An unusual cause of foreign-body sensation in the throat: a displaced superior cornu of the thyroid cartilage.

Foreign-body sensation is a nonspecific symptom of aerodigestive tract diseases. We describe the case of a 42-year-old man who presented with a foreign-body sensation in the throat that was found to be caused by a displaced superior cornu of the thyroid cartilage. Such a displacement is not well known, but we believe that it may not be rare. These cases can be overlooked and misdiagnosed as chronic nonspecific pharyngitis or laryngopharyngeal reflux. However, a careful laryngoscopic examination by an otolaryngologist who considers the possibility of such a pathology may result in an accurate diagnosis, which might spare an affected patient from a lifelong pharmacotherapeutic regimen.

Congenital vocal cord paralysis.

Congenital stridor is rare. The most common presentation for congenital stridor is chronic loud breathing since birth. It is noticed in patients by the first 4 to 6 weeks of life. There are many causes of congenital stridor. Laryngomalacia is the most common cause of congenital stridor. Congenital vocal cord paralysis is the second most common cause of congenital stridor. Vocal cord paralysis in infants and children can be either congenital or acquired and either unilateral or bilateral. Although most commonly the paralysis is idiopathic, there are many causes of acquired vocal cord paralysis. Arnold-Chiari malformation is the most common congenital central nervous system abnormality resulting in vocal cord paralysis, and central nervous system abnormalities usually may cause bilateral vocal cord paralysis. In this article, we report 2 patients with idiopathic congenital vocal cord paralysis. One of them has the unilateral vocal cord paralysis, and the other, bilateral.

Follicular dendritic cell sarcoma of the parotid gland recurring 6 times within 12 years.

Follicular dendritic cell sarcoma is a rare neoplasm of low to intermediate malignant potential. It can occur in any location where follicular dendritic cells reside, and nearly all the cases reported in clinical notes have occurred as primary lymph node tumors. Carcinosarcoma or true malignant mixed tumor of the salivary gland is a tumor composed of both carcinomatous and sarcomatous elements. It is an exceedingly rare tumor of the salivary glands, and only approximately 60 clinical notes have been reported. In this report, we describe a recurrent carcinosarcoma of the parotid gland that contained an unusual mesenchymal component (follicular dendritic cell sarcoma) in a 42-year-old woman with cytohistologic and immunohistochemical findings. The predominant sarcomatous component made the diagnosis in the current report difficult because only one clinical note on follicular dendritic cell sarcoma in the parotid gland has been previously reported in the English literature. During the 12-year follow-up period, 6 local recurrences were also detected.

Otomyiasis by Wohlfahrtia magnifica.

Myiasis has been defined as the infestation of tissue with dipterous larvae that feed on the host's dead or living tissue. A new clinical report of otomyiasis in a 57-year-old woman caused by Wohlfahrtia magnifica was reported. A review of the English language literature reveals 5 articles on otomyiasis cases caused by W. magnifica. Although it is not a frequent manifestation in otorhinolaryngology, the opportunity of its occurrence always exists. In the treatment, a combination of suctioning and alligator forceps was used to remove larvae. Also, tympanoplasty was performed for the reconstruction of perforated ear.

Evaluation of nasal cytology in subjects with chronic rhinitis: a 7-year study.

BACKGROUND: No diagnostic test had been specifically developed to diagnose nonallergic rhinitis (NAR). Also a negative nasal smear for eosinophils does not rule out the diagnosis. There is a significant diagnostic problem in patients with NAR. How can we solve this problem? OBJECTIVES: Assessment of other cells than eosinophils present in the cytogram such as basophils, neutrophils, and goblet cells may help us to classify and management of diagnostic problem of rhinitis. We sought to characterize the cellular pattern of patients with allergic rhinitis (AR) and compare them with those of NAR. METHODS: According to the skin prick test positivity or negativity, individuals were divided into AR and NAR groups, respectively. Allergic rhinitis group was further divided into seasonal, perennial, and mixed subgroups. Nonallergic rhinitis group was also divided into the following 5 subgroups according to the nasal smear cytologic result: basophilic, neutrophilic, eosinophilic, mixed, and nonallergic noninfectious type. So the frequency rates of the subgroups were calculated and also smear cytologic results were compared. RESULTS: Frequency of AR was approximately equal to NAR in subjects with chronic rhinitis. Neutrophilic, eosinophilic, mixed, and nonallergic noninfectious types were the common types of NAR. An evident nasal eosinophilia was found in AR and eosinophilic NAR, whereas a higher percentage of goblet cells were determined in nonallergic noninfectious rhinitis. There is no significant difference between cytologic results from NAR and AR patients. CONCLUSION: In the patient with positive skin test result, the presence of nasal eosinophilia strongly supports the diagnosis of AR. No diagnostic test had been specifically developed to diagnose chronic NAR. Also, a negative nasal smear for eosinophils does not rule out the diagnosis. Assessment of other cells present in the cytogram such as basophils, neutrophils, and goblet cells may also provide valuable information for differential diagnosis and management of these conditions.

