Ann Otol Rhinol Laryngol
· 2025 Dec · PMID 40629707
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OBJECTIVE: This case report describes five related patients presenting with signs and symptoms of chronic aspiration who were found to have laryngeal clefts requiring surgical intervention. This case highlights a possibl...OBJECTIVE: This case report describes five related patients presenting with signs and symptoms of chronic aspiration who were found to have laryngeal clefts requiring surgical intervention. This case highlights a possible underlying genetic cause of laryngeal cleft and need for further study in this area. METHODS: A retrospective review of patients' clinical presentations, surgical intervention, procedural photographs and imaging studies was conducted. RESULTS: Five members of a family of 6 demonstrated symptoms consistent with chronic aspiration that became more evident during the COVID pandemic due to social isolation and perceived social pressure around coughing. One child had a history of swallowing difficulty and was found to have a laryngeal cleft on operative evaluation. This led to further evaluation of the rest of the family, with all 4 children and their father having an identifiable laryngeal cleft. All showed marked improvement after surgical repair. Genetic testing was performed and identified a familial variant of uncertain significance in the gene (c.466A > C; p.N156H). CONCLUSION: An unidentified genetic or environmental component may contribute to laryngeal cleft. There is insufficient reporting of case of related patients to identify an inheritance pattern or specific genetic mutation. Further case reporting and study is needed in this area.
Ann Otol Rhinol Laryngol
· 2025 Dec · PMID 40624855
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OBJECTIVE: To evaluate the incidence of recurrent facial palsy and the frequency of misdiagnosis as Bell's palsy in patients with intratemporal facial nerve schwannomas (FNSs)Methods:A systematic review of PubMed and Coc...OBJECTIVE: To evaluate the incidence of recurrent facial palsy and the frequency of misdiagnosis as Bell's palsy in patients with intratemporal facial nerve schwannomas (FNSs)Methods:A systematic review of PubMed and Cochrane databases and a single-institutional analysis were conducted, covering studies from the past 10 years on adult cases of intratemporal FNS with documented facial nerve function at presentation. Inclusion criteria focused on patients presenting with facial paralysis to assess recurrence rates and misdiagnoses as Bell's palsy. Key outcomes included incidence, severity, and the number of prior facial paralysis episodes at the time of FNS diagnosis. RESULTS: From 284 studies identified, 77 full texts were reviewed, and 53 met inclusion criteria, totaling 531 patients. Among the 531 patients, 55.6% (295) initially presented with facial paralysis. We found that 4.5% (24) of all patients in the systematic review and 22.2% (2) of cases in our institutional review with an intratemporal FNS were initially misdiagnosed with Bell's palsy. Of those who presented with facial paralysis, misdiagnosis as Bell's palsy was noted in 8.14% (24) of the systematic review and 100% (2) of our institutional review. The average House-Brackmann (HB) scores worsened from initial presentation to pre-operative assessment (mean scores: 2.07 ± 1.49 vs 2.94 ± 1.73). CONCLUSIONS: Our single-institutional and systematic review emphasizes that facial paralysis is a common presenting symptom of FNS. Although idiopathic (Bell's) palsy is the most frequent cause of facial paralysis, it remains a diagnosis of exclusion and a neoplastic cause should be ruled out in certain cases. A high index of suspicion is warranted for persistent (>3 months) or recurrent facial palsy, particularly when accompanied by otologic symptoms. Early identification of FNS enables timely interventions, such as facial nerve decompression, which may preserve native nerve function.
Ann Otol Rhinol Laryngol
· 2025 Dec · PMID 40619831
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OBJECTIVES: Neuritis ossificans is a rare condition involving heterotopic ossification of nerves, usually affecting major peripheral nerves. Two cases involving cranial nerves are documented, with none affecting the faci...OBJECTIVES: Neuritis ossificans is a rare condition involving heterotopic ossification of nerves, usually affecting major peripheral nerves. Two cases involving cranial nerves are documented, with none affecting the facial nerve. The aim of this report is to present the first documented case of neuritis ossificans involving the facial nerve (CN VII), with a review of clinical, radiologic, and histologic findings. METHODS: An 88-year-old male with a history of radiation therapy for right ear basal cell carcinoma presented with 18 months of progressive right-sided facial weakness, resulting in complete flaccid paralysis. MRI revealed subtle enhancement of the right trigeminal nerve. He underwent facial nerve exploration. Intraoperatively, a large segment of the facial nerve appeared grossly abnormal, and biopsy revealed small rounded and linear mineral deposits with concentric internal structuring, lined focally by collections of histiocytes. This is a single case report with literature review. RESULTS: Histopathology confirmed the absence of malignancy and identified mineral deposits consistent with neuritis ossificans. Given the extensive nerve damage, nerve transfers were not feasible, leading to the decision to proceed with static suspension surgery. CONCLUSION: This case is the first known instance of neuritis ossificans affecting the facial nerve, emphasizing the diagnostic challenge in this rare condition. Histopathological evaluation was critical for diagnosis, informing the decision for static suspension surgery due to irreversible paralysis.
