Udi Cinamon

The growth rate and size of the mastoid air cell system and mastoid bone: a review and reference

This review suggests a reference to the postnatal growth of mastoid air cells and bone. Information was retrieved from studies having large consecutive age groups, in order to reveal a development pattern. Data regarding origin, gender, and antibiotic treatment was investigated as well. Most measurements were obtained by planimetry. Assessment of the various data sources suggested the antrum to be well developed at birth (1–1.5xa0cm2), the mastoid cells to be about 3.5–4xa0cm2 at 1xa0year, followed by a linear growth till the age of 6 (1–1.2xa0cm2/year), having a slower increment up to adult size at puberty (~12xa0cm2). The mastoid bone expansion is about 0.6–0.9xa0cm/year in length and width and 0.4xa0cm/year in depth in the first year, followed by half that rate until the age of 6–7. At puberty there was a slower sprout reaching adult size. Different ethnic groups share similar mastoid aeration and bone growth patterns. There were no differences between mastoid aeration measured at the pre-antibiotic era and after its widespread use. In conclusion, there are three distinguishable phases of mastoid pneumatization from birth till reaching final size. Bone and air cell compartments share a similar growth pattern; bone expansion lags behind aeration. Antibiotic treatment for otitis may have no impact upon mastoid aeration.

Cochlear implantation in patients suffering from Cogan's syndrome

Among patients who receive cochlear implants, those with Cogans syndrome make a unique group. On one hand they are part of the post-lingual patients and good results can be anticipated. On the other hand, their basic illness is thought to have an autoimmune aetiology and for that reason more susceptible to complications, especially flap problems. In a series of 60 patients who were implanted at the Sheba Medical Center, three had Cogans syndrome. No post-operative complications, including flap problems, were observed (followed-up for at least 18 months). Subjective and objective hearing results were very good.

Head and neck manifestations of 22q11.2 deletion syndromes.

The allelic loss of 22q11.2 results in various developmental failures of pharyngeal pouch derivatives (“22q11.2 deletion syndromes”, 22q.11DS), consequently affecting the anatomy and physiology of head and neck (H&N) organs. The objective of this paper was to describe those manifestations. Two 22q11.2DS patients with H&N manifestations were studied along with a comprehensive review of the English literature, from 1975 to 2010 regarding the associated H&N malformations among 22q11.2DS. A 24-year-old mentally disabled 22q11.2DS male presented with right hemithyroid enlargement, causing significant compressive signs. Sonography revealed a homogeneous 8xa0×xa03xa0cm lesion, replacing almost the entire thyroid lobe. Fine needle aspiration revealed colloid material and abundant eosinophils. The hemithyroidectomy specimen confirmed follicular adenoma. A 19-year-old mentally disabled 22q11.2DS female underwent CT-angiography due to an upper GI bleeding. The study revealed a vascular malformation in the infratemporal fossa. Reviewing the reported data regarding 22q11.2DS-associated H&N malformations revealed abnormalities and malfunctions of the thyroid gland, parathyroid glands, thymus agenesis, cleft palate, carotid artery aberrations, malformations of the larynx and trachea and esophageal dysmotility. 22q11.DS patients may present with H&N anatomical abnormalities, along with hormonal dysfunctions, which require special awareness once treatment is offered, especially when concerning anesthetic and surgical aspects. In addition, hSNF5/INI1, a tumor suppressor gene, detected at location 22q11.2 was described to be “knocked out” in some patients. This may be associated with H&N tumors reported in these patients.

Modified endoscopic swallowing test for improved diagnosis and prevention of aspiration

Laryngopharyngeal sensation is important in the normal process of swallowing, it is often impaired after neurological events and it has been common practice in such an occurrence to order non-oral tube feeding to prevent aspiration. This study assesses a novel approach to the evaluation of the laryngopharyngeal sensation that allows for improved triage of aspiration risk and more lenience towards oral feeding. This is a case series with follow-up period ranging from 6 to 24xa0months. Forty patients with neurological deficiencies were tested by a modified laryngopharyngeal sensation study that included evaluation of both supra and infra-glottis. All patients had impaired supra glottic sensation but had good infra glottic sensation that enabled cough protection. All had received oral feeding. Main outcome measure is incident aspiration pneumonia. Twenty-two patients maintained oral feeding without any evidence of aspiration. Eighteen patients had some aspirations associated with cough, and were maintained on modified oral feeding. Out of these 18 patients, four patients (10% of the entire group) developed aspiration pneumonia. The presented procedure identified patients with impaired supraglottic sensation but preserved good infra glottic sensation. This observation enables safe oral feeding in most patients and therefore offers a better quality of life for these individuals.