A case of increased intracranial pressure after unilateral modified radical neck dissection.

OBJECTIVE: This study aimed to study case reports and review the world literature concerning increased intracranial pressure secondary to unilateral radical neck dissection. CASE REPORT: A male patient presented with a painless lump in the left side of his neck. Diagnostic investigation revealed papillary thyroid carcinoma and 4 x 2-cm left cervical lymph node. Total thyroidectomy with modified radical neck dissection on the left side that included removal of the internal jugular vein was undertaken. Eleven days after the operation, the patient presented with a history of headache and diplopia. Clinical examination showed bilateral papilledema and right-sided sixth cranial nerve palsy. A computed tomographic scan and magnetic resonance image of the brain was normal. Subsequent magnetic resonance venography revealed an aplastic contralateral transverse sinus. CONCLUSION: Based on our case, vascular anomalies should be considered in any patient who exhibits signs of increased intracranial pressure after unilateral neck dissection.

Rhabdomyoma of the tonsillar fossa.

Extracardiac rhabdomyomas are very uncommon tumors comprising approximately 2% of the neoplasms of striated muscle origin. The adult extracardiac rhabdomyoma is generally characterized as a slowly growing, usually solitary lesion, which is nearly always found in the head and neck area of elderly persons. The most common reported head and neck subsites are the floor of the mouth, tongue, palate, lips, and cheeks. We report an unusual presentation of rhabdomyoma that should be included in the differential diagnosis of tumors presenting as a large tonsillar fossa mass. In our review of the almost 160 clinical notes reported in the literature, only 2 instances of tonsillar rhabdomyomas were found. The cytologic and immunohistochemical differential diagnoses of this tumor are also discussed.

Nasal patency by rhinomanometry in patients with sensation of nasal obstruction.

BACKGROUND: The objective assessment of nasal patency is a common challenge in clinical practice. This study was designed to show and compare the values of active anterior rhinomanometry (RMM) in patients with sensation of nasal obstruction. METHODS: According to the physical examination, 7283 individuals with sensation of nasal obstruction were divided into the nasal septal deviation (NSD) group and normal nasal anatomy group. The NSD group and normal nasal anatomy group were further divided into subgroups according to skin-prick test positivity or negativity, respectively. Nasal airway resistances (NARs) of the subgroups were evaluated and compared. RESULTS: The mean value of total inspiratory NAR was 0.51 and 0.34 Pa/cm3 per second at 150-Pa pressure point in allergic rhinitis subjects with and without NSD, respectively; 0.48 and 0.32 Pa/cm3 per second were the mean values of total inspiratory NAR in nonallergic rhinitis subjects with and without NSD, respectively. The total inspiratory resistances in groups with NSD were significantly higher than the others. CONCLUSION: We believe that the results of so large a number of participants in this test will make an obvious contribution to the medical literature.

Intraglandular toxoplasmic lymphadenitis of the parotid gland.

Most preauricular masses are parotid neoplasms; however, some infectious and inflammatory causes may exhibit similar presentation. Toxoplasmosis is a worldwide parasitary disease. The clinical presentation of toxoplasmosis is mostly asymptomatic and may include subfebrile fever, fatigue, and lymphadenopathy. Only 13 clinical reports of intraglandular toxoplasmic lymphadenitis have been previously reported in the English literature. A careful history and examination with appropriate investigations, including immunoglobulin G avidity assay, will frequently provide the diagnosis of intraparotid toxoplasmosis. Surgery might therefore have been delayed or avoided depending on a satisfactory clinical improvement in consequence of proper medical treatment.

