Successful endoscopic ablation of a pyriform sinus fistula in a child: case report and literature review.

Recurrent thyroid infections are rare in children. When present, patients should be evaluated for anatomic anomalies such as pyriform sinus fistulae. We describe a 12-year-old girl with history of recurrent thyroid abscesses secondary to a pyriform sinus fistula and managed with concurrent endoscopic ablation and incision and drainage.

The role of alternative medicine in rhinology.

Complementary and alternative medicine (CAM) includes treatments from traditional Chinese medicine, homeopathy, naturopathy, herbal medicine, Ayurvedic medicine, mind-body medicine, chiropractic or osteopathic manipulations, and massage. More than 40% of patients in the United States use CAM, with 17% of CAM use related to otolaryngology diagnoses, but nearly half of CAM users do not communicate their use of these medications to their physicians. Perioperative risk of bleeding is a particular concern in surgical specialties, and knowledge of these therapies and their potential adverse effects is critical.

Phoma and Acremonium invasive fungal rhinosinusitis in congenital acute lymphocytic leukemia and literature review.

OBJECTIVE: Invasive rhinocerebral fungal infections are a difficult and often fatal problem in children with hematologic malignancies, with increasing reports of rare pathogens. We describe a case of congenital acute lymphoblastic leukemia (ALL) and invasive fungal rhinosinusitis involving Acremonium and Phoma species, not previously reported in invasive pediatric fungal rhinosinusitis, and review all published cases of human Phoma infections. METHODS: A literature and institutional review for Phoma spp. was completed including patient demographics, infection site, immune status, treatment and outcome. RESULTS: A female neonate with acute lymphoblastic leukemia presented with hyperleukocytosis and advanced invasive Phoma and Acremonium spp. rhinosinusitis. Despite aggressive medical and surgical therapy, the disease progressed to a rhinocerebral infection with a fatal outcome. Twenty cases of Phoma spp. were found in a complete literature search, including 6 females and 14 males from 18 months to 77 years old. Infections were superficial in fifteen patients and involved deeper tissue in five patients, with sites including cutaneous, subcutaneous and deep tissue sites (eye, lung, extremity deep tissue compartments). CONCLUSIONS: This case highlights the risks and grave prognosis of fulminant invasive fungal rhinosinusitis in the context of congenital leukemia, and the potential for rare fungal species in neonates with immunosuppression.

Unilateral endoscopic approach for repair of frontal sinus cerebrospinal fluid leak.

Cerebrospinal fluid (CSF) leak closure remains one of the most difficult surgeries for skull base surgeons, particularly with frontal sinus involvement. Technological advances in endoscopic surgery increasingly allow for less morbid approaches to the frontal sinus. We describe a series of patients who underwent endoscopic frontal sinus CSF leak repair utilizing a unilateral approach, to evaluate the utility and outcomes of this method. We performed a retrospective review of four cases in tertiary care centers. Participants included patients with CSF leak involving the frontal sinus. Main outcome measures included cessation of CSF leak and frontal sinus patency. Three patients were closed on the first surgical attempt; one with a communicating hydrocephalus required a revision procedure. Leak etiologies included prior craniotomy for frontal sinus mucopyocele, spontaneous meningoencephalocele, erosion due to mucormycosis, and prior endoscopic sinus surgery. The frontal sinus remained patent in three of four patients. No patients have evidence of a leak at a minimum of 1 year after surgery. The repair of frontal sinus CSF leaks is possible in specific cases with an endoscopic unilateral approach in leaks with multiple etiologies. Surgeons should consider this approach when selecting the appropriate procedure for repair of frontal sinus CSF leaks.

Preliminary findings on the effects of topical photoactivated antimicrobial methyl-δ-aminolevulinic acid on murine hearing thresholds.

