Clinical medicine insights. Ear, nose and throat最新文献

Objectives: Pleomorphic adenomas are benign tumors that rarely involve nonsalivary glands. We report an uncommon case of ala nasi pleomorphic adenoma. We discuss the clinical and histopathologic characteristics, and review the literature on nasal pleomorphic adenoma.

Method: A 20-year-old man presented with a painless slow growing lobulated mass located on the right ala nasi extending into the nasal vestibule.

Results: Complete surgical excision was performed. Histologic examination found a mixed cellular component: epithelial and myoepithelial cells with chondromyxoid stroma. This was consistent with the diagnosis of a typical pleomorphic adenoma. There was no evidence of recurrence at 18 months after the surgery.

Conclusions: Pleomorphic adenomas located in the external nose are extremely rare. In such case, pleomorphic adenoma could originate from ectopic minor salivary gland. Complete surgical excision with long-term follow-up is recommended due to the potential risk of recurrence and malignant transformation.

Objectives: Improved intraoperative visibility during functional endoscopic sinus surgery (FESS) decreases the risk of serious orbital or skull base injuries. Esmolol and labetalol have been used to reduce bleeding and achieve better visibility, but it remains unclear which drug is more effective. This study aims to measure visibility scores and mucosal bleeding rates for esmolol and labetalol in FESS.

Methods: This is a 1-year randomized double-blind trial of adults undergoing FESS at a tertiary academic center. The inclusion criteria were as follows: age 18 or older; history of chronic rhinosinusitis (CRS) with or without nasal polyps; undergoing FESS for CRS; and American Society of Anesthesiologists (ASA) physical status 1 (healthy) or 2 (patient with mild systemic disease). The exclusion criteria were as follows: pregnancy; asthma, chronic obstructive pulmonary disease (COPD), bradycardia, heart failure, end-stage renal disease, cerebrovascular accident, diabetes mellitus; preoperative use of nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, or beta-blockers; and body mass index (BMI) greater than 40 kg/m². Patients received either dose-infused esmolol or intravenous push labetalol. The primary outcome was intraoperative visibility determined by surgeon using validated scoring systems (Boezaart, Wormald). The secondary outcome was hemodynamic control (rate of blood loss, average mean arterial pressure [MAP], average heart rate [HR]). Hypothesis of no difference between drugs formed before data collection.

Results: Of the 32 adults given drug (mean age = 50), 28 patients (13 esmolol and 15 labetalol) with complete data were included in the final analysis. There were no statistically significant differences between esmolol and labetalol in rate of blood loss (0.59 [0.28] vs 0.66 [0.37] mL/min, P = 0.62), average MAP (79.7 [7.5] vs 79.4 [7.7] mm Hg, P = .93), HR (72 [8.7] vs 68 [11.7] bpm, P = .26), or mean visibility scores for the Boezaart (3.1 [0.69] vs 3.1 [0.89], P = .85) and Wormald (6.1 [1.7] vs 5.9 [1.9], P = .72) grading scales.

Conclusions: There were no significant differences between esmolol and labetalol in rate of blood loss, MAP control, HR, or surgical visibility in FESS. Either drug may be used, and other considerations (availability, cost) can dictate choice.

Objective: In this work, our aim was to measure the taste function of healthy Taiwanese adults using 2 commonly used taste tests.

Methods: The taste function of 102 healthy Taiwanese adults was evaluated using the whole-mouth suprathreshold taste test and the taste quad test. In the whole-mouth taste test, 5 concentrations of sweet, bitter, sour, and salty solutions were sipped and swished in the mouth twice in a counterbalanced order. A total of 40 tests were done to give a maximum score of 40 for correct quality identification of tastant solutions. In the taste quad test, the 4 quadrants of the tongue were tested using high concentration drops of sweet, bitter, sour, and salty solutions 6 times. A total of 96 tests were done to give a maximum score of 96 for correct quality identification of tastant solutions.

Results: The score of the whole-mouth taste test ranged from 33 to 40 with a mean of 38.6 for men and from 31 to 40 with a mean of 38.9 for women. The score of the taste quad test ranged from 40 to 91 with a mean of 75 for men and from 38 to 96 with a mean of 78 for women. Sex was shown not to affect the taste function.

Conclusions: Our result showed that sex did not affect the taste function of healthy Taiwanese adults.

