Urine concentrations changes of cysteinyl leukotrienes in non-obese children with obstructive sleep apnea undergoing adenotonsillectomy.

OBJECTIVE: The main objective of the study was to compare preoperative to postoperative levels of urine-Cysteinyl leukotrienes (uCysLT) in children undergoing adenotonsillectomy (AT) for obstructive sleep apnea (OSA) in order to investigate whether exaggerated leukotriene activity is the cause or consequence of OSA. METHODS AND MATERIALS: A prospective study was conducted on non-obese children (4-10 years old) referred for overnight PSG. Children with moderate/severe OSA treated with AT were included. A second PSG study performed 2 months postoperatively to confirm OSA resolution, and those with residual OSA were excluded. Morning urine specimens after both PSG studies were obtained and pre-operative uCysLT levels were compared to postoperative levels. RESULTS: 27 children fulfilled the criteria and underwent a post-operative PSG study with three exclusions for residual OSA (postop-AHI>2), so the study group consisted of 24 children (mean age: 5.7 ±â€¯2.1 years). Mean preoperative and postoperative AHI was 10.96 ±â€¯5.93 and 1.44 ±â€¯0.56 respectively. Mean preop-uCysLT were 21.14 ±â€¯4.65, while after AT they significantly reduced to 12.62 ±â€¯2.67 (P < 0.01). CONCLUSION: uCysLT levels are significantly reduced after AT in non-obese children with moderate/severe OSA, suggesting that exaggerated leukotriene activity is mainly a consequence of OSA.

Herpes viruses and human papilloma virus in nasal polyposis and controls / Herpesvírus e vírus do papiloma humano na polipose nasal e controles

ABSTRACT INTRODUCTION: Chronic rhinosinusitis with nasal polyps is a multifactorial disease entity with an unclear pathogenesis. Contradictory data exist in the literature on the potential implication of viral elements in adult patients with chronic rhinosinusitis. OBJECTIVE: To compare the prevalence of human herpes viruses (1-6) and Human Papilloma Virus in adult patients with chronic rhinosinusitis with nasal polyps and healthy controls. METHODS: Viral DNA presence was evaluated by real-time polymerase chain reaction application to nasal polyps specimens from 91 chronic rhinosinusitis with nasal polyps patients and nasal turbinate mucosa from 38 healthy controls. RESULTS: Epstein-Barr virus positivity was higher in nasal polyps (24/91; 26.4%) versus controls (4/38; 10.5%), but the difference did not reach significance (p = 0.06). Human herpes virus-6 positivity was lower in nasal polyps (13/91; 14.29%) versus controls (10/38; 26.32%,p = 0.13). In chronic rhinosinusitis with nasal polyps group, 1 sample was herpes simplex virus-1-positive (1/91; 1.1%), and another was cytomegalovirus-positive (1/91; 1.1%), versus none in controls. No sample was positive for herpes simplex virus-2, varicella-zoster virus, high-risk-human papilloma viruses (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) and low-risk-human papilloma viruses (6, 11). CONCLUSION: Differences in Epstein-Barr virus and human herpes virus-6 positivity among patients with chronic rhinosinusitis with nasal polyps and healthy controls are not statistically significant, weakening the likelihood of their implication in chronic rhinosinusitis with nasal polyps pathogenesis.

RESUMO INTRODUÇÃO: A rinossinusite crônica com pólipos é uma doença multifatorial de etiopatogênese ainda não definida. Existem dados contraditórios na literatura sobre a implicação potencial de elementos virais na etiologia de pólipos nasossinusais. OBJETIVO: Comparar a prevalência de herpes vírus humanos (1-6) e papiloma vírus humano em pacientes adultos com rinossinusite crônica com pólipos nasais (CRwNP) e controles saudáveis. MÉTODO: A presença de DNA viral foi avaliada por PCR em tempo real, em amostras de pólipos nasais de 91 pacientes com CRwNP e na mucosa das conchas nasais de 38 controles saudáveis. RESULTADOS: A positividade do EBV foi maior nos pólipos nasais (24/91; 26,4%) do que nos controles (4/38; 10,5%), mas a diferença não foi significante (p = 0,06). O HHV-6 apresentou positividade menor nos pólipos nasais (13/91; 14,29%) do que os controles (10/38; 26,32%), (p = 0,13). No grupo CRwNP, uma amostra foi positiva para o vírus herpes simples (HSV-1) (1/91; 1,1%), e uma para citomegalovírus (CMV) (1/91; 1,1%); e nenhuma amostra foi positiva no grupo controle. Não houve amostra positiva para HSV-2, VZV, HR-HPV (16,18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) e LR-HPV (6,11). CONCLUSÃO: Diferenças de positividade do EBV e HHV-6 entre pacientes com CRwNP e controles saudáveis não são estatisticamente significantes, enfraquecendo a probabilidade de sua implicação na patogênese da CRwNP.

