MAUDE database and Eustachian tube balloon dilation: Evaluation of adverse events and sales data.

STUDY DESIGN: Review of database. SETTING: Tertiary care neurotology center. PATIENTS: Patients undergoing adverse events. INTERVENTION: MAUDE database evaluation of Eustachian tube balloon dilation (ETBD) for the treatment of Eustachian tube dysfunction. MAIN OUTCOME MEASURES: Medical device reports (MDRs) from the MAUDE database were analyzed for adverse patient events (AE) and device malfunctions (DM) among different devices for ETBD. The objective of this analysis is to assess AE rates and compare them across different devices. Sales data was also used to calculate AE rates. RESULTS: There were 18 MDRs noted in the MAUDE database for patients undergoing ETBD out of an initial 23 results. When separated into devices, the Aera had 9 total MDRs (50 %), Xpress had 8 (44.4 %) and Audion had 1 (5.6 %). There were 10 AE and 8 DM. When separated by device, Aera had 4 AEs and 5 DMs, Xpress had 5 AEs and 3 DMs, and Audion had 1 AE. The most common AE was subcutaneous emphysema (n = 4), in the head and neck region with one report of mediastinal involvement. Using this sales data, the Aera balloon has an MDR rate of 0.0128 % is established, with a rate of AE at 0.0058 %. The Audion balloon had an MDR and AE rate of 0.0164 %. CONCLUSIONS: ETBD is a safe procedure with minimal complications, with subcutaneous emphysema being the most commonly reported adverse event, consistent with literature findings. A comprehensive analysis of AE, coupled with sales data, indicates a commendably low MDR rate of 0.0128 % for the Aera balloon while the Audion balloon had an MDR rate of 0.0164 %. These findings offer valuable insights on post-procedure expectations and engaging in informed consent discussions with patients, highlighting the overall safety of ETBD as an intervention.

Effect of pre-incident antiplatelet therapy on sudden sensorineural hearing loss.

OBJECTIVE: Identify if pre-incident aspirin influences severity and outcome of idiopathic sudden sensorineural hearing loss (SSNHL). STUDY DESIGN: Retrospective review. SETTING: Tertiary care center. METHODS: Patients with idiopathic SSNHL were identified and separated into aspirin and non-aspirin groups. Variables, including demographics, comorbid conditions, audiologic outcomes were identified and compared between groups. RESULTS: One hundred forty-eight patients were included that met inclusion criteria. There were 38 patients who were on pre-incident aspirin therapy and 110 patients not on aspirin prior to the onset of SSNHL. Pre- and post-treatment audiologic status was worsened in the aspirin group. Other comorbid conditions, including hyperlipidemia, coronary artery disease (CAD), cerebrovascular accident (CVA), and vertigo symptoms had an effect as well. With multivariate analysis, CAD, CVA, and vertigo symptoms appeared to have an effect more than aspirin. CONCLUSIONS: Patients on aspirin have a worsened pre- and post-treatment audiologic status. This appears to be more due to the underlying CAD or history of CVA rather than aspirin use itself.

Systematic Review: Cardiac Metastasis of Lingual Squamous Cell Carcinoma.

INTRODUCTION: Lingual squamous cell carcinoma (LSCC) is an aggressive malignancy that carries significant mortality risk and the potential for cardiac metastasis. The authors performed a systematic review designed to characterize disease progression of LSCC cardiac metastasis by evaluating patient demographics, characteristics, management, and clinical outcomes. METHODS: Two authors independently screened articles in Embase, PubMed, and Cochrane Database of Systematic Reviews up until December 2019 for study eligibility. Demographic data, patient symptomatology, imaging findings, management strategies, and patient outcomes were obtained and analyzed. The Oxford Centre for Evidence Based Medicine (OCEBM) Levels of Evidence categorization was implemented to determine the quality of studies selected in this review. RESULTS: From this review, a total of 28 studies met inclusion criteria and received an OCEBM Level 4 evidence designation. Thirty-one patients were identified with cardiac metastasis from LSCC. Shortness of breath (29.0%) and chest pain (29.0%) were the most common presenting symptoms, and pericardial effusion (29.2%) and right ventricular outflow tract obstruction (25.0%) were the predominant echocardiogram findings. Cardiac metastases most often presented in the right ventricle (56.7%), followed by the left ventricle (43.3%). Palliative intervention (68.2%) or chemotherapy (40.9%) were typically implemented as treatments. All sample patients expired within one year of metastatic cancer diagnosis in cases that reported mortality outcomes. CONCLUSIONS: Patients presenting with shortness of breath, tachycardia, and a history of squamous cell carcinoma of the tongue may indicate evaluation for LSCC cardiac metastasis. Although LSCC cardiac metastases typically favor the right and left ventricles, they are not exclusive to these sites. Palliative care may be indicated as treatment due to high mortality and overall poor outcomes from current interventions.

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.

Collision Tumor in the Pituitary, Concurrent Pituitary Adenoma, and Craniopharyngioma.

