Organ-preserving Treatment Strategy for Extra-Axial Chordoma Metastatic

Head and Neck ClinicOrgan-Preserving Treatment Strategy for Extra-Axial Chordoma Metastatic to the Larynx Causing Airway CompromiseJeffanie Wu, BS, Miriam R. Smetak, MD, MS, Madelyn N. Stevens, MD, James S. Lewis, MD, and James L. Netterville, MDDOI: 10.1177/01455613211037639Significance Statement
Chordomas are rare, malignant bone tumors that arise from embryological remnants of the notochord, typically affecting the skull base, mobile spine, and sacrum with uncommon metastasis to the larynx. Patients with metastasis to the larynx may present with slowly progressive dysphonia and dyspnea. Here, we report an organ-preservation treatment strategy for a patient with widely metastatic extra-axial chordoma presenting with airway compromise who was found to have a new metastasis to the cricoid cartilage.Dividing RuleHead and Neck ClinicUnusual Cervical Lymph Node Metastasis of Papillary Urothelial CarcinomaHyun Jung Kim, MD, Jae-Yeop Sim, MD, Min Bum Kim, MD, and Suk Won Chang, MD

DOI: 10.1177/01455613211036222

Significance Statement
Papillary urothelial carcinoma is aggressive and characterized by frequent metastasis to distant sites at an early stage. Papillary urothelial carcinoma of the urinary bladder usually metastasizes to the local lymph nodes, liver, lungs, bone, and mediastinum. Urogenital tract carcinoma of the head and neck metastasis is uncommon and rarely reported to the cervical lymph nodes. We present a case of cervical lymph node metastasis of papillary urothelial carcinoma of the urinary bladder.

Dividing Rule-1703659708Case ReportAngiomyolipoma Originating From the Nasal Vestibule: A Case ReportAleksandar Perić, MD, PhD, Jelena Sotirović, MD, PhD, Miljan Folić, MD, PhD, and Biserka Vukomanović Ðurdević, MD, PhD

DOI: 10.1177/01455613211036241

Abstract
Angiomyolipoma is a benign, mesenchymal, hamartomatous lesion often described in the kidney and may be associated with tuberous sclerosis. Nasal angiomyolipoma is an extremely rare tumor with fewer than 20 cases reported in the literature. We report a case of angiomyolipoma arising in the right nasal vestibule in a 68-yearold male with mild, recurrent right-sided epistaxis, and nasal obstruction. With the exception of arterial hypertension, the patient did not have any comorbidities. Gross examination showed a well-circumscribed, lobulated mass. On the microscopic level, it was composed of mature smooth muscle cells, thickwalled blood vessels of varying sizes, and islands of mature adipose tissue. Angiomyolipoma should be considered as a differential diagnosis for unilateral nasal masses, especially those situated in the nasal vestibule.

Dividing Rule-1703659712Original ResearchAssociation Between Severity of COVID-19 Respiratory Disease and Risk of Obstructive Sleep ApneaGiannicola Iannella, MD, PhD, Claudio Vicini, MD, Jerome R. Lechien, MD, PhD, Claudia Ravaglia, MD, Venerino Poletti, MD, Simona di Cesare, MD, Elena Amicarelli, MD, Lucia Gardelli, MD, Carmela Grosso, MD, Aria Patacca, MD, Eleonora Magistrelli, MD, Michele De Benedetto, MD, Domenico Maurizio Toraldo, MD, Michele Arigliani, MD, Giovanni Cammaroto, MD, Giuseppe Meccariello, MD, Andrea De Vito, MD, Giuseppe Magliulo, MD, Antonio Greco, MD, Marco de Vincentiis, MD, Massimo Ralli, MD, PhD, Annalisa Pace, MD, Valentina Montincone, MD, Antonino Maniaci, MD, Salvatore Cocuzza, MD, Matteo Seligardi, MD, Ida di Giacinto, MD, and Ruggero Massimo Corso, MD