Herpes viruses and human papilloma virus in nasal polyposis and controls.

INTRODUCTION: Chronic rhinosinusitis with nasal polyps is a multifactorial disease entity with an unclear pathogenesis. Contradictory data exist in the literature on the potential implication of viral elements in adult patients with chronic rhinosinusitis. OBJECTIVE: To compare the prevalence of human herpes viruses (1-6) and Human Papilloma Virus in adult patients with chronic rhinosinusitis with nasal polyps and healthy controls. METHODS: Viral DNA presence was evaluated by real-time polymerase chain reaction application to nasal polyps specimens from 91 chronic rhinosinusitis with nasal polyps patients and nasal turbinate mucosa from 38 healthy controls. RESULTS: Epstein-Barr virus positivity was higher in nasal polyps (24/91; 26.4%) versus controls (4/38; 10.5%), but the difference did not reach significance (p=0.06). Human herpes virus-6 positivity was lower in nasal polyps (13/91; 14.29%) versus controls (10/38; 26.32%, p=0.13). In chronic rhinosinusitis with nasal polyps group, 1 sample was herpes simplex virus-1-positive (1/91; 1.1%), and another was cytomegalovirus-positive (1/91; 1.1%), versus none in controls. No sample was positive for herpes simplex virus-2, varicella-zoster virus, high-risk-human papilloma viruses (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) and low-risk-human papilloma viruses (6, 11). CONCLUSION: Differences in Epstein-Barr virus and human herpes virus-6 positivity among patients with chronic rhinosinusitis with nasal polyps and healthy controls are not statistically significant, weakening the likelihood of their implication in chronic rhinosinusitis with nasal polyps pathogenesis.

Cross-cultural adaptation and validation of the Greek OSA-18 questionnaire in children undergoing polysomnography.

OBJECTIVE: Translations of validated questionnaires help to compare different countries/cultures populations and establish protocols for global health. OSA-18 is a validated disease-specific questionnaire for pediatric Obstructive Sleep Apnea (OSA). Our aim was to validate OSA-18 in Greek and correlate it with polysomnography results and OSA severity. STUDY DESIGN: Prospective instrument validation study. SUBJECTS AND METHODS: OSA-18 was translated in Greek and back into English. Children undergoing polysomnography due to snoring were recruited prospectively. OSA-18 was completed by parents during the initial clinic visit (test), in the evening prior to the sleep study (retest), and 3 months postoperatively for subjects who underwent adenotonsillectomy. Internal consistency and test-retest reliability were evaluated. Validity was assessed by exploring correlations between OSA-18 and AHI, by comparing OSA-18 of OSA and non-OSA groups, and by calculating questionnaire's sensitivity and specificity for detecting OSA. Total scores of non-OSA, mild, moderate and severe OSA subgroups were compared. In OSA children who underwent adenotonsillectomy, preoperative and postoperative total scores were compared to assess responsiveness. RESULTS: Test-retest questionnaires were fully completed for 141 children. OSA-18 in Greek had good internal consistency (Cronbach's alpha 0.951 for test and 0.947 for retest) and test-retest reliability (Pearson's correlation coefficients between test and retest scores: 0.850-0.946; P<0.05). Total and subscale OSA-18 scores and AHI were significantly correlated (Spearman's correlation coefficients: 0.376-0.633; P<0.01), while children with OSA had higher total OSA-18 score than those without OSA [median (interquartile range): 61 (35) vs. 38 (22), respectively; P<0.001)]. Sensitivity was 53.4%, suggesting poor validity compared to polysomnography. All OSA severity subgroups had significant higher score than non-OSA. OSA-18 scores postoperatively were significantly lower compared to preoperatively (22.91±5.49 vs. 67.13±15.27, respectively; P<0.001), indicating good responsiveness. CONCLUSION: Greek OSA-18 is an instrument with satisfactory internal consistency, reliability, and responsiveness, but it is a poor predictor of OSA severity.

