Frontal Balloon Sinuplasty in Complicated Acute Pediatric Rhinosinusitis (ARS).

Utilization of frontal balloon sinuplasty in pediatric complicated acute rhinosinusitis (ARS) is demonstrated to be a safe and expedient alternative to other procedures such as trephination or functional endoscopic sinus surgery (FESS) in this case series. We performed a retrospective review of six pediatric cases of frontal balloon sinuplasty for ARS with intracranial complications at a tertiary academic center. Patients underwent unilateral (n = 5) or bilateral dilation (n = 1) in addition to functional endoscopic sinus surgery (FESS) including anterior ethmoidectomy (n = 5) and maxillary antrostomy (n = 6). This technique effectively addressed frontal sinus obstruction and served as an alternative to procedures such as trephination or functional endoscopic sinus surgery. No immediate or short-term complications of balloon dilation were observed in these cases. A larger cohort and extended follow-up are necessary to determine the use and long-term impact of this technique.

Non-Neural (S-100 Negative) Bronchial Granular Cell Tumor Causing Acute Respiratory Failure.

Introduction: Endobronchial granular cell tumors are uncommon in the pediatric population. Case report: A 9-year-old female presented with respiratory failure due to an endobronchial tumor. After debulking and diagnosis, she underwent thoracotomy with right upper lobe resection and bronchoplasty. Pathology demonstrated an endobronchial S-100 negative granular cell tumor, which to our knowledge, is the first such report in the literature. Conclusion: Endobronchial granular cell tumors may cause obstructive respiratory failure, are amenable to surgery, and may be S-100 negative.

Cardiorespiratory Fitness in Middle Age and Health Care Costs in Later Life.

BACKGROUND: Low cardiovascular risk factor burdens in middle age are associated with lower health care costs in later life. However, there are few data regarding the effect of cardiorespiratory fitness on health care costs independent of these risk factors. OBJECTIVES: This study sought to evaluate the association of health care costs in later life with cardiorespiratory fitness in midlife after adjustment for cardiovascular risk factors. METHODS: We studied 19,571 healthy individuals in the Cooper Center Longitudinal Study who underwent cardiorespiratory fitness assessment at a mean age of 49 years and received Medicare coverage from 1999 to 2009 at an average age of 71 years. Cardiorespiratory fitness was estimated by maximal metabolic equivalents (METs) calculated from treadmill time. The primary outcome was average annual health care costs obtained from Medicare standard analytical files. RESULTS: Over 126,388 person-years of follow-up, average annual health care costs were significantly lower forparticipants aged 65 years or older with high midlife fitness than with low midlife fitness in both men($7,569 vs. $12,811; p < 0.001) and women ($6,065 vs. $10,029; p < 0.001). [corrected].In a generalized linear model adjusted for cardiovascular risk factors, average annual health care costs in later life were incrementally lower per MET achieved in midlife in men (6.8% decrease in costs per MET achieved; 95% confidence interval: 5.7% to 7.8%; p < 0.001) and women (6.7% decrease in costs per MET achieved; 95% confidence interval: 4.1% to 9.3%; p < 0.001). These associations persisted when participants were separated into those who died during Medicare follow-up and those who survived. CONCLUSIONS: Higher cardiorespiratory fitness in middle age is strongly associated with lower health care costs at an average of 22 years later in life, independent of cardiovascular risk factors. These findings may have important implications for health policies directed at improving physical fitness.

Balloon frontal sinuplasty for intracranial abscess in a pediatric acute sinusitis patient.

A case of balloon frontal sinuplasty in a 12-year old male with intracranial abscess from acute sinusitis is presented. The patient experienced photophobia, fever, headache, nausea and vomiting. Frontal sinusitis with intracranial abscess was diagnosed on imaging. The patient was taken to the operating room for drainage with left frontal balloon sinuplasty. The patient showed immediate clinical improvement, did not suffer from any complications of surgery and was further managed with long term intravenous antibiotics. We believe that balloon frontal sinuplasty is potentially safe and effective in the treatment of complicated acute frontal sinus obstruction in children.