DOI: 10.1177/01455613211029783

The purpose of this observational retrospective study was to evaluate, in patients with a severe acute respiratory syndrome coronavirus 2 infection, the association between the severity of coronavirus disease 2019 (COVID-19) respiratory illness and the risk of infected patients to develop obstructive sleep apnea (OSA). Methods: Ninety-six patients with confirmed COVID-19 infection were enrolled in the study. The STOP-BANG questionnaire to investigate the risk of the OSA syndrome was filled in by the patients at admission. The enrolled patients were divided into 2 groups according to the respiratory disease: group 1 (72 patients), hospitalized patients undergoing conventional oxygen therapy; group 2 (24 patients), patients requiring enhanced respiratory support. STOP-BANG results of these 2 groups were compared to observe whether patients with high OSA risk more frequently presented a severe form of COVID-19. Results: 41.6% of the patients in group 2 had a STOP-BANG score between 5 and 8 (high risk of having apnea); in contrast, 20.8% of the patients in group 1 had a STOP-BANG score between 5 and 8, with a statistically significant difference between the 2 groups (P = .05). A complementary trend was observed regarding the proportion of patients in the range 0 to 2, which classifies patients at a low risk of OSA (48.6% vs 20.8% for groups 1 and 2, P = .01). Conclusions: According to our data, the chances of having a severe case of COVID-19 should be considered in patients at high risk of OSA. Current Knowledge/Study Rationale: Emerging research suggests that OSA could represent a potentially important risk factor for the severe forms of COVID-19. The purpose of this observational retrospective study was to evaluate the potential association between OSA and the severity of COVID-19 disease. Study Impact: According to our data, the likelihood of contracting a severe form of COVID-19 disease should be considered in patients at high risk of OSA.

Dividing Rule-1703659710Pediatric ClinicAdolescent Tracheostomy for COVID-19 Respiratory FailureTaylor Leavitt, BS, Rebecca L. Brooks, MSN, APRN, RNC-NIC, PCNS-BC, Ron B. Mitchell, MD, Romaine F. Johnson, MD, MPH, FACS, and Stephen R. Chorney, MD, MPH

DOI: 10.1177/01455613211034594

Significance Statement
Pediatric tracheostomy for COVID-19 infections is uncommon and requires age-appropriate adaptations. This case adds to a limited body of literature related to tracheostomy placement and management in an adolescent. Thoughtful planning and communication by a dedicated tracheostomy team was crucial in obtaining a successful outcome.

Dividing Rule-1703659713Original ResearchEffect of Using N95 and Surgical Masks on Otoacoustic Emission in Cochlear Outer Hair CellsSedat Alagoz, MD, Kemal Koray Bal, MD, Talih Ozdas, MD, Vedat Delibas, MD, Gokhan Kuran, MD, Nur Yucel Ekici, MD, Orhan Gorgulu, MD, and Ragıp Onur Oztornacı, PhD

DOI: 10.1177/01455613211034600

Abstract
Introduction: Distortion product otoacoustic emission (DPOAE) was measured to investigate the effect of mask use and type on oxygen saturation on cochlear function in health care professionals during the COVID-19 pandemic. Material and Methods: Group 1 participants wore surgical masks; Group 2 participants wore N95 masks. Distortion product otoacoustic emission and oxygen saturation were measured in both groups before and after mask use. Results: Comparison of signal-to-noise ratio (SNR) values before and after surgical mask use in DPOAE measurements of group 1 revealed statistically significant difference in the right and left ears. Comparison of the SNR values in DPOAE measurements of group 2 before and after 8 hours of N95 mask use revealed statistically significant differences in the right ear at 988, 2963, 4444, and 8000 Hz and in the left ear at 8000 Hz. Conclusion: We found that prolonged mask use may affect the outer hair cells in the cochlea, causing deterioration in DPOAE values.

Dividing Rule-1703659715Case ReportParathyroid Carcinoma in a Patient With Secondary Hyperparathyroidism and Thyroid Hemiagenesis: A Case Report and Review of the LiteratureShinpei Kada, MD, PhD, Miho Tanaka, MD, and Akihiro Yasoda, MD, PhD

DOI: 10.1177/01455613211036240

Abstract
Parathyroid carcinoma is a rare endocrine tumor. Parathyroid carcinoma in patients with secondary hyperparathyroidism due to chronic kidney disease is also rare. In addition, thyroid hemiagenesis is a rare congenital anomaly. We report an extremely rare case of parathyroid carcinoma in a patient with secondary hyperparathyroidism and thyroid hemiagenesis. We also present a review of the literature of this rare entity. We also discuss the surgical procedure performed for this patient. Our review of the literature found 34 case reports of parathyroid carcinoma in patients undergoing dialysis due to chronic renal failure; 14 reports of thyroid hemiagenesis with parathyroid disease; and no previous reports of thyroid hemiagenesis with secondary hyperparathyroidism and parathyroid carcinoma. Although surgical treatment of parathyroid carcinoma requires combined resection with the thyroid, peritracheal dissection with total parathyroidectomy, and monitoring intact parathyroid hormone as a tumor marker, our procedure preserved the patient’s thyroid function. There has been no evidence of recurrence for over 8 years.