Ann Otol Rhinol Laryngol
· 2025 Dec · PMID 40616415
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OBJECTIVES: Novel biomechanics of the exhalation delivery system can deliver fluticasone (EDS-FLU; XHANCE) to sinonasal areas above the inferior turbinate, especially sinus drainage pathways not reached by standard nasal...OBJECTIVES: Novel biomechanics of the exhalation delivery system can deliver fluticasone (EDS-FLU; XHANCE) to sinonasal areas above the inferior turbinate, especially sinus drainage pathways not reached by standard nasal sprays. This study aimed to evaluate the effectiveness of EDS-FLU in treating chronic rhinosinusitis (CRS). METHODS: Studies were retrieved from PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases up to April 2024. We analyzed 5 studies that compared EDS-FLU with a control group (exhalation delivery system with placebo) on various outcomes, including the 22-item Sinonasal Outcome Test (SNOT-22), nasal symptom scores (congestion, facial pain, olfactory dysfunction, and rhinorrhea), nasal polyp scores, surgical indication rate, and the incidence of adverse effects. RESULTS: Five studies with 2129 patients were included. EDS-FLU significantly improved SNOT-22 score (-20.9657 [-23.5639; -18.3674]) and the polyp score (-1.5099 [-1.7810; -1.2388]) after 6 months. The incidence of epistaxis was significantly higher in the treatment group compared to the control group (OR = 5.7954 [2.1004; 15.9909]). Effects of EDS-FLU on polyp score (-0.6497 [-0.8186; -0.4807]), responder rate (OR = 2.1755 [1.2784; 3.7020]), complete responder rate (OR = 2.0423 [1.0109; 4.1262]), surgical indication rate (OR = 0.7313 [0.5459; 0.9797]), and SNOT-22 score (-6.1513 [-11.3054; -0.9972]) were significantly higher in the treatment group than in the control group. CONCLUSIONS: This study demonstrated that EDS-FLU (372 µg twice daily) produced statistically significant improvements compared to EDS-placebo in multiple subjective and objective outcomes, although some adverse effects, such as epistaxis, may occur.
Smith E, Adkins D, Gupta N
… +3 more, Dunlap QA, Lukins D, Cass ND
Ann Otol Rhinol Laryngol
· 2026 Jan · PMID 40583833
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OBJECTIVE: This case report describes an 82-year-old female presenting with sudden onset, total right-sided facial paralysis, later diagnosed as metastatic squamous cell carcinoma (SCC) with perineural invasion of the fa...OBJECTIVE: This case report describes an 82-year-old female presenting with sudden onset, total right-sided facial paralysis, later diagnosed as metastatic squamous cell carcinoma (SCC) with perineural invasion of the facial nerve. The case highlights the diagnostic challenges of facial paralysis with associated pain in elderly patients and underscores the importance of recognizing subtle imaging findings suggestive of malignancy. METHODS: A retrospective review of the patient's clinical presentation, imaging studies, surgical intervention, and pathological findings was conducted. RESULTS: The patient developed right-sided facial paralysis ten months prior to presentation, followed by progressive hearing loss, imbalance, and excruciating facial pain. Initial treatment, including intratympanic dexamethasone injections, failed to alleviate symptoms. Examination revealed a central tympanic membrane perforation, complete flaccid facial paralysis (House-Brackmann grade 6), and sensorineural hearing loss. Imaging showed subtle widening of the labyrinthine segment of the right facial nerve and geniculate ganglion on CT, with corresponding enhancement and a filling defect in the internal auditory canal (IAC) on MRI. The differential diagnosis included facial nerve schwannoma, hemangioma, atypical Ramsay Hunt syndrome, and metastatic SCC. Imaging findings prompted surgical biopsy via a transcanal endoscopic approach, which confirmed metastatic SCC. Despite targeted radiation therapy, the patient developed failure to thrive, transitioned to hospice, and passed away. CONCLUSION: This case emphasizes the need for thorough evaluation of atypical facial paralysis, particularly in elderly patients with a history of cutaneous malignancy. The presence of facial pain, progressive hearing loss, and imaging abnormalities should prompt consideration of perineural tumor spread. Early recognition and multidisciplinary management are critical for timely intervention and improved palliative care outcomes.
