A 9-year-old, vaccinated boy with glucose-6-phosphate dehydrogenase deficiency and β-thalassemia trait presented with 1 month of progressive dyspnea, snoring, dysphagia, and weight loss. Both parents had a history of latent tuberculosis infection treated after immigrating to the US from Syria shortly after the patient's birth. The patient's pediatrician diagnosed him with reactive airway disease and adenotonsillar hypertrophy. He was referred to the otolaryngology clinic, where flexible laryngoscopy revealed diffuse upper airway lymphoid hyperplasia and supraglottic edema. He was sent to the emergency department, where he was stridulous and afebrile with a normal white blood cell count and an elevated erythrocyte sedimentation rate. A computed tomography scan of the neck revealed diffuse edema and contrast enhancement of the nasopharynx, oropharynx, hypopharynx, and supraglottis. A chest radiograph was normal.The patient was taken urgently to the operating room for direct microlaryngoscopy (Figure 1A and B) and intubated. Results of biopsies and cultures of the tonsils, adenoids, and supraglottis revealed diffuse non-necrotizing granulomas (Figure 1C) and oropharyngeal flora with negative acid-fast bacilli and Grocott methenamine silver stains. He remained intubated, and treatment with systemic corticosteroids and antibiotics was initiated. During this time, he had a normal angiotensin-converting enzyme (ACE) level and normal titers for antinuclear antibody (ANA), cytoplasmic antineutrophilic cytoplasmic antibody, perinuclear antineutrophilic cytoplasmic antibody, antimyeloperoxidase antibody, antiproteinase 3 antibody,anti-double-strandedDNAantibody,Smithantibody,Sjogrenantibodies,andhistoplasma antibodies. He also had normal results on tuberculin purified protein derivative and interferon-γ release assay (QuantiFERON; Qiagen).

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The risk of suicide in cancer patients: a review of the literature.

Objective Examine the characteristics of recent head and neck (H&N) oncology fellowship graduates and assess their current perceptions of career alignment and satisfaction. Methods H&N fellowship graduates from American Head and Neck Society–accredited programs between 2015 to 2020 were surveyed. Two-sample t tests and analysis of variance tests were used to determine the effect of respondents’ demographics, fellowship characteristics, career preferences, and current practice on their degree of career alignment with expectations and overall job satisfaction. Results Fifty-eight fellowship graduates completed the cross-sectional survey. Of all respondents, 52 (89.7%) primarily preferred an academic job, of whom 5 (9.6%) went into private practice. Respondents in private practice, those treating general otolaryngology patients, and those who do not work with residents demonstrated significantly poorer job alignment and career satisfaction as compared with those in academic medicine, those treating only H&N patients, and those working with residents, respectively. Discussion The majority of graduating H&N fellows prefer a job in academic medicine; however, there may be an insufficient number of desirable academic positions available each year to meet such demand. Implications for Practice By setting realistic career expectations, preparing for a mixed scope of practice, and integrating resident involvement into private practice groups, H&N providers may ultimately find more fulfillment in their work. These findings could also be valuable to the American Head and Neck Society and fellowship programs in designing training and in planning for the number of available fellowship positions each year.

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