Otorhinolaryngology RSS : Gourt

Long-term Health-Related Quality of Life in Survivors of Head and Neck Cancer [Original Article]

Objective To examine health-related quality of life (HRQOL) reported by 5-year head and neck cancer survivors and factors that predicted these long-term scores. Design Prospective, observational outcomes study. Setting Tertiary care institution. Patients A total of 337 patients diagnosed as having head and neck carcinoma between January 1995 and December 2004, who enrolled in the Outcomes Assessment Project and survived at least 5 years. Interventions While participating in the longitudinal Outcomes Assessment Project, patients filled out surveys measuring HRQOL at numerous points in time. Main Outcome Measures Outcomes included 5-year scores in eating, speech, aesthetics, social disruption, physical and mental health, depressive symptoms, and overall quality of life (QOL). In addition to analyzing patients' 5-year HRQOL outcomes, multivariate analyses were performed to determine which patient, clinical, treatment, and 1-year HRQOL factors independently predicted these 5-year outcomes. Results Overall, the cohort's long-term general health was similar to that to age-matched norms from the general population. But over 50% of these survivors had problems eating, 28.5% reported depressive symptoms, and 17.3% reported substantial pain. At long-term follow-up, 13.6% continued to smoke, and 38.9% used alcohol. Multivariate analyses demonstrated that 1-year pain and diet were the strongest independent predictors of 5-year HRQOL outcomes. Conclusions Eating problems due to poor oropharyngeal functioning and persistent pain are the most prevalent problems that these survivors face. Early interventions addressing eating issues, swallowing problems, and pain management will be a crucial component in improving this patient population's long-term QOL, especially in those who are functioning poorly 1 year after diagnosis.

Sequential Bilateral Cochlear Implantation in Children: Quality of Life [Original Article]

Objective To assess the effect of sequential bilateral cochlear implantation in children on their quality of life (QoL). Design Prospective cohort-control study. Setting Tertiary academic referral center. Patients Thirty children with prelingual deafness underwent sequential bilateral cochlear implantation (mean age at first implant, 1.8 years; mean age at second implant, 5.3 years). Nine children with a unilateral cochlear implant were also included in the study. All children had prelingual deafness, had good implant performance, and had no benefit from a contralateral conventional hearing aid. The groups were matched on duration of unilateral implant use, chronological age, and degree of bilateral hearing loss. Intervention Sequential bilateral cochlear implantation. Main Outcome Measures Quality of life was assessed before surgery of the second implant and after 12 and 24 months of bilateral implant use. In the children with a unilateral cochlear implant, QoL was assessed over time and was compared with the study group after 12 and 24 months. Six questionnaires were used to measure QoL: overall health status using a visual analog scale; the Health Utilities Index Mark 3 (HUI3); the Pediatric Quality of Life Inventory (PedsQL); the Glasgow Children's Benefit Inventory (GCBI); the Speech, Spatial, and Qualities of Hearing Scale (SSQ); and the Nijmegen Cochlear Implant Questionnaire (NCIQ). Results Results showed no significant gain in generic QoL measures associated with sequential bilateral cochlear implantation (P > .05). The nonsignificant effect yielded on the HUI3 could be attributed to the ceiling effect and the lack of resolution in the hearing domain obtained in cochlear implant recipients. The gain in QoL of +0.04 may, therefore, be underestimated. In contrast, the 3 disease-specific questionnaires showed a significant improvement in QoL (P < .05). Results also showed that, unlike the children with a unilateral implant, QoL measures continued to improve with longer durations of bilateral implant use. Within the study group, the age at second implantation had no influence on the gain in QoL (P > .05). Conclusion Sequential bilateral cochlear implantation in children is associated with an improvement in QoL, although this is predominantly reflected in the disease-related aspects of QoL and not necessarily in generic QoL.