Ouverney LOC, Lucchetti G, Hansen da Silva C
… +3 more, Berzoini Albuquerque J, da Silva Ezequiel O, Lucchetti ALG
Ann Otol Rhinol Laryngol
· 2025 Dec · PMID 40583800
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OBJECTIVE: Despite the growing evidence on the role of spiritual and religious beliefs on physical and mental health outcomes, this remains inadequately explored in the field of otolaryngology, particularly for chronic c...OBJECTIVE: Despite the growing evidence on the role of spiritual and religious beliefs on physical and mental health outcomes, this remains inadequately explored in the field of otolaryngology, particularly for chronic conditions such as tinnitus. This study aims to investigate the influence of spiritual and religious beliefs on symptom severity, quality of life, and mental health of Brazilian patients with chronic subjective tinnitus. METHODS: Cross-sectional study including patients with chronic subjective tinnitus. SETTING: Specialized outpatient center in Brazil. Religious and spiritual variables (Duke Religion Index, FACIT-Sp 12, and SRCOPE - religious coping) were investigated on the relationship with tinnitus severity (Tinnitus Handicap Inventory), mental health (DASS-21), and quality of life (WHOQOL-Bref), adjusting for sociodemographics, clinical data, and physical examination findings. Linear Regression models were used. RESULTS: A total of 313 patients were included. Spiritual well-being measures were associated with better results (particularly for Meaning and Peace); meanwhile, negative religious coping was associated with worse outcomes for all variables. Religiosity has presented a mixed effect, with nonorganizational religiosity having better outcomes for mental health and quality of life, and intrinsic religiosity having worse outcomes for tinnitus severity. CONCLUSION: The present study found that religious and spiritual beliefs can have an important influence on the perception of tinnitus severity, mental health, and quality of life of individuals with chronic tinnitus. These findings support the importance of otolaryngologists' and audiologists' understanding of their patients' beliefs to provide more comprehensive and integrative care.
Ann Otol Rhinol Laryngol
· 2025 Dec · PMID 40560606
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OBJECTIVES: The submental island flap is a dependable option for head and neck reconstruction. Venous drainage depends on the submental vein, which typically drains into the facial vein and, subsequently, the internal ju...OBJECTIVES: The submental island flap is a dependable option for head and neck reconstruction. Venous drainage depends on the submental vein, which typically drains into the facial vein and, subsequently, the internal jugular vein. Variations in venous anatomy often involve drainage into the anterior jugular or external jugular venous systems. This study evaluates the likelihood of encountering submental venous anatomy variants and the accuracy of preoperative imaging in identifying them. METHODS: Twenty-two patients who underwent a submental island flap procedure at the University of New Mexico Hospital from 2015 through 2023 with defined submental venous anatomy were analyzed. Three surgeons, blinded to intraoperative findings, predicted venous anatomy from preoperative imaging, with inter-rater reliability assessed using Fleiss Kappa. RESULTS: Fifteen patients exhibited typical venous anatomy. Four patients' submental venous vasculature showed drainage into the external jugular vein, and 3 into the anterior jugular vein. Imaging reviews showed accuracy rates of 72.23%, 90.91%, and 86.36%, respectively. Analysis of cases with CT scans yielded k = 0.46 ( < .001). CONCLUSION: The submental island flap is versatile and reliable but demonstrates common variant venous anatomy. Accurate imaging-based predictions can optimize surgical efficiency and outcomes.
