Ear, nose, & throat journal最新文献

In a patient whose sudden vision loss is suspected on the side of a previously operated sphenoid or ethmoid sinus, an ischemic insult to the optic nerve may occur due to a compressing mucocele, especially when there is bony dehiscence of the orbital apex. We report a case of a 41-year-old healthy male patient who had a history of previous sinus surgery, and visited the emergency department for an abrupt left ocular pain following visual loss of the affected eye. The patient's left eye's best corrected visual acuity (BCVA) was hand motions with a reduced light reflex. A sphenoethmoidal sinus cell (Onodi cell) mucocele with bone dehiscence in the left orbital apex was seen on computed tomography. Upon suspicion of compressive ischemic optic neuropathy, urgent endoscopy-assisted endonasal marsupialization of the Onodi cell mucocele with high-dose pulse intravenous dexamethasone was performed. The pathology showed an inflamed nasal mucosa, confirming a mucocele. On the second postoperative day, his BCVA slightly improved in counting fingers at 30 cm. However, even though the nasalized Onodi cell remained intact, his eyesight did not show further improvement. The optic nerve may be directly insulted when a mucocele in the Onodi cell takes place, especially when there is bony dehiscence in the orbital apex. Despite accelerated surgical marsupialization and high-dose steroids, the chance of visual recovery remains very low, as demonstrated in our case.

Iatrogenic displacement of third molars is a rare but significant complication of dental extractions, particularly in children where unique anatomic and developmental factors pose additional challenges. This report describes the case of a 12-year-old female who presented with a displaced maxillary third molar crown into the left maxillary sinus following dental extraction. This displacement resulted in acute orbital cellulitis, which was initially managed with oral antibiotic therapy. Endoscopic endonasal retrieval of the foreign body 4 months later was recommended after the initial infection was treated to reduce the risk of recurrent orbital and/or sinonasal infections. Surgical planning incorporated intraoperative navigation with existing cone beam computed tomography to minimize radiation exposure. The procedure was successful with no perioperative complications. This case highlights the importance of prompt recognition, careful surgical planning, and utilization of minimally invasive approaches to optimize outcomes while minimizing craniofacial morbidity in pediatric patients.

Introduction: Otosclerosis is a progressive, autosomal dominant hereditary disease of temporal bone causing tinnitus, and conductive hearing loss. Stapes surgery is safe and effective treatment with evidence suggesting tinnitus improvement corelates with hearing restoration. This systematic review evaluates evidence related to tinnitus improvement and hearing restoration following stapedectomy.

Methods: This systematic review was prepared in accordance with the Preferred Reporting Item for Systematic Review and Meta-Analysis-P statement. The search included bibliographic databases like MEDLINE, EMBASE, the Cumulative Index of Nursing and Allied Health Literature, and Cochrane Library from inception until June 2024. The review included all studies reporting tinnitus severity and hearing outcomes post-stapes surgery. Outcome measures were tinnitus severity, hearing improvement, and timeframe of improvement. This review was registered with PROSPERO (CRD42024566593).

Result: The initial search generated 609 studies from multiple databases, of which 22 studies involving 2233 patients were included. Due to heterogeneity in study design, patient population, and outcome measures used, pooling of data for meta-analysis was not feasible. Most of the studies were prospective in nature (77.3%), conducted in university hospitals (45.5%), and the average mean age of patients ranged from 18 to 75 years, predominantly females (60.7%). Most studies reported improvement of tinnitus severity post-stapes surgery 15.7% to 64% (median 46.3%), only fewer studies noted worsening among 2.9% to 11% patients. Hearing outcomes were consistently positive among majority of the studies, and only a small subset of patients reported no improvement or worsening. There was a moderate-to-strong relation between tinnitus improvement and air-bone gap (ABG) closure (32%), tinnitus resolution versus ABG closure (55%). More than 50% of the studies reported adherence to the Strengthening the Reporting of Observational Studies in Epidemiology quality assessment checklist.

Conclusion: The systematic review indicates that stapes surgery improves degree of tinnitus severity and hearing outcomes and has moderate-to-strong correlation between resolution in tinnitus versus ABG closure. Most patients experienced significant improvement within 6 months.

Pleomorphic adenoma (PA) is the most prevalent benign tumor of the salivary glands, characterized by both epithelial and mesenchymal differentiation. It primarily originates within the parotid and submandibular glands, with only rare occurrences in the minor salivary glands. PA in the sinonasal area is extremely rare. Herein, we present a case of a 61-year-old female with a large soft tissue mass in the paranasal sinus and nasal cavity, as evidenced by computed tomography imaging. The patient suffered from repeated nasal congestion for more than 6 months. Eventually, the mass was completely resected using an endoscopic endonasal prelacrimal approach under general anesthesia. Postoperative pathological examination revealed the presence of PA in the nasal sinus.