Disinfection of Flexible Fiberoptic Laryngoscopes After In Vitro Contamination With Staphylococcus aureus and Candida albicans [Original Article]

Objective To determine the efficacy of various cleaning and disinfective methods in reducing bacterial and fungal load on flexible fiberoptic laryngoscopes (FFLs). Design In vitro model. Subjects Flexible fiberoptic laryngoscopes contaminated with Staphylococcus aureus and Candida albicans. Interventions Contamination with S aureus and C albicans was separately induced on FFLs, which were then disinfected with different protocols: 20-, 15-, 10-, and 5-minute soaks in ortho-phthalaldehyde (Cidex OPA; Johnson & Johnson) with or without presoaking in an enzymatic soap solution for 5 minutes; an isolated 5-minute soak in an enzymatic soap solution; a 30-second wipe with antibacterial soap and water; a 30-second wipe with isopropyl alcohol; a 30-second wipe with antibacterial soap, followed by a 30-second scrub with isopropyl alcohol; and a 30-second wipe with germicidal cloth, all accompanied by previous rinsing with 30 seconds of running tap water. Results All protocols except the isolated 5-minute soak in enzymatic soap solution were successful in completely disinfecting the FFLs after experimental contamination with S aureus or C albicans. Conclusion Various different cleaning methods appeared to properly disinfect FFLs after inoculation with S aureus and C albicans in an in vitro model.

Winter scene, Pittsburgh, Pennsylvania [About the Cover]

About This Journal [About This Journal]

In Memoriam: John Albert Kirchner, MD (1915-2011) [Reflections]

Qualities of Residency Applicants: Comparison of Otolaryngology Program Criteria With Applicant Expectations [Original Article]

Objectives To evaluate the criteria used by otolaryngology programs in ranking residency candidates and to compare residency candidate ranking criteria among otolaryngology programs and applicant expectations. Design Cross-sectional, anonymous survey administered during the 2009 and 2010 match cycles. Setting Otolaryngology residency programs. Participants Otolaryngology residency program applicants (PAs) and otolaryngology program directors (PDs). Main Outcome Measures The PDs were asked to rank the importance of 10 criteria in choosing a residency candidate on a 20-point scale (with 1 indicating utmost importance; 20, not important at all). The PAs were asked to express their expectations of how candidates should be ranked using those same criteria. Results The interview and personal knowledge of the applicant (mean rank, 3.63) were the most important criteria to PDs, whereas the interview and letters of recommendation (mean rank, 3.65) were the most important criteria among PAs. Likelihood to rank program highly and ethnicity/sex were the least valued by PDs and PAs. Conclusions Although PDs and PAs agree on the least important criteria for ranking otolaryngology residency candidates, they disagree on the most important criteria. This information provides insight into how programs select residency candidates and how this compares with applicant expectations. Furthermore, this information will assist applicants in understanding how they might be evaluated by programs. Improved understanding of the match process may increase the likelihood of having a good fit between otolaryngology programs and matched applicants.

Therapeutic Sialendoscopy for the Management of Radioiodine Sialadenitis [Original Article]

Objective To describe our experience with therapeutic sialendoscopy for radioiodine (iodine 131 [131I]) sialadenitis. Design Retrospective medical chart review. Setting Academic tertiary referral center. Patients The study included 11 patients who underwent therapeutic sialendoscopy for the treatment of 131I sialadenitis after failing medical management. Interventions Therapeutic sialendoscopy with dilation and irrigation of the ductal system was performed in all patients. Main Outcome Measures Patient-reported frequency and severity of symptoms. Results Our series included 9 women and 2 men (mean age, 51 years; age range, 35-65 years). A total of 23 parotid glands and 5 submandibular glands were treated. Sialendoscopy was possible in all patients, except one in whom the Stensen duct could not be cannulated. Typical endoscopic findings included pale ductal mucosa, thick mucous plugs, ductal debris, and stenosis of the duct. Most patients (91%) reported improvement of symptoms after a single procedure. Complete resolution of symptoms, with sustained benefit, was reported by 6 patients (54%) at a mean follow-up of 18 months. Partial improvement of symptoms, with some persistent intermittent episodes of pain or swelling, was reported by 4 patients (36%). One patient reported no subjective symptomatic improvement after 2 procedures and subsequently underwent a parotidectomy. Conclusions Sialendoscopy is useful for the improvement of symptoms due to radioiodine-induced sialadenitis in patients who are refractory to conservative medical therapy. Therapeutic sialendoscopy appears to provide effective and sustained symptom improvement in most patients in our experience.

