Airway and Swallowing Outcomes in Children With Combined Laryngomalacia and Laryngeal Cleft.

Laryngomalacia (LM) and laryngeal cleft (LC) can independently cause dysphagia but rarely can occur concomitantly. We discuss the presentation, decision-making, and swallow outcomes following surgical correction of combined LM and LC. We present four patients with combined LM and an LC who underwent both primary supraglottoplasty (SGP) and laryngeal cleft repair (LCR). Each patient presented with recurrent choking or coughing with feeds. Stridor was only present in two patients. Patients with SGP saw the resolution of stridor when present, but dysphagia persisted in all four cases. LCR clinically and objectively resolved all symptoms of dysphagia. We found that flexible fiberoptic laryngoscopy is not always reliable at detecting combined pathology. Patients presenting with persistent dysphagia following SGP should be suspected of having interarytenoid pathology. We recommend a staged surgical approach with SGP before LCR.

Mind-Body Therapies in the Management of Otolaryngologic Disease: A State-of-the-Art Review of Randomized Controlled Trials.

OBJECTIVE: To review and assess the peer-reviewed literature on the utility of mind-body therapy (MBT) as an adjunct treatment in the management of otolaryngologic disease. DATA SOURCES: PubMed, Embase, and Cochrane. REVIEW METHODS: Randomized control trials (RCTs) of MBTs in the management of otolaryngologic disease from 2002 to 2022 were identified and included according to predefined criteria. Interventions requiring expensive equipment were excluded because the goal of MBT is to be cost-conscious. All studies were subjected to a two-stage blinded screening, extraction, and appraisal process. The outcomes of the intervention and control groups were compared. CONCLUSION: RCTs of MBTs, including breathing exercises (4), aromatherapy (2), biofeedback (2), meditation, (2), and yoga (2), have been studied in several otolaryngologic conditions, including septoplasty/rhinoplasty (3), head and neck cancer (2), facial palsy (2), and tinnitus (2). Most studies were of moderate risk of bias on appraisal, and each MBT studied was found to significantly reduce subjective and objective distress associated with the otolaryngologic condition in question. IMPLICATIONS FOR PRACTICE: Despite a paucity of strong evidence supporting the universal use of MBTs, our review suggests that MBTs are cost-effective and easily deployable complementary tools in the management of otolaryngologic disease. Future large, methodologically rigorous RCTs are needed to address the limitations of the included studies, such as improper blinding and inappropriate statistical analysis. As MBTs are studied further, a case for their current use can be made because of their low cost and minimal risk to patients.

Palato-Pharyngo-Laryngeal Rhythmic Myoclonus in Neuro-Behcet Syndrome: A Case Report.

OBJECTIVE: Behcet's syndrome (BS) is a chronic, relapsing multisystemic inflammatory perivasculitis and can affect any tissue, including the nervous system. Neuro-Behcet's syndrome (NBS) most commonly affects the CNS parenchyma and presents with a subacute brainstem syndrome that includes cranial neuropathies. Here we describe a rare case of palato-pharyngo-laryngeal myoclonus as a manifestation of NBS and discuss it from a laryngology perspective. METHODS: Case report at tertiary care center. Informed consent was obtained from patient. IRB approved as non-human subjects research. RESULTS: A 52-year-old male presented with a progressive history of ataxia, fatigue, apathy, dysphagia, depressed mood, dizziness, poor appetite, subjective fever and recurrent orogenital lesions. He was diagnosed with NBS and treated with methylprednisolone, followed by infliximab and methotrexate. Despite treatment, his severe spastic dysarthria, dysphagia, and aspiration worsened over the next few months, necessitating a gastrotomy tube. With concern for laryngospasm, he was referred to otolaryngology and found to have synchronous and symmetric palatal, pharyngeal, and laryngeal rhythmic myoclonus bilaterally at a frequency of 2 Hz with inappropriate vocal cord closure. Treatment with baclofen and a scopolamine patch improved his breathing and reduced choking events. CONCLUSIONS: Palato-pharyngo-laryngeal rhythmic myoclonus can be a presentation of brainstem NBS in the otolaryngology clinic. We theorize perivascular disease in NBS results in a brainstem lesion in the denato-rubro-olivary tract, which results in hypertrophic olivary degeneration and subsequent activation of the inferior olives oscillatory activity, causing palato-pharyngo-laryngeal rhythmic myoclonus. Common symptoms include significant dysarthria, dysphonia, and dysphagia with concern for obstructive sleep apnea and airway compromise. Treatments include pharmacologic therapy, laryngeal botox, and tracheostomy in cases of significant airway compromise.

Comparison of Nasal Obstruction Symptom Evaluation Score Outcomes After Autologous Cartilage Grafts and Latera Nasal Implants.