Silicone implants are commonly used alloplastic materials for rhinoplasty in Asia, as they are easy to manipulate, provide adequate volume augmentation, and exhibit excellent biocompatibility. However, they are associated with complications such as infection, displacement, and extrusion. Recently, we encountered an interesting complication in a 53-year-old woman presenting with palpable and visible stepping of the nasal dorsum. The patient had previously undergone rhinoplasty with an L-shaped silicone implant, and symptoms had been noticeable for approximately 1 year. Lateral nasal computed tomography revealed a fractured silicone implant. Because the patient reported no history of nasal trauma since rhinoplasty, we assumed that the silicone implant might have fractured spontaneously. The findings in this case suggest that spontaneous implant fracture can be a late complication of rhinoplasty with silicone implant.

Undifferentiated small round cell sarcoma is an extremely rare and highly aggressive tumor touching the soft tissues and bones. Here, we report the case of a 7-month-old girl who presented to our department with respiratory distress due to a hypopharyngeal mass causing airway obstruction. The patient underwent a tracheotomy and had a direct laryngoscopy. Histological examination confirmed the diagnosis of an undifferentiated small round cell sarcoma. The patient received chemotherapy and radiotherapy and underwent neck dissection. One year later, the patient was diagnosed with local recurrence as well as metastatic cervical nodes and liver and pulmonary metastases. The case is original by the tumor's location and the age of onset. To the best of our knowledge, this could be the first case in English and French literature reporting an undifferentiated small round cell sarcoma affecting the hypopharynx among infants. The purpose of this article is to report our case and discuss its clinical and anatomopathological features as well as its prognosis and treatment options.

Pterygopalatine fossa (PPF) abscess is an exceedingly rare occurrence. Typically, it has been reported in association with odontogenic infections or hematogenous dissemination. In this report, we present the first case of PPF abscess where no obvious underlying cause or primary infection was evident. The patient initially presented with a 2-week history of left ptosis and persistent headaches, which were subsequently accompanied by fever and limited mouth opening. Based on elevated inflammatory markers and imaging findings, the diagnosis of a PPF abscess was established. Successful treatment was achieved through surgical drainage using an external cervical approach. Cultures from the aspirated pus identified Streptococcus constellatus as the causative agent. This case highlights the importance of considering PPF abscess in patients presenting with ptosis as an initial symptom. When diagnosed, surgical drainage should be considered as a viable therapeutic option.

Laryngeal mucosa-associated lymphoid tissue (MALT) is an extra-nodal margin zone B-cell lymphoma (MALT lymphoma) and a low-grade malignant lymphoma with a low incidence, the etiology of the condition remains obscure, and the process of differential diagnosis poses a significant challenge, so it is easy to miss diagnosis and misdiagnosis clinically. The present article presents a clinical case study of a patient who was diagnosed with subglottic MALT lymphoma, which was associated with laryngeal amyloidosis. The patient underwent a successful treatment regimen comprising carbon dioxide laser and radiotherapy. In addition, the article provides an overview of relevant literature that can aid in the diagnosis and management of this rare disease. The study is expected to contribute to the existing body of knowledge on the treatment of subglottic MALT lymphoma and laryngeal amyloidosis.

Neck hybrid schwannoma/neurofibromas are uncommon and classified as peripheral nerve sheath tumors (PNSTs). PNSTs develop from soft tissues, of which schwannoma, perineurioma, and neurofibroma are the most common. Hybrid PNSTs consist of more than 1 type of PNST, such as hybrid schwannoma/neurofibromas. The exact epidemiology and pathogenesis of these tumors are still largely unknown because of the limited studies on this topic. Such tumors can spread over the soft tissues, although most cases reported involve the subcutaneous layer or dermis. Some studies have suggested that hybrid schwannoma/neurofibromas may be associated with neurofibromatosis. We present a case of a 51-year-old female patient with a neck hybrid schwannoma/neurofibroma diagnosed by histopathology and immunohistochemistry. The patient was referred to the neurology department for neurofibromatosis screening, which reported negative results. After 12 months, the patient showed no evidence of tumor recurrence.

Objective: This study aimed to evaluate the effect of e-cigarette use on nasal mucociliary clearance (NMC) by comparing e-cigarette users, traditional cigarette smokers, and nonsmokers. Although numerous studies have investigated the impact of cigarettes and other tobacco products on mucociliary clearance, research specifically focusing on e-cigarettes is limited.

Methods: The study included 120 healthy participants, comprising 40 electronic cigarette users, 40 cigarette users, and 40 nonsmokers. NMC was evaluated using the saccharin test. Participants were asked to retain a saccharin particle on the inferior turbinate, and the time taken for the participant to perceive the sweet taste was recorded as the NMC time. The results were compared and analyzed statistically using the Statistical Package for the Social Sciences (SPSS).

Results: The mean NMC time for e-cigarette users was 14.08 ± 5.99, which was significantly longer than that of nonsmokers, who had a mean NMC time of 10.80 ± 5.28 (P = .027), indicating impaired mucociliary clearance. The NMC time for cigarette smokers was 13.13 ± 6.97, which was also significantly prolonged compared to nonsmokers. No statistically significant difference was found between the groups regarding mean age.

Conclusion: This study demonstrates that electronic cigarette use is associated with impairment of NMC, similar to conventional cigarette smoking. The findings suggest that e-cigarette use may have detrimental effects on the respiratory defense mechanism, potentially increasing the risk of respiratory infections and other pulmonary complications.