Ear, nose, & throat journal最新文献

Objective: To present our experience in the diagnosis and treatment of the migrating pharyngeal foreign bodies. Methods: Seven patients with migrating pharyngeal foreign bodies were retrospectively reviewed. The following data were collected: symptoms, time of onset, examination methods, buried sites of foreign bodies, methods of removal, and clinical outcomes. Results: All the 7 patients were diagnosed by computed tomography (CT) scan or ultrasound and then underwent foreign body removal through the transoral approach surgery under laryngoscope. The transoral removal of foreign bodies failed in 2 cases, in which the foreign bodies were removed via the transcervical approach subsequently. No complications were observed during the follow-up of 1 month. Conclusions: Migrating pharyngeal foreign bodies can be found and located by CT scan or ultrasound preoperatively. It is feasible and minimally invasive to remove migrating pharyngeal foreign bodies with radiofrequency coblation or CO₂ laser through transoral approach surgery under laryngoscope.

Angiofibrolipomas are rare, benign soft tissue tumors composed of mature fat cells, blood vessels, and fibrous connective tissue. Typically occurring in subcutaneous locations, this case report presents a unique instance of an angiofibrolipoma arising in the pharynx. According to our review of the literature, it is the second reported case in the pharynx and the sixth in the head and neck region. A 58-year-old woman presented with a 1 year history of globus sensation and an incidentally-discovered extra-oral polyp. Endoscopic examination revealed the polyp originating from the upper esophagus and extending into the pharynx. Magnetic resonance imaging confirmed the nature and extent of the lesion. The polyp was successfully removed via endoscopic resection, and histopathological analysis confirmed the diagnosis of angiofibrolipoma. This case highlights the rarity of pharyngeal angiofibrolipomas and underscores the importance of endoscopic evaluation for patients presenting with ambiguous pharyngeal symptoms. While surgical resection is generally recommended for such tumors, endoscopic removal can be a safe and effective option for smaller pedunculated lesions.

Background: Bacterial labyrinthitis has been rarely described. Pseudomonas incrimination is even exceptional. Herein, we present a case of pseudomonas labyrinthitis and discuss diagnosis, value of imaging, treatment and prognosis of this entity. Case Report: A 18-year-old female presented with left sudden hearing loss, rotatory vertigo, vomiting, and tinnitus evolving for 24 hours. Ten days earlier, she presented symptoms of acute media otitis. Otoendoscopic examination revealed a tympanic perforation with purulent otorrhea. Vestibular examination revealed a harmonious peripheric vestibular syndrome. A tonal audiogram showed a left perceptive deafness. A temporal computed tomography scan showed left opacity of the middle ear. Magnetic resonance imaging (MRI) excluded cholesteatomatous otitis, and constructive interference steady state (CISS) sequence revealed intense labyrinthine enhancement. Otorrhea sample culture isolated Pseudomonas aeruginosa. She initially received probabilistic intravenous antibiotherapy associating cefotaxime to vancomycin for 17 days, then, we switched to adapt to the antibiogram. She had a total of 25 days of antibiotic therapy and 14 days of corticosteroid treatment. She also benefited of vestibular rehabilitation and hyperbaric oxygenotherapy. The dizziness subsided, but the deafness persisted. Conclusion: Labyrinthitis is increasingly rare in the era of antibiotic therapy. P. aeruginosa is an exceptional germ in this context. MRI is an indispensable tool for the positive and the differential diagnosis.

The excessive length of the superior cornu of the thyroid cartilage is extremely rare, and the etiology is unknown. Few reports of this condition exist in the literature. The objective of the present study was to present a rare case of unilateral excessive length of the superior cornu of the thyroid cartilage.

