Otolaryngology

Vestibulotoxicity in a patient without renal failure after inhaled tobramycin Publication date: Available online 19 March 2019 Source: American Journal of Otolaryngology Author(s): Adam C. Kaufman, Steven J. Eliades Abstract Aminoglycoside antibiotics have a long history of use in the control of gram-negative bacterial infections, but their systemic use has been complicated by known ototoxicity and nephrotoxicity. Because of the utility of these medications in patients with frequent pulmonary infections, there has been a move towards the use of inhaled agents, in particular tobramycin, due to a lower rate of systemic complications. Inhaled tobramycin is generally consider to be safe from otologic complications, with only two previous reports of ototoxicity, both in patients who had underlying chronic renal disease. Here we present the first case of a patient developing isolated vestibular toxicity, without associated hearing loss or evidence of renal insufficiency, in a patient receiving inhaled tobramycin. This is an extremely rare complication of an inhaled aminoglycoside and underscores the importance of careful monitoring despite perceived safety.

Transdermal lidocaine as treatment for chronic subjective tinnitus: A pilot study Publication date: Available online 18 March 2019 Source: American Journal of Otolaryngology Author(s): Daniel C. O'Brien, Aaron D. Robinson, Nancy Wang, Rodney Diaz Abstract Objective To assess the efficacy of transdermal lidocaine as a treatment for chronic subjective tinnitus as measured by the Tinnitus Functional Index (TFI). Study design Pilot, prospective efficacy trial. Setting Tertiary care hospital. Patients Men and women, over the age of 18 with chronic subjective tinnitus for >6 months. Intervention Daily application of commercially available transdermal lidocaine patch. Outcome measure Change in the TFI. Results The average pre-treatment TFI score was 56.2. After 1 month the average TFI decreased to 41 (p < 0.05). The scores dropped to 34 and 35 after 2 and 3 months of treatment respectively. Despite improvement in symptoms of tinnitus, most patients did not continue the study after the first month, dropping out due to the size, discomfort, and appearance of the lidocaine patch, failure to follow-up and lack of perceived benefit from treatment. Conclusions In this preliminary study, 5% transdermal lidocaine appears to be a potential treatment for chronic subjective tinnitus. The majority of subjects who completed 1 month of treatment had clinically significantly improved tinnitus. These findings are confounded however by the small sample size and significant drop out rate.

PEAK PlasmaBlade versus monopolar electrocautery tonsillectomy in adults: A prospective double-blinded randomized controlled trial Publication date: Available online 18 March 2019 Source: American Journal of Otolaryngology Author(s): Alvin Tan Kah Leong, Sanjay Ganhasan, Peter Lu Kuo Sun, Yuen Heng Wai, Ian Loh Chi Yuan, Hsu Pon Poh, Chan Yiong Huak Abstract Objective To evaluate the efficacy and compare postoperative pain and recovery following PEAK PlasmaBlade and monopolar electrocautery tonsillectomy in adults. Study design Prospective double-blinded randomized controlled trial. Methods Fifty-eight patients were recruited and randomized into 2 groups: PEAK PlasmaBlade (n = 29) or monopolar electrocautery (n = 29) tonsillectomy. Postoperative pain, complications, patient satisfaction, number of tablets of analgesia taken and days taken to return to soft diet, normal diet, normal activities and achieve pain-free swallowing were compared and analysed, with the aid of a pain diary given to patients. Statistical analysis was performed with SPSS 13.0 with statistical significance set at P < 0.05. Results Patients in the PEAK PlasmaBlade group were able to achieve pain-free swallowing in a shorter time compared to the electrocautery group (13.28 versus 15.76 days, P = 0.035). Patients were also more satisfied with PEAK PlasmaBlade tonsillectomy (P = 0.046). No significant differences in the incidence of postoperative haemorrhage, daily visual analog score for pain, number of tablets of analgesia taken and time taken to return to soft diet, normal diet and activities were seen for both groups. Conclusions This study showed that PEAK PlasmaBlade tonsillectomy has a faster recovery period in terms of time taken to achieve pain-free swallowing and may offer advantages when compared to monopolar electrocautery tonsillectomy. Level of evidence 1b.