Lin ME, Ayo-Ajibola OO, Davis RJ
… +3 more, Castellanos CX, West JD, Kokot NC
Ann Otol Rhinol Laryngol
· 2025 Dec · PMID 40552514
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OBJECTIVES: To understand United States family medicine physicians' and trainees' awareness, understanding, and confidence in following HNC survivorship guidelines. METHODS: Cross-sectional survey regarding FM provider a...OBJECTIVES: To understand United States family medicine physicians' and trainees' awareness, understanding, and confidence in following HNC survivorship guidelines. METHODS: Cross-sectional survey regarding FM provider awareness of HNC survivorship guidelines. The survey was distributed to FM mailing lists and national forums. Descriptive statistics were used to characterize responses. RESULTS: Eighty-six-physician cohort of majority attending physicians (86.1%) reporting an average of 20.0 years in practice working in non-rural (75.6%) outpatient community medical centers (41.9%). Respondents rarely cared for HNC survivors - 4.9% of patients per provider on average. They were largely unaware of the updated AHNS guidelines (8.1%). Physicians were least aware of the importance of discussing sexual intimacy/dysfunction (29%), considering pituitary dysfunction among patients with prior skull base radiation (29.1%), and evaluating for thyroid dysfunction (54.65%). Physicians were generally aware of cardiovascular disease's impact on mortality risk (64.0%) and higher prevalence of lung cancer (60.5%) among HNC patients but were less aware of their increased risk of depression (45.4%) and suicide (39.5%). On a 5-point Likert scale, physicians endorsed high confidence in counseling about substance use cessation (mean = 3.67), screening for thyroid dysfunction (mean = 3.65), and low confidence in managing long-term effects of chemotherapy (mean = 1.48), radiotherapy (mean = 1.48), and surgery (mean = 1.47). Physicians endorsed moderate overall confidence in managing HNC patients (mean = 2.38). CONCLUSIONS: FM physicians are critical to HNC survivorship care but have a variable understanding of HNC survivorship guidelines. Increasing FM physicians' awareness and understanding of survivorship care will help to continue improvement in HNC survivors' quality of care and life.
Ann Otol Rhinol Laryngol
· 2025 Dec · PMID 40552511
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INTRODUCTION: Lymphatic malformations (LMs) are not uncommon findings in neonates, with an estimated incidence of 1 in 2000 live births. Most LMs involving the airway are grossly symptomatic and are diagnosed either pren...INTRODUCTION: Lymphatic malformations (LMs) are not uncommon findings in neonates, with an estimated incidence of 1 in 2000 live births. Most LMs involving the airway are grossly symptomatic and are diagnosed either prenatally or immediately after birth. In cases of airway LMs that are not diagnosed perinatally, the child often experiences significant symptoms beginning at birth. This case report describes a child presenting with stridor and snoring at the age of 17 months, a timeframe and clinical picture making LM a less likely diagnosis. CASE DESCRIPTION: A 17-month-old female presented to the pediatric otolaryngology clinic after referral for stridor and snoring with concern for laryngomalacia. Stridor was first noted 6 to 12 months prior to evaluation and was associated with an uri. Her breathing was described as low-pitched biphasic stridor, worse upon inspiration, with biphasic noises both at rest and with activity. Awake flexible laryngoscopy was significant for supraglottic erythema and edema, thickened epiglottis and arytenoids, shortened AE folds, and arytenoid prolapse. Urgent formal airway evaluation with sleep endoscopy, and microlaryngoscopy with bronchoscopy demonstrated amorphous irregularity of the epiglottis extending into the base of tongue concerning for lm. MRI revealed a lesion at the base of tongue consistent with lm. Treatment with oral sirolimus was initiated, and the patient's symptoms significantly improved. DISCUSSION: while most airway LMs are diagnosed perinatally, this case describes a later and more subtle presentation. This unique presentation suggests that clinical suspicion for LM should be considered in children with respiratory symptoms and prompt further diagnostic workup.
