Kunal H. Thakkar

Chronic Rhinosinusitis and Asthma

Based on considerations of the underlying epidemiology, pathophysiology, histopathology, clinical relationships and treatment outcomes, the links between rhinosinusitis and asthma become evident supporting the unified airway concept.

Treatment of culture-negative skull base osteomyelitis.

Objective: To evaluate the efficacy of a therapeutic regimen in the treatment of patients with culture-negative skull base osteomyelitis. Study Design: Retrospective case review. Setting: Tertiary referral hospital. Patients: Eight patients with diabetes mellitus presented with otalgia and were found to have positive technetium and gallium scans of the temporal bone. These patients, however, all had negative cultures of their external auditory canals. All patients had been treated with ototopic drops and two patients had undergone a 2-week course of oral quinolones. Interventions: All patients were treated with a 6-week course of intravenous ceftazidime or aztreonam for penicillin-allergic patients, oral ciprofloxacin at a higher dose than normal, and topical aminoglycoside steroid drops. Main Outcome Measures: Resolution of the temporal bone gallium scan abnormality, recurrence rate, and time to discharge from the hospital. Results: The patients were discharged from the hospital within 4 days from admission. All patients showed resolution of the temporal bone abnormality on the gallium scan at the 6-week time point. The median follow-up period was 6 months, and none of the patients had a recurrence of the infection. Conclusion: The above-described treatment regimen will result in a high cure rate and a short hospitalization period.

Aspiration following CO2 laser-assisted supraglottoplasty

OBJECTIVE To review the incidence, risk factors, and treatment of aspiration following CO(2) laser-assisted supraglottoplasty for severe laryngomalacia (LM). DESIGN IRB approved retrospective study of pediatric patients with severe LM treated with CO(2) laser supraglottoplasty over a 5-year period. SETTING Tertiary pediatric hospital. PATIENTS Fifty-two patients met inclusion criteria. Indication for supraglottoplasty was respiratory distress in 90% of patients and/or failure to thrive in 19%. INTERVENTIONS All children underwent bilateral CO(2) laser supraglottoplasty and were assessed postoperatively with swallow evaluation by a speech pathologist. Videoflouroscopic evaluation was utilized to confirm aspiration and guide management. MAIN OUTCOME MEASURES Aspiration, treatment required to manage aspiration, duration of treatment required. RESULTS Thirty-seven percent (20/52) of patients had postoperative aspiration. Aspiration was demonstrated on videoflouroscopic swallow study (VFSS) after supraglottoplasty is 28% (12/43). All patients with newly diagnosed aspiration had treatment with thickened and/or nasogastric feedings with mean resolution time of 6 months. In nine children with preoperative aspiration, eight (89%) had postoperative aspiration and seven required gastrostomy tube placement for feeding management. All individuals requiring gastrostomy for aspiration management had neurological conditions. In the absence of preoperative clinically evident aspiration, children with neurological conditions have an equivalent rate of postoperative aspiration as healthy children. The only risk factor for postoperative aspiration was preoperative aspiration. CONCLUSION Aspiration is more common after CO(2) laser-assisted supraglottoplasty than previously recognized. In otherwise healthy children, postoperative aspiration is of short duration and can be treated with conservative measures. Optimal treatment after supraglottoplasty includes screening for and management of aspiration in conjunction with a speech pathologist.

Patient Compliance to Radiation for Advanced Head and Neck Cancer at a Tertiary Care County Hospital

Background: Combined chemotherapy and radiotherapy are routinely used to treat advanced‐stage head and neck squamous cell carcinoma (HNSCC). Patient compliance is often difficult given increased toxicities. Medically underserved or uninsured patients may lack the necessary support to complete such treatment.

Endoscopic posterior costal cartilage graft placement for acute management of pediatric bilateral vocal fold paralysis without tracheostomy

Endoscopic posterior cricoid split with costal cartilage graft stabilization has previously been shont to allow for glottic/infraglottic expansion in children with long standing vocal fold paralysis. We report on an extension of this technique to use in the acute setting in the management of acute BVP in children with acute upper airway obstructive symptoms.

Congenital cholesteatoma isolated to the mastoid.

Congenital cholesteatoma is an epithelial-lined cyst filled with desquamated keratin thought to be acquired embryologically from squamous epithelial rest in the temporal bone. The reported sites of origin within the temporal bone include the middle ear, petrous apex adjacent to the facial canal, external auditory canal, and mastoid. Congenital cholesteatoma may be intradural and present as a cerebellopontine angle mass. The middle ear is the most prevalent site, and a mastoid primary is the rarest (1). Clinical presentations vary depending on the site of origin and include conductive hearing loss, disequilibrium, and neural manifestations. Computed tomography and magnetic resonance imaging (MRI) are invaluable in the diagnosis of occult congenital cholesteatomas, especially those originating in the mastoid.

New findings in the semicircular canal dehiscence syndrome

We describe a young patient with conductive hearing loss (CHL) associated with a posterior semicircular canal dehiscence (PCD) next to a large jugular bulb. Vestibular evoked myogenic potentials (VEMPs), audiogram, and computed tomography (CT) confirmed the diagnosis. The contralateral ear also showed lowered VEMP thresholds and PCD on CT, but no CHL. Increased vigilance is warranted in the evaluation of CHL in patients with uninfected, normal-appearing ears. PCD as a cause of CHL is just beginning to surface in the otologic literature. This case, along with two other recent case series, demonstrates the need for CT imaging in cases of atypical CHL.