Mild hypothermia is associated with improved outcomes in patients undergoing microvascular head and neck reconstruction Publication date: Available online 16 March 2019 Source: American Journal of Otolaryngology Author(s): Benjamin M. Laitman, Yue Ma, Bryan Hill, Marita Teng, Eric Genden, Samuel DeMaria, Brett A. Miles Abstract Objective Microvascular free tissue transfer has become the standard for reconstruction for large defects. With long operative times and an increased surface area exposed, transient hypothermia is common, but it is unclear how this impacts surgical outcomes. This study evaluated the impact of core body temperature on free tissue flap outcomes in patients undergoing microvascular reconstruction. Study design Retrospective data analysis. Setting Mount Sinai Hospital; NYC, NY; 2007–2016. Subjects and methods Demographic information, mean/minimum/maximum body temperatures, and the presence of flap complications (venous thrombosis, arterial insufficiency, flap death, wound infection/dehiscence, fistula, chyle leak, hematoma/seroma) of 519 free tissue transfer patients were documented. Binomial logistic regression was used to examine associations between the presence of flap complications and mean temperature. Statistical analysis used SPSS, with p-values ≤0.05 deemed statistically significant. Results 393 soft-tissue and 125 osteocutaneous flaps were included. 19.8% (n = 103) patients had the presence of ≥1 flap complication, while 80.2% (n = 416) did not. Average temperature for all patients was 36.12 ± 0.84 °C, with minimum at 34.43 ± 0.97 °C and maximum at 37.24 ± 1.23 °C. After controlling for several factors including: tumor stage, radiation, diabetes, BMI, age, sex, and flap type, there was a significant association between flap complications and mean intraoperative temperature (Exp(B) = 1.559, p = 0.004). Conclusion Higher intraoperative temperatures were associated with worse outcomes. A mild relative hypothermia may improve flap outcomes in this population. This represents the largest study to date evaluating the impact of intraoperative temperature on free tissue transfer outcomes.

Angiolymphoid hyperplasia with eosinophilia of the external ear Publication date: Available online 12 March 2019 Source: American Journal of Otolaryngology Author(s): Brian C. Deutsch, Zachary G. Schwam, Vivian Z. Kaul, George B. Wanna Abstract Herein we present the rare case of angiolymphoid hyperplasia with eosinophilia of the external ear treated by surgical resection and full-thickness skin graft. Current diagnosis and management options are reviewed.

Non-recurrent laryngeal nerve in thyroid surgery: Frequency, anatomical variations according to a new classification and surgery consideration Publication date: Available online 12 March 2019 Source: American Journal of Otolaryngology Author(s): Quang Van Le, Quoc Ngo Duy, Quy Xuan Ngo Abstract Background Iatrogenic injury to the recurrent laryngeal nerve (RLN) is one of the most concerning problems of thyroid surgery. The non-recurrent laryngeal nerve (NRLN) is a rare variation of the RLN. Objectives We aimed to identify the proportion of NRLN (during thyroidectomy), introduce a new details classification and recommend some surgical considerations. Materials and methods From May 2017 to September 2018, our hospital carried out 2462 thyroid operations. We reported the NRLN rate and distinguished NRLN into three types: (a) Type 1: descending – NRLN runs downward to the cricothyroid joint; (b) Type 2: vertical – NRLN runs vertically to the cricothyroid joint; (c) Type 3: ascending – NRLN runs upward to the cricothyroid joint. Results Overall, right-side NRLN had an incidence rate of 0.74% (16 out of 2158 total right thyroid surgeries). However, we did not detect any patient with left-sided NRLN. 12.5% of our patients had type 1, 25% had type 2 and 62.5% had type 3. All 16 patients with NRLN were treated without any complications or injury and some considerations for surgeons were mentioned on how to avoid injury of the NRLN. Conclusion Despite NRLN occurrence being rare, the injury probability during surgery can reach up to 12.9% if correct procedures were not carried out. Here, we introduce a new details classification and information with which they can make appropriate surgical considerations to avoid nerve injury in thyroid surgery.