Impact of Incision and Drainage of Infected Thyroglossal Duct Cyst on Recurrence After Sistrunk Procedure [Original Article]

Objective To determine whether incision and drainage of infected thyroglossal duct cysts (TGDCs) is associated with increased risk of recurrence after Sistrunk procedure when compared with antibiotic treatment alone. Design Retrospective case review. Setting Tertiary referral practice. Patients Patients treated for thyroglossal duct remnants in a tertiary care pediatric center from January 1, 2002, through December 31, 2008. Study subjects were identified using the diagnosis code for TGDC or the procedure code for excision of thyroglossal duct cyst or sinus. Main Outcome Measures The presence of infection, treatment of infected TGDCs, and relationship between infection, treatment of infection, and recurrence. Results We identified 120 patients from 2002 through 2008 who met the search criteria. The mean age at the time of presentation was 5.1 years; at the time of surgery, 5.4 years. More than half the patients (58.2%) were male, and the most common presentation was an asymptomatic midline neck mass. Forty-nine of our patients (40.8%) had a history of infection and 6 of these (12%) required incision and drainage. The overall recurrence rate was 10.8%. Ten of the patients with preoperative infection (20%) had a recurrence compared with 3 of the 71 patients (4%) without preoperative infection (P = .002). Of all patients with recurrences, only 1 had undergone incision and drainage. Conclusions This case series suggests that preoperative infection is associated with an increased recurrence rate. Incision and drainage of an infected TGDC may not increase the risk of postoperative recurrence. The results of this case series may assist in preoperative counseling and management of infected TGDC prior to definitive surgery.

Non-Cancer-Related Deaths From Suicide, Cardiovascular Disease, and Pneumonia in Patients With Oral Cavity and Oropharyngeal Squamous Carcinoma [Original Article]

Objective To study non–cancer-related mortality rates over time and examine the possible causes for several major deaths in patients with oral cavity and oropharyngeal (OC/OP) cancer. Design Retrospective cohort analysis using the Surveillance, Epidemiology, and End Results (SEER) cancer registry data of the National Cancer Institute. Main Outcome Measure Cause-specific mortality rates during the first year after diagnosis of OC/OP cancer were calculated for 4 cohorts (1980-1984, 1990-1994, 2000-2003, and 2004-2007). The percentage changes over time were calculated. Standardized mortality ratios (SMRs) for suicide, cardiovascular disease, and pneumonia were calculated and compared with patient demographic and clinical characteristics. Results We analyzed data for 32 487 patients in 4 cohorts. From 1980-1984 to 2004-2007, mortality from suicide increased by 406.2% (P = .01), cardiovascular disease–related and pneumonia–related mortality decreased by 45.9% (P < .001) and 42.9% (P = .009), respectively, and rates of other non–cancer-related deaths did not change. Compared with the general population, patients diagnosed as having OC/OP cancer were at a significantly higher risk of mortality from suicide (SMR, 7.8; 95% CI, 4.6-12.4; P < .001), cardiovascular disease (SMR, 2.4; 95% CI, 2.1-2.7; P < .001), and pneumonia (SMR, 8.9; 95% CI, 6.8-11.5; P < .001) during the first year after cancer diagnosis. Risk factors for increased mortality included age of 55 to 64 years, marital status (including never married, divorced, or separated), advanced tumor stage (including regional and distant disease), treatment with radiotherapy alone, and pharyngeal tumor location. Conclusions Suicide rates have significantly increased in patients with OC/OP cancer since 1980 to 1984. Although cardiovascular disease–and pneumonia-related deaths have significantly decreased over time, they remain higher than the general US population. Increased knowledge of risk factors associated with non–cancer-related mortality in OC/OP cancer may lead to early intervention and enhanced overall survival.

