RESUMEN
Aberrant internal carotid artery in the middle ear (aICA) is a rare congenital malformation in which the internal carotid artery passes through the tympanic cavity without being separated by bone. A pulsatile vascular mass can be observed in the tympanic cavity of patients with aICA. The diagnosis of aICA may be challenging because improper surgery or treatment can lead to iatrogenic injury, including massive hemorrhage. The aim of this case report was to describe a 39-year-old woman with aICA presenting with mixed hearing loss and postauricular pain. We provided detailed clinical images of the patient to illustrate how aICA can be diagnosed. Because this patient's aICA had no risk of bleeding, close observation, pharmacological therapy, and regular follow-up were applied. The patient's postauricular pain was significantly improved after treatment with oxcarbazepine. At the time of this manuscript's preparation, the patient had been monitored for 10 years and had stable mixed hearing loss with no other complications. Based on the management of this patient, oxcarbazepine can improve aICA-associated postauricular pain, and conservative treatment should be prioritized in cases of aICA without a risk of bleeding. Further studies in a large cohort are required to confirm our findings and recommendations.
Asunto(s)
Sordera , Perdida Auditiva Conductiva-Sensorineural Mixta , Pérdida Auditiva , Femenino , Humanos , Adulto , Arteria Carótida Interna , Oxcarbazepina , Oído Medio , DolorRESUMEN
PURPOSE: Patients with obstructive sleep apnea syndrome (OSAS) have difficulties in compliance with continuous positive airway pressure (CPAP) and the treatment outcome is heterogeneous. We proposed a proof-of-concept study of a novel intermittent negative air pressure (iNAP®) device for physicians to apply on patients who have failed or refused to use CPAP. METHODS: The iNAP® device retains the tongue and the soft palate in a forward position to decrease airway obstruction. A full nightly usage with the device was evaluated with polysomnography. Subgrouping by baseline apnea-hypopnea index (AHI) and body mass index (BMI) with different treatment response criteria was applied to characterize the responder group of this novel device. RESULTS: Thirty-five patients were enrolled: age 41.9 ± 12.2 years (mean ± standard deviation), BMI 26.6 ± 4.3 kg/m2, AHI 41.4 ± 24.3 events/h, and oxygen desaturation index (ODI) 40.9 ± 24.4 events/h at baseline. AHI and ODI were significantly decreased (p < 0.001) by the device. Patients with moderate OSAS, with baseline AHI between 15 to 30 events/h, achieved 64% response rate; and non-obese patients, with BMI below 25 kg/m2, achieved 57% response rate, with response rate defined as 50% reduction in AHI from baseline and treated AHI lower than 20. There were minimal side effects reported. CONCLUSIONS: In a proof-of-concept study, the device attained response to treatment as defined, in more than half of the moderate and non-obese OSAS patients, with minimal side effects.
Asunto(s)
Cooperación del Paciente , Apnea Obstructiva del Sueño/terapia , Ventiladores de Presión Negativa/estadística & datos numéricos , Adulto , Presión de las Vías Aéreas Positiva Contínua , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polisomnografía , Apnea Obstructiva del Sueño/prevención & control , Resultado del TratamientoRESUMEN
IgG4-related disease is a newly recognized systemic fibroinflammatory disorder. We report a 36-year-old man who presented with intractable right nasal pain and frontal headache for 1 month. Computed tomography revealed an ill-defined lesion with bony erosion over the right anterior ethmoid sinus and middle turbinate. The lesion was resected through endoscopic anterior ethmoidectomy and middle turbinectomy. IgG4-related disease was definitively diagnosed according to histopathological features. Prednisolone was administered postoperatively. IgG4-related disease presenting with destructive sinonasal lesion mimicking malignancy is rare. Awareness is essential to avoid delayed diagnosis or unnecessary invasive intervention, because the disorder responds to glucocorticoid and immunosuppressant therapy.