Dividing Rule-1703659717Original ResearchEpiglottitis in Patients With Preexisting Autoimmune Diseases: A Nationwide Case–Control Study in TaiwanCheng-Ming Hsu, MD, PhD, Ming-Shao Tsai, MD, Yao-Hsu Yang, MD, PhD, Ko-Ming Lin, MD, Yun-Ting Wang, MD, Shu-Yi Huang, MD, Meng-Hung Lin, PhD, Ethan I. Huang, MD, PhD, Geng-He Chang, MD, Chia-Yen Liu, MSc, and Yao-Te Tsai, MD

DOI: 10.1177/01455613211033689

The role of autoimmune diseases on the risk for acute epiglottitis remains uncertain. This study aimed to delineate the association between epiglottitis and autoimmune diseases using population database. Methods: A population-based retrospective study was conducted to analyze claims data from Taiwan National Health Insurance Research Database collected over January, 2000, to December, 2013. Results: In total, 2339 patients with epiglottitis were matched with 9356 controls without epiglottitis by sex, age, socioeconomic status, and urbanization level. The correlation between autoimmune diseases and epiglottitis was analyzed by multivariate logistic regression. Compared with controls, patients with epiglottitis were much more likely to have preexisting Sjo¨gren syndrome (adjusted odds ratio [aOR]: 2.37; 95% CI: 1.14-4.91; P = .021). In addition, polyautoimmunity was associated with increased risk of epiglottitis (aOR: 2.08; 95% CI: 1.14-3.80; P = .018), particularly in those aged >50 years (aOR: 2.61; 95% CI: 1.21-5.66; P = .015). Conclusions: Among autoimmune diseases, we verify the association between epiglottitis and Sjögren syndrome in Taiwan. Furthermore, we present the novel discovery that patients with epiglottitis have an increased risk of polyautoimmunity, particularly those aged >50 years.

Dividing Rule-1703660418Original ResearchClinical Observations of a Surgical Method Comprising a Combination of Cross Flap and Autologous Auricular Cartilage Transplantation in the Treatment of Type I to III Congenital Concha-Type MicrotiaPengfei Sun, MD, Meng Lu, MD, Changchen Wang, MD, Bo Pan, MD, and Haiyue Jiang, MD

DOI: 10.1177/01455613211038079

The present study attempted to investigate the clinical efficacy of a surgical method involving a combination of cross flap with autologous auricular cartilage transplantation in the treatment of type I to III congenital concha-type microtia. Methods: The present retrospective study was conducted on the clinical and postoperative data of 50 patients with unilateral type I to III concha-type microtia treated with a combination of cross flap and autologous auricular cartilage transplantation at the Plastic Surgery Hospital of Chinese Academy of Medical Sciences from January 2018 to December 2021. Results: The postoperative perimeters of malformed ears were significantly larger than the preoperative perimeters (P < .05). Of the total, 2 patients exhibited incision dehiscence, 3 patients exhibited incision infection, 2 patients exhibited flap hematoma, and 1 patient exhibited ischemic necrosis at the flap tip. The satisfaction rate of the patients and their families was 100%. Conclusions: The surgical method involving a combination of cross flap and autogenous auricular cartilage transplantation was effective in treating patients with type I to III congenital concha-type microtia, and therefore, this surgical approach can be applied widely to correct this deformity.

Dividing Rule-1703660419Case ReportTo X-Ray or Not to X-Ray? Discussing Unknown Nasal Foreign Bodies and Button BatteriesRujuta R. Roplekar Bance, BSc, MBBS, MRCS, MRCS-ENT, FRCS-ORL, Vikas Acharya, BMBS, MA, MBA, MRCS(ENT), MFSTed, MAcadMed, Coyle Paula, BSc (Hons), BMBS (Hons), DOHNS, DCH,FRCS-Orl, and J Panesar, BSc, MD, FRCS, MEd

DOI: 10.1177/01455613211033123

Abstract
The emergency of esophageal button batteries is recognized. Foreign bodies in the ear or nose are treated as comparatively nonemergent. We present the case of a child who presented with suspected pen-nib in the nostril to highlight the importance of investigation and intervention in unwitnessed nasal foreign body and review the literature regarding X-rays in these cases. Fifteen papers were identified as per search parameters; 3 papers recommend the use of plain radiographs for nasal foreign bodies. We propose that in unwitnessed pediatric nasal foreign body insertion, a facial X-ray should be considered, especially if suspecting a metallic foreign body.

