Advanced oral tongue cancer in a 22-year-old pregnant woman.

OBJECTIVES: Oral squamous cell carcinoma generally occurs in older men and is associated mostly with tobacco and alcohol as the primary risk factors. The incidence of oral squamous cell carcinoma in younger patients has increased. We report a case of a young woman, 25 weeks pregnant, who presented with stage IV carcinoma of the oral tongue. METHODS: The following is a case presentation and literature review. RESULTS: The patient presented with T4 N3 M0 oral tongue cancer. A team consisting of a head and neck surgeon, a radiation oncologist, a medical oncologist, and a maternal-fetal medicine specialist was assembled. The patient initially refused surgery. Chemotherapy was initiated until 32 weeks' gestation. After an infant boy was delivered via cesarean section, the patient began concurrent irradiation and chemotherapy, which induced complete regression of the primary tongue neoplasm with a partial response of the neck nodes. The patient underwent bilateral neck dissection followed by hemiglossectomy for recurrence. CONCLUSIONS: Management of advanced oral carcinoma in pregnancy presents a unique set of challenges. Few studies have described chemotherapy and radiotherapy during pregnancy, and long-term results are needed. Care must be taken to balance appropriate and adequate treatment of disease and to ensure the safety of the patient and the fetus.

Cavernous sinus thrombosis secondary to allergic fungal sinusitis.

Cavernous sinus thrombosis (CST) is a rare and serious complication secondary to invasive fungal sinusitis, but rarer still in cases of allergic fungal sinusitis. Current recommendations for cavernous sinus thrombosis are controversial, especially regarding anticoagulation, secondary to the rarity of the diagnosis. Early surgical debridement and intravenous antibiotics are crucial to prevent mortality and decrease morbidity. Because thrombosis is thought to be caused by a bacterial superinfection, which follows a response to Aspergillus, antifungals may not be necessary. Despite the controversy, most physicians opt to treat with anticoagulation.

Evaluation of optical rhinometry for nasal provocation testing in allergic and nonallergic subjects.

OBJECTIVE: Optical rhinometry is a new method that quantifies light extinction in optical density to assess nasal blood volume as a measure of nasal patency. The purpose of this study is to evaluate optical rhinometry as an objective evaluation of nasal patency using nasal provocation testing with histamine and oxymetazoline. STUDY DESIGN: Prospective pilot. SETTING: Academic tertiary rhinologic practice. SUBJECTS AND METHODS: Convenience sample of five adult subjects with allergic rhinitis and five adult normal subjects who underwent challenge with histamine and oxymetazoline. Patients underwent challenge with increasing concentrations of histamine to determine the amount of histamine needed to cause a positive optical rhinometry reading. The same subjects then underwent histamine challenge with this amount followed by oxymetazoline. Nasal patency was assessed subjectively after each challenge with the visual analog scale. RESULTS: The median histamine amount needed to cause a positive response was statistically lower in allergic rhinitis as compared with nonallergic subjects at 150 microg and 300 microg, respectively (P = 0.04). When comparing the optical rhinometry with subjective nasal congestion after histamine and oxymetazoline challenges, there was a statistically significant correlation with r = 0.79 (P = 0.00003). CONCLUSION: This initial study demonstrates a correlation between subjective symptoms of nasal patency and objective measurements with the optical rhinometer. Less histamine amount necessary to incite nasal congestion in allergic rhinitis suggests that these patients may be primed to the effects of histamine. These preliminary data suggest that optical rhinometry is able to assess changes in nasal patency during challenges with histamine and oxymetazoline.

Comparison of optical rhinometry to acoustic rhinometry using nasal provocation testing with Dermatophagoides farinae.

OBJECTIVE: To evaluate optical rhinometry (ORM) as an objective evaluation of nasal patency using nasal provocation testing with Dermatophagoides farinae (Df) as compared with acoustic rhinometry. STUDY DESIGN: Prospective pilot. SETTING: Academic rhinologic practice. SUBJECTS AND METHODS: Five adult healthy controls and five adult subjects with allergic rhinitis (AR) underwent nasal provocation testing with increasing concentrations of Df while undergoing ORM. The minimum concentration of Df causing a positive reading was recorded. Nasal cross-sectional area was measured before and after testing using acoustic rhinometry. Nasal patency was assessed subjectively after each challenge with the visual analogue scale. RESULTS: The median amount of Df causing a positive response on ORM was less in AR patients as compared to healthy controls, at 5000 AU/mL and greater than 10,000 AU/mL, respectively. There was a statistically significant correlation between the change in optical density in ORM and subjective nasal congestion after increasing Df challenges (r = 0.63; P = 0.0007). Similarly, there was a statistically significant correlation between change in optical density by ORM and both minimum cross-sectional areas as measured by acoustic rhinometry (r = -0.60, P = 0.03; and r = -0.64, P = 0.02, respectively). CONCLUSION: This is the first study to show a correlation between optical rhinometry and acoustic rhinometry during nasal provocation testing with Df. In addition, the data support a correlation of optical rhinometry to subjective symptoms of nasal congestion. These preliminary data suggest that optical rhinometry is able to assess changes in nasal patency during challenges with Df.

Vocal fold paresis: clinical and electrophysiologic features in a tertiary laryngology practice.

A retrospective chart review was performed at the senior author's voice disorder clinic to report the symptoms, signs, and laryngeal electromyography (LEMG) data of patients presenting with vocal fold paresis (VFP) in a tertiary laryngology academic practice over a 4-year period. Medical records of 739 patients presenting to the clinic with a chief complaint of dysphonia (for 2000-2004) were assessed. History intake forms, strobovideolaryngoscopy images, and LEMG reports were reviewed for all patients with a clinical diagnosis of VFP. Of the 739 patients presenting to the clinic with voice complaints, 195 were initially diagnosed with either vocal fold paralysis or VFP (26.4%). Only 13 out of 739 patients (1.8%) with voice complaints were diagnosed with LEMG-confirmed unilateral or bilateral VFP. The most common findings on strobovideolaryngoscopy were vocal fold bowing (70%), incomplete closure (62%), and increased vibratory amplitude (38%). Seventy percentage of the patients had unilateral VFP, predominantly isolated recurrent laryngeal nerve (RLN) disease. Only 9% had unilateral superior laryngeal nerve (SLN) involvement. The most common LEMG abnormality was reduced recruitment of motor units. In our voice center, VFP was a relatively uncommon diagnostic entity. Despite the low prevalence, VFP needs to be considered in all patients who present with dysphonia. Further study is needed to examine the prevalence of "abnormal" LEMG studies in an asymptomatic control population, and to determine the utility of LEMG in the evaluation and management of dysphonia. In the same way that strobovideolaryngoscopy has been critically evaluated in the past, there is also a need to determine how commonly LEMG contributes essential data which leads to a change in the patient's management and/or ultimate vocal outcome.