Exceptionally elevated creatine kinase levels in a laryngectomized patient: hypothyroid myopathy.

We present a laryngectomized patient with unspecific complaints of fatigue whose laboratory findings were out of proportion with the clinical presentation. The enormously high blood levels of creatine kinase (CPK) (8000 IU/l, normal range 30-190 IU/l) and thyroid-stimulating hormone (100 mU/l, normal range 0.5-4.5 mU/l) led to diagnosis and treatment of and recovery from hypothyroid myopathy. Hypothyroidism reduces the ability of the muscle to maintain its adequate energetic economy, via several suggested mechanisms. This may lead to injury (myopathy) that allows enzymes such as CPK to leak out of cells and causes elevation of their serum levels. To our knowledge, this is the first reported case of a patient previously treated for head and neck cancer who developed hypothyroid myopathy, presenting with exceptionally elevated CPK levels. This is noteworthy, since hypothyroidism may be easily avoided by a comprehensive follow-up of patients treated for head and neck cancer.

Cardiovascular Risk Factors Among Patients With Vestibular Neuritis

Objective: To investigate the correlation between cardiovascular risk factors (CVRFs) and vestibular neuritis (VN) in hospitalized adult patients. Methods: A cross-sectional retrospective study was conducted in a tertiary hospital setting. The medical records of patients (aged over 18 years old) who were hospitalized between the years 2005 and 2014 with the diagnosis of VN were retrieved. Inclusion criteria were: (1) acute vertigo lasting for at least 24 hours, (2) absence of auditory complaints, (3) horizontal unidirectional nystagmus present during physical examination, and (4) absence of neurological symptoms or signs. The ratio of CVRFs among VN patients was compared to the ratio of those among the general Israeli population. Results: A significantly higher prevalence of CVRFs was found among VN hospitalized patients in comparison to the general population (P < .05). Furthermore, a significant correlation (P < .001) was found between the patients’ age and the number of CVRFs (r = .387). A positive correlation (r = .643) was found between the number of CVRFs and VN in each age group (P = .119). Conclusion: There may be a possible interrelation between CVRFs and VN. This correlation can be caused by occlusion of small blood vessels leading to labyrinthine ischemia and apparition of symptoms of VN.

Extraordinary Adult Thyroglossal Duct Cyst

This work received the approval of the Edith Wolfson Medical Center institutional review board (IRB). A 35-yearold man with schizophrenia presented with a longstanding painless huge anterior neck mass. The overlying skin was irritated, with a peau d’orange appearance (Figure 1). Accompanied by his family, he reported a previously known neck lump that had grown during recent years. He attended the clinic because of increasing dysphagia, discomfort, and drooling. There were no respiratory symptoms. Neither the patient nor his family members appeared disturbed by the extraordinary neck finding. The patient was pale, with a huge, soft, lobulated anterior neck mass measuring 30 3 24 cm, moving upon deglutition. The base of the tongue was pushed posteriorly by the cystic mass, causing a slight oropharyngeal obstruction and swallowing difficulties. However, the floor of the mouth was normal. Larynx appeared normal. A neck computed tomography (CT) study demonstrated a lobulated cystic neck mass, extending from the base of the tongue, adjacent to the floor of the mouth and anterior to the hyoid bone, the sternocleidomastoid muscles, and the normal-appearing thyroid gland (Figure 2). The differential diagnosis included thyroglossal duct cyst, cystic hygroma/ lymphangioma, thyroid neoplasm, epidermoid cyst, and plunging ranula, which may present as a midline neck mass. A diagnostic aspiration revealed abundant colloid, with a few pseudociliated epithelial cells, suggesting TGDC. Addressing the relatively large size, surgical planning mandated a wide horizontal neck incision to allow the safe exploration of the mass and its surroundings, including the hyoid bone, suprahyoid muscles, laryngeal skeleton, submandibular glands, and hypoglossal nerves. Partial excision of the body of the hyoid bone and the excess skin was also taken into consideration. Anticipating a possible difficult intubation, an awake, nasotracheal intubation was performed. The patient underwent an ‘‘extended’’ Sistrunk operation that included an en bloc resection of the cystic mass, along with the suprahyoid muscles that were adherent to it. A meticulous dissection of compressed nerves and vessels was necessary, in particular the left tortuous hypoglossal nerve. As planned, the middle portion of the hyoid bone, including a short, wide tract leading to the base of tongue and the overlying skin, was resected. The cyst colloid volume was 3 L. Pathological report confirmed thyroglossal duct cyst, with no signs of malignancy. The postoperative course was remarkable for worsening swallowing difficulties, which caused aspirations and required feeding gastrostomy and swallowing training. A remarkable improvement was observed at follow-up visits.