Efficacy and Safety of Central Compartment Neck Dissection for Recurrent Thyroid Carcinoma [Original Article]

Objective To explore the safety and efficacy of central compartment neck dissection (CCND) in the treatment of well-differentiated thyroid carcinoma (WDTC) recurrences in the central compartment of the neck. Design Retrospective medical chart review. Setting Tertiary-care academic hospital. Patients Eighty-two consecutively treated patients with recurrent WDTC, with a median follow-up of 28 months. Main Outcome Measures Postoperative complications, disease control posttreatment, and normalization of serum thyroglobulin (Tg) level. Results Eighty-two patients underwent 86 central compartment procedures. Only CCND was performed in 36 patients (42%), while a lateral neck dissection was also required in the remainder. Postoperative hypoparathyroidism was temporary in 17 patients (20%) and permanent in 6 patients (7%). Postoperative intact serum parathyroid hormone level was greater than 15.0 pg/mL (to convert to nanograms per liter, multiply by 1.0) in 81% of patients, accurately predicting eucalcemia postoperatively. Unilateral recurrent laryngeal nerve injury was transient in 3 patients (2% of nerves at risk) and permanent in 3 patients (2%). Seventeen patients (21%) experienced subsequent recurrences after their CCND—2 patients (2%) had recurrence in the central neck, 8 (9%) in the lateral neck, 2 (2%) in the central and lateral neck, and 7 (8%) at distant sites. Twenty-seven patients underwent a CCND alone and were deemed appropriate for efficacy analysis. The Tg level was normalized in 15 patients (56%) in the group overall. Normalization occurred in 10 of the 20 patients (50%) who received sodium iodide I 131 ablation and in 5 of the 7 patients (71%) who did not. Conclusion Central compartment neck dissection is a safe and efficacious procedure for the management of central neck recurrences in WDTC.

Radial Forearm Free Flap Donor Site Morbidity: Ulnar-Based Transposition Flap vs Split-Thickness Skin Graft [Original Article]

Objectives To evaluate morbidity associated with the radial forearm free flap donor site and to compare functional and aesthetic outcomes of ulnar-based transposition flap (UBTF) vs split-thickness skin graft (STSG) closure of the donor site. Design Case-control study. Setting Tertiary care institution. Patients The inclusion criteria were flap size not exceeding 30 cm2, patient availability for a single follow-up visit, and performance of surgery at least 6 months previously. Forty-four patients were included in the study and were reviewed. Twenty-two patients had UBTF closure, and 22 had STSG closure. Main Outcome Measures Variables analyzed included wrist mobility, Michigan Hand Outcomes Questionnaire scores, pinch and grip strength (using a dynamometer), and hand sensitivity (using monofilament testing over the radial nerve distribution). In analyses of operated arms vs nonoperated arms, variables obtained only for the operated arms included Vancouver Scar Scale scores and visual analog scale scores for Aesthetics and Overall Arm Function. Results The mean (SD) wrist extension was significantly better in the UBTF group (56.0° [10.4°] for nonoperated arms and 62.0° [9.7°] for operated arms) than in the STSG group (59.0° [7.1°] for nonoperated arms and 58.4° [12.1°] for operated arms) (P = .02). The improvement in wrist range of motion for the UBTF group approached statistical significance (P = .07). All other variables (Michigan Hand Outcomes Questionnaire scores, pinch and grip strength, hand sensitivity, and visual analog scale scores) were significantly better for nonoperated arms vs operated arms, but no significant differences were observed between the UBTF and STSG groups. Conclusions The radial forearm free flap donor site carries significant morbidity. Donor site UBTF closure was associated with improved wrist extension and represents an alternative method of closure for small donor site defects.

The Role of Molecular Markers and Tumor Histological Type in Central Lymph Node Metastasis of Papillary Thyroid Carcinoma [Original Article]

