We report the case ofa 14-year-old girl who was ref erred to us with a 2-yea r history ofabnormal panoramic dental x-rays. Comput ed tomography of the paranasal sinuses demonstrated a left unilateral maxilla ry sinus opacification that had been produced by an ectopic molar: The tooth was removed via an endoscopic app roach rather than with a traditional Caldwell-Lu c procedure. A nasal endoscope was used to create a middle meatal antrostomy and deliver the tooth and its cystic contents. The patient recove red without complications, and she exhibited no signs of recurrence at the 2-year fo llow-up.
The purpose of this study was to evaluate the types of consultations received by an otolaryngology service at a 772-bed large metropolitan, MI-based hospital. METHODS METHODS The authors performed a retrospective review of the specific types of consultations received during calendar year 2016. RESULTS RESULTS A total of 518 consultations were reviewed and analyzed by the first and second authors (MM, CB). Consultations with low intervention rates included dysphagia (difficulty swallowing) (32.3%), dysphonia (difficulty speaking) (16%), otalgia (earache) (20.8%), hearing loss (13.3%), rule out vocal cord dysfunction (0%), and vertigo/dizziness (0%). Epistaxis (nosebleed) was the most frequent reason for consultations, and angioedema (lip or airway swelling) was the most common airway-related consultation. Notably, emergent or urgent surgery was only performed on 4.6% of sample patients. Several common consultation reasons (e.g., longer-term hearing loss evaluation and cerumen ("earwax") removal) could have been deferred for clinic-based evaluation where audiograms and microscopes are more readily available. CONCLUSIONS CONCLUSIONS These findings suggest areas for continuing education for primary care provider and resident education to place more appropriate hospital consultations. Annual resident lectures to prepare junior residents for the most common call scenarios (i.e., control epistaxis and incision and drainage of peritonsillar abscesses) could be helpful in this area. In addition, didactic lectures for primary care physicians on how to evaluate patients with dysphagia may be of value as this was a common consult for otolaryngologist referrals.
Tear production resulting from obstruction of the nasolacrimal duct is a common ophthalmic problem. The diagnosis and treatment of this condition require a thorough understanding of the lacrimal apparatus and its ocular and nasal relationships. Idiopathic or primary acquired nasolacrimal duct obstruction is a syndrome of unknown etiology. Of all nontraumatic fonus, it accounts for the vast majority of cases found in adults. The authors discuss a number of potential causes, some of them iatrogenic and discuss the technique of dacryocystorhinostomy, the standard surgical treatment, in detail.
Snoring is a common complaint in the primary care and otolaryngology clinic with a wide differential diagnosis. Primary nasopharyngeal mantle cell lymphoma is a rare cause of a nasopharyngeal mass, which can commonly manifest as snoring. The patient in this case presented with extensive history of recent worsening snoring as well as nasal congestion over the past several months. Additionally, the patient had previously undergone endoscopic sinus surgery several years prior but was lost to follow up. During nasal endoscopy, a nasopharyngeal mass was visualized with near-complete obstruction of the nasal airway. Intraoperative biopsies indicated MCL which is an uncommon pathology presenting in a rare location. Flow cytometry of the biopsy specimen was CD19+, CD20+, CD5+, and positive for lambda light chains with immunohistochemistry showed strong diffuse cyclin D1 nuclear staining on lymphoid cells. PET/CT and bone marrow biopsy were essential in staging disease, predicting success of treatment, and determining optimal treatment planning. Once the diagnosis was established, R-CHOP therapy alternating with R-DHAP for a total of six cycles. This case report highlights the importance of recognizing new or changing symptoms, appropriate diagnostic workup for lymphoma, as well as one of few case reports describing primary nasopharyngeal mantle cell lymphoma.
We describe the case of a 7-year-old girl who had pla ced magnetic earrings bilat erally on her nasal ala. H owever; the two backing magnets that had been placed inside the nasal cavity becam e atta ched to each othe r rather than to the outerjewelry, compressing the nasal septum. Several weeks lateI; the septum became pelforat ed. The patient was treated conservatively with tnupirocin ointment, oral amoxicillin, and nasal saline. Subsequent examinations revealed no enlargement ofthe pelf oration, and the patient was f ollowed conservatively with saline nasal spray.
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