Spontaneous Labyrinthine Hemorrhage: A Case Series.

OBJECTIVES: To describe patient characteristics, audiometric outcomes, and magnetic resonance imaging (MRI) signal patterns in patients with suspected labyrinthine hemorrhage. STUDY DESIGN: Retrospective review. SETTING: Tertiary medical center. SUBJECTS AND METHODS: Radiology database was queried for terms related to labyrinth hemorrhage or labyrinthitis and then selected for patients in which labyrinthine hemorrhage was suspected in the report. Eleven patients were identified and all treated at our institution. Blinded assessment of temporal bone MRI by 2 experienced neuroradiologists was performed and interrater reliability assessed. Patient demographics, medical comorbidities, and audiometric outcomes are described. RESULTS: Of the 11 patients identified, the median patient age was 60 years; 7 were female and 4 male. Ten of 11 patients presented with unilateral sudden sensorineural hearing loss (SNHL), and 8 of 11 had associated vertigo. One patient experienced vertigo without hearing loss. Of those presenting with sudden SNHL, 82% were left with nonserviceable American Academy of Otolaryngology-Head and Neck Surgery class D hearing. Interrater reliability for detecting T1 signal abnormalities was moderate but very good for detecting fluid attenuation inversion recovery (FLAIR) signal abnormalities. Most patients had existing hypertension. Average follow-up was 13.3 months. CONCLUSION: We present the largest cohort of patients with radiographic diagnosis of labyrinthine hemorrhage using T1 and FLAIR signal abnormalities on MRI. Most patients presented with a profound unilateral sudden SNHL that did not recover. Our findings are consistent with prior reports that abnormal FLAIR signal on MRI is a reliable marker for detecting inner ear injury and can potentially be used as a marker for poor prognosis.

Otopolyposis With Middle Ear Allergic Mucin in a Patient With Allergic Fungal Rhinosinusitis.

OBJECTIVE: The purpose of this study is to report a case of otopolyposis and middle ear allergic mucin in a patient with allergic fungal rhinosinusitis (AFRS) and no history of middle ear disease and introduce these as possible otologic manifestations of the AFRS. METHODS: A case of a 31-year-old female with the aforementioned findings is reported. A review of the pertinent literature was performed. RESULTS: We report a case of a 31-year-old female with a history of AFRS but no history of middle ear disease or hearing loss who presented to our institution complaining of aural fullness. Physical exam was significant for middle ear masses of unknown etiology. Surgical exploration revealed the presence of allergic mucin and middle ear polyposis histologically identical to tissue sampled during prior sinonasal surgeries at the same institution. Aspiration of the middle ear space did not resolve the otologic symptoms. CONCLUSION: Otopolyposis and middle ear allergic mucin are extremely rare but possible otologic manifestations of AFRS. We encourage otolaryngologists to consider this in the clinical differential diagnosis of patients with a history of AFRS with new onset otologic symptoms.

Presbynasalis.

BACKGROUND: As with all systems in the body, the nose and paranasal sinuses change in time as we age. Some of these changes have been individually studied, but a unified description of current research has not been published since 1996. Since that time, a great deal has changed in our understanding of the aging nose. METHODS: The English language literature was examined using a combination of PubMed and Google Scholar search inquiries. The focus was on articles published since 1996 that described sinonasal changes or disease processes within the advanced-age population. RESULTS: Publications since 1996 were prioritized for discussion. Of the 50 articles selected, manuscripts were grouped into categories of allergy and cellular-level change, rhinorrhea, mechanical and airflow change, olfactory change, and sinusitis. CONCLUSION: Understanding the normal aging process is essential for otolaryngologists for patient education. We propose use of the term presbynasalis for description of the aging nose, paranasal sinuses, and olfactory system. Several points are consistent across the literature. The immune system becomes less responsive with age, a process known as immunosenescence. The incidence of rhinorrhea increases as the population ages. Though nasal volumes increase with age, other age-related changes may result in the perception of increasing nasal obstruction with age. There is a trend toward diminished olfaction in the elderly, and in some patients, this may be an early manifestation of neurodegenerative conditions. Sinusitis treatment should be similar in the elderly population, and the data demonstrates the safety of surgery when needed.

Patient outcomes, satisfaction, and improvement in headaches after endoscopic brow-lift.

IMPORTANCE: To improve preoperative counseling for patients considering endoscopic brow-lift (EBL). OBJECTIVES: To understand patient-reported outcomes, satisfaction, and recovery after EBL surgery to improve preoperative counseling. DESIGN, SETTING, AND PARTICIPANTS: A retrospective telephone survey of 57 patients who had EBL or EBL with concurrent rhytidectomy to assess cosmetic and functional outcomes using 47 questions. MAIN OUTCOME AND MEASURE: Questions evaluated outcomes, satisfaction, and recovery. RESULTS: Fifty-three patients (93%) reported the procedure was successful, and 55 patients (96%) would recommend undergoing this procedure. Forty-two (74%) were incidentally told they looked younger; 37 patients (65%) were told they looked less tired. Forty-two patients (74%) reported increased confidence. Fifty-one patients (89%) required analgesics for less than 1 week, 44 patients (77%) reported scars as unnoticeable, 54 patients (95%) reported postoperative edema lasting less than 2 weeks, 16 patients (28%) reported alopecia at an incision site, and 36 patients (63%) had some numbness. In the 16 patients who reported headaches before surgery, 8 patients (50%) reported an improvement in either frequency or intensity. Patients who underwent rhytidectomy were significantly more likely to take 2 weeks or longer to return to normal activities. No differences were noted between rhytidectomy with EBL compared with EBL alone in analgesic use, edema, numbness, alopecia, and satisfaction. CONCLUSIONS AND RELEVANCE: Endoscopic brow-lift is well tolerated and most patients are happy with the outcome. Relying on patient-reported information helps us to better understand the surgical experience and to improve preoperative counseling. LEVEL OF EVIDENCE: 4.

Disk battery ingestion: case series with assessment of clinical and financial impact of a preventable disease.

BACKGROUND: Commonly, foreign objects are incidentally ingested and pass harmlessly through the gastrointestinal tract; however, disk batteries present exceptional risk. In 2009, the American Association of Poison Control Centers listed disk batteries as the number 1 cause of fatal ingestions in children younger than 5 years. Lithium batteries are the most dangerous, and they are rapidly rising in use by manufacturers. Paralleling that rise, there has been a 6.7-fold increase in major or fatal outcomes between 1985 and 2009. This study describes the variability in patient presentations, the courses of patients' evaluations, and the clinical and financial consequences of disk battery ingestion. METHODS: In this retrospective study, cases from 2001 to 2011 were reviewed for details of care for disk battery ingestions including presentation and management details. Cost of care information from our patients' records was compared with that of national averages on esophageal foreign bodies using the Healthcare Cost and Utilization Project's Kids' Inpatient Database. RESULTS: Six cases are presented. The patients' age averaged 1.85 years. Presentations varied with respect to symptoms, time course, and steps in treatment. Mean length of stay was 9.0 days, and mean cost was $14,994. CONCLUSIONS: Emergency medicine physicians, otolaryngologists, radiologists, gastroenterologists, and pediatric surgeons may be able to mitigate, albeit not entirely prevent, potential serious complications in patients with disk battery ingestions by proper diagnosis and timely treatment. Recommendations for management are presented, which highlight the need for emergent removal of any battery that is lodged and close follow-up of these patients once they are out of the hospital.