Ann Otol Rhinol Laryngol
· 2025 Nov · PMID 40539859
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BACKGROUND: Eagle Syndrome is characterized by an elongated or angulated styloid process, often linked to symptoms such as throat pain, otalgia, and dizziness. The association between styloid morphology and symptoms rema...BACKGROUND: Eagle Syndrome is characterized by an elongated or angulated styloid process, often linked to symptoms such as throat pain, otalgia, and dizziness. The association between styloid morphology and symptoms remains unclear. This study evaluates the potential correlation between styloid process characteristics and Eagle Syndrome symptoms. METHODS: This retrospective study included 945 patients who underwent paranasal sinus CT between 2019 and 2022. Styloid process length, angulation, and morphological types (continuous, pseudoarticular, and segmentary) were evaluated. Clinical symptoms, including throat pain, neck pain, headache, otalgia, and dizziness, were obtained from hospital records. Statistical analyses were performed to assess correlations between styloid process morphology and symptoms. RESULTS: The styloid process was continuous in 59.8%, pseudoarticular in 14.7%, and segmentary in 25.5% of patients. Significant differences were found in styloid process length across these types ( < .001), but not in angulation ( > .05). No statistically significant association was found between styloid process length, angulation, or type and the presence of symptoms ( > .05). CONCLUSION: Our findings suggest that styloid process morphology alone may not predict symptoms associated with Eagle Syndrome. Diagnosis should be based on a comprehensive clinical evaluation rather than radiological criteria alone. These results highlight the importance of integrating clinical evaluation with radiological findings rather than relying solely on imaging features.
de Groot ECM, Nyirjesy SC, Faden DL
… +4 more, Lin DT, Deschler DG, Feng AL, Richmon JD
Ann Otol Rhinol Laryngol
· 2025 Nov · PMID 40539857
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OBJECTIVE: Approximately 10% of recurrent oropharyngeal squamous cell carcinoma (OPSCC) cases undergoing salvage surgery require reconstruction. Treatment options include transoral robotic surgery (TORS) combined with mi...OBJECTIVE: Approximately 10% of recurrent oropharyngeal squamous cell carcinoma (OPSCC) cases undergoing salvage surgery require reconstruction. Treatment options include transoral robotic surgery (TORS) combined with microvascular free or pedicled flaps including the submental island flap (SMIF). This study evaluates perioperative, oncological, and functional outcomes of patients with recurrent OPSCC treated with TORS and SMIF reconstruction. METHODS: This retrospective cohort study included patients treated between 2019 and 2024. Perioperative, oncologic, and functional data were collected. Swallowing was evaluated with a video swallow study graded with the Dynamic Image Grade of Swallowing Toxicity (DIGEST) scoring system. A DIGEST-score increase of 2 points or more compared to baseline was considered a significant decrease in swallowing function. RESULTS: Eight patients were included. The mean time between initial OPSCC and recurrence was 4.7 years (SD = 3.1). Average operative time was 314 minutes (SD = 31.6). Three patients (37.5%) received a tracheostomy for 5 days. The median length of stay was 6.5 days (IQR = 6-7). Postoperative complications occurred in 2 patients (25%). Three patients (37.5%) underwent adjuvant therapy. During a follow-up time of 23.7 months (IQR = 19.1) 1 patient died due to disease. Patients required enteral feeding for a median of 43 days (IQR = 15-197). DIGEST-scores showed no significant change in swallowing at 6 weeks and 6 months compared to baseline. CONCLUSION: The SMIF is a reliable reconstructive option for salvage TORS-patients. It is readily available without microvascular expertise, provides healthy vascularized tissue that is outside the at-risk nodal basin, and results in excellent functional outcomes.
Imam MS, Alghamdi MAA, Albukhari JNA
… +11 more, AlAtawi SMI, Altuwariqi DTM, Mashoon Shen JAH, Mathkoor SAH, Al Talhi BS, Alosaimi RS, Alzahrani GA, Althobaity RS, Alhothly SAM, Dawood YMA, Alsobky ME
Ann Otol Rhinol Laryngol
· 2025 Nov · PMID 40538165
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OBJECTIVES: An association between COVID-19 and olfactory dysfunction has been reported worldwide. It has been recognized that olfactory dysfunction may be the only sign of COVID-19. Reports demonstrate an increase of th...OBJECTIVES: An association between COVID-19 and olfactory dysfunction has been reported worldwide. It has been recognized that olfactory dysfunction may be the only sign of COVID-19. Reports demonstrate an increase of the nasal calcium levels in the patients with olfactory dysfunction. Disodium orthophosphate is a calcium chelating agent which may be associated with improving olfactory function. The main objective of this study is to investigate the effect of intranasal disodium orthophosphate on reducing the increase of calcium in the mucus of patients with olfactory dysfunction post COVID-19, thereby improving the olfaction process. METHODS: Fifty-two patients with a history of COVID-19 and olfactory dysfunction persisted more than 6 months were enrolled in prospective randomized blinded double controlled clinical trial. They received a nasal spray containing either 0.9% sodium chloride or 1% disodium orthophosphate. Olfactory function was assessed before treatment and 2 months later using the Sniffin' Sticks test. Quantitative analysis of calcium level in the nasal secretions was performed using a prepared screen-printed ion-selective electrode. RESULTS: Compared to sodium chloride, intranasal disodium orthophosphate resulted in a reduction in nasal calcium concentrations. Clinically, 81% of patients in this group demonstrated improvement in olfactory function, with a shift from anosmia to hyposmia based on TDI score classification. CONCLUSIONS: Intra-nasal disodium orthophosphate is beneficial in improving olfactory dysfunction post COVID-19.
