Giant Fibrovascular Polyp as an Unusual Cause of Globus Pharyngeus.

Differential diagnosis of globus sensation in an otherwise asymptomatic patient should include hypopharyngeal fibrovascular polyp to avoid potentially fatal complications like airway compromise following regurgitation. We present a case of a 74-year-old man with a 13-cm long hypopharyngeal fibrovascular polyp with 9 months history of globus sensation. A narrow stalk of the giant polyp allowed endoscopic removal and complete resection with the CO2 laser. Histopathological examination was conclusive for the fibrovascular polyp.

Adaptation and Validation of the Voice Handicap Index (VHI)-30 into Serbian.

OBJECTIVES: To evaluate the internal consistency, test-retest reliability, and clinical validity of the Serbian version of the self-administered Voice Handicap Index (VHI)-30. STUDY DESIGN: Cross-sectional study. METHODS: The English version of VHI-30 was translated into Serbian and then back-translated into English. The Serbian VHI-30 was administered to 91 patients divided into four groups according to voice pathology: structural, inflammatory, neurologic, and functional groups. The control group included 90 subjects with no voice problems. The internal consistency (Cronbach's alpha coefficient α), test-retest reliability (interclass correlation coefficient) of VHI-30, comparison of patient's and control's VHI-30 scores (Mann-Whitney U test; Kruskal-Wallis test), and correlation with overall severity of dysphonia (Spearman correlation coefficient, ρ) were calculated. RESULTS: In the patient group, we observed excellent internal consistency for the Serbian VHI-30 (α = 0.95) and good internal consistency for all VHI-30 subscales: physical (α = 0.88), functional (α = 0.88), and emotional (α = 0.88). The interclass correlation coefficient indicated strong test-retest reliability for patients (0.99) and controls (0.84). The mean scores of all 30 items in dysphonic participants were significantly higher than in controls (P < 0.001). Good correlation was obtained between the total scores of VHI-30 and patients' self-perceived overall severity of dysphonia (ρ = 0.748, P < 0.001). Within the patient group, the female participants displayed significantly higher VHI-30 scores than male participants (Mann-Whitney U test, P < 0.001). The VHI-30 scores showed strong correlation within different patient groups and controls (Spearman correlation coefficient: structural, 0.942; inflammatory, 0.756; neurologic, 0.888; functional, 0.982; controls, 0.882). CONCLUSIONS: The Serbian VHI-30 is a useful and valuable tool for the evaluation of patients with vocal disorders and for making subsequent clinical decisions.

Risk factors for surgical site infection in laryngeal cancer surgery.

Surgical site infection (SSI) is a significant factor of morbidity and mortality in patients surgically treated for laryngeal carcinoma. The aim of this prospective study in 277 patients was to determine the incidence of SSI in patients surgically treated for laryngeal squamous cell carcinoma and to identify risk factors for development of SSI. Patients with previous chemotherapy and/or radiotherapy were excluded. All patients had tracheostomy postoperatively and received antibiotic prophylaxis with cephalosporin, aminoglycoside and metronidazole. The overall incidence of SSIs in our cohort was 6.5% (18 patients): 4 (22.22%) patients with superficial infections, 11 (61.11%) with deep infections and 3 (16.66%) with organ-space infections. The remaining infections included pneumonia (1 case) and Clostridium difficile colitis (2 cases). The median hospital stay in patients having developed SSIs was longer than in those without SSIs (33.5 vs. 16 days, p < 0.001). By using univariate analysis American Society of Anesthesiologists score > 3, duration of surgery longer than 120 minutes and National Nosocomial Infections Surveillance risk index > 1 were found to be significantly associated with the occurrence of SSI. Age, sex, body mass index, history of smoking, underlying diabetes and preoperative length of stay were found not to be associated with SSI. The most frequently isolated microorganism was Klebsiella spp.

Recurrent lipomatous tumor of hypopharynx: case report and literature review.

Liposarcoma is one of the most common soft-tissue sarcomas in adults, but head and neck are rarely involved, especially regions of the larynx and hypopharynx. According to Enzinger and Weiss, liposarcoma can be divided into 5 subtypes: well-differentiated, myxoid, round cell, pleomorphic and dedifferentiated. We present an unusual case of well-differentiated liposarcoma of the hypopharynx in a patient with previous three procedures of endoscopic removal of hypopharyngeal tumor classified as benign lipoma. Well-differentiated liposarcoma is a tumor of low-grade malignancy, which frequently recurs locally, but does not metastasize. Wide tumor resection with free margins is mandatory. Immunohistochemistry is a useful diagnostic tool. We also discuss recently published literature on this unusual presentation of well-differentiated liposarcoma.

Congenital cholesteatoma of mastoid origin--a multicenter case series.

