Adult herpetic laryngitis with concurrent candidal infection: a case report and literature review.

Rarely, adult herpetic laryngitis without involvement of the oropharynx has been reported. However, to our knowledge, laryngitis caused by herpes simplex virus with coexisting Candida albicans has not been reported. We report what we believe to be the first case of localized herpetic laryngitis superimposed by laryngeal Candida species infection in an immunosuppressed patient. This diagnosis was made on the basis of the findings of a laryngeal mucosal biopsy and ancillary testing using fungal stains and immunohistochemical stains for herpetic antigens. We also review the literature and discuss the clinical and diagnostic presentations, including potential pitfalls in the diagnosis.

Mucormycosis. Adjunctive therapy with hydrogen peroxide.

Mucormycosis is a devastating fungal disease affecting mainly diabetic and immunosuppressed patients and frequently causing death. Mucor rhizopus, the opportunistic fungus, has been controlled via radical extirpation and intravenous Amphotericin B. Hyperbaric oxygen also has been used. The authors present two interesting patients: 1) A diabetic female with rhinoorbital mucormycosis post total maxillectomy with recurrent mucormycosis and 2) A diabetic female with acute myelogenous leukemia and sphenoid sinus mucormycosis post functional endoscopic sinus surgery with residual mucormycosis. Both patients were receiving Amphotericin B without improvement. Both fungal infections were apparently eradicated with 1/2 strength topical hydrogen peroxide soaks. It appears the hydrogen peroxide destroys mucor and supporting host tissue by oxidation. The authors propose adding 1/2 strength topical hydrogen peroxide soaks to the list of possible adjunctive treatments of mucormycosis.

Kawasaki disease: early presentation to the otolaryngologist.

Kawasaki disease is an acute febrile illness of unknown etiology that occurs primarily in childhood. Early diagnosis and treatment can reduce the risk of cardiac complications of Kawasaki disease, which carries a 1% to 2% mortality for cardiovascular events. Clinical features include: (1) fever; (2) conjunctival injection; (3) oral cavity changes; (4) changes in the peripheral extremities; (5) erythematous rash; and (6) cervical adenopathy without suppuration. We describe three cases in detail and survey a series of 42 patients at our institution. Otolaryngologic manifestations were found to occur in the early stages of Kawasaki disease. The otolaryngologist may see these patients early in the disease and should be alert to the signs and symptoms for appropriate diagnosis and treatment. Characteristics of Kawasaki disease, difficulties in diagnosis during the initial febrile stage, and the importance of early diagnosis by the otolaryngologist is stressed.

Drug-induced, life-threatening angioedema revisited.

Few drug reactions are more life threatening than the sudden development of edema involving the mucosal and submucosal layers of the upper aerodigestive tract. Drug-induced angioedema is a recognized entity of angiotensin-converting enzyme (ACE) inhibitors, and despite reports in medical journals and drug insert warnings, captopril and enalapril continue to be widely prescribed. As these drugs are efficacious and usually well-tolerated in the treatment of mild forms of hypertension, their popularity is rising. From June 1, 1984 to August 1, 1991, 36 patients with angioedema secondary to ACE inhibitors presented at the Medical College of Virginia Hospitals. Thirty were successfully managed with medical therapy. Two were intubated, 1 had placement of a nasal trumpet, and 3 required tracheostomies. Of extreme importance is the recognition that angioedema resulting from ACE inhibitors is probably not immunoglobulin E (IgE) mediated and that antihistaminics and steroids may not alleviate the airway obstruction. The otolaryngologist must be prepared for the need of possible early surgical intervention.

Invasive sinusitis due to Pseudallescheria boydii in an immunocompetent host.

Chronic invasive sinusitis with Pseudallescheria boydii as the etiologic agent is uncommon but occurs in immunocompetent hosts. We have presented the fourth documented case of sinusitis due to P boydii in a patient without other medical problems. Pseudallescheria is generally sensitive to ketoconazole and not amphotericin B in therapeutic levels. In vitro culture and sensitivity studies are essential in selecting the appropriate antibiotic.

Fine-needle aspiration biopsy: application to pediatric head and neck masses.