Olfactory neuroblastoma (ON; Esthesioneuroblastoma) is a malignant tumor that arises from the olfactory neuroepithelium. Very rarely, ON can histologically display a biphenotypic pattern, with only 7 cases reported in the literature to date. We describe a case of this poorly understood entity and review the patient's histology, pathology, and treatment. An 85-year-old man presented with endoscopy and imaging findings of a sinonasal mass arising from the olfactory cleft. Biopsy and further pathological review established Hyams grade 3 and Kadish stage C tumor. The patient underwent combined endoscopic and open-approach resection due to the involvement of the nasal bone and subsequent adjuvant radiation therapy. Specimen contained Flexner-Wintersteiner rosettes and stained positive for the neuroendocrine marker synaptophysin consistent with ON. A second, epithelial component pattern of goblet cells and mucin was observed suggesting divergent differentiation. We are the first group to report next-generation sequencing of this tumor, which revealed a pathogenic mutation in PIK3CA and a likely pathogenic variant in RUNX1 (AML1). ON with divergent differentiation is very rare, and more robust studies characterizing molecular drivers and pathology may aid in clinical management.

Background: Epistaxis is a common emergency, particularly in the context of trauma. Understanding patterns and outcomes of epistaxis in a trauma setting can inform treatment strategies and improve patient care. Objectives: To evaluate the demographic characteristics, clinical features, and outcomes of patients treated for epistaxis following trauma. Methods: This retrospective case-control study included 1106 patients from the National Trauma Data Bank diagnosed with trauma-related epistaxis. The clinical outcomes assessed included hospital stay duration, complication rates, and mortality. Results: In comparison with younger patients, older patients were found to undergo operative intervention significantly more frequently (median age, 65 years vs 44 years; P < .001). The prevalence of cardiovascular and psychiatric comorbidities was higher in the operative group (P = .004 and P = .041, respectively). Mortality risk was not found to be independently influenced by epistaxis management approach. Conclusions: In older individuals with comorbid conditions, trauma-related epistaxis is more likely to result in operative intervention and associated complications. Nonetheless, the management of epistaxis does not appear to have a significant impact on mortality risk.

Background: Despite the growing literature on racial disparities in the utilization of total laryngectomy (TL), and survival following the treatment of laryngeal cancers, there is a paucity of research in TL cohorts evaluating disparities in the immediate postoperative setting.

Methods: In a national multi-institutional cohort, TL cases between 2010 and 2021 were identified using relevant Current Procedural Terminology (CPT) codes. Logistic regression analyses investigated the association between race/ethnicity and adverse outcomes within 30 days postoperatively.

Results: This study consisted of 1493 patients who underwent TL with or without radical neck dissection. Black patients underwent free flap and pedicled flap reconstruction more frequently than their counterparts (P = .023) and exhibited a 1.532 times higher odds of surgical complications (P < .001).

Conclusions: There are increased rates of surgical complications in Black patients undergoing TL. Given the limited oncologic and socioeconomic variables available through National Surgical Quality Improvement Program, future study of disparate postoperative outcomes in this population is recommended.

Objectives: Steroid-eluting stent implantation after endoscopic sinus surgery (ESS) effectively alleviates postoperative symptoms and polyp recurrence in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). However, the efficacy of steroid-eluting stents for the treatment of olfactory dysfunction in CRSwNP and the influencing factors therein have not been studied.

Methods: Fifty-nine patients with CRSwNP with olfactory dysfunction from Peking University Third Hospital who were hospitalized for ESS were recruited and randomly divided into a stent group (n = 30) and a control group (n = 29), and were assessed for symptom scores, olfactory function, endoscopic findings, and type 2 inflammatory mediators (IL-4, IL-5, IL-13, IL-33, eotaxin-3, periostin) expression.

Results: Postoperative olfactory Visual Analogue Scale (VAS) scores, T&T olfactometer scores, SNOT-22 scores, and Lund-Kennedy (LK) scores were reduced in patients with CRSwNP (P < .01). Postoperative olfactory VAS scores, T&T olfactometer scores, SNOT-22 scores, and LK scores, IL-5, IL-13, and periostin were significantly lower in the stent group than in the control group (P < .05). Correlation analysis was performed and found that the postoperative olfactory VAS scores were strongly correlated with IL-5 and IL-13 (r = .496, P < .001 and r = .289, P = .026), and the postoperative T&T olfactometer scores were strongly correlated with IL-5 and IL-13 (r = .553, P < .001 and r = .398, P = .002).

Conclusions: Steroid-eluting stent implantation after ESS is an effective treatment for olfactory deficits in patients with CRSwNP and may be related to the stent's more effective reduction of local type 2 inflammatory mediators in the nasal cavity.