OBJECTIVE: To compare quantitative Nasal Obstruction Symptom Evaluation (NOSE) scores for ACG and Latera implants for nasal valve repair. METHODS: Retrospective chart review of patients who underwent ACG or Latera placement between January 2016 through May 2019 by a single surgeon. Patients who had completed NOSE surveys pre- and post-operatively were identified and eligible for inclusion. Data regarding baseline demographic characteristics, adjunctive surgical procedures, NOSE scores at 1, 3, and 6-month post-operative visits, complications, and total operative time were collected. Unpaired t-tests and linear mixed models were performed to analyze differences between study groups. RESULTS: There were 24 and 39 patients who underwent ACG and Latera, respectively, who met eligibility criteria. There were no differences in demographic characteristics or pre-operative baseline NOSE scores (ACG: 65.1 and Latera: 64.4; P = .92) between groups. Mean operative times were not significantly different between groups (ACG: 113 minutes and Latera: 102 minutes; P = .76). Within each group, NOSE scores were significantly improved at each post-operative visit compared to pre-operative baselines. Between groups, mean NOSE scores were lower at each post-operative visit for ACG compared to Latera (1-month ACG: 21.7 and Latera: 45.9, P = .002 ; 3-month ACG: 14.5 and Latera: 39.9, P = .034; 6-month ACG: 8.4 and Latera: 44.2, P = .003). CONCLUSIONS: Both ACG and Latera offer significant improvements in patient-reported nasal obstruction severity; however, ACG may yield more favorable subjective symptom scores.

Eagle syndrome in the pediatric population: A case report.

OBJECTIVES: To present a rare case of Eagle Syndrome in a pediatric patient, reminding the medical community to keep this diagnosis on their differential.

Fireworks Injuries to the Head and Neck: A Retrospective Analysis Between 2008 and 2017.

This study examines firework-associated head and neck injuries in the United States from 2008 to 2017 obtained from a single epidemiology source. The National Electronic Injury Surveillance System (NEISS) was used to collect epidemiologic data and retrospectively analyze firework-associated injuries from 2008 to 2017. Injury types included burns, concussions, contusions, foreign bodies, hematomas, internal organ injury, lacerations, and puncture wounds. Four hundred and thirty-one individuals were originally included; however, 14 participants were excluded due to inadequate injury information. Chi-squared analyses were performed between the following categorical variables: gender vs body part injured, patient age vs injury type, and patient age vs body part injured. About 417 injuries to the head and neck (67.4% male, 32.6% female) were treated in NEISS-reporting emergency departments during the 10-year period. Sixty-nine percent of the injuries occurred in July. Body parts injured included the ear (10.6%), face (61.6%), head (13.0%), mouth (4.8%), and neck (10.0%). Chi-squared analysis demonstrated an association between gender and body part injured (P = .0001). Patient age (P = .066) was independent of injury type. Children aged 0 to 12 years had the highest probability of being injured (40.2%), then adults 22 and older (33.1%) and adolescents 13 to 21 years (26.9%). Given that the preponderance of injuries caused by fireworks occurred primarily in minors, pediatricians should screen for any household firework use during the anticipatory guidance portion of well-child checks, which we believe would improve patient safety and decrease injury rates.

A Rare Presentation of Primary Cutaneous Low-Grade Neuroendocrine Tumor of the External Auditory Canal.

OBJECTIVE: To describe the first case of a primary cutaneous low-grade neuroendocrine tumor (cLGNET) originating from the external auditory canal as well as our team's surgical management. PATIENT: A healthy 34-year-old female presented with a low-grade neuroendocrine tumor of her right external auditory canal (EAC) which extended from the posterior-superior aspect of the EAC into the middle ear. INTERVENTION: A complete otological examination was performed in addition to CT and MRI imaging. The low-grade neuroendocrine tumor was surgically biopsied and further surgery was recommended for complete resection. RESULTS: Audiogram revealed profound right sensorineural hearing loss. CT scan demonstrated complete opacification of the right EAC, middle ear, and mastoid air cells, dystrophic calcification in the mesotympanum overlying the cochlear promontory, and no associated osseous erosion. MRI revealed abnormal FLAIR hyperintensity and enhancement of the labyrinthine segment of the right facial nerve, cochlea, and horizontal and posterior semicircular canals. An enhancing mass opacifying the right EAC demonstrating restricted diffusion on diffusion-weighted image was also evident. Pathologic examination and immunohistochemical staining confirmed a diagnosis of primary cLGNET of the EAC. CONCLUSION: Primary cLGNETs of the external ear are exceedingly rare but should be considered if an adult patient presents with a mass in the EAC. Management should include early biopsy and surgical excision followed by histological and immunohistochemical confirmation.

Rare presentation of bilateral thumb psoriatic arthritis treated with arthrodesis: a case report.

Psoriatic arthritis (PsA) is a seronegative inflammatory arthritis that occurs concomitantly with cutaneous manifestations and tendinous pathology that affects up to 1% of the general population. While the majority of cases are mild, nearly 20% of PsA patients will progress to severe disease manifesting as debilitating polyarticular inflammation and joint destruction. PsA is most commonly asymmetric and bilateral severe disease involving the same joints in each hand has rarely been reported in the literature. It is estimated that PsA only presents bilaterally in a quarter of patients. The recent increase in popularity and efficacy of disease-modifying anti-rheumatic drugs (DMARDs) has led to increasing rarity of such severe disease progression. We present a case of a 47-year-old male with PsA who had a unique pattern of bilateral first metacarpophalangeal (MP) and interphalangeal (IP) involvement with minimal erosion leading to significant joint pain, instability, dislocation, and loss of function. After failure of conservative treatment that included both DMARDs and non-steroidal anti-inflammatory drugs (NSAIDs), the patient opted for surgical management. The purpose of this report is to identify a rare presentation of PsA and consider the significance of MP joint arthrodesis as a viable treatment to restore functional status and improve quality of life.