Objective To look for genetic mutations that might predict central compartment lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) using strict criteria for N0 and N1 disease. Design We identified patients with PTC from our institution's pathology archives. Strict criteria were used for assessing the presence or the absence of central neck LNM. Disease was classified as N0 only if a comprehensive ipsilateral and pretracheal central neck dissection was performed and if pathological analysis revealed no evidence of LNM. Primary tumor samples were analyzed for a panel of known or suspected PTC-associated molecular markers, including BRAF, RET -PTC, KRAS, NRAS, HRAS, PIK3CA, and their variants. Setting Academic medical center. Patients Three hundred eighty-nine patients with PTC. Main Outcome Measure Molecular mutations in tumors with and without LNM. Results Of 389 identified cases, 209 fit the inclusion criteria, with 158 classified as node positive (N1) and 51 as node negative (N0). The follicular variant histological type was present in 7 of 158 N1 tumors (4.4%) and 24 of 51 N0 tumors (47.1%) and thus was strongly associated with lack of central neck metastasis in this study (odds ratio, 0.05; 95% CI, 0.02-0.14). Predictive factors for central LNM included extracapsular extension, angiolymphatic invasion, and higher T stage (T3 and T4). The BRAF mutation was more prevalent in the classic PTC histological type than the follicular variant. None of the molecular marker mutations that were analyzed in this study, including the BRAF mutation, predicted LNM in classic PTC. Conclusions Positive risk factors for central LNM include male sex, extracapsular extension, angiolymphatic invasion, and advanced T stage. The follicular variant histological type has a significantly lower incidence of central neck metastasis. In contrast to recent studies, the BRAF mutation was not significantly associated with central neck LNM from PTC when using a strict definition of a central neck dissection.

Supraglottoplasty for Occult Laryngomalacia to Improve Obstructive Sleep Apnea Syndrome [Original Article]

Objective To evaluate the polysomnographic outcomes after supraglottoplasty (SGP) performed for obstructive sleep apnea syndrome (OSAS) associated with occult laryngomalacia. Design Retrospective case series with medical chart review. Setting Tertiary pediatric medical center. Patients Twenty-two patients aged 2 to 17 years met the inclusion criteria of polysomnography-proven OSAS and occult laryngomalacia seen on flexible fiber-optic sleep endoscopy. Infants with congenital laryngomalacia were excluded. Intervention Carbon dioxide laser SGP was performed either alone or in conjunction with other operations for OSAS. Main Outcome Measure Preoperative and postoperative nocturnal polysomnographic data were paired and analyzed statistically. Results Supraglottoplasty for occult laryngomalacia resulted in statistically significant reduction in the apnea-hypopnea index (AHI) (from 15.4 to 5.4) (P <.001). Subgroup analysis of children who underwent either SGP alone or in combination with other interventions showed comparable reductions in AHI. Medical comorbidities were associated with worsened postoperative outcomes, although still significantly improved compared with baseline. Overall, 91% of children had an improvement in AHI, and 64% had only mild or no residual OSAS after SGP. Conclusion Supraglottoplasty is an effective technique for the treatment of OSAS associated with occult laryngomalacia.

Association Between Obstructive Sleep Apnea and Sudden Sensorineural Hearing Loss: A Population-Based Case-Control Study [Original Article]

Objective To examine the putative association between obstructive sleep apnea (OSA) and sudden sensorineural hearing loss (SSNHL) using a nationwide population-based data set. Obstructive sleep apnea has been associated with generalized inflammation and nervous-endocrine, cardiovascular, and other systemic biophysiologic phenomena. However, to our knowledge, no investigations have been conducted using large data sets to examine the association between OSA and auditory disorders. Design Case-control study. Participants We identified 3192 patients diagnosed with SSNHL from the Taiwan Longitudinal Health Insurance Database as the study group and randomly extracted the data of 15 960 subjects matched by sex, age and year of first SSNHL diagnosis as controls. Main Outcome Measures Cases of OSA were identified by having been diagnosed as OSA prior to the index date of SSNHL diagnosis. Conditional logistic regression matched on age group and sex was used to assess the possible association between SSNHL and OSA among the sampled patients. Results Of 19 152 patients, 1.2% had OSA diagnoses prior to the index date; OSA was diagnosed in 1.7% of the SSNHL group and 1.2% of the controls. After adjusting for sociodemographic characteristics and co-morbid medical disorders, we found that male patients with SSNHL were more likely to have prior OSA than controls (odds ratio, 1.48; 95% CI, 1.02-2.16) (P = .04). No such association was found among female patients. Conclusions Male patients with SSNHL had a higher proportion of prior OSA than non-SSNHL-diagnosed controls; no such association was found among female patients. Further study will be needed to confirm our findings, explore the underlying pathomechanisms, and investigate the difference between sexes.