Isolated primary squamous cell carcinoma of the tympanic membrane.

INTRODUCTION: Primary squamous cell carcinoma (SCC) of the tympanic membrane is exceptionally rare. We describe the history, investigation and management of this disease. PRESENTATION OF CASE: A 68-year-old woman presented with a three month history of intermittent otorrhoea and external ear canal (EAC) pruritus. Otoscopy revealed a polypoidal granular nodule, confined to the posterior aspect of the tympanic membrane. Examination under anaesthesia (EUA) confirmed that the lesion was confined to the tympanic membrane, with a surrounding rim of normal drum. Biopsies were consistent with well differentiated SCC. DISCUSSION: Following discussion at multi-disciplinary team meeting for treatment planning, the patient underwent lateral temporal bone resection with ipsilateral superficial parotidectomy and selective neck dissection. Post-operative histology confirmed an SCC confined to the tympanic membrane. CONCLUSION: SCC of the tympanic membrane is an extremely rare condition. As with early temporal bone SCC, surgical resection with adjacent structure clearance remains the primary treatment modality.

The role of pectoralis major myofascial flap in salvage laryngectomy: a single surgeon experience.

CONCLUSIONS: These results support the use of a pectoralis major myofascial flap (PMMF) in patients undergoing salvage surgery. BACKGROUND: Pharyngocutaneous fistula (PCF) is the most common major complication following laryngectomy. Preceding chemoradiotherapy increases the incidence and severity of PCF formation. The aim of this study was to determine whether the use of a PMMF reduces the incidence and severity of PCF formation in patients undergoing salvage surgery. METHODS: This was a retrospective cohort analysis. RESULTS: A total of 33 patients were identified, including 10 patients who underwent salvage surgery after chemoradiotherapy. In all, 80% of salvage surgery patients underwent PMMF reinforcement of the pharyngeal closure. A PCF rate of 50% was recorded for salvage surgery patients without PMMF reinforcement. Identical PCF rates (25%) were recorded for patients who underwent primary total laryngectomy and salvage surgery patients treated with PMMF reinforcement. Mean duration to fistula closure was 57.16 days in the primary laryngectomy group compared with 20.5 days in salvage surgery patients with PMMF reinforcement.

Association between low serum 25-hydroxyvitamin D and depression in a large sample of healthy adults: the Cooper Center longitudinal study.

OBJECTIVE: To investigate the association between serum vitamin D levels and depression in a large database of patients from the Cooper Clinic. PATIENTS AND METHODS: We conducted a cross-sectional study of 12,594 participants seen at the Cooper Clinic from November 27, 2006, to October 4, 2010. Serum 25-hydroxyvitamin D [25(OH)D] was analyzed, and depression was defined as a Center for Epidemiologic Studies Depression Scale (CES-D) score of 10 or more. Those with and those without a history of depression represented 2 distinct populations with respect to CES-D scores; accordingly, they were analyzed separately. RESULTS: In the total sample, higher vitamin D levels were associated with a significantly decreased risk [odds ratio, 0.92 (95% confidence interval, 0.87-0.97)] of current depression based on CES-D scores. The finding was stronger in those with a prior history of depression [odds ratio, 0.90 (95% confidence interval, 0.82-0.98)] and not significant in those without a history of depression [odds ratio, 0.95 (95% confidence interval, 0.89-1.02)]. CONCLUSION: We found that low vitamin D levels are associated with depressive symptoms, especially in persons with a history of depression. These findings suggest that primary care patients with a history of depression may be an important target for assessment of vitamin D levels.

ABO blood type as a risk factor for secondary post-tonsillectomy haemorrhage.