Shah B, Xu W, Bartholomew RA
… +9 more, Ben-Shlomo N, Zhang A, Fan G, Unadkat P, Ziaei A, Zhou H, Guenette JP, Corrales CE, Jagadeesan J
Ann Otol Rhinol Laryngol
· 2025 Nov · PMID 40537409
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OBJECTIVE: To design and validate an augmented reality application for identification of temporal bone anatomy. BACKGROUND: The anatomy of the temporal bone is highly complex and can present challenges for operative plan...OBJECTIVE: To design and validate an augmented reality application for identification of temporal bone anatomy. BACKGROUND: The anatomy of the temporal bone is highly complex and can present challenges for operative planning and for education of both patients and medical trainees. METHODS: An augmented reality application for visualization and identification of temporal bone anatomy in 3D was developed using Slicer, OpenGL, and Angle libraries on the Augmented Reality on Microsoft HoloLens (AR-MH). A total of 14 physicians, including 7 otolaryngologists (4 trainees and 3 attendings) and 7 radiologists (4 trainees and 3 attendings), participated in this study to visualize temporal bone structures using 2D CT imaging, 3D CT model visualization on a monitor, and AR-MH. Quantitative metrics to compare the users' performance between modalities included time taken to identify structures, accuracy of identification, and the NASA Task Load Index. RESULTS: The rendering rate for individual models was 60 fps, excluding the temporal bone model. The mean time for participants to identify 16 structures was 3:04 minutes on 2D, 2:02 minutes on 3D, and 2:09 minutes on AR-MH. The adjusted accuracy of identifying structures was 89.0% on 2D, 93.2% on 3D, and 91.6% on AR-MH. Mean NASA-TLX values showed no significant difference in workload metrics between modalities. Visualization of anatomy in 3D (either on a monitor or via AR-MH) resulted in greater speed and accuracy of anatomy identification for trainees but not attendings. CONCLUSION: Augmented reality provides a means of intuitively visualizing temporal bone anatomy which may function as an effective tool for surgical planning and education, particularly for novices.
Schwarz Y, Ben-David E, Yeshua T
… +4 more, Ben-Haim Y, Shaul C, Sichel JY, Attal P
Ann Otol Rhinol Laryngol
· 2025 Nov · PMID 40537407
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OBJECTIVE: To investigate whether inferior turbinate position contributes to nasal obstruction in congenital nasal pyriform aperture stenosis (CNPAS) by characterizing the position of the inferior turbinates compared to...OBJECTIVE: To investigate whether inferior turbinate position contributes to nasal obstruction in congenital nasal pyriform aperture stenosis (CNPAS) by characterizing the position of the inferior turbinates compared to healthy newborns via computed tomography (CT). METHODS: In this retrospective case-control study, CT scans of 12 CNPAS newborns that were part of their diagnostic workup and the CT scans of 31 control newborns obtained for unrelated clinical reasons were analyzed. Measurements included aperture width, distance between the inferior turbinates, the anterior nasal wall as well as the mid-nasal and choanal widths. RESULTS: The CNPAS cases consistently showed medialized inferior turbinates in the anterior nasal cavities. The mean distance between the inferior turbinates was significantly narrower (3.98 ± 0.63 mm) than the distance between the maxillary processes of the pyriform aperture (4.94 ± 0.88 mm) in the CNPAS infants as compared to 8.48 ± 1.12 and 11.95 ± 1.13 mm respectively in the controls ( < .001 for both comparisons). The average ratio of the inferior turbinate distance to the lateral nasal cavity wall width was 0.35 ± 0.08 in the CNPAS versus 0.50 ± 0.05 in the controls ( < .001). In all the CNPAS cases, the mid-nasal width was narrower than the choanal width ( < .001), whereas in the control group, the mid-nasal width was wider ( < .001). CONCLUSION: These results indicate that the inferior turbinates tend to be medialized in newborns with CNPAS. This suggests that the inferior turbinates may be a significant factor in infants with CNPAS, thus pointing to the potential value of their surgical reduction. Therefore, measuring the inferior turbinate width can provide additional insight into the severity of nasal obstruction and assist in determining the appropriate management strategy.