Entrapment neuropathy is a known cause of neurological disorders. In the head and neck area, this pathophysiological mechanism could be a trigger for headache. Over the last few decades, injection of botulinum toxin type A in the muscles that are causing the compression as well as surgical decompression have proved to be effective treatment methods worldwide for large numbers of patients with daily headaches. In particular the entrapment of the supraorbital nerves in the glabellar musculature and the occipital nerves in the neck musculature are triggers for headache disorders for which many patients are still seeking an effective treatment. This article reviews the literature and aims to bring the concept of neural entrapment to the attention of a wider audience. By doing so, we hope to give more exposure to an effective and relatively safe headache treatment.

Objective: Voice serves as an identity and is one of the primary requisites of an individual, especially for singers who are extensive professional voice users with greater vulnerability to voice disorders. The aim of this study is to translate and validate the Tamil version of Voice-Related Quality of Life (T-VRQOL), a self-rating questionnaire that estimates the influence of voice disorders on quality of life. The study also intends to compare the T-VRQOL scores in singers (with and without voice complaint) and non-singers, and to correlate T-VRQOL and the Tamil Singing Voice Handicap Index-10 (TSVHI-10).

Method: In this cross-sectional study, 120 native Tamil speakers (40 classically trained Carnatic singers without voice complaints, 40 Carnatic singers with voice complaints and 40 normal non-singers) in the age range of 20 to 50 years, filled in the T-VRQOL and the TSVHI-10 rating scales, along with a demographic questionnaire.

Results: Reliability of T-VRQOL was established with Cronbach α coefficient (r = 0.9, P < .001) and good test-retest reliability (r = 0.98). The validity of T-VRQOL was confirmed by examining convergent and discriminant validity. T-VRQOL also demonstrated a good correlation with the TSVHI-10 (r = 0.838, P < .001). On comparing the T-VRQOL scores across the groups, singers (13.88 and 24.3) obtained higher values than the non-singers (11.63). Among the singers, those with voice complaints (24.3) scored higher than those without voice complaints (13.88) in the T-VRQOL.

Conclusions: The Tamil version of Voice-Related Quality of Life (VRQOL) questionnaire correlates well with TSVHI-10. It proves to be an effective clinical tool in effectively evaluating the VRQOL among the Tamil-speaking population.

Background: Kikuchi-Fujimoto Disease (KFD), also known as Histiocytic Necrotizing Lymphadenitis, is a rare cause of prolonged cervical lymphadenopathy in both the pediatric and adult populations. It was first reported in Japan in 1972, and since, this disease has been described worldwide, although most cases have been reported in Asia. The etiology of KFD is not fully understood, although there are 2 theories that are described in detail in this review. Kikuchi-Fujimoto Disease typically follows a benign course, with resolution of the lymphadenopathy within 6 months. It is important to recognize KFD as a cause of persistent lymphadenopathy, as it shares many characteristics with and must be differentiated from other causes of lymphadenopathy, including lymphoma, inflammatory disorders, autoimmune conditions, and infectious causes of lymphadenopathy.

Case presentation: Here is presented a case of an 11-year-old male who was born in Vietnam, but subsequently adopted and raised in the United States, who presented to a private practice community-based Otolaryngology group. His chief complaint was a persistent neck mass of approximately 3 months duration. He underwent excisional biopsy for suspected lymphoma, but final pathology rendered a diagnosis of KFD.

Conclusion: The purpose of this article is not only to review the literature but also to contribute awareness of this entity in the differential diagnosis of persistent lymphadenopathy, especially for the general Otolaryngologist in a community-based setting. In addition, this review would be beneficial for other practitioners as well, specifically Pediatricians, Infectious Disease Physicians, Rheumatologists, Pathologists, and Medical Oncologists.

Objectives: We aim to increase awareness of pleomorphic mantle cell lymphoma as a rare, but aggressive form of lymphoma with propensity for recurrence in secondary locations.

Methods: We report the case of a 70-year-old man who presented with chronic post-nasal drainage, dysphagia, and voice changes caused by a tongue base mass.

Results: Partial excision and pathology showed a pleomorphic mantle cell lymphoma, and radiation treatment was completed. A regional recurrence was detected 3 years later and treated with radiation. He had no evidence of disease 17 months after treatment of the recurrence and is under close surveillance.

Conclusions: Pleomorphic mantle cell lymphoma is an aggressive subtype of non-Hodgkin lymphoma that can affect the head and neck. Confirming the diagnosis with immunotyping and genotyping from fresh specimens can guide appropriate treatment and then close clinical follow-up.