Comparison of the long-term efficacy of subcutaneous and sublingual immunotherapies in perennial rhinitis.

BACKGROUND: Both sublingual and subcutaneous immunotherapies have a documented clinical efficacy, but only a few comparative studies have been performed. OBJECTIVES: To evaluate and compare the long-term efficacies of subcutaneous and sublingual immunotherapy. METHODS: One hundred and ninety-three patients with house dust mite allergies, out of an original total of 230, were treated with subcutaneous and sublingual house dust mite-specific immunotherapies for 3 years and also observed for 3 years after discontinuation of the treatment. The patients were randomized into 2 groups: the sublingual group (97 patients) and the subcutaneous group (96 patients). The therapy's success was evaluated using the symptom score, skin prick test results, and the nasal allergen challenge score. The patients were evaluated at the beginning of the study, at the end of years 1, 2, and 3, and also at the end of the 1st and 3rd years after discontinuation of the specific immunotherapy treatment. RESULTS: Immunotherapy induced a significant improvement during the treatment and the follow-up period. We found a greater improvement in the subcutaneous group compared to the sublingual group when we looked at the comparative results of the total 6 years. CONCLUSION: We suggest subcutaneous immunotherapy for patients with perennial allergic rhinitis due to the better results that were obtained during our study period. Nevertheless, sublingual immunotherapy is now accepted by WHO as a valid alternative to the subcutaneous route and should be used in all patients who require immunotherapy and do not accept the subcutaneous route of allergen administration.

Long-term efficacy of sublingual immunotherapy in patients with perennial rhinitis.

BACKGROUND: Sublingual immunotherapy has a documented clinical efficacy, but only a few long-term studies have been performed in people with perennial rhinitis. OBJECTIVES: The purpose of this study was to evaluate the long-term efficacy of sublingual immunotherapy. METHODS: One hundred thirty-seven patients with allergies to house dust mites were treated with sublingual house dust-mite-specific immunotherapy for 2 or 3 years and were also observed for 3 years after discontinuation of the treatment. The patients were divided into 2 groups: group A (67 patients) received active treatment for 2 years and then 1 year for placebo, and group B (70 patients) received active treatment for 3 years. The success of the treatment was evaluated with the symptom score, skin prick test results, and the nasal allergen challenge score. RESULTS: According to our study results, we found a greater improvement in the 3 years of sublingual immunotherapy compared with the 2 years of sublingual immunotherapy when we looked at the comparative results of the total 6 years. CONCLUSION: We suggest 3 years of sublingual immunotherapy for patients with perennial allergic rhinitis who require immunotherapy and do not accept the subcutaneous route of allergen administration.

[Comparison of nasal histamine and allergen provocations in patients with allergic rhinitis]. / Alerjik rinitli hastalarda nazal histamin ve alerjen provokasyonunun karsilastirilmasi.

OBJECTIVES: We evaluated the effects of histamine and allergen provocations in the nasal mucosa. PATIENTS AND METHODS: Nasal provocations were performed with extracts of histamine, Dermatophagoides pteronyssinus (Dp) and mixed grass pollen (Mg) in patients with perennial and seasonal allergic rhinitis and in healthy subjects. Nasal airway resistance (NAR), the amount of secretions, and the number of sneezes were recorded and evaluated. RESULTS: Regarding NAR, histamine provocation resulted in a significant difference compared to Dp provocation, but the difference was not significant when compared to Mg provocation. Only associated antigen provocation caused a significant increase in secretion. No significantly different effect on sneezing was detected between allergens and histamine. Considering total scores, histamine did not cause an increase in nasal reactivity in healthy subjects. A significant but slight difference was found between allergens and histamine in terms of nasal hyperreactivity in patients with allergic rhinitis. CONCLUSION: As there is a weakly significant difference between allergens and histamine in terms of nasal hyperreactivity in patients with allergic rhinitis, histamine provocation can be used in conditions where allergen provocation is not available.