Vocal Outcome After Arytenoid Adduction and Ansa Cervicalis Transfer [Original Article]

Objective To evaluate the long-term efficacy of arytenoid adduction (AA) combined with ansa cervicalis–recurrent laryngeal nerve anastomosis (ACN-RLN) in the treatment of unilateral vocal fold paralysis. Design Retrospective review of clinical records. Setting Institutional practice. Patients Nine patients with severe paralytic dysphonia with large glottal gap were included. Voice outcome was followed up over 24 months postoperatively. One patient did not attend the 24-month evaluation. Interventions All patients underwent AA + ACN-RLN. The ansa cervicalis nerve to the sternohyoid muscle was used as the donor nerve. Main Outcome Measures Maximum phonation time (MPT), pitch range, harmonics-to-noise ratio (HNR), and perceptual voice quality were evaluated preoperatively and postoperatively at 1 to 3 months, 6 to 8 months, 12 to 14 months, and 24 months. Results All parameters improved significantly after surgery and continued to improve over the 24-month period. The MPT continued to improve over time (P = .01, P = .006, and P = .001 when comparing the 1- to 3-month evaluation with the 6- to 8-month, 12- to 14-month, and 24-month evaluations, respectively). Also, pitch range and HNR showed significant, steady improvement over the 24-month duration of the study. Perceptual voice quality markedly improved at 24 months compared with the 1- to 3-month, 6- to 8-month, and 12- to 14-month follow-ups (P = .004, P = .005, and P = .02, respectively, for grade overall, and P = .004, P = .008, and P = .02, respectively, for breathiness grade). Conclusions Treatment with AA + ACN-RLN provides near-normal vocal function in the 24-month follow-up. Therefore, this method could be a successful surgical treatment for severe paralytic dysphonia.

A Clinical and Histopathologic Study of Jugular Bulb Abnormalities [Original Article]

Objective To further define the spectrum of clinical presentation and explore the histologic sequelae of jugular bulb abnormalities (JBAs). Design Retrospective review. Setting Academic medical center. Patients Thirty patients with radiologic evidence of inner ear dehiscence by JBA. Main Outcome Measure Thirty patients with radiologic inner ear dehiscence by JBA and 1579 temporal bone specimens were evaluated for consequences from JBA. Results We found that JBA-associated inner ear dehiscence could be identified on computed tomography of the temporal bone but not on magnetic resonance imaging scan. Jugular bulb abnormalities eroded the vestibular aqueduct most often (in 25 patients), followed by the facial nerve (5 patients) and the posterior semicircular canal (4 patients). Half of the patients (15) were asymptomatic. Results from vestibular evoked myogenic potential (VEMP) tests were positive in 8 of 12 patients with inner ear dehiscence. Histologically, only 2 of 41 temporal bones with dehiscence of the vestibular aqueduct demonstrated endolymphatic hydrops. Conclusions Jugular bulb abnormalities can erode into the vestibular aqueduct, facial nerve, and the posterior semicircular canal. While symptoms may include pulsatile tinnitus, vertigo, or conductive hearing loss, in contrast to earlier reports, half of the patients were asymptomatic. Dehiscence of vestibular aqueduct rarely leads to clinical or histologic hydrops. The VEMP testing was useful in confirming the presence of inner ear dehiscence due to JBAs. Because the natural history of JBAs is unknown, these patients should be followed closely to evaluate for progression of the JBA or development of symptoms.

Surgical Management of Auricular Infantile Hemangiomas [Original Article]