INTRODUCTION: Blood type-O is associated with decreased expression of von Willebrand factor. Type-O patients suffer fewer thrombotic problems and may be more prone to haemorrhage. Secondary post-tonsillectomy haemorrhage is the most common severe complication of tonsillectomy. We propose that type-O blood may be over-represented in patients presenting with secondary bleeds. METHODS: We reviewed patients treated in the Royal Victoria Eye and Ear Hospital and the Midwestern Regional Hospital for secondary post-tonsillectomy haemorrhages from 2001 to 2006. RESULTS: Three-hundred and three patients suffered secondary post-tonsillectomy haemorrhages over the study period. Blood group data was available in 206 cases (68%). Sixty-three percent of patients studied were blood group O, compared with 55% of the general population (p=0.01). CONCLUSIONS: Blood group O is disproportionately represented in secondary post-tonsillectomy haemorrhage patients. Although we cannot demonstrate causality, this association suggests that patients with type-O blood are more likely to suffer from secondary bleeds following tonsillectomy.

Laryngotracheobronchitis complicated by spontaneous pneumomediastinum.

Spontaneous pneumomediastinum (SPM) is an unusual clinical entity that most frequently follows episodes of increased intrathoracic pressures. While typically a benign condition, potentially fatal complications of SPM must be considered and ruled out with each case. We aim to present the first case of croup-associated SPM in the otolaryngology literature and to discuss clinical, diagnostic and management principles. Days following the diagnosis of viral croup, a 7-year-old asthmatic girl presented with unstable vital signs and severe SPM. The patient was urgently taken to the operating room for an endoscopic airway evaluation, which revealed only a mild bacterial croup superinfection. Conservative treatment with inpatient monitoring and antibiotic therapy successfully resolved the episode. SPM should be immediately considered in the differential diagnosis of any patient presenting with cervical emphysema, especially in association with asthma, cough or strenuous activity. Following exclusion of other causes of SPM, conservative and supportive therapies are the mainstays of SPM management.

Neonatal respiratory distress secondary to bilateral intranasal dacryocystocoeles.

Obstruction of the nasolacrimal duct is a common congenital abnormality reported in up to 84% of neonatal patients [J. Yohendran, A.C. Wignall, E.J. Beckenham, Bilateral congenital dacryocystocoeles with concurrent intranasal mucocoeles causing respiratory distress in a neonate, Asian J. Surg. 29 (2) (2006) 109-111; M.J. Cunningham, J.J. Woog, Endonasal endoscopic dacryocystorhinostomy in children, Arch. Otolaryngol. Head Neck Surg. 124 (1998) 328-333; D. Guery, E.L. Kendig, Congenital impotency of the nasolacrimal duct, Arch. Ophthalmol. 97 (1979) 1656-1658]. Rarely, obstruction results in the development of an intranasal lacrimal duct cyst, or dacryocystocoele, which arises inferolateral to the inferior turbinate [H.R. Jin, S.O. Shin, Endoscopic marsupialisation of bilateral lacrimal sac mucoceles with nasolacrimal duct cysts, Auris Nasus Larynx 26 (1999) 441-445]. These lesions can cause nasal obstruction and, when bilateral, significant respiratory compromise. We present the case of a 3-day-old infant with bilateral intranasal lacrimal duct cysts causing nasal obstruction and intermittent respiratory compromise. The diagnosis was suspected on clinical examination and confirmed on MRI. The patient was successfully managed by bilateral endoscopic marsupialisation and probing of the nasolacrimal ducts. We also present a review of the literature surrounding investigation and management of intranasal lacrimal duct cysts.

Prospective trial of the ultrasonic dissector in thyroid surgery.

BACKGROUND: Use of the ultrasonic dissector in thyroid surgery is becoming more prevalent, with reduced operative time and incision size reported. We assessed the value of the harmonic scalpel in routine thyroid lobectomy. METHODS: We conducted a single blind, prospective pilot study of 52 euthyroid patients requiring thyroid lobectomy. Those with lesions not suitable for resection through a 4-cm incision, a history of thyroiditis, or uncontrolled thyroid dysfunction were excluded. Patients were allocated to 1 of 2 groups: group I (n = 31), thyroid lobectomies using conventional surgical techniques; or group II (n = 21), thyroid lobectomies using the ultrasonic dissector. RESULTS: Outcomes for the 2 patient groups were comparable. There was no significant difference in operative time or incision size. CONCLUSIONS: The ultrasonic dissector does not confer any quantifiable benefit in routine thyroid lobectomy when compared with conventional techniques. This is the first reported series in which its use has not reduced operative time.