Collision tumors are two independent, distinct tumors occupying the same anatomical space. This case presents a pituitary adenoma-craniopharyngioma collision tumor presenting with hemianopsia. A 60-year-old with a past history of a nonsecretory pituitary adenoma presented with progressive headaches, bitemporal hemianopsia, and nausea. Previously, in 2008, his adenoma was effectively treated with nasal septal flap and transsphenoidal pituitary resection. A magnetic resonance imaging (MRI) was ordered for concern of recurrence, given his history and neurologic complaints. The MRI revealed a suprasellar mass extending into the third ventricle with displacement of the hypothalamus and optic chiasm. Laboratory testing revealed no indicators of endocrinopathy. The neurosurgical and otolaryngologic teams were elected to perform tumor resection given the ongoing symptoms. An image-guided transsphenoidal tumor resection with abdominal fat graft harvest and septal mucosal flap CSF leak repair was performed. Histopathological examination revealed two tumor components within the resection including an adamantinomatous craniopharyngioma and recurrent pituitary adenoma.

Myocardial Ischemia, a Rare Presentation of Meckel's Diverticulum.

CONTEXT: Meckel's diverticulum is a rare congenital anomaly of the gastrointestinal tract. It is typically asymptomatic and found incidentally in the work-up of another medical complaint. However, it has been known to cause complications in a minority of cases. METHODS: This case involves an elderly male in his early 80's who presented to the emergency department with a 2-day history of emesis and hematochezia, in addition to sudden onset syncope and angina-like symptoms. Serial electrocardiograms demonstrated diffuse ST-segment depressions, consistent with myocardial ischemia. The patient underwent laboratory testing, imaging, endoscopy, and a subsequent exploratory laparotomy. RESULTS: Laboratory results revealed lactic acidosis, anemia, and leukocytosis. Upper endoscopy resulted in negative findings. Imaging, including CT-scan and Technetium-99 RBC scan, visualized a gastrointestinal bleed. However, the arterial embolization procedure was unable to stop the bleeding diverticulum. Exploratory laparotomy revealed an infarcted Meckel's diverticulum. CONCLUSIONS: This case demonstrates the importance of clinicians generating a wide differential when evaluating a gastrointestinal bleed, and considering Meckel's diverticulum as a potential cause of a bleed with an unknown source. The primary test to diagnose a Meckel's diverticulum is a Technetium-99 RBC scan. However, visualization via exploratory laparotomy is the best test for definitive diagnosis. The decision to intervene surgically earlier can limit mortality with symptomatic Meckel's diverticula.

Lingual Osseous Choristoma: A Comprehensive Systematic Review of Lesion Presentation, Histology, and Morphology.

INTRODUCTION: Osseous choristomas of the tongue are rare, benign tumor-like lesions composed of abnormally placed bone and cartilage tissue. The few publications to date concerning this condition have been primarily limited to case reports. This systematic review aimed to clarify the clinical presentations of osseous choristomas and how to delineate them from other oral pathologies. METHODS: The authors utilized PubMed, Embase, and Cochrane Library reference databases from 1971 to mid-2020. Search terms were "osseous choristoma," "oral cavity," and "lingual." Preferred Reporting Systems for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used to aggregate relevant data from each study. The authors specifically collected data regarding patient demographics, clinical findings, symptoms, treatments, and subsequent outcomes relating to lingual osseous choristomas. RESULTS: A total of 35 (14.6% of total identified) publications that met inclusion criteria were identified concerning a total of 69 lingual osseous choristoma cases. Results were compiled focusing on sex and age, presenting symptoms, histology, appearance of the lesion base being most commonly pedunculated (e.g., stalk or stem-like), the lesion's location on the tongue, and subsequent treatments. Osseous choristomas had a higher rate of occurrence in females, 48 (70%) and those under the age of 40. Symptomatic presentations occurred in 38 (55%) patients, with the most common presenting symptoms being gagging/globus (i.e., lump or foreign body) sensation (n = 47, 68%) and dysphagia (n = 20, 29%). Identified masses were pedunculated in 33 (80%) of cases and eight (20%) were identified as sessile (i.e., immobile). A total of 41 (59%) lesions were more commonly located in the posterior one third of the tongue compared to 28 (41%) in the anterior two thirds of the tongue. Of those 49 (71%) cases requiring surgical mass excisions, recurrence was reported in 0% of cases. CONCLUSIONS: Although osseous choristomas are benign processes that rarely arise from the tongue, providers should carefully inspect patients with a gagging/globus sensation and pedunculated mass toward the back of the tongue. Surgical resection remains the best treatment to prevent recurrence.

Early Disseminated Lyme Carditis Inducing High-Degree Atrioventricular Block.

Lyme disease is the most common tick-borne illness in the United States due to Borrelia burgdorferi infection. This case demonstrates a 20-year-old male patient presenting with complaints of annular skin rash, malaise, fever, and lightheadedness after significant outdoor exposure. Physical exam revealed multiple large targetoid lesions on the back and extremities. The rash had raised borders and centralized clearing consistent with erythema migrans chronicum. Electrocardiogram (ECG) revealed a high-degree atrioventricular (AV) block. The patient was started on intravenous ceftriaxone due to clinical suspicion for Lyme carditis. ELISA and Western blot tests were reactive for Lyme IgM and IgG, confirming the diagnosis. The AV block resolved by hospital day four and the patient was discharged with outpatient follow-up. Early identification of disease allowed for effective treatment with no adverse outcomes or sequelae.