Objective To report our experience with surgical management of auricular infantile hemangiomas and reconstruction of the affected ear. Design Retrospective case series. Setting Dedicated Birthmarks and Vascular Anomalies Center in a tertiary pediatric hospital. Patients Ten patients with surgically treated, histopathologically confirmed auricular infantile hemangiomas. Main Outcome Measures Outcomes of surgical management. Results The case series included 5 male and 5 female patients (age range, 4 months to 4 years). Indications for surgery were pain, bleeding, infection, and cosmetic deformity. Four patients had failed prior medical treatment, including pulsed dye laser, topical corticosteroids, and intralesional corticosteroids. Nine patients underwent single-stage resection. Otoplasty reconstruction was performed in 2 patients with hemangioma-induced deformities, while primary Z-plasty closure was performed in 2 patients with extensive lesions. No recurrence or complication has been reported to date. Conclusions Most infantile hemangiomas do not require treatment. Surgical excision of auricular infantile hemangiomas at any phase is effective in preventing fibrofatty scarring, reducing cartilage deformities, and treating complicated cases or patients who have failed medical management. Surgical excision with Z-plasty reconstruction is a viable option that should be considered to limit postoperative deformities.

Tracheal Obstruction Due to Heterotopic Ossification in a Tracheostomy Scar [Clinical Note]

Spontaneous Cerebrospinal Fluid Rhinorrhea of the Foramen Cecum in Adulthood [Clinical Note]

Nasoseptal Cholesterol Granuloma: A Case Report and Review of Pathogenesis [Clinical Note]

Cholesterol granulomas are rare inflammatory deposits that can be located corporally, but are classically found in the petrous apex and other pneumatized areas of the temporal bone. Originally thought to be a response to hypoventilation due to mucosal swelling and occlusion of air cells, the pathogenesis of cholesterol granulomas recently has come under speculation. This is partly due to new theories of the importance of a rich blood supply in the lesion's development. Cholesterol granulomas have been reported in uncommon areas of the head and neck, such as surrounding the endolymphatic sac and pterygoid process of the sphenoid sinus.1 This entity has been described within the paranasal sinuses, including the maxillary, ethmoid, sphenoid, and frontal sinus locations. To our knowledge, we report the first case of a nasoseptal cholesterol granuloma.

Otorhinolaryngology RSS : Gourt

Long-term Health-Related Quality of Life in Survivors of Head and Neck Cancer [Original Article]

Sequential Bilateral Cochlear Implantation in Children: Quality of Life [Original Article]

Disinfection of Flexible Fiberoptic Laryngoscopes After In Vitro Contamination With Staphylococcus aureus and Candida albicans [Original Article]

Winter scene, Pittsburgh, Pennsylvania [About the Cover]

About This Journal [About This Journal]

In Memoriam: John Albert Kirchner, MD (1915-2011) [Reflections]

Qualities of Residency Applicants: Comparison of Otolaryngology Program Criteria With Applicant Expectations [Original Article]

Therapeutic Sialendoscopy for the Management of Radioiodine Sialadenitis [Original Article]

Impact of Incision and Drainage of Infected Thyroglossal Duct Cyst on Recurrence After Sistrunk Procedure [Original Article]

Non-Cancer-Related Deaths From Suicide, Cardiovascular Disease, and Pneumonia in Patients With Oral Cavity and Oropharyngeal Squamous Carcinoma [Original Article]

Efficacy and Safety of Central Compartment Neck Dissection for Recurrent Thyroid Carcinoma [Original Article]

Radial Forearm Free Flap Donor Site Morbidity: Ulnar-Based Transposition Flap vs Split-Thickness Skin Graft [Original Article]

The Role of Molecular Markers and Tumor Histological Type in Central Lymph Node Metastasis of Papillary Thyroid Carcinoma [Original Article]

Supraglottoplasty for Occult Laryngomalacia to Improve Obstructive Sleep Apnea Syndrome [Original Article]

Association Between Obstructive Sleep Apnea and Sudden Sensorineural Hearing Loss: A Population-Based Case-Control Study [Original Article]

Vocal Outcome After Arytenoid Adduction and Ansa Cervicalis Transfer [Original Article]

A Clinical and Histopathologic Study of Jugular Bulb Abnormalities [Original Article]

Surgical Management of Auricular Infantile Hemangiomas [Original Article]

Tracheal Obstruction Due to Heterotopic Ossification in a Tracheostomy Scar [Clinical Note]

Spontaneous Cerebrospinal Fluid Rhinorrhea of the Foramen Cecum in Adulthood [Clinical Note]

Nasoseptal Cholesterol Granuloma: A Case Report and Review of Pathogenesis [Clinical Note]

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