Audiologic Outcomes After Oval and Round Window Reinforcement Surgery.

INTRODUCTION: Oval window (OW) and round window (RW) reinforcement surgery has been used for symptomatic treatment of multiple clinical entities, most commonly perilymphatic fistula and superior semicircular canal dehiscence. Owing to the theoretical acoustically negative effect of stiffening the windows, there has been concern of an unfavorable effect on audiologic outcomes due to the procedure. The purpose of this study is to specifically evaluate audiologic outcomes after OW and RW reinforcement. METHODS: A retrospective review of patients undergoing transcanal OW or RW reinforcement was completed. Patients were evaluated both as a total group and as two groups separated into "third window" and "two-window" groups based on their specific diagnosis. Primary outcomes included changes in individual pure-tone thresholds, pure-tone average (PTA), air-bone gap, speech reception threshold (SRT), and word recognition scores (WRS) between the preoperative and postoperative groups. RESULTS: Seventy-one patients were included in the study. The combined cohort demonstrated a significant postoperative 2.75 dB increase in the air conduction hearing level at 4000 Hz (p < 0.05). This was almost entirely accounted for by a 2.18 dB increase in the air-bone gap at this frequency (p < 0.05). There were no significant changes in PTA, SRT, or WRS between in the combined group or in the subgroup analysis. CONCLUSION: OW and RW tissue reinforcement resulted in a statistically significant but likely clinically insignificant decrease in hearing at the 4000 Hz frequency. There was no worsening of PTA, WRS, or SRT.

Laryngeal Burn from a Sweet Potato: A Case Report.

CONTEXT: Thermal injury to the larynx and other pharyngeal structures as a result of food ingestion is a rare occurrence, particularly in an adult population. Since the 1970's, only a few cases have been reported in the literature. CASE PRESENTATION: We present the case of a male in their early 30's with a history of left sided spastic hemiparesis and unilateral vocal fold paresis who ingested a sweet potato which resulted in supraglottic burns. The patient denied any prior swallowing difficulties. Conservative therapy with steroids, proton pump inhibitors (PPI's) and antibiotics were sufficient for full recovery without any lasting sequelae. CONCLUSIONS: This case demonstrates how careful attention should be paid to food temperature particularly in patients at higher risk of dysphagia. It also demonstrates how prompt diagnosis and implementation of appropriate medications can prevent permanent and debilitating damage.

Congenital Pharyngeal Web in an Adult: Treatment of a Rare Clinical Anomaly by Coblation.

INTRODUCTION TO THE TOPIC: Previous reports of congenital pharyngeal webs, although rare, have been described in children. Clinical presentation varies, ranging from aspiration to intermittent airway obstruction, and most commonly, dysphagia. In this case report, the authors describe an unusual finding of a hypopharyngeal web in an adult patient. This patient had no prior history of chemoradiotherapy, malignancy, or total laryngectomy, all of which have been associated with acquired pharyngeal stenosis, supporting that this finding was of congenital origin. After a review of the possible embryological developmental abnormalities, the hypothesis is that of gut recanalization failure during development. CASE PRESENTATION: We present a case of a woman in her mid-40's with a history of solid food dysphagia resulting in a 20 kg weight loss over three months. The patient denied dysphagia progressing to liquids, pain with swallowing, and a history of alcohol or tobacco use. Upon examination of the larynx via laryngoscope, a congenital hypopharyngeal web was identified. Successful excision of the web via coblation restored proper drainage of the pyriform sinus into the esophagus and resulted in markedly improved swallowing function and weight gain. CONCLUSIONS: Pharyngeal webs are rare findings, particularly in adult patients. These congenital anomalies can be safely and effectively treated endoscopically via coblation.