Asunto(s)
Enfermedades Óseas/diagnóstico , Hueso Etmoides , Enfermedades del Sistema Inmune/diagnóstico , Inmunoglobulina G , Neoplasias Craneales/diagnóstico , Cornetes Nasales , Adulto , Enfermedades Óseas/tratamiento farmacológico , Diagnóstico Diferencial , Endoscopía , Glucocorticoides/uso terapéutico , Cefaleas Secundarias/etiología , Humanos , Enfermedades del Sistema Inmune/tratamiento farmacológico , Masculino , Enfermedades Nasales/etiología , Dolor/etiología , Prednisolona/uso terapéutico , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: Vallecular cyst is not a common disease of neonate and infant. However, it may cause severe airway obstruction and even death. Its clinical symptoms are similar to laryngomalacia, including stridor, suprasternal retraction, substernal retraction, feeding difficulties, vomiting, failure to thrive, feeding choking and desaturation. This study is aimed to evaluate the surgical outcomes of infantile vallecular cyst post CO2 laser treatment and to explore the appropriate time point of surgery for infantile vallecular cyst. METHODS: In a retrospective review, thirty three patients diagnosed as vellecular cyst were enrolled in this study. All the patients received awake fiberoptic videobronchoscopic examination in order to prove the diagnosis. Pre-operative and post-operative eight symptom items were both recorded for comparison of the surgical outcomes. The age of diagnosis, gender, operation, body weight at surgery, co-morbidities, dates of postoperative endotracheal intubation, ICU stays and admission days were all recorded for analysis. RESULTS: Total 33 cases of vallecular cyst were diagnosed by fiberoptic videobrochoscopy at our department. Most infants were diagnosed at 2-3 months-old. Stridor was the most common pre-operative symptom (100%). Additionally, feeding choking was the most common post-operative one (29.41%). Two patients (6.06%) with newly onset postoperative feeding choking recovered spontaneously within 2 weeks. Failure to thrive got worse as age increased before the operation. Eighty-eight percent of patients had good or excellent improvement of symptoms after surgery. There was neither recurrence nor surgical complication in our study. CONCLUSION: Vallecular cyst often combined with laryngomalacia. Different from laryngomalacia, it had excellent outcomes after CO2 laser treatment. Failure to thrive got worse if delay diagnosis. Therefore, if definite diagnosis is made, early laser excision of cyst is a good method and the surgical outcomes are excellent.
Asunto(s)
Obstrucción de las Vías Aéreas/diagnóstico , Quistes/cirugía , Laringomalacia/diagnóstico , Láseres de Gas/uso terapéutico , Complicaciones Posoperatorias/epidemiología , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/cirugía , Broncoscopía , Quistes/complicaciones , Quistes/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Lactante , Láseres de Gas/efectos adversos , Masculino , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The concomitant occurrence of tuberculosis infection within a Warthin tumor is extremely rare, as only 6 cases have been previously reported in the English-language literature. We report a new case in a 92-year-old man, who presented with a 20-year history of a painless swelling in the right infra-auricular area that had recently become painful and larger. The patient had no history of tuberculosis, weight loss, or chronic cough. The fluctuant mass was aspirated, but histopathology and routine culture were negative. Computed tomography identified a 5-cm, heterogeneous, enhancing mass with multiple, variably sized, low-density areas without surrounding edema in the area of the right parotid gland. Complete excision was performed to relieve the patient's symptoms. Histopathology diagnosed an acid-fast bacillus infection within a Warthin tumor. On polymerase chain reaction testing, formalin-fixed, paraffin-embedded tissue was negative for tuberculosis, but subsequent culture identified Mycobacterium tuberculosis. Initially, the patient refused antituberculosis therapy, but he relented when miliary pulmonary tuberculosis was diagnosed 11 weeks postoperatively.
