ABSTRACT
The prevalence of chronic otitis media with effusion (COME) was investigated in a 4-year retrospective study of a pediatric tracheotomy population followed in the outpatient Tracheotomy-Ventilation Clinic of Children's Hospital of Wisconsin. After exclusions, 83 patients comprised the study population. In a given patient, COME was defined by the presence of middle ear effusion in more than 50% of ear evaluations during the 4-year study period, or tympanostomy tube placement. The prevalence of COME was 60% in the study population as a whole. Special population groups had prevalence as follows: 90% in craniofacial anomaly patients, 79% in chronically ventilated patients, and 48% in nonventilated patients. Chronically ventilated patients had a statistically significant higher prevalence of COME than the nonventilated group (P < 0.025). These data indicate that COME is a prevalent condition in the pediatric tracheotomy population.
Subject(s)
Otitis Media with Effusion/etiology , Tracheotomy/adverse effects , Adolescent , Child , Child, Preschool , Craniofacial Abnormalities/complications , Female , Humans , Infant , Male , Otitis Media with Effusion/epidemiology , Prevalence , Respiration, Artificial/adverse effects , Retrospective Studies , Risk FactorsABSTRACT
Malignant melanoma of the ear, other than the pinna, rarely occurs. This is the first report of a melanoma confined to the external auditory canal. The case presented is of a 75-year-old man with a malignant melanoma confined to the external auditory canal. Excision of the tumor and surrounding lymphatics was accomplished with a lateral temporal bone resection, superficial parotidectomy, and selective neck dissection. The patient initially refused postoperative radiation therapy. Histologic evaluation documented a 17-mm thick malignant melanoma. All margins were clear and none of the nodes was positive. Eight months later, he returned with local, regional, and distant recurrence. Despite attempts at salvage with external radiation, brachytherapy, and chemotherapy, he died 13 months postoperatively with widespread disease. Melanoma confined to the external auditory canal has not been previously reported. A 17-mm thick melanoma carries a dismal prognosis. Despite initial negative surgical margins and lack of regional metastases, this patient developed a rapid, widespread pattern of recurrence.
Subject(s)
Ear Canal , Ear Neoplasms , Melanoma , Aged , Ear Canal/surgery , Ear Neoplasms/diagnosis , Ear Neoplasms/surgery , Fatal Outcome , Humans , Male , Melanoma/diagnosis , Melanoma/surgeryABSTRACT
The cause of subglottic stenosis (SGS) is unknown for a subgroup of patients in which there is a female predominance. Seven women ranging in age from 39 to 66 years developed symptomatic and progressive SGS. Six of the 7 patients failed to respond to all measures of conservative and radical surgical intervention. After recent thorough evaluation for gastroesophageal reflux disease (GERD) followed by medical management for such, these 6 patients have stabilized and have responded to surgical management. The seventh patient recently presented with SGS, was evaluated and treated for GERD, and has not required any surgical management. This study suggests that GERD laryngitis may be pertinent in the development of SGS. Medical management of GERD thus appears vital to successful treatment of idiopathic SGS.
Subject(s)
Gastroesophageal Reflux/complications , Laryngostenosis/etiology , Adult , Aged , Diagnosis, Differential , Female , Gastroesophageal Reflux/diagnosis , Glottis , Humans , Laryngostenosis/pathology , Laryngostenosis/surgery , Middle Aged , Retrospective StudiesABSTRACT
The precise embryological source for fat in juxtaposition to the vertical portion of the seventh nerve in the mastoid is unknown. Seventeen percent of 240 temporal bones disclosed various amounts of fat adjacent to this portion of the nerve. Shiny areas of fat granules are occasionally seen around, and perhaps at first glance mistaken for, the seventh nerve during mastoid surgery. The radiographic appearance of fat in this area has not been described. Bilateral 1-cm ovoid images were interpreted in a 16-year-old girl as seventh nerve neuromas or perhaps hemangiomas, but were surgically proven to be a lipoma in the only ear operated on. Lipoma should be considered in the differential diagnosis for a mass in this location which demonstrates increased T1 signal, progressive decreased signal on T2-weighted images, and has signal intensity isodense with that of fat.
Subject(s)
Adipose Tissue/anatomy & histology , Cranial Nerve Neoplasms/diagnosis , Facial Nerve Diseases/diagnosis , Facial Nerve/anatomy & histology , Lipoma/diagnosis , Adolescent , Diagnosis, Differential , Female , Hemangioma/diagnosis , Humans , Magnetic Resonance Imaging , Neuroma/diagnosis , Temporal Bone/anatomy & histologySubject(s)
Intubation, Intratracheal , Larynx, Artificial , Speech , Tracheotomy , Aged , Female , Humans , MaleABSTRACT
Granular cell tumor of the larynx is an uncommon, benign tumor which has rarely been described in the pediatric population. Fewer than 10 cases in children under the age of 10 years have been reported. This paper describes two pediatric patients: An eight-year-old boy with a seven-year history of hoarseness due to an anterior subglottic tumor, and an 11-year-old boy with a one-year history of hoarseness due to a left true vocal cord tumor. Subglottic involvement by laryngeal granular cell tumor is rare in adults, but has been seen in half of the reported cases in the pediatric population. The clinical course of granular cell tumor and its pathology are reviewed.