Michael A, Russillo M, Katwala A
… +3 more, Buchakjian MR, Pagedar NA, Bayon R
Ann Otol Rhinol Laryngol
· 2025 Nov · PMID 40522196
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BACKGROUND: Surgical management of oropharyngeal p16 positive squamous cell carcinoma (p16+ OPSCC) often includes neck dissection, however the prevalence of level IB metastasis is not widely reported. Our study aims to d...BACKGROUND: Surgical management of oropharyngeal p16 positive squamous cell carcinoma (p16+ OPSCC) often includes neck dissection, however the prevalence of level IB metastasis is not widely reported. Our study aims to determine the prevalence of level IB nodal metastasis in p16+ OPSCC to help determine if level IB should routinely be included in neck dissection. METHODS: We assessed a 102 patient cohort of surgically treated p16+ OPSCC to determine the prevalence of level IB metastasis among patients that underwent neck dissection and TORS. RESULTS: One hundred two patients (105 necks) underwent TORS neck dissection. A 52.9% (n = 54) of patients presented with T1 tumors and 39.2% (n = 40) of patients presented with T2 disease. Perineural invasion was noted in 12.7% (n = 13) of patients, while lymphovascular invasion was noted in 26.5% (n = 27) of patients. Extranodal extension was noted in 41.2% (n = 42) of neck dissection specimens. The average number of nodes dissected per neck was 35.1 (SD = 12.9). Metastasis to cervical lymph nodes was noted in 91 patients (89.2%). Level IIA was most frequently affected (n = 85, 93.4%), followed by level III (n = 29, 31.9%) and level IIB (n = 15, 16.5%). Metastasis to level IB was noted in 3 patients out of 102 that underwent dissection of level IB (2.9%). No patients in this cohort were found to have metastasis to levels V or VI. Nine patients (8.8%) were found to have recurrence of any kind. Of those that did have recurrence of disease, 2 were classified as local, 3 (2.9%) classified as regional, and 4 (3.9%) classified as distant. CONCLUSION: Our results indicate a low burden of metastatic disease in the level IB nodal basin concordant with results reported by other institutions. We argue that the level IB nodal basin should not be routinely included in neck dissection for p16+ OPSCC.
Ann Otol Rhinol Laryngol
· 2025 Nov · PMID 40522188
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AIM: To report a rare occurrence of 2 granulomatous diseases in a patient. BACKGROUND: Rhinosporidiosis is common in certain parts of tropical countries but rare in other regions. The migration of people in search of opp...AIM: To report a rare occurrence of 2 granulomatous diseases in a patient. BACKGROUND: Rhinosporidiosis is common in certain parts of tropical countries but rare in other regions. The migration of people in search of opportunities has led to the spread of contagious diseases. Although tuberculosis is prevalent in India, we had to perform a GeneXpert analysis to prove that the granulomatous lymphadenitis was due to tuberculosis and not rhinosporidiosis. CASE DESCRIPTION: This is a case of nasal rhinosporidiosis with tuberculous cervical lymphadenitis in a 40-year-old male. He underwent excision of the rhinosporidiosis lesion and was started on multidrug therapy for treatment. CONCLUSION AND CLINICAL SIGNIFICANCE: We present a case of rhinosporidiosis coexisting with tuberculous cervical lymphadenitis in a patient, both of which are granulomatous diseases. Rhinosporidiosis can also cause lymphatic spread to regional lymphadenitis with features of granulomas in histopathology. We diagnosed 2 granulomatous diseases in this patient by confirming tuberculous lymphadenitis using the GeneXpert test. Treatment was newly formulated with multiple drugs to address both granulomatous diseases.