Asunto(s)
Adenolinfoma/epidemiología , Enfermedades de las Parótidas/epidemiología , Neoplasias de la Parótida/epidemiología , Tuberculosis Bucal/epidemiología , Adenolinfoma/microbiología , Adenolinfoma/patología , Adenolinfoma/cirugía , Anciano de 80 o más Años , Comorbilidad , Humanos , Masculino , Neoplasias de la Parótida/microbiología , Neoplasias de la Parótida/patología , Neoplasias de la Parótida/cirugía , Tomografía Computarizada por Rayos XRESUMEN
A subglottic cyst is a rare cause of neonatal upper airway obstruction, which may be misinterpreted as a subglottic hemangioma. With the advent of narrow-band imaging, the application of its unique features in analyzing the mucosa surface's vascular structures in pediatric subglottic lesions remains to be investigated. Here, we report the case of a preterm baby who developed two subglottic cysts when he was 3-months old. Both traditional endoscopic examination and narrow-band imaging were performed pre-operatively. Both the potential impact of this new technique and the diagnosis and management of this disease are discussed.
Asunto(s)
Quistes/diagnóstico , Glotis , Enfermedades del Prematuro/diagnóstico , Enfermedades de la Laringe/diagnóstico , Quistes/cirugía , Diagnóstico por Imagen , Endoscopía , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/cirugía , Enfermedades de la Laringe/cirugía , MasculinoRESUMEN
Mycobacterium chelonae usually causes soft-tissue and skin infection. It is a rare cause of otomastoiditis. The clinical presentation and operative findings are similar to those of other nontuberculous mycobacterial infections. We describe a case of left-sided otomastoiditis with acute facial nerve paralysis caused by this organism in a previously well middle-aged woman. Her facial palsy totally resolved after tympanomastoidectomy plus a 7-week regimen of clarithromycin and moxifloxacin. To our knowledge, a case of otomastoiditis with acute facial nerve paralysis caused by M chelonae has not been reported previously.
Asunto(s)
Parálisis Facial/microbiología , Mastoiditis/microbiología , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Mycobacterium chelonae , Parálisis Facial/diagnóstico , Parálisis Facial/terapia , Femenino , Humanos , Mastoiditis/diagnóstico , Mastoiditis/terapia , Persona de Mediana Edad , Infecciones por Mycobacterium no Tuberculosas/complicaciones , Infecciones por Mycobacterium no Tuberculosas/terapiaRESUMEN
OBJECTIVE: To investigate post-operative symptom improvement in patients with severe laryngomalacia. STUDY DESIGN: Severe laryngomalacia was diagnosed in 138 patients (average age of 6.97 months) by bronchoscopy. Laryngomalacia was defined by the direction of supraglottic collapse: type A (posterolateral), type B (complete), and type C (anterior). As multiple laryngomalacia types within an individual were common, patients were further categorized into group I (type A only), group II (type B or B+A), and group III (type C, C+A, or C+B+A). CO(2) laser supraglottoplasty was performed. Improvements in inspiratory stridor, suprasternal retraction, substernal retraction, feeding difficulty, choking, post-feeding vomit, failure to thrive, and cyanosis were investigated. The presence of a symptom was scored as 1, and the absence as 0. The total score of symptoms was calculated for each patient. General medical history, age at time of surgery, type of laryngomalacia, post-operative intubation period, duration in ICU and dates of postoperative admission were recorded. RESULTS: Overall symptom improvement was observed in 82.6% of patients, with statistically significant resolution evident in group III (B-value=0.79, 95% CI: -0.01, 1.59). Symptoms were not well improved in patients with cerebral palsy (n=32, B-value=-1.02, 95% CI: -1.80, -0.25; p<0.01). The two most improved symptoms were substernal retraction and suprasternal retraction, while the two least improved symptoms were choking and feeding difficulties. CONCLUSION: CO(2) laser supraglottoplasty is an effective treatment option for severe laryngomalacia, especially for group III laryngomalacia cases in the absence of cerebral palsy. It has the superiority of facilitating significant symptomatic resolution and reducing the post-operative complications.