Fine-needle aspiration biopsy cytology is widely used to screen masses in adults. The authors present a series of 89 fine-needle aspiration biopsies performed between January 1973 and December 1988 on 86 pediatric patients with clinically significant head and neck masses. All fine-needle aspiration diagnoses were confirmed by subsequent surgical biopsy, autopsy, or clinical follow-up for a minimum of 18 months. Of 21 tumors identified, 19 were malignant. Of the 89 aspirations performed, 67 required no subsequent surgical biopsy. In 11 of these cases, metastatic or recurrent tumor was diagnosed and appropriate therapy instituted. Fifteen of the 89 aspirates revealed previously undiagnosed tumors requiring surgical intervention. One false-negative and two false-positive results were obtained. No radical treatment resulted from the false-positive diagnoses, and no patient delay in treatment occurred because of the false-negative result. The sensitivity was 94.4%, and the specificity was 97.1%. The usefulness and cost-effectiveness of fine-needle aspiration is stressed.

Fine-needle aspiration biopsy of salivary glands.

Between January 1, 1973, and December 31, 1988, the authors or their associates performed 552 fine-needle aspiration biopsies on patients with clinically significant masses of the salivary glands. All patients presented at the Medical College of Virginia Hospitals or Clinics of Virginia Commonwealth University; they were followed for periods ranging from 1 to 16 years. When available, the fine-needle aspiration diagnoses were correlated with histologic diagnoses and long-term patient outcomes. The sensitivity for a neoplasm was 93.3%; the specificity for the absence of a neoplasm was 99%. Diagnostic efficiency was 96.4%, and predictive value of a positive aspiration for a neoplasm was 98.3%. With fine-needle aspiration, surgical excision of salivary gland masses is often unnecessary. In patients with primary and metastatic neoplasms involving the salivary glands, fine-needle aspiration aids the surgeon in mapping the extent of the surgical procedure and in preoperatively preparing the patient. The procedure is cost-effective.

Life-threatening angioedema.

Angioedema is a well-recognized edema involving the deeper layers of the skin, subcutaneous tissue, and mucosa. From July 1986 to July 1989 the authors have observed and treated 10 patients admitted to the Medical College of Virginia (MCV) Hospitals in Richmond, Virginia, with life-threatening angioedema as a complication of enalapril or captopril ingestion. Both drugs are angiotensin-converting enzyme (ACE) inhibitors prescribed for antihypertensive activity and the ability to improve symptoms in patients with congestive heart failure. We describe the clinical symptoms, diagnosis, and management of these patients, as well as reasons for each occurrence. Sporadic reports of angioedema secondary to ACE inhibitor therapy have appeared in the literature. This represents the first time a significant series of patients from the same institution have encountered this complication over a short period of time, suggesting that the complication may be much more common than has been thought.

Tolusa-Hunt syndrome: resolution of a 12-year course after tonsillectomy.

The authors review the symptoms, physical findings, possible causes, and treatment of Tolusa-Hunt syndrome (THS). The authors present a patient with THS and tonsillitis. The symptoms, except for blindness, were alleviated after tonsillectomy. Anatomical relationships of the tonsils to the cavernous sinus are demonstrated and tonsillitis as a possible trigger mechanism of THS is suggested.

Velar closure and ear tubings as a primary procedure in the repair of cleft palates.

This ten-year study reviews 36 patients with complete clefts of the hard and soft palates treated with primary velar closure, bilateral myringotomies, and tubings performed when the infant was 12 to 15 months of age. The hard palate and prepalate were not closed until the child was at least 5 1/2 years of age. By early velar closure, a population with an almost 100% incidence of otitis media with effusion has been converted to a population with a 17% incidence of recurrent otitis media requiring repeat myringotomies and tubings.

Fine-needle aspiration biopsy: efficacy in the diagnosis of head and neck sarcoidosis.

The authors report the usefulness of fine-needle aspiration biopsy to establish the diagnosis of sarcoidosis in patients with palpable disease in the head and neck areas. Aspiration biopsy proved to be a simple and quick method for establishing this diagnosis in the eight cases reported in this series. Interpretation of cytologic smears with identification of typical sarcoid-like granulomas proved to be quite easy. No complications occurred secondary to use of this technique.

Epidermoid cyst of the frontal bone masquerading as frontal sinusitis.

Epidermoid cysts occur whenever two epidermal surfaces fuse together during early intrauterine life and an ectodermal implant is retained deep to the surface. They are very slow growing and symptoms may not occur till middle age. The authors present a patient whose symptoms of frontal headache were mistaken for frontal sinusitis for over 10 years. The patient's symptoms were completely relieved by surgical excision of an epidermoid cyst of the frontal bone.