BACKGROUND/AIM: The mastoid is the rarest site for the onset of congenital cholesteatoma (CC). The symptoms are atypical and minimal. The aim of this multicenter retrospective descriptive study was to define this extremely rare condition and its clinical presentation, diagnosis and management. METHODS: We analyzed data files for a 15-year period in 4 tertiary otology centers and discovered 6 patients with the diagnosis of CC of the mastoid. RESULTS: The clinical presentation of CC varied from incidental findings in patient to patient with otogenic meningitis. The most common findings during surgical procedures were mastoid cortex erosion, sigmoid plate dehiscence, dural exposure and external canal wall destruction. CONCLUSION: CC of mastoid origin tends to occur in adult patients probably because of minimal symptoms and the delayed diagnosis. It can exist for years in a nonaggressive state and develop to giant sizes. In children it is almost incidentally diagnosed. Early imaging is necessary in order to prevent serious complication.

[Rare extracranial localizations of the head and neck schwannomas].

INTRODUCTION: Schwannomas are tumors of neurogenic origin, that arise from Schwann cells which surround peripheral, cranial and autonomic nerves. Schwannomas account for only 5% of all benign soft tissue tumors, and 25-45% of extracranial schwannomas are present in the head and neck region. They are usually classified according to the nerve of origin and the site within the head and neck. CASE REPORT: We presented extremely rare extracranial localizations of schwannomas and discussed about diagnosis and management of these tumors. CONCLUSION: Schwannomas are slow-growing tumors and late symptoms appearance may cause a delay in diagnosis and treatment of patients with these tumors. An appropriate diagnostic protocol is indispensable tool in performing a differential diagnosis of malignant from benign lesions. Choice of surgical approach depends on schwannomas localization.

[Does acute sensorineural deafness befall to urgent conditions?].

BACKGROUND/AIM: Idiopathic sudden sensorineural hearing loss (ISSHL) is one of the most controversial issues in otology. The aim of this study was to determine whether a delay in treatment has any influence on hearing recovery in ISSHL. METHOD: This study was designed as a retrospective evaluation of an electronic patient data base of the University Hospital Zürich from January 1995 to August 2006. Five hundred and forty one patients with a sudden hearing loss were identified. The standard treatment was carbogen inhalation (95% O2 and 5% CO2 eight times per day in the duration of 30 minutes) and prednisone orally (100 mg in one morning dose) for 7 days. Factor that was analyzed included the interval between the onset of symptoms and the beginning of the treatment. The initial hearing loss was described using the pure tone average (PTA in dB) heating level at 4 frequencies (0.5, 1, 2 and 4 kHz). Hearing gain was expressed either as absolute hearing gain (dB values from initial PTA minus dB values from final PTA) or as relative hearing gain (absolute hearing gain divided by initial PTA minus baseline PTA) x 100. Significant recovery of heating was defined as the final PTA < or =30 dB (or same as PTA of the opposite ear). RESULTS: An absolute hearing gain between the initial audiogram and the final audiogram was 15.1 dB. The mean relative heating gain was 47%. Three hundred one (57%) patients had a significant recovery of hearing, and 228 (43%) had not. If the patients received treatment in the first 24 hours after onset of symptoms, then the rate of significant recovery was 56%, and no significant difference existed between this group and the patients who received the therapy after 24 hours, but within seven days (chi2=0.007, DF=1, p>0.01). CONCLUSION: These results suggest that it is not critical to begin the treatment of ISSHL immediately as an emergency, but within seven days.

[Significance of ultrasound and ultrasound-guided fine-needle aspiration for the detection of laryngeal occult metastases].

BACKGROUND/AIM: To evaluate ultrasound criteria based on a node size, shape, vascularity and cytology findings with respect to their value for the comparative determination of metastatic lymph nodes in laryngeal carcinoma. METHODS: A prospective study included 30 patients with laryngeal squamous cell carcinoma without node enlargement on computerized tomography, at the Department of Otorhinolaryngology, the University Hospital, Zemun. Thirty-six neck lymph nodes were evaluated sonographically and aspirated with an ultrasound-guided fine-needle. They were examined cytologically and/or histopathologically and compared to the sonographic assessment of their malignancy. RESULTS: Of the 36 neck lymph nodes evaluated cytologically, the 13 were found to be with a metastatic deposit. The assessment of a lymph node malignancy using the parameter of size had the senzitivity of 84%, the specificity of 70%, and the reliability of 75%. Using the criteria of a lymph node shape for the assessment of malignancy, the sensitivity of 61%, specificity of 65%, and the reliability of 64% were achieved. The evaluation of a lymph node vascularity by the use of the effect of Doppler showed the sensitivity of 69%, the specificity of 95%, and the reliability of 86%. CONCLUSION: Ultrasound and ultrasound-guided fine-needle aspiration citology should be always used for the preoperative staging and for the postoperative follow-up of the status of the neck with cancer of the larynx becouse of their high accuracy, availability and semiinvasivity, and in order to enhance the reliability of the evaluation of the malignant disease progression.