American Journal of Otolaryngology - Head and Neck Medicine and Surgery

Treatment of bilateral vocal cord paralysis following permanent recurrent laryngeal nerve injury

2011-09-16

Abstract: Bilateral vocal cord paralysis is a serious illness requiring emergency intervention to resolve the potentially life-threatening respiratory distress. Several surgical procedures were proposed to help improve the airway and to eliminate the tracheostoma in those patients with permanent paralysis. All the procedures have their own advantages and disadvantages. We conducted a retrospective study of 30 patients affected by bilateral vocal cord paralysis following total thyroidectomy. All the patients underwent total thyroidectomy for benign thyroid pathology. In 26 patients (86.6%), cord paralysis occurred during the perioperative stage; and in the remaining 4 cases (13.3%), it occurred within the following 6 months. We treated all these bilateral recurrent laryngeal nerve paralysis patients with arytenoidectomy alone in 5 patients and arytenoidectomy with concomitant true and false posterior cordectomy in the remaining 25 patients. Twenty-four of the 25 patients who underwent the combined procedures (96%) reported subjective respiratory improvement and were decannulated within 60 days, being able to return to their normal daily activities. This study demonstrates that arytenoidectomy associated with posterior cordectomy is a satisfactory surgical treatment of bilateral vocal cord paralysis because it leads to a considerable and stable enlargement of the breathing space.

Role of positron emission tomography in management of sinonasal neoplasms—a single institution's experience

2011-09-20

Abstract: Objective: The objective of the study is to examine the utility of positron emission tomography (PET) for staging and restaging after treatment of paranasal sinus carcinomas.Study design: Retrospective data review was done.Subjects and methods: Patients selected underwent PET for sinonasal neoplasms from 2003 to 2008 at a tertiary care referral center.Results: Seventy-seven scans were reviewed from 31 patients. The pathologies included olfactory neuroblastoma (n = 9), squamous cell carcinoma (n = 6), sinonasal undifferentiated carcinoma (n = 6), sinonasal melanoma (n = 6), and minor salivary gland carcinomas (n = 4). The positive predictive value of studies performed for restaging at the primary, neck, and distant sites were 56%, 54%, and 63%; negative predictive values were 93%, 100%, and 98%, respectively. During restaging, 32% of patients were accurately upstaged secondary to neck or distant site involvement.Conclusion: Positron emission tomography serves as a useful adjunct to conventional imaging in the management of sinonasal malignancies. Negative studies are effective in predicting absence of disease as seen in the consistently high-negative predictive values. Positive studies need to be viewed cautiously given the high rate of false-positive studies. When viewed in conjunction with clinical examination, endoscopic assessment, and focused biopsies, they may effectively result in a more accurate assessment of the extent of disease.

Vallecular cyst in an infant: does your specimen show D2-40 immunoreactivity?

Anil Gungor — 2011-09-20

Abstract: Vallecular cysts are infrequent causes of supraglottic obstruction causing stridor and swallowing difficulty in infants. When detected early in life, the management consists of marsupialization or resection. Supraglottic lymphangiomas of the tongue base and vallecula present with similar symptoms and time of presentation. Endoscopic visualization is traditionally considered to be sufficient in identifying and differentiating these. When a vallecular cyst is visually diagnosed by the surgeon during endoscopy, surgical treatment is provided at the same time. Obtaining a specimen is rarely considered for histopathologic diagnostic verification. However, the natural presentation of a cystic lymphangioma may be indistinguishable from a solitary vallecular cyst by endoscopy alone. This case presentation argues in favor of histopathologic diagnosis in vallecular cysts because the 2 may represent a continuum of disease. A vallecular mass with a single large mucus-filled cyst and adjoining edematous soft tissue extension into the tongue base and piriform sinus diagnosed as lymphangioma through D2-40 immunoreactivity is presented.

Thyroid hemiagenesis: a case series and review of the literature

Yi-Hsuan Emmy Wu, Richard O. Wein, Barbara Carter — 2011-09-20

Abstract: Purpose: The purpose of this study is to present a case series and review recommendations within the literature concerning thyroid hemiagenesis.Materials and Methods: This is a (1) retrospective case series review of 5 patients and (2) literature review (using Medline) on thyroid hemiagenesis.Results: Most reported cases are female with the left thyroid lobe absent. Compensatory hypertrophy occurs in most thyroid remnants. Associated diagnoses in the remaining lobe include hyperthyroidism, hypothyroidism, simple and multinodular goiter, and carcinoma. There is no increased risk for the subsequent development of cancer in the remaining lobe, and empiric thyroidectomy is not justified.Conclusions: Thyroid hemiagenesis is an uncommon presentation that is frequently asymptomatic and detected incidentally when imaging for another condition. Awareness of its existence can help prevent unnecessary interventions associated with incorrect assumptions in patient care.