Does perioperative dexamethasone affect voice-related quality of life after thyroidectomy?

The objective of this study is to assess the impact of perioperative dexamethasone on post-thyroidectomy voice outcomes. This study is a retrospective review of prospectively collected data in a tertiary referral center. This is a retrospective analysis of prospectively collected data on adult patients undergoing total thyroidectomy. Exclusion criteria were: previous neck surgery, thyroid lobectomy, neck dissection or other procedure together with thyroidectomy, pathological findings on laryngeal examination, preoperative or postoperative steroid therapy, diabetes mellitus, pregnancy, and postoperative recurrent laryngeal nerve palsy. In all patients, flexible laryngoscopy was performed and Voice Handicap Index (VHI) scores were obtained the day before, 48 h and 1 month after surgery. Patients' medical records were reviewed to find the patients who had received dexamethasone by the anesthesiologist as nausea and vomiting prophylaxis or analgesia. Thus, two groups of patients were formed: dexamethasone (D) group and non-steroid (NS) group. Mann-Whitney test used to compare VHI between the two groups. 122 patients fulfilled the criteria. D group consisted of 50 patients (44 females; mean age 53.16 ± 17.61), in which a single IV dose of 8 mg dexamethasone had been administered perioperative, and NS group consisted of 72 patients (58 females; mean age 50.53 ± 13.60), where no steroids had been administered. No significant difference was noticed between D and NS groups for preoperative VHI score, VHI scores 48 h and 1 month after surgery. In our study, a single perioperative IV dose of 8 mg dexamethasone did not seem to add any benefit on voice-related quality of life after thyroid surgery.

Validation of the Greek OSD-6 quality of life questionnaire in children undergoing polysomnography.

OBJECTIVE: OSD-6 is a disease specific questionnaire for pediatric obstructive sleep apnea (OSA). The aims of this study were to validate OSD-6 in Greek language and correlate OSD-6 with polysomnography results. STUDY DESIGN: Prospective study. SETTING: Tertiary referral center. SUBJECTS AND METHODS: OSD-6 questionnaire was translated to Greek and back to English. A prospective study was conducted on children undergoing overnight polysomnography due to snoring and disrupted sleep. Test-retest evaluation was carried out. Internal consistency and test-retest reliability were evaluated. Validity was assessed by exploring correlations between OSD-6 scores and apnea-hypopnea index (AHI), and by comparing total scores of OSA and non-OSA groups. Responsiveness was assessed by comparing preoperative to postoperative total scores in OSA children who underwent adenotonsillectomy. RESULTS: Test-retest evaluation of 91 subjects showed good internal consistency (Cronbach's alpha 0.860 for test and 0.873 for retest) and reliability (Pearson's correlation coefficients between test and retest scores: 0.751-0.546; p<0.01). Total and domains' OSD-6 scores and AHI were significantly correlated (Spearman's correlation coefficients: 0.277-0.630; p<0.01), while children with OSA had higher total OSD-6 score than those without OSA (median (interquartile range): 16 (11) vs. 10 (7), respectively; p<0.01), indicating good validity. Postoperative OSD-6 scores were significantly lower than preoperative (2.84 ± 3.21 vs. 15.42 ± 6.48, respectively; p<0.001), suggesting good responsiveness. CONCLUSION: The Greek version of the OSD-6 questionnaire proved to be a valid instrument with satisfactory internal consistency, reliability, validity and responsiveness. Furthermore, in our study OSD-6 was significantly correlated to polysomnography results.

The sino-nasal outcome test (SNOT)-22: validation for Greek patients.

