Primary Combined Small-Cell and Squamous Cell Carcinoma of the Supraglottis: Case Report and Literature Review.

Combined small-cell carcinoma and squamous cell carcinoma of the larynx is an exquisitely rare and underreported primary tumor the head and neck region, with an English literature review revealing only 17 documented cases. There is limited information on how best to treat these patients oncologically, given the low number of reported cases. A subset of the reported cases also detail a unique local spread of this combined carcinoma, further obscuring the clinical picture of these patients. Here, we detail an 18th case, with nodal metastasis of only one component of the primary tumor, and discuss the published literature surrounding this etiology.

Analysis of Patients Diagnosed with Benign Paroxysmal Positional Vertigo and the Corresponding Incidence and Patterns of Electric Toothbrush Use.

Objective To investigate whether mechanical vibrational energy from using an electric toothbrush may cause an increase in the incidence of benign paroxysmal positional vertigo (BPPV) and prevent successful treatment of BPPV with canalith repositioning procedure. Methods This was a retrospective study conducted at an otolaryngology private practice. A survey of 111 patients who were diagnosed with BPPV in an otolaryngology practice between May 2012 and January 2017 was conducted using a questionnaire that included questions regarding demographics, inner ear pathology, treatment method, and use of an electric toothbrush. The results were recorded and compared using a chi-square test of analysis or Fisher's exact test. Results Overall, 47 (42.3%) of the 111 BPPV patients used an electric toothbrush, whereas 64 of the 111 (57.6%) patients did not. Six (12.7%) of the 47 patients experienced dizziness with electric toothbrush use. Of the 47 patients using an electric toothbrush, 33 (70.2%) had a resolution of symptoms after Epley treatment, whereas 14 (23.4%) of 47 patients did not. Of the 64 patients who did not use an electric toothbrush, 15 (23.4%) did not have resolution after Epley treatment. Of the 47 patients using an electric toothbrush, 6 (12.8%) had a recurrence of BPPV diagnosed in the office, whereas 41 (82.2%) did not. Seven (10.9%) of those who did not use an electric toothbrush had a recurrence of BPPV, whereas 57 (89.1%) of the 64 patients did not. These results were not statistically significant (p = 0.77). Conclusions This study suggests that the mechanical vibrations from electric toothbrush use do not have an association with recurrent BPPV. The results align with some publications demonstrating that vibrations in the head and neck area from the use of an electric toothbrush can initiate dizziness; however, it does not appear that this modality of vibration is significant for inducing recurrent BPPV.

Case of Incidental Asymptomatic Carotid Body Paraganglioma in a Patient with Infectious Mononucleosis.

A paraganglioma is a rare form of neuroendocrine tumor of neural crest cell origin. These tumors arise from autonomic ganglia, and are classified based on their origin in the autonomic nervous system, with sympathetic paragangliomas being more commonly located in the abdomen and parasympathetic paragangliomas more commonly found in the head and neck region. Paragangliomas have a characteristically slow growth rate, and while many will present due to symptoms of mass effect or from hyper functional catecholamine secretion, some tumors are diagnosed incidentally on imaging studies. In this report, we present the case of a 33-year-old man who presented to the emergency department with symptoms of infectious mononucleosis and recurrent tonsillitis, for which he was scheduled to have a tonsillectomy in the near future, but was incidentally found on a CT scan of the neck to have an asymptomatic carotid body paraganglioma. Due to the close anatomical relationship between the carotid artery and tonsillar bed, had this surgery occurred without first discovering the paraganglioma it may have placed the patient at increased risk for a disastrous intraoperative hemorrhage. This idea prompts otolaryngologists to consider how best to approach the diagnosis of paragangliomas in patients that have yet to become symptomatic.

Rare Solitary Fibrous Tumor in the Pediatric Neck: A Case Report and Review of the Literature.

Solitary fibrous tumors (SFT) are a rare type of mesenchymal-derived tumor not commonly found in the pediatric population, especially in the head and neck. Tumors of this nature are most commonly seen in the adult population and are identified with unique immunohistochemical markers, specifically signal transducer and activator of transcription 6 (STAT6) and hematopoietic progenitor cell antigen (CD34). Including SFTs in the differential diagnosis while working up a mass can be difficult considering their relatively non-descript appearance on imaging and the low yield immunohistochemical staining that must be ordered to confirm diagnosis. The current literature identifies only a handful of cases of SFTs occurring in the pediatric population, with a majority arising from the pleura. We present the case of a 13-year-old male who underwent radical excision of a left occipital triangle neck mass after radiological and pathological workup failed to conclusively make a diagnosis. Postoperative pathologic analysis revealed it to be an SFT. Due to the exceptionally rare presentation of SFTs in pediatric patients, the aim of this case report is to discuss diagnostic measures, solitary fibrous tumor etiology, as well as a recent risk stratification system used for the evaluation of postoperative disease progression. Our hope is that clinicians will include SFTs in their differential diagnosis when working up a neck mass in the pediatric population.