This study evaluates the ototoxicity of a potential novel ototopical antimicrobial, photoactivated methyl-δ-aminolevulinic acid (M-ALA). Ten CBA/J mice received intratympanic injections of 10 mM M-ALA and 640 nm light source illumination for 7 days, with contralateral ears receiving saline. Auditory-evoked brainstem response (ABR) thresholds (8, 16, 24, and 32 kHz) were determined preinjection and at 1, 30, and 90 days postinjection. Mean ABR thresholds were similar after intratympanic administration of M-ALA and saline (F ratio, 0.001; P = .971). ABR thresholds temporarily increased in both groups (F ratio, 28.52; P = .00) at day 1 postinjection of intratympanic treatments but returned to baseline at day 30 and 90. This temporary elevation was associated with tympanic membrane perforations and granulation tissue at the injection sites, which resolved by day 30 posttreatment. The preliminary findings indicate that intratympanic application of M-ALA with light activation over a 7-day course in a murine model does not produce measurable ototoxicity and is well tolerated.

Enhanced video images for tympanic membrane characterization.

The objective of this article is to introduce portable devices capable of providing video images of the tympanic membrane and tympanic cavity of the ear. Specifically, digital video otoscopy is introduced as an effective platform for tympanic membrane characterization. In addition, we show how digital image enhancement and segmentation processing techniques can be applied to the acquired images, which could provide more visual detail and objective clinical interpretation.

Postcricoid vascular lesions: histopathological and immunohistochemical diagnosis.

OBJECTIVES/HYPOTHESIS: Postcricoid vascular lesions are a rare cause of dysphagia and stridor in the pediatric population. Currently, there is no clear consensus on what type of vascular lesions are common in the postcricoid area because adequate histological or immunohistochemistry studies are lacking. This study aimed to describe the histology and immunohistochemistry of postcricoid masses in our institutions' experience, and consolidate available data on the symptoms, management, and histology of these unusual malformations with a comprehensive literature review. STUDY DESIGN: Retrospective patient and literature review. METHODS: A retrospective review of patients with postcricoid vascular lesions was performed at two pediatric tertiary care institutions. Histology and immunohistochemistry studies were performed in patients undergoing a lesion biopsy. A complete literature review of the English language was completed for cases involving vascular lesions of the postcricoid area. RESULTS: Four patients were identified in our study with postcricoid vascular lesions. All patients presented with symptoms of dysphagia and intermittent stridor. Histology and immunohistochemistry studies were performed in three patients. GLUT-1 was negative in all three patients, and CD34 was positive in all patients tested. Lewis Y antigen was performed in one patient and was negative. A description of 19 cases reported in the English literature is included. CONCLUSIONS: Patients with postcricoid vascular lesions usually present with mild to moderate feeding difficulties, and stridor or dyspnea with agitation. Histopathology and immunohistochemistry results suggest that postcricoid vascular lesions may often represent congenital vascular malformations instead of infantile hemangiomas.

Predicting hypocalcemia after total thyroidectomy: parathyroid hormone level vs. serial calcium levels.

A 24- to 48-hour in-hospital observation period to monitor for hypocalcemia is common after total thyroidectomy. Because most thyroidectomy patients do not experience this potentially serious complication, investigators have searched for methods and clinical indicators that may help stratify thyroidectomy patients according to their risk of developing hypocalcemia and identify those who can be safely discharged earlier. We conducted a retrospective study to compare the value of an immediate postoperative intact parathyroid hormone (PTH) level and serial calcium levels in predicting the development of hypocalcemia following total thyroidectomy. Our study population was made up of 69 consecutive patients who had undergone total thyroidectomy from January 2004 through March 2005. These patients were divided into two groups on the basis of their postoperative calcium levels; 11 patients (16%) had developed transient hypocalcemia (serum calcium level: <7.5 mg/dl) and 58 (84%) had remained normocalcemic. A model was developed to assess the relationship between early (<60 min) postoperative PTH levels and serial (6 and 18 hr) calcium levels, and the two-sample Student t test was used to identify differences between the two groups. Analysis showed that hypocalcemia was associated with a postoperative PTH level of less than 14 pg/ml and a negative serum calcium slope between 6 and 18 hours postoperatively. A single early postoperative intact PTH measurement may be the most cost-effective screening tool for hypocalcemia, but even greater specificity can be achieved by combining those findings with a serum calcium measurement taken 6 hours postoperatively. The combination of the two measurements represents the safest method of assessing risk and identifying those patients who can be discharged on the day of surgery.