with duct dilatation and left submandibular gland total atrophy. She underwent transoral sialolithotomy with removal of a huge stone, measuring 3.5 × 1.4 cm in size. Sialolithiasis usually presents with typical symptoms of the involved salivary gland, and the size of calculi is usually less than 20 mm. This is a rare case report of an asymptomatic giant sialolith in the Wharton's duct, causing left submandibular salivary gland total atrophy, and its diagnosis and management.

IntroductionAllergic fungal rhinosinusitis (AFRS) is characterized by refractory and high recurrence rate. Improper treatment may lead to repeated recurrence and even serious complications, including vision loss, blindness, and intracranial complications. However, AFRS is easy to be misdiagnosed clinically.ObjectiveTo ensure early diagnosis, the clinical presentations of patients with AFRS were studied.MethodsData from patients with sinusitis hospitalized in the First Affiliated Hospital of the University of Science and Technology of China (USTC) from January 2015 to October 2022 were collected. The patients were divided into three groups; group A patients with AFRS, group B patients suspected of AFRS, and group C patients with fungus ball sinusitis (FBS).We retrospectively analyzed the data using IBM SPSS 19.0 to perform the chi-square test and one-way ANOVA test.ResultsIn total, 35 cases of AFRS, 91 cases of suspected AFRS, and 661 cases of FBS were rediagnosed. Compared with FBS patients, AFRS patients were younger, the total IgE, the percentage of eosinophils and basophils in peripheral blood were higher, and the proportion of patients with allergic rhinitis, asthma or hypo olfactory was higher. It had a higher recurrence rate. These results were also observed in the comparison between suspected AFRS patients and FBS patients, but no significant difference was found in the comparison between suspected AFRS patients and suspected AFRS patients.Conclusions and SignificanceAFRS may be misdiagnosed due to the low detection of fungi. To ensure early diagnosis, we recommend that patients with clinical, radiological, and laboratory features similar to those of AFRS but without evidence of fungal staining be treated according to the treatment criteria of AFRS.

Unilateral vocal cord paralysis-related voice change is a common presentation in the otorhinolaryngology clinic. The well-known etiology was recurrent laryngeal nerve injury due to surgery, traumatic event, or tumor compression, but there are still other etiologies that could interfere with the route of the recurrence laryngeal nerve and lead to unilateral paralysis of the vocal cord. In this report, we presented a rare case of unilateral vocal cord paralysis resulting in diffuse idiopathic skeletal hyperostosis.

The prevalence of primary hyperparathyroidism (PHPT) is increasing as routine laboratory testing for calcium and parathyroid hormone becomes more prevalent due to heightened awareness of the disease. PHPT affects multiple organ systems including the cardiovascular system. This case report highlights a patient with first degree atrio-ventricular block pre-operatively that resolved after resection of her parathyroid adenoma. This case emphasizes the importance of treating asymptomatic hyperparathyroidism to optimize cardiac function.

Foreign bodies, particularly fish bones, in the hypopharynx and cervical esophagus are a common complaint. A swallowed foreign body can be embedded in the tonsil, the base of the tongue, the pyriform fossae, or any region of the upper esophagus. A 70-year-old woman presented with persistent left-sided pharyngeal pain with the sensation of a foreign body for 10 days. She felt a sudden sharp pain in her pharynx while eating a fish head 10 days before the presentation. On examination, an elderly woman was found in painful distress. Flexible fiberoptic laryngoscopy revealed a pool of saliva in the pyriform fossae and a diagnosis of a foreign body in the esophagus was suspected. She was planned for direct laryngoscopy, left (lateral/external) pharyngotomy, and removal of foreign bodies under fluoroscopic guidance of the C-arm. A metallic fish hook that hung over the greater left horn, buried in the neck muscles, was found during the surgery and was extracted. The patient did well postoperatively and was discharged from the clinic. Foreign bodies, particularly fish bones, in the hypopharynx and cervical esophagus are a common complaint, particularly in the African setting.

Significance StatementNasopharyngeal angiofibroma rarely presents in post-adolescent and elderly men, either as the natural evolution of a pre-existing lesion or as a de novo skull-base tumor. As the lesion ages, its composition changes from vessel-predominant to stroma-predominant-the angiofibroma-fibroangioma spectrum. As a fibroangioma, it has restrained clinical features (asymptomatic or occasional epistaxis), minimal avidity for contrast agents, and limited spread potential evident on imaging. These atypical features lead to a diagnostic dilemma when an innocuous choanal/nasopharyngeal fibrovascular mass is encountered in hitherto asymptomatic adult men presenting with epistaxis.

We report a rare case of objective tinnitus induced by nasopharyngeal muscle constriction. A 49-year-old female patient presented at the clinic with unintentional sounds coming from the nasal cavity while talking or swallowing, which were similar to the lip-smacking sound. Physical examination revealed a hypertrophic posterior nasopharyngeal wall and torus tubarius at rest. With voluntary effort, the posterior pharyngeal wall protruded prominently and collided with the torus tubarius on either side, generating a sound when they were separated. Botox injection was recommended but the patient refused. The diagnosis and treatment of objective tinnitus are well established, but in some cases, it may occur under unexpected conditions. We report a novel type of objective tinnitus. A thorough physical examination for tinnitus could reveal the cause.

Background: We describe a patient with sinonasal mucosal melanoma (SNMM) and an inverted papilloma, which existed independently in both nasal cavities. Case presentation: We describe an unusual case of a 74-year-old male patient with SNMM and an inverted papilloma. He presented with symptoms of coughing up blood and pain in the left forehead. The patient underwent surgical resection of the lesion, and the SNMM and inverted papilloma were confirmed by histopathology. The patient refused further treatment after surgery, but was re-admitted 7 months later with local recurrence of the left tumor and systemic metastases. Conclusions: Nasal malignant melanoma with an inverted papilloma in the contralateral nasal cavity is rare and can easily be misdiagnosed as the same tumor by imaging. Simultaneous histopathology of bilateral nasal masses is very necessary. The recommended treatment is surgery for the inverted papilloma. An SNMM is a devastating tumor with poor outcomes.

Rosai-Dorfman disease is a very rare disease characterized by histiocytic accumulation in the head and neck region and lymph node enlargement. We report a rare pseudo-malignant paranasal extranodal Rosai-Dorfman disease. A 69-year-old-man presented nasal bleeding and nasal obstruction. Paranasal mass was detected in the left nasal cavity and computed tomography (CT) findings are the sphenoid sinus, maxillary sinus, and ethmoid sinus were involved with inconstant bone thickening, however, no bone destruction was detected. Magnetic resonance imaging scans show iso-intensity signal in T1-weighed image and T2-weighed image. Positron emission tomography/CT fluorodeoxyglucose (FDG) uptake in posterior ethmoid sinus and sphenoid sinus, bilateral cervical lymph node, clavicle, and sternum. Based on the above results, we considered malignant lymphoma and performed a biopsy. After pathological examination, a diagnosis of Rosai-Dorfman disease was established.