Dividing Rule-1703660580Original ResearchClassifying and Predicting Surgical Complications After Laryngectomy: A Novel Approach to Diagnosing and Treating PatientsLukas Koenen, MD, Philipp Arens, MD, Heidi Olze, MD, PhD, and Steffen Dommerich, MD

DOI: 10.1177/01455613211029749

The total laryngectomy is one of the most standardized major surgical procedures in otolaryngology. Several studies have proposed the Clavien-Dindo classification (CDC) as a solution to classifying postoperative complications into 5 grades from less severe to severe. Yet more data on classifying larger patient populations undergoing major otolaryngologic surgery according to the CDC are needed. Predicting postoperative complications in clinical practice is often subject to generalized clinical scoring systems with uncertain predictive abilities for otolaryngologic surgery. Machine learning offers methods to predict postoperative complications based on data obtained prior to surgery. Methods: We included all patients (N = 148) who underwent a total laryngectomy after diagnosis of squamous cell carcinoma at our institution. A univariate and multivariate logistic regression analysis of multiple complex risk factors was performed, and patients were grouped into severe postoperative complications (CDC ≥ 4) and less severe complications. Four different commonly used machine learning algorithms were trained on the dataset. The best model was selected to predict postoperative complications on the complete dataset. Results: Univariate analysis showed that the most significant predictors for postoperative complications were the Charlson Comorbidity Index (CCI) and whether reconstruction was performed intraoperatively. A multivariate analysis showed that the CCI and reconstruction remained significant. The commonly used AdaBoost algorithm achieved the highest area under the curve with 0.77 with high positive and negative predictive values in subsequent analysis. Conclusions: This study shows that postoperative complications can be classified according to the CDC with the CCI being a useful screening tool to predict patients at risk for postoperative complications. We provide evidence that could help identify single patients at risk for complications and customize treatment accordingly which could finally lead to a custom approach for every patient. We also suggest that there is no increase in complications with patients of higher age.

Dividing Rule-1703660581Original ResearchEfficacy and Safety of Long-Term Low-Dose Clarithromycin in Patients With Refractory Chronic Sinusitis After Endoscopic Sinus Surgery: A Prospective Clinical TrialHan Chen, MD, Bing Zhou, MD, Qian Huang, MD, Cheng Li, MD, Yubin Wu, MD, Zhenxiao Huang, MD, PhD, Yunxia Li, MD, Jing Qu, MD, Nianci Xiao, MD, and Mingjie Wang, MD, PhD

DOI: 10.1177/01455613211032020

To observe the efficacy and safety of postoperative long-term low-dose oral administration of clarithromycin in patients with refractory chronic rhinosinusitis (RCRS), to explore the characteristics of postoperative microbiota in the nasal cavity in patients with RCRS, and to compare the differences and changes in microbiota in the nasal cavity before and after medication. Methods: This was a prospective, selfcontrolled study. Eighteen patients with RCRS who had persistent symptoms after endoscopic sinus surgery and standard therapy with normal immunoglobulin E and eosinophil level were included. Low dose (250 mg, once daily) clarithromycin was orally administrated for 12 weeks. Symptom severity and endoscopic findings were evaluated before, after 4 weeks, and 12 weeks of treatment, and nasal cavity microbiota was analyzed simultaneously. Results: A total of 18 patients with RCRS were enrolled and 17 patients completed the study. Four weeks after oral administration of clarithromycin, significant improvement was observed in subjective symptoms including nasal congestion, rhinorrhea, postnasal drip, and general discomfort, as well as endoscopic findings including general surgical cavity condition, rhinedema, and rhinorrhea (P < .05). After continuous treatment to the 12th week, symptoms showed significant improvement compared with baseline, and endoscopic score showed significant improvement compared with both baseline and 4 weeks after treatment. Analysis of middle nasal meatus flora revealed a significant decrease of Streptococcus pneumoniae after 12 weeks of clarithromycin treatment (P < .05), while the richness, composition, and diversity were similar before and after treatment. Patients enrolled experienced no adverse drug reaction or allergic reaction, nor clinical significant liver function impairment observed. Conclusion: Postoperative low-dose long-term oral administration of clarithromycin in patients with RCRS can improve the clinical symptoms and facilitate the mucosal epithelialization, with good tolerance and safety. The efficacy of clarithromycin in patients with RCRS may be related to its regulatory effect on nasal cavity microbiota.

Journal CoverEoseraXlearEB12023 Deep BackfileEB22023_Reviewer_Rewards2023 PremierParaganglioma of the thyroid gland: a case report and a review of the literatureExcision of Greater Superficial Petrosal Nerve Schwannoma via a Pure Endoscopic Endonasal ApproachNasal cavity schwannoma - A case report and review of the literatureExtra-skeletal Mesenchymal Chondrosarcoma in Nasal Cavity: a rare case reportClinical Biomarkers in Otolaryngology—Head and Neck Surgery: Autoimmune DiseasesBibliometric Analysis of Microtia-Related Publications From 2006 to 2020Postoperative Urinary Retention Following General Anesthesia for Endoscopic Nasal Surgery in MenEffects of endoscopic sinus surgery for eosinophilic chronic rhinosinusitisAnalysis of age-related prevalence and risk factors of chronic rhinosinusitis with asthmaOnline only cover pageOrgan-preserving Treatment Strategy for Extra-Axial Chordoma MetastaticVersoMcKeon