A solitary supraglottic neurofibroma presenting with obstructive sleep apnea in an adolescent.

None: Obstructive sleep apnea (OSA) is commonly encountered in the pediatric population and has a large differential diagnosis. As clinicians, we must determine who needs to undergo flexible laryngoscopy to rule out potential obstructing lesions causing OSA. This report presents a 16-year-old female who presented with snoring, "asthma," dysphagia, and OSA. Flexible laryngoscopy and computed tomography revealed a neurofibroma of the aryepiglottic fold without associated neurofibromatosis type 1. The patient underwent microlaryngoscopy and the lesion was excised using cold steel and a carbon dioxide laser. At 6 months' follow-up, the patient was breathing without difficulty and had no evidence of recurrence. Solitary laryngeal neurofibromas are extremely rare, and this is the first case of an adolescent with OSA caused by a solitary supraglottic neurofibroma. A supraglottic mass needs to be considered in the differential diagnosis of patients with OSA who fail conservative treatment, even a diagnosis as rare as a solitary laryngeal neurofibroma.

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): an indication for tonsillectomy.

Children with obsessive compulsive disorder or tic disorders that are associated with streptococcal infections (Group A beta-hemolytic) in the oro-pharyngeal region are given the diagnosis of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Tonsillectomy has been reported to resolve the neuro-psychiatric symptoms in these children. We have a case of a 9-year-old boy who was seen in our clinic with multiple recurrent streptococcal infections of the oro-pharyngeal cavity. He also exhibited neuro-psychiatric symptoms including agitation, hyperactivity, and tics. These symptoms followed his recurrent infections. Tonsillectomy was performed and in one year follow-up the patient did not have any recurrent streptococcal infections, and his neuro-psychiatric symptoms resolved completely. Guidelines for medical and surgical management of recurrent strep infections in the face of PANDAS are reviewed.

The use of the pulse dye laser in the treatment of vocal fold scar: a preliminary study.

OBJECTIVES/HYPOTHESIS: Dysphonia due to vocal fold scarring is a challenging problem to the laryngologist. Vocal fold scarring after radiation, phonosurgery, and laser cordectomy causes moderate to severe dysphonia. Surgical attempts at scar removal and voice restoration have limited success. Pulsed dye laser (PDL) treatment has been shown to be effective in softening scarred skin by serial office treatments. The objective of this preliminary study was to evaluate the use of the PDL in the management of patients with established vocal fold scar. STUDY DESIGN: This is an Institutional Review Board-approved prospective study involving 11 patients. The causes of scarring were phonosurgery (n = 7), radiation (n = 2), and partial laryngectomy (n = 2). The subjects were evaluated pre- and postprocedure using the voice handicap index (VHI), laryngeal stroboscopy rating, voice recordings with acoustic and aerodynamic analysis, and self-evaluation. METHODS: The PDL was applied with the fiberoptic delivery system by three treatments at 1-month intervals in the office setting. Each treatment endpoint was blanching of the treatment site. RESULTS: : There were three women and eight men in our study group. Ten of 11 patients subjectively improved by self-rating. No patients were worse. VHI improved from 48.44 pretreatment to 35.55 at 6 months posttreatment (P < .05). The jitter at 6 months improved from 2.230% to 1.654% (P = NS) and shimmer improved from 3.679% to 3.196% (P = NS). The noise to harmonic ration improved from 0.1428 to 0.1316 (P = NS). The mean phonotory flow went from 0.177 to 0.254 L/S (P < .05). Three raters blinded to treatment sequence rated the posttreatment stroboscopy findings as better than pretreatment in a forced choice comparison, kappa score 0.903. CONCLUSION: PDL is a safe and potentially promising treatment for established vocal fold scar. Subjectively, no patients were worse and 10 of 11 patients reported improved voice. There was improvement in the VHI, acoustic measures of shimmer and jitter, and stroboscopy findings. Further study using this approach in a larger cohort seems to be warranted.