Dennis R. Maceri

Laryngospasm: an atypical manifestation of severe gastroesophageal reflux disease (GERD).

Objectives To present a potentially life‐threatening manifestation of gastroesophageal reflux disease (GERD), laryngospasm. This review covers the diagnosis and management of eight patients treated by the authors.

Vestibular autorotation test asymmetry analysis of acoustic neuromas

The vestibular autorotation test (VAT) measures the vestibulo-ocular reflex (VOR) response from 2 to 6 Hz, during 18 seconds of active head movements, while the patient attempts to fixate on a wall-mounted target. A new method of measuring eye velocity asymmetry from VAT data is presented, based on computer estimation of the 0th harmonics of discrete Fourier spectra over short segments of digital eye and head velocity records. Eye asymmetries greater than a 3% normal range are shown to be directionally correlated with the side of the lesions in patients with unilateral labyrinthectomies. Among patients with a diagnosis of acoustic neuroma, who were tested preoperatively with the VAT, nine of nine patients showed eye asymmetries greater than 3% toward the side of the neuroma. Those patients with acoustic neuromas who have sufficiently vigorous high-frequency head responses showed mean percentages of eye asymmetry that were linearly correlated with the size of the acoustic neuroma. These results suggest that VAT high-frequency asymmetry provides a useful method of diagnostic evaluation of the side and extent of unilateral peripheral lesions.

US-guided Fine-Needle Aspiration of Major Salivary Gland Masses and Adjacent Lymph Nodes: Accuracy and Impact on Clinical Decision Making

PURPOSE To determine whether ultrasonography (US)-guided fine-needle aspiration (FNA) is an effective technique for diagnosing masses in the salivary gland and adjacent lymph nodes. MATERIALS AND METHODS The institutional review board waived the requirement to obtain informed consent and approved this HIPAA-compliant retrospective study. Radiology records of 50 patients (28 female patients aged 25-85 years [median age, 58 years], 22 male patients aged 11-82 years [median age, 62 years]) who underwent 52 consecutive US-guided FNA procedures from 2004 to 2009 were reviewed. In 46 cases, lesions were sampled for biopsy under real-time US guidance by means of three passes with a 25-gauge needle. In six cases, two subsequent passes were performed with a 22-gauge needle after the first pass showed minimal or no aspirate. Findings from cytopathologic analysis, clinical follow-up, and surgery were evaluated and compared. RESULTS A diagnostically adequate biopsy specimen was obtained in 48 of the 52 cases (92%). Among the 20 patients who underwent surgical intervention after diagnostic US-guided FNA findings, results of surgical-pathologic analysis helped confirm the cytologic diagnosis in 19 (95%). Twenty of the 50 patients (40%) were spared surgical intervention on the basis of findings from US-guided FNA. US-guided FNA did not result in any intra- or postprocedural complications. CONCLUSION The diagnostic accuracy of US-guided FNA is similar to that of core needle biopsy, and there were no complications in this study. Information yielded with FNA cytology plays an integral role in clinical decision making in the management of masses in the major salivary glands and adjacent structures.

Third branchial cleft anomaly presenting as a retropharyngeal abscess

Branchial cleft anomalies are congenital developmental defects that typically present as a soft fluctuant mass or fistulous tract along the anterior border of the sternocleidomastoid muscle. However, branchial anomalies can manifest atypically, presenting diagnostic and therapeutic challenges. Error or delay in diagnosis can lead to complications, recurrences, and even life-threatening emergencies. We describe a case of an infected branchial cleft cyst that progressed to a retropharyngeal abscess in a 5-week-old female patient. The clinical, radiographic, and histologic findings of this rare presentation of branchial cleft cyst are discussed.

Brain Stem Compression Secondary to Adipose Graft Prolapse after Translabyrinthine Craniotomy: Case Report

Three cases of fat graft prolapse into the cerebellopontine angle with clinical deterioration are presented. These patients had undergone translabyrinthine craniotomy for cerebellopontine angle tumors and had autologous abdominal fat strips placed to obliterate the dural defect and the mastoid cavity. Two patients suffered significant morbidity, and one patient died. Clinical presentation, computed tomographic scan findings, methods of treatment, and avoidance of this complication are discussed.

