Intramuscular myxoma of the longus colli mistaken for a cervical rootlet schwannoma.

An 86-year-old woman was referred to the otolaryngology clinic for a 1-year history of a painless, slow-growing neck mass. Physical examination showed a fixed, immobile right level II neck mass with normal vocal cord movement. MRI demonstrated a lobulated mass laterally displacing the carotid vessels, consistent with a schwannoma. Despite the pathognomonic radiographic findings for schwannoma, core needle biopsy of the mass was consistent with intramuscular myxoma (IM), which rarely presents in the head and neck region. After multiple years of slow growth with bulging into the pharynx, the patient ultimately underwent surgery to reduce the risk of airway compromise. The location of this IM together with its unusual imaging appearance is a unique finding in the head and neck and adds to the differential diagnoses for neck masses displacing the carotid sheath.

Steroid eluting biocompatible stent for subglottic stenosis.

OBJECTIVE: Develop a prototype steroid eluting stent suitable for endoscopic treatment of subglottic stenosis. METHODS: Rectangular-shaped spoke design stents thermally molded into horseshoe-shaped stents were developed using AutoCAD program, and printed on a Lulzbot 3D printer with polycaprolactone (PCL). Kenalog saturated AEROSIL 200 was embedded in the PCL filament. Horizontal radial force measurements were measured at baseline, 1 day, and 1 month when deformation switched from bending to compression. Amount of Kenalog eluted after 1 day, 1 week and 1 month were measured using HPLC. RESULTS: Horizontal pressure applied to the PCL stent corresponding to a 5-0 ET were 1.27 ± 0.38 lb. at baseline, 1.79 ± 0.045 lb. at 1 day, 1.94 ± - 0.22 lb. at 1 week and 2.07 ± 0.11 lb. at 1 month. The horizontal pressure applied to PCL stent corresponding to an 8-0 ET tube were 0.82 ± 0.018 lb. at baseline, 1.008 ± 0.045 lb. at 1 day, 0.95 ± - 0.064 lb. at 1 week and 1.078 ± 0.021 lb. at 1 month. The amount of Kenalog eluted increased from 5.78 µg/mL at 1 day to 15.01 µg/mL at 1 week to 19.35 µg/mL at 1 month. CONCLUSION: This proof-of-concept project is an initial step to demonstrate and create a novel stent in the treatment of subglottic stenosis that applies expansile force on the trachea, elutes steroids and dissolves. Over time the expansile force along the trachea increases allowing the PCL to mucosalize, while it dissolves and continues to elute steroids. The limitations of this in vitro study necessitate experiments on animal models, such as rabbit tracheas to observe for complications and histologic changes. LEVEL OF EVIDENCE: This proof-of-concept project is a Level 5 mechanism-based reasoning study.

Needle aspiration as primary surgical treatment of pediatric deep neck space abscesses.

OBJECTIVE: Examination of the outcomes of needle aspiration (NA) under sedation as the primary surgical treatment for pediatric deep neck space abscesses (DNSA) to determine its adequacy, safety, and cost. STUDY DESIGN: Retrospective chart review. METHODS: 10 consecutive pediatric patients (age 4-48 months) that were diagnosed with DNSA starting from August 2008 through October 2015 were included in our review. All patients were on antibiotics and were treated with NA as the primary surgical treatment modality. Procedures were all performed in our pediatric sedation suite. We have examined our outcomes including need to convert to open incision and drainage (I&D), number of aspirations required, hospital stay, if purulence obtained, culture results, and imaging modality used. We also compared our results with previous studies using incision and drainage as the primary treatment modality focusing on the duration of their hospital stay. RESULTS: None of our 10 patients required an open I&D. Two of 10 (20%) did require repeat aspiration once with no patient requiring more than two aspirations. Median hospital stay was 4 days (range 3-8). CONCLUSION: In our small study group NA performed under sedation was an effective treatment modality with duration of hospital stay comparable to other studies that included treatment with I&D under general anesthesia.

Sinonasal Quality of Life in Children After Outfracture of Inferior Turbinates and Submucous Inferior Turbinoplasty for Chronic Nasal Congestion.