Arytenoid adduction combined with medialization laryngoplasty under general anesthesia using a laryngeal mask airway

2011-09-29

Abstract: Purpose: Laryngeal framework surgery is usually performed under local anesthesia but cannot be tolerated by some patients. To develop a new procedure for these patients, we evaluated voice outcomes after arytenoid adduction combined with medialization laryngoplasty under general anesthesia using a laryngeal mask airway (LMA) for unilateral vocal cord paralysis.Materials and Methods: Eleven consecutive patients with severe unilateral vocal cord paralysis, with a maximum phonation time of less than 5 seconds, underwent arytenoid adduction combined with medialization laryngoplasty under general anesthesia using an LMA. Each paralyzed vocal cord was observed by intraoperative videolaryngoscopy. The vocal cord was moved to the position where the best vocal outcome could be expected, according to 3 parameters obtained from glottal images.Results: All patients achieved a maximum phonation time of more than 11 seconds. The mean airflow rate, which ranged from 550 to 1000 mL/s before surgery, improved to less than 390 mL/s. Perceptual evaluation using the grade, roughness, breathiness, asthenia and strain scale also improved significantly.Conclusions: These results were equivalent to those of previous reports of surgeries performed under local anesthesia. Intraoperative endoscopic vocal cord observation through the LMA may have contributed to the positive results.

Clinical features and surgical outcomes of congenital choanal atresia: factors influencing success from 20-year review in an institute

2011-09-20

Abstract: Purpose: Congenital choanal atresia (CCA) is a rare disease entity. The prevention of restenosis has been the main concerns of choanoplasty. The authors retrospectively analyzed patients with CCA to investigate clinical features and factors affecting surgical outcomes.Material/methods: Forty sides in 27 patients with CCA from 1987 through 2009 were reviewed with medical records that included symptoms, associated anomalies, laterality of atresia, types of the atretic plate, surgical approaches, uses of stent or mitomycin C, ages at operation, and surgical outcomes.Results: CHARGE association was the most commonly associated malformation in bilateral CCA and cleft lip and cleft palate in unilateral CCA. Age at operation was related to restenosis rate. The cases of bilateral CCA were operated on younger ages than those of unilateral CCA (4.9 months vs 11.5 years, respectively), and the restenosis appeared to be higher in bilateral cases than in unilateral ones. The use of stent did not improve preventive rate of restenosis: 42.9% of restenosis with stent and 47.4% without stent, respectively. Mitomycin C did not seem to be effective in preventing restenosis either. No significant difference in restenosis rate was observed in terms of symptoms, associated anomalies, types of the atretic plate, and surgical approaches as well.Conclusions: Our study suggests that bilateral CCA, meaning early operation age, develops restenosis more frequently. However, the patency rate was not related to surgical approaches or postoperative use of stent and mitomycin C.

Clinical manifestations and prognosis of patients with Ramsay Hunt syndrome

Eun Woong Ryu, Ho Yun Lee, So Yoon Lee, Moon Suh Park, Seung Geun Yeo — 2011-11-10

Abstract: Purpose: Patients with Ramsay Hunt syndrome have a poorer prognosis than those with Bell palsy despite the use of various treatment modalities. We compared the clinical characteristics, treatment methods, and outcomes in patients with Ramsay Hunt syndrome and Bell palsy.Materials and Methods: Patients with Ramsay Hunt syndrome were compared with patients with Bell palsy treated using oral steroids and with those treated with both steroids and an antiviral agent. Functional recovery of the facial nerve was scored according to the House-Brackmann grading system. Patients were followed up until recovery or for 3 months. Recovery rates in each group were assessed by age, sex, and initial and last House-Brackmann grade.Results: Compared with patients with Bell palsy, those with Ramsay Hunt syndrome were generally younger, had initially more severe facial palsy, and a lower recovery rate. Various factors including initial House-Brackmann grade, starting time to treatment, age, comorbid disease, electroneurography, and electromyography showed some correlations with prognosis in all groups. The addition of antiviral agents to an oral steroid regimen did not improve the recovery rate of patients with Bell palsy.Conclusion: Patients with Ramsay Hunt syndrome have a poorer prognosis than do those with Bell palsy