Bone-Anchored Hearing Aid vs. Reconstruction of the External Auditory Canal in Children and Adolescents with Congenital Aural Atresia: A Comparison Study of Outcomes.

Objectives/hypothesis: Congenital aural atresia is a rare condition affecting 1 in 10,000–20,000 children a year. Surgery is required to restore hearing to facilitate normal development. The objective of this study was to compare outcomes in hearing, complications, and quality of life of surgical reconstruction of the external auditory canal reconstruction (EACR) and bone-anchored hearing aid (BAHA) in a pediatric population with congenital aural atresia. Study design: Subjects were children who had a diagnosis of congenital aural atresia or stenosis and who received either BAHA or EACR. Methods: The medical records of 68 children were reviewed for operative complications and audiometric results. A quality of life questionnaire was prospectively administered to a subset of subjects. Results: Pre-operatively, air conduction threshold was not significantly different between groups at 500, 1000, 2000, and 4000 Hz (p > 0.05). Post-operatively, the BAHA group (44.3 ± 14.3 and 44.5 ± 11.3) demonstrated a significantly larger hearing gain than the EACR group (20.0 ± 18.9 and 15.3 ± 19.9) in both the short and long-term periods (p < 0.001). Overall, the incidence of complications and need for revision surgery were comparable between groups (p > 0.05). Quality of life assessment revealed no statistical significance between the two groups (p > 0.05). Conclusion: Although the quality of life and incidence of surgical complications between the two interventions was not significantly different, BAHA implantation appears to provide a better, more reliable audiologic outcome than EACR.

Brain Stem Compression Secondary to Adipose Graft Prolapse after Translabyrinthine Craniotomy

Three cases of fat graft prolapse into the cerebellopontine angle with clinical deterioration are presented. These patients had undergone translabyrinthine craniotomy for cerebellopontine angle tumors and had autologous abdominal fat strips placed to obliterate the dural defect and the mastoid cavity. Two patients suffered significant morbidity, and one patient died. Clinical presentation, computed tomographic scan findings, methods of treatment, and avoidance of this complication are discussed

Anterior Communicating Artery Aneurysm Presenting as Pulsatile Tinnitus

Objective tinnitus is caused by a vascular abnormality of the cervical region, skull base or intracranium. These lesions produce an abnormal flow lesion in the arterial or venus circulatory system of the brain, skull base or cervical region. This flow abnormality is perceived by the auditory system as pulsatile tinnitus. An aberrant carotid artery, a dehiscent jugular bulb or a glomus tumor are common causes. The cause of subjective tinnitus is often not found. Many serious vascular anomalies and tumors can present as pulsatile tinnitus. These include: arteriovenous malformations, atherosclerotic vascular disease, and intracranial tumors with elevated cerebrospinal fluid pressure. We recently diagnosed a patient with an anterior communicating artery aneurysm presenting with pulsatile tinnitus. An aneurysm presenting as pulsatile tinnitus is extremely uncommon. Only 8 have been identified in the literature. The clinician evaluating patients with tinnitus must be aware of this diagnosis. A complete evaluation should include an appropriate radiologic exam; either computed tomography or magnetic reasonance imaging.

Tracheal agenesis: the importance of an endoscopic diagnosis.

Tracheal agenesis is a rare cause of respiratory distress in the newborn. Characteristically, the larynx is normal, but distally there is complete absence of the trachea. Respiratory exchange occurs through a trachealike fistulous communication attached distally to the esophagus or, less commonly, through bronchi that communicate separately with the esophagus. Bronchial and pulmonary parenchymal development is usually normal. Forty-nine cases of tracheal agenesis have been described in the literature, but only a few have had the diagnosis established antemortem. The following case report describes a newborn with agenesis of the trachea successfully diagnosed by endoscopic examination. The infant died on day 3; autopsy confirmed the diagnosis. We review the clinical manifestations, embryology, diagnosis, and present therapy of tracheal agenesis. The otolaryngologists role in establishing this diagnosis is highlighted.

Overexpression of EphB4, EphrinB2, and epidermal growth factor receptor in papillary thyroid carcinoma: A pilot study

The purpose of this study was to examine the differential expression of EphB4, EphrinB2, and epidermal growth factor receptor (EGFR) genes in papillary thyroid carcinoma (PTC) and evaluate their association with lymph node metastasis.