Importance: Chronic nasal congestion often persists in children despite empirical treatment using intranasal corticosteroids, systemic antihistamines, and/or leukotriene receptor antagonists. Symptoms are often reported even with negative results of skin or blood allergy testing. Inferior turbinoplasty has been effective in adults and children, but outfracture of inferior turbinates in children is rarely reported, as is use of validated quality-of-life measures to quantify improvements after intervention. Effective use of these 2 procedures for treating chronic nasal congestion may reduce the need for medication and improve sinonasal quality of life. Objective: To quantify changes in sinonasal quality of life for children after outfracture of inferior turbinates and concomitant submucous microdebrider inferior turbinoplasty for chronic nasal congestion. Design, Setting, and Participants: A case series with planned data collection was conducted in an ambulatory pediatric otolaryngology clinic among 43 patients with chronic nasal congestion who underwent surgical intervention between January 1, 2014, and May 31, 2015. Exposures: Microdebrider submucous inferior turbinoplasty (without bony resection) and outfracture of inferior turbinates. Main Outcomes and Measures: Demographics and medication use before and after the procedure were reviewed. Scores on the Sinus and Nasal Quality of Life Survey (SN-5) and quality-of-life scores were collected at baseline, 4 to 6 weeks after the procedure, and more than 6 months after the procedure. Results: Among the 43 patients (14 girls and 29 boys; mean age, 11.2 years [range, 4.8-17.6 years]), every domain showed significant improvements in scores on the Sinus and Nasal Quality of Life Survey and quality-of-life scores 1 to 2 months after the proecdure: sinus infection (-2.55; 95% CI, 1.85-3.26), nasal obstruction (-3.51; 95% CI, 2.88-4.14), allergy symptoms (-2.14; 95% CI, 1.43-2.86), emotional distress (-2.37; 95% CI, 1.68-3.06), activity limitation (-1.70; 95% CI, 1.14-2.25), and overall quality of life (3.72; 95% CI, 2.95-4.48). At long-term follow-up, improvement was maintained in all categories. Significant improvements in SN-5 and quality-of-life scores correlated with proportional decreased reporting of snoring after the procedure (33 [77%] vs 1 [2%]; absolute reduction, 75%; 95% CI, 62%-88%), as well as nasal congestion (41 [95%] vs 1 [2%]; absolute reduction, 93% ; 95% CI, 85%-100%), and rhinorrhea (44 [41%] vs 1 [2%]; absolute reduction, 42%; 95% CI, 27%-57%). The proportion reporting use of intranasal corticosteroids (25 [58%] vs 2 [5%]; absolute reduction, 50%; 95% CI, 39%-71%), antihistamines (27 [63%] vs 1 [2%]; absolute reduction, 61%; 95% CI, 46%-75%), and leukotriene receptor antagonists (13 [30%] vs 0; absolute reduction, 30%; 95% CI, 16%-44%) also decreased. Conclusions and Relevance: Concomitant outfracture and submucous microdebrider inferior turbinoplasty improves quality of life in children with chronic nasal congestion and can reduce use of daily medication.

Intensity of regionally applied tastes in relation to administration method: an investigation based on the "taste strips" test.

To compare various methods to apply regional taste stimuli to the tongue. "Taste strips" are a clinical tool to determine gustatory function. How a patient perceives the chemical environment in the mouth is a result of many factors such as taste bud distribution and interactions between the cranial nerves. To date, there have been few studies describing the different approaches to administer taste strips to maximize taste identification accuracy and intensity. This is a normative value acquisition pilot and single-center study. The investigation involved 30 participants reporting a normal sense of smell and taste (18 women, 12 men, mean age 33 years). The taste test was based on spoon-shaped filter paper strips impregnated with four taste qualities (sweet, sour, salty, and bitter) at concentrations shown to be easily detectable by young healthy subjects. The strips were administered in three methods (held stationary on the tip of the tongue, applied across the tongue, held in the mouth), resulting in a total of 12 trials per participant. Subjects identified the taste from a list of four descriptors, (sweet, sour, salty, bitter) and ranked the intensity on a scale from 0 to 10. Statistical analyses were performed on the accuracy of taste identification and rated intensities. The participants perceived in order of most to least intense: salt, sour, bitter, sweet. Of the four tastes, sour consistently was least accurately identified. Presenting the taste strip inside the closed mouth of the participants produced the least accurate taste identification, whereas moving the taste strip across the tongue led to a significant increase in intensity for the sweet taste. In this study of 30 subjects at the second concentration, optimized accuracy and intensity of taste identification was observed through administration of taste strips laterally across the anterior third of the extended tongue. Further studies are required on more subjects and the additional concentrations prior to determining the ideal taste strip application method.