The Middle Ear Cleft Status in a “Natural” Cohort With Eustachian Tube Dysfunction

BACKGROUNDnThe Eustachian tube (ET) has a major role in the middle ear (ME) pressure homeostasis. ET dysfunction is the accepted paradigm for pressure-related ME disorders. We studied the ME status in patients with severely diminished ET opening abilities, and anticipated to find ME disorders in most of them.nnnPATIENTS AND METHODSnME status was evaluated in unconscious adults, who were hospitalized in a rehabilitation center with severe brain damage, requiring tracheotomy and gastrostomy. These patients were unable to swallow, produce valsalva, yawn, and needed oral suctioning. Examination included fiberoptic nasopharyngoscopy, gag reflex and soft palate assessments, otoscopy, and tympanometry.nnnRESULTSnNineteen patients (38 ears) were evaluated: 14 men and 5 women, aged 18 to 93 years (average 59). Duration of gastrostomy and tracheotomy were between 3 months and 18 years. All the patients lacked gag reflex, palatal movements, or supraglottic sensation. Eighteen ears (47%) had otitis media with effusion (OME) (versus ∼3% in the general population, pu200a=u200a0.00001), none had significant tympanic membrane atelectasis, but 20 (53%) ears were normal. Twenty-two ears (59%) had tympanometry types B/C and 16 (41%) had type A. Cerumen impaction incidence (26 ears, 68%) was significantly higher than in normal adults (10%), mentally retarded (36%), and nursing homes residents (57%).nnnCONCLUSIONSnA dysfunctional ET predisposed ME disorders. Yet, ∼50% of the ears were normal, in contrast to the current paradigm. This implies that ME pressure homeostasis is maintained by factors that can compensate for ET dysfunction. Treating cerumen impaction and OME may be beneficial for rehabilitation.

Studies by Nature of “Eustachian Tube Dysfunction”: A Preliminary Report

Thisgroupofpatients after 1year to3years back, theclose type keep plane wall of mastoid tympanoplasty 102 cases, hearing had no obvious change in 62 cases (51%); , people with hearing improve 13 cases (11%), apparent decline in hearing in 2 cases, accounting for 1%. Hearing a reformer, 41 cases hearing improve 29 cases, accounted for 70.73%, hearing no change of 12 cases, accounted for 29.26%, open removed concha mastoid tympanoplasty 18 cases, hearing had no obvious changes in 4 cases (22.2%); The improvement in 1 case, 5.6%, the hearing in 13 cases, accounting for 72.2%.

ENT Aspects of Sudden Infant Death Syndrome

Objective: To address sudden infant death syndrome from the otolaryngologist’s perspective, describe relevant pathologies, discuss controversies, and suggest preventive measures in high-risk populations. Method: A MEDLINE search and hand search were conducted to identify reports published between 1969 and 2011 in the English language on the pathophysiology of SIDS related to the head and neck organs. Search terms included SIDS (MeSH term), SIDS and pathophysiology (text words), and SIDS and autopsy (text words). Results: A growing number of reports suggested head and neck organ involvement in SIDS autopsies. Laryngeal, oropharyngeal, maxillofacial, otologic, cervical vascular abnormalities, and infectious etiologies were recognized and discussed. Conclusion: Otolaryngologists should be aware of relevant pathologies, as some are treatable, if identified early enough in infancy. A proactive risk-management approach is warranted in infants presenting with certain abnormalities reviewed here.