Thyroid cancer in patients undergoing surgery for hyperthyroidism Publication date: Available online 11 March 2019 Source: American Journal of Otolaryngology Author(s): Yogesh More, Aly Bernard Khalil, Huda Mustafa, Manjiri Gupte, Musa al abbadi, Doua Elamin, Luay Aziz, Shaikh Irfan Basha

Seed and soil? - Pharyngeal Merkel cell carcinoma after radiotherapy for laryngeal squamous cell carcinoma Publication date: Available online 9 March 2019 Source: American Journal of Otolaryngology Author(s): Monica K. Rossi, D. Anand Rajan Kanagasabapathy, Henry T. Hoffman Abstract Merkel cell carcinoma (MCC) is a neuroendocrine cutaneous malignancy that may present as metastatic disease without a known primary site but, most commonly originates in the sun-exposed skin of the head, neck, and extremities. We present a 66-year-old male treated with chemo-radiation for T3N2cM0 laryngeal squamous cell carcinoma (SCCa) six years before he was diagnosed with MCC isolated to the radiated laryngopharynx. Mucosal MCC is rare and radiation-induced MCC has been hypothesized to occur in previously radiated tissue but, never before to the laryngopharynx. Implications regarding cancer biology and management is focused with discussion on relevant advances in pathologic assessment and immunotherapy.

Sensorineural hearing loss and volatile organic compound metabolites in urine Publication date: Available online 4 March 2019 Source: American Journal of Otolaryngology Author(s): Charles Pudrith, William N. Dudley Abstract Purpose Oxidative stress in the auditory system contributes to acquired sensorineural hearing loss. Systemic oxidative stress, which may predict auditory oxidative stress, can be assessed by measuring volatile organic compound metabolite concentrations in urine. The purpose of this retrospective study was to determine if hearing decreased in those with higher concentrations of urinary volatile organic compound metabolites. Materials and methods Audiometric, demographic, and metabolite concentration data were downloaded from the 2011–2012 cycle of the U.S. National Health and Nutritional Examination Survey. Participants were first grouped by reported noise exposure. For each metabolite, an analysis of covariance was used to look for differences in age-adjusted hearing loss among urinary volatile organic compound metabolite concentration groups. Participants were grouped into quartiles based on concentration for each metabolite separately because many individuals were at the lower limit of concentration detection for several metabolites, leading to a non-normal distribution. Results Age-adjusted high-frequency pure-tone thresholds were significantly (FDR < 0.05) increased by about 3 to 4 dB in high concentration quartile groups for five metabolites. All five metabolites were glutathione-dependent mercapturic acids. The parent compounds of these metabolites included acrylonitrile, 1,3 butadiene, styrene, acrylamide, and N,N-dimethylformamide. Significant associations were only found in those with no reported noise exposure. Conclusions Urinary metabolites may help to explain susceptibility to oxidative stress-induced hearing loss.

A systematic review of the nasal septal turbinate: An overlooked surgical target Publication date: Available online 4 March 2019 Source: American Journal of Otolaryngology Author(s): William J. Moss, Farhoud Faraji, Aria Jafari, Adam S. DeConde Abstract Objective The nasal septal turbinate (NST) is a conspicuous structure located in the anterior nasal cavity that impacts the internal nasal valve. Its structure and function is often thought to be poorly characterized, and it is rarely addressed surgically. The authors perform a systematic review in an attempt to synthesize what has been learned of this structure and to evaluate its potential as a treatment target. Methods A query of the Medline, Embase, Web of Science and Cochrane databases was undertaken in search of studies evaluating the NST. This qualitative systematic review was performed in accordance with PRISMA guidelines. Study quality and risk of bias were assessed with established criteria. Results Of the initial 1069 hits from the four databases, 16 articles were ultimately included in the review, which varied in quality and risk of bias. The included articles consisted predominantly of radiographic and histopathologic studies. Four studies evaluated NST treatment outcomes. The NST represents a fusiform-shaped region of erectile tissue, similar in structure and function to that of the turbinates. Preliminary treatment outcomes suggest the NST represents an important surgical target in nasal airway surgery. Conclusion When evaluating nasal obstruction patients, surgeons should assess the NST and consider addressing it surgically.