The aim of this study was to perform translation, cross-cultural adaptation, and validation of the sinonasal outcome test 22 (SNOT-22) in the Greek language. SNOT-22 was translated into Greek. A prospective study was conducted on adult patients with chronic rhinosinusitis (CRS) according to rhinosinusitis and nasal polyps (EPOS) criteria. Test-retest evaluation of the patients was carried out. Internal consistency was assessed with Cronbach's alpha test, and test-retest reliability with Pearson's test (parametric correlation coefficient), kappa (reproducibility) and Bland-Altman plot (extent of agreement). Validity was assessed by comparing scores between a control group of volunteers without CRS and the CRS group using Mann-Whitney test. Responsiveness was assessed on CRS patients who underwent surgery, by comparing preoperative to 3 months postoperative scores with paired t test. Furthermore the magnitude of surgery effect was evaluated. Test-retest evaluation was accepted in 64 patients. Cronbach's alpha was 0.84 and 0.89 at test and retest, respectively, suggesting good internal consistency. Pearson's correlation coefficient was 0.91 (p < 0.001), revealing good correlation between initial and retest scores. Mean kappa value was 0.65, indicating a high level of reproducibility, while in Bland-Altman plot the differences were located between agreement thresholds. The control group consisted of 120 volunteers. Mann-Whitney test showed a statistically significant lower score for the control group (p < 0.0001). 32 CRS patients underwent surgical treatment. Postoperative scores were significantly lower than preoperative (p < 0.0001) while the magnitude of surgery effect was considered high. Greek SNOT-22 is a valid instrument with good internal consistency, reliability, reproducibility, validity and responsiveness.

Evaluating the outcome of phonosurgery: comparing the role of VHI and VoiSS questionnaires in the Greek language.

OBJECTIVES/HYPOTHESIS: The objective was to study the role of the Greek version of Voice Handicap Index (VHI) in comparison with Voice Symptom Scale (VoiSS) in terms of measuring voice surgery outcome in patients with benign laryngeal lesions. STUDY DESIGN: Nonrandomized prospective. METHODS: Forty-six patients operated for benign laryngeal lesions were enrolled in the present study. All patients were assessed according to the European Laryngological Society guidelines. In terms of self-evaluation, patients answered the Greek versions of both VHI and VoiSS, preoperatively and 6 weeks postoperatively, and the results were statistically analyzed. RESULTS: The strongest correlation was observed between the functional subscale of VHI and the impairment subscale of VoiSS, as well as, between the emotional subscales of both VHI and VoiSS, pre- and postoperatively. A statistically significant change in subscale and total scores was found. VHI and VoiSS subscales and total scores correlated with the stroboscopic and aerodynamic measurements in a variable manner. Perceptual measurements, as well as shimmer and harmonic-to-noise ratio showed significant correlation with both VHI and VoiSS subscale and total scores postoperatively. CONCLUSION: VHI and VoiSS are considered useful tools in evaluating voice surgery outcome, in the Greek language.

Hidrocystoma of the external auditory canal: a case report.

BACKGROUND: Apocrine hydrocystomas arising in the external auditory canal are very rare. In this report a clinical case of apocrine hydrocystoma located in the cartilaginous part of the external auditory canal is presented. CASE PRESENTATION: A 64-year-old Caucasian female patient presented with a solitary nodule, located in the outer part of the external ear canal after repeated episodes of external otitis. For diagnostic purposes, computerized tomography was used. The patient underwent an excisional biopsy of the mass via an intra-aural incision and the surgical specimen was sent for histopathologic examination. CONCLUSION: An apocrine hidrocystoma inside the auricular canal is uncommon. It can cause recurrent external otitis and conductive hearing loss and should be treated with wide local excision and reconstruction of the external auditory canal for diagnostic and therapeutic purposes.

Ectopic internal carotid artery presenting as an oropharyngeal mass.

Ectopic internal carotid artery (ICA) is a very rare variation. The major congenital abnormalities of the ICA can be classified as agenesis, aplasia and hypoplasia, and they can be unilateral or bilateral. Anomalies of the neck artery may be vascular neoplasms or ectopic position. Carotid angiograms provide absolute confirmation of an aberrant carotid artery, while EcoColorDoppler (ECD) gives also important information about the evaluation of carotid vassels. Nevertheless Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) of the neck provide spatial information about the adjacent pharyngeal anatomy and are less invasive than angiogram. Injuries to the ICA during simple pharyngeal surgical procedures can be catastrophic due to the risk of massive bleeding. We report a case of a 56 year-old male patient suffering from dysphagia associated with aberrant ICA manifesting itself as a pulsative protruding of the left lateral wall of the oropharynx.

Diagnosis of tetanus by an otorhinolaryngologist and immunity against tetanus among adults on the island of Crete.

