Sinonasal organized hematoma: Case report and review of the literature.

Sinonasal organized hematoma is a rare condition characterized by an organizing blood clot in the sinonasal cavity, which consists of blood products, fibrin, and dilated blood vessels. As a benign entity with an aggressive imaging appearance, it is important to differentiate sinonasal organized hematoma from malignancies affecting the paranasal sinuses and nasal cavities to guide appropriate management. In this report, we discuss the clinical presentation and diagnostic evaluation of an 82-year-old male with a left maxillary sinus organized hematoma and provide a comprehensive review of the relevant literature.

Current understanding of allergic fungal rhinosinusitis and treatment implications.

PURPOSE OF REVIEW: The pathophysiology of allergic fungal rhinosinusitis (AFRS) is not fully understood and is in constant evolution. Although initial theories favored an immunoglobulin E-mediated immune response to fungal antigens as having a primary role in the immunopathologic process of AFRS, the purpose of this review is to highlight recent studies that suggest a more complex, epithelial cell-driven immune response being central to the pathophysiology of the disease. Treatment implications are considered. RECENT FINDINGS: Recent studies demonstrate a central role of cytokines derived from respiratory epithelial cells, including interleukin (IL)-25, IL-33, and thymic stromal lymphopoietin, in the orchestration of both innate and adaptive T helper 2 immune responses that are important components of the immunopathology of chronic rhinosinusitis with nasal polyposis and AFRS. In addition, the robust Th2 adaptive response may be mediated by both fungal antigens and Staphylococcus aureus superantigens. SUMMARY: Given the evolving understanding of AFRS pathophysiology, management continues to maintain a broad focus on minimizing the burden of the inflammatory trigger(s) and suppressing the inflammatory cascade. This is primarily accomplished through surgery and corticosteroid therapy. Immunotherapy, antimicrobial therapy, and other immunomodulatory medications may help mediate the disease process as well.

Internal carotid artery in zone IIb and its implications: A case report.

The potential for aberrant anatomy in the neck should be respected in order to avoid unexpected and potentially devastating injury during surgical and other procedures. Anatomic variations involving the internal carotid artery are believed to exist in as much as 6% of the population. We describe a case of a tortuous internal carotid artery that was found in zone IIb during a neck dissection in a 60-year-old man, and we discuss the implications of this anomaly.

Effects of chemesthetic stimuli mixtures with barium on swallowing apnea duration.

OBJECTIVES/HYPOTHESIS: This study tested the hypotheses that swallowing apnea duration (SAD) will increase given barium versus water, chemesthetic stimuli (i.e., water < ethanol, acid, and carbonation) mixed with barium, age (older > younger), and genetic taste differences (supertasters > nontasters). STUDY DESIGN: Prospective group design. SETTING: University Medical Center. METHODS: Eighty healthy women were identified as nontasters and supertasters, equally comprising two age groups: 18 to 35 years and 60+ years. The KayPentax Swallowing Signals Lab was used to acquire SAD via nasal cannula during individually randomized swallows of 5 mL barium, 2.7% w/v citric acid with barium, carbonation with barium, and 50:50 diluted ethanol with barium. Data were analyzed using path analysis, with the mediator of chemesthetic perception, adjusted for repeated measures. RESULTS: Significant main effects of age (P = .012) and chemesthetic stimuli (P = .014) were found, as well as a significant interaction between chemesthetic stimuli and age (P = .028). Older women had a significantly longer SAD than younger women. Post hoc analyses revealed that barium mixed with ethanol elicited a significantly longer SAD than other bolus conditions, regardless of age group. There were no significant differences in SAD between barium and water conditions, and no significant effect of chemesthetic perception (P > .05). CONCLUSIONS: Ethanol added to barium elicited longer SAD compared to plain barium, but not the other chemesthetic conditions. Older women had a longer SAD than younger women in all conditions. These findings may influence design of future studies examining effects of various stimuli on SAD.

Main taste effects on swallowing apnea duration in healthy adults.

OBJECTIVE: This study examined swallowing apnea duration (SAD) and respiratory phase patterns as a function of taste, tastes combined with barium, age, and genetic taste group. STUDY DESIGN: Prospective group design. SETTING: University medical center. SUBJECTS AND METHODS: Eighty healthy adult women were identified as nontasters and supertasters and equally comprised 2 age groups: 18 to 35 years (n = 40) and 60+ years (n = 40). The KayPentax Swallowing Signals Lab was used to acquire SAD and respiratory phase patterns via nasal cannula during randomized 5-mL swallows of water, 1.0 M sucrose (sweet), 1.0 M sodium chloride (salty), and 0.032 M caffeine (bitter) alone and mixed with barium. The SAD and respiratory patterns were analyzed in a linear mixed model and a binary logistic regression generalized estimating equation model, respectively. RESULTS: A significant main effect of age was found (P = .007). Older women demonstrated longer SAD than younger women. There were no significant effects of taste or genetic taste group on SAD. There was a significant interaction between barium and supertaster status; SAD was shorter in supertasters when barium was included. There were no significant differences in respiratory patterns between age groups, genetic taste groups, or among taste stimuli. CONCLUSION: Advanced age elicited longer SAD, a robust finding in repeated investigations from multiple laboratories. Main tastes did not affect SAD or respiratory phase patterns. Genetic taste group altered SAD when barium was combined with the taste. That is, taste + barium shortened SAD in supertasters. This finding may affect clinical management of dysphagia patients and warrants further investigation.

Effects of chemesthetic stimuli, age, and genetic taste groups on swallowing apnea duration.

OBJECTIVE: This study tested the hypotheses that swallowing apnea duration (SAD) will increase given chemesthetic stimuli (ie, water < ethanol, acid, and carbonation), age (older > young), and genetic taste differences (supertasters > nontasters). STUDY DESIGN: Prospective group design. SETTING: University medical center. SUBJECTS AND METHODS: Eighty healthy adult women were identified as nontasters and supertasters, equally comprising 2 age groups: 18 to 35 years (n = 40) and 60+ years (n = 40). The KayPentax Swallowing Signals Lab was used to acquire SAD via nasal cannula during individually randomized swallows of 5 mL deionized water, 2.7% w/v citric acid, seltzer water, and 50:50 diluted ethanol/water. Data were analyzed using path analysis, with the mediator of chemesthetic perception, adjusted for repeated measures. RESULTS: Significant main effects of chemesthetic stimuli (P = .002), age (P < .001), and genetic taste differences (P = .04) on SAD were found. Older women and supertasters had longer SADs than young women and nontasters. Post hoc analyses revealed ethanol and acid boluses elicited significantly longer SADs than water boluses did. There was no significant effect of chemesthetic perception (P > .05). CONCLUSION: SAD in healthy women increased with changes in chemesthetic stimuli, older age, and in supertasters versus nontasters. It is unclear at this stage if increased SAD is a helpful mechanistic change (potentially protective against aspiration) or a maladaptive change (associated with aspiration). Future research should use these chemesthetic changes in bolus properties to assess if increased SAD decreases aspiration in patients with dysphagia while accounting for genetic taste differences.