A prospective study was performed on 45 patients for an assessment of the use of computed tomography (CT) in the management of a suspected esophageal fish bone or chicken bone. All patients had negative findings on laryngoscopy; therefore, pharyngeal and hypopharyngeal foreign bodies were excluded from further consideration. The patients underwent radiographic examination with plain films and a cervical CT scan without contrast material. Patients with positive findings were taken to the operating room, where they underwent rigid esophagoscopy under general anesthesia, while those with negative findings remained for observation for 24 hours. Thirty CT scans were positive for an esophageal foreign body, and in all cases but 1, a foreign body was found during the operation. Fourteen of 15 patients with normal CT scan findings managed well with no further intervention. One patient with persistent complaints underwent esophagoscopy, but no foreign body was found. Our conclusion is therefore that CT is a simple and reliable method for diagnosing esophageal bone impaction and may reduce the rate of unnecessary esophagoscopies.

Two clinical signs are described: the location of the sinus opening in the neck, which is situated in a triangle limited by the external auditory canal above, the mental region anteriorly, and the hyoid bone inferiorly, and the presence in some cases of a myringeal web that runs from the floor of the external auditory canal to the umbo. In addition, imaging with computed tomography and magnetic resonance of the parotid area may be helpful in confirming the diagnosis.

A 36-year-old woman with Marfan syndrome came to the Ear, Nose and Throat clinic complaining of severe dysphagia and regurgitation of ingested food from which she had been suffering for the past three years. She had undergone Nissen's fundoplication for hiatal hernia repair at the age of 20 years, a sigmoidectomy for colonic diverticulosis with perforation of a diverticulum when she was 25 years old, and small bowel resection due to small bowel obstruction 3 years later. The patient's history also included inguinal hernia repair, mitral valve prolapse, mild congestive heart failure, atrial fibrillation, and hypothyroidism. Upon examination, an obvious Marfanoid habitus was noted with severe kyphoscoliosis and pectus excavatum, and a 3/6 systolic murmur at the apex was detected. Her abdomen was marked with multiple scars. Chest X-ray showed severe kyphoscoliosis. A computed tomography (CT) scan of the neck and chest was performed (figure). The patient was then operated on under general anaesthesia and a diverticulectomy and cricopharyngeal myotomy were performed. Postoperatively, she managed well with improvement of the dysphagia and no regurgitation of ingested food.

No abstract

In rare cases, severe reaction to silk sutures may develop after thyroid surgery. Surgical removal of the stitches is the treatment of choice. Intradermal skin test is a good predictor of allergy to sutures.