BACKGROUND: Tetanus (lockjaw) is a rare disease in developed countries. METHODS: An otorhinolaryngologist can be the first physician to see a patient with tetanus. In our department, we have seen 10 such cases presenting with head and neck symptoms. We report 2 of these cases followed by an investigation of the immune status of the adult Cretan population against tetanus using 200 random patients who visited our clinic. RESULTS: A negative history of complete childhood immunization was recorded in 37% of individuals. Of the male population, 88.5% had received active immunization during adulthood, although 47% had received all three doses. Only 12.6% of the females had received full-dose immunization during adulthood. Overall, only 8.5% of the studied population had received either complete immunization or a scheduled booster dose during the last decade. CONCLUSIONS: In many cases, an otorhinolaryngologist can be the first physician to examine a patient with tetanus. The incidence of the disease in Crete, Greece, is significantly higher than in most parts of developed countries.

Pattern of parotid gland tumors on Crete, Greece: a retrospective study of 131 cases.

BACKGROUND: Salivary gland tumors constitute a highly heterogeneous group. There are few large epidemiological studies of benign and malignant salivary gland tumors in Greece. The aim of the present study was to define the pattern of parotid gland neoplasms on the island of Crete. MATERIAL/METHODS: The medical records of 131 patients who underwent parotidectomy in the Otorhinolaryngology department of the University hospital of Heraklion over the last ten years were retrospectively reviewed. Gender and age of the patients, size, location, and histology of the tumors, as well as postoperative complications were analyzed and tabulated. RESULTS: There were 101 (77.1%) benign parotid gland tumors and 30 (22.9%) of malignant ones. The most common benign tumor was pleomorphic adenoma (44.2%), while the most common malignant tumor was mucoepidermoid carcinoma (5.3%). The female-to-male ratio was 1.18/1.00. Median age was 48.2 years (range: 16-75 years) in patients with benign tumors and 65.4 years (range: 27-90 years) in patients with malignancy. After superficial parotidectomy, the most common postoperative complication was Frey syndrome (8.1%), while after total parotidectomy the most frequent complication was transient facial nerve palsy (45.5%). CONCLUSIONS: On Crete, parotid gland tumors show epidemiological characteristics similar to studies worldwide. Benign parotid tumors are largely more frequent than malignant tumors. The most common benign parotid gland tumor was pleomorphic adenoma, while the most frequent malignant tumor was mucoepidermoid carcinoma. Future research needs to be done to better define the epidemiology of these tumors among the Greek population.

Osteoid osteoma of the ethmoid bone associated with dacryocystitis.

BACKGROUND: Osteoid osteomas (OO) are small, benign osteoblastic lesions. Ethmoid bone OO has been very rarely reported so far. CASE PRESENTATION: We report a case of a 16-year-old boy suffering from persistent epiphora and a mild pain in the area of median canthus, due to a bone density mass within the right ethmoid air cells extending to the ipsilateral right orbit. The mass was removed via an external ethmoidectomy approach. Histopathologic examination of the specimen set the diagnosis of OO. One year after the operation the patient is free of symptoms, while no recurrence occurred. CONCLUSION: A case of ethmoid bone OO associated with dacryocystitis is reported. Although benign and rare, OO should be considered in differential diagnosis of the ethmoid bone osteoblastic lesions.

Oral mucosal melanoma: a malignant trap.

Oral mucosal melanomas are highly malignant tumors. The 'chameleonic' presentation of a mainly asymptomatic condition, the rarity of these lesions, the poor prognosis and the necessity of a highly specialized treatment are factors that should be seriously considered by the involved health provider. We present the case of a 75-year-old man who was referred to the Ear, Nose and Throat department. His symptoms were voice alteration and saliva drooling, progressively worsening during the last few weeks. The absence of pain was the reason for the delay of seeking medical care. The diagnosis was an oversized oral melanoma. This is an example of how the time of diagnosis and the evolution of a disease could be seriously influenced by patient's behavior. Melanomas arising from oral mucosa have poor prognosis unless they are discovered and treated early. The vigilance of the physicians is necessary to have success in this difficult task.

Canal wall down mastoidectomy for cholesteatoma: experience at the University of Crete.

OBJECTIVE: To evaluate clinical and audiologic data as well as operative findings and postoperative follow-up in the management of chronic cholesteatomatous otitis media with canal wall down mastoidectomy (CWDM). STUDY DESIGN: A retrospective review of cases followed up between 1990 and 2002. SETTING: Tertiary referral centre. METHOD: Two hundred one patients with chronic otitis media with cholesteatoma underwent CWDM. MAIN OUTCOME MEASURES: Clinical presentation, surgical findings, and audiologic evaluation were assessed. RESULTS: Preoperatively, eight patients suffered from vertigo and four presented with facial nerve paralysis. In 40 patients (20%), erosion of the lateral semicircular canal was found, and in 31 patients (15%), there was dehiscence of the facial nerve canal. Dural plate erosion and sinus plate dehiscence were found in 13 and 17 patients, respectively. Nine patients experienced serious endocranial complications at their admission. The malleus was noted to be intact in the majority of patients in all age groups. The incus was eroded or absent in most of the cases in all age groups. On postoperative evaluation 3 months after surgery, 195 audiograms were performed, with a mean pure-tone average of 55 dB HL and a mean air-bone gap of 30 dB HL. CONCLUSION: Although CWDM has the disadvantages of the necessity to avoid water insertion in the external auditory canal and lifelong mastoid care, it is an effective treatment in a single-step procedure for patients with advanced disease and for those who refuse to submit to postoperative follow-up.

Malignant mixed tumor of the nasal cavity.

Parotid gland is the most common location of malignant mixed tumors. Three different subtypes of these tumors exist: carcinoma ex pleomorphic adenoma, carcinosarcoma, and metastasizing mixed tumor. Carcinoma ex-pleomorphic adenoma is by far the most common subtype. Although unusual sites of these tumors have been published, we report an extremely rare case of a malignant mixed tumor located in the nasal cavity.

Kikuchi's disease: a benign cause of fever and cervical lymphadenopathy.

Histiocytic necrotizing lymphadenitis (Kikuchi's disease, KD) is a rare benign condition of unknown origin, usually characterized by lymphadenopathy and fever, affecting mainly young women. We describe three cases of patients, one man and two women, with biopsy-proven KD detected at our university hospital during the past 3 years and we review the literature.

Implications of laser assisted tympanostomy in adults.

OBJECTIVES: To assess outcome in adult individuals undergoing laser-assisted tympanostomy without ventilation tube placement. STUDY DESIGN: Case series with 2-month follow-up. SETTING: Faculty practice, research protocol, tertiary care academic medical center. PATIENTS AND METHOD: Laser-assisted tympanostomy was performed on a total of 142 ears (108 individuals). Indications included serous otitis media with effusion (66 ears/47 patients), functional eustachian tube dysfunction (48 ears/36 patients), acute otitis media (19 ears/16 patients), and endoscopic visualization of the middle ear (9 ears/9 patients). INTERVENTION: The laser-assisted tympanostomy procedure is performed with a CO2 laser under local anesthesia on an outpatient basis. MAIN OUTCOME MEASURES: Patency time of the tympanostomy, presence of fluid after the closure of the tympanostomy, tympanometry and tone audiometry findings, relief of symptoms. RESULTS: Middle ear disease was resolved after the closure of tympanostomy in 47.9% of patients with serous otitis media with effusion. In 79.1% of patients with functional eustachian tube dysfunction, symptoms were diminished. All patients with acute otitis media had a satisfactory outcome. Laser-assisted tympanostomy was found to be quite helpful in patients undergoing middle ear endoscopy. CONCLUSIONS: Laser-assisted tympanostomy without ventilation tubes provides a safe alternative surgical option in adult patients in certain cases. The selection criteria for this procedure are addressed in detail.

Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists.

The use of angiotensin-converting enzyme inhibitors (ACEIs) has been implicated in many cases of angioedema, but, given the potential mechanism of this complication, it was not expected to be caused by angiotensin II receptor blockers (ARBs). However, in the past few years, scattered reports of angioedema associated with ARBs have appeared in the medical literature. We performed a retrospective chart review from January 1, 1998, through June 30, 2003, and a review of the literature. During this time, we managed head and neck angioedema induced by ACEIs (n = 27) and ARBs (n = 4) in 31 patients. All of them had significant mucosal swelling, and in some of them dyspnea and dysphagia coexisted. The most frequently involved areas were the oral tongue (13 cases), uvula and soft palate (5 cases), and larynx, mouth floor, and lips (3 cases each). Angioedema may be a more common complication of ACEI and/or ARB use than originally thought. This complication may occur after long-term use of these drugs. We advise that ARBs not be prescribed to patients with a history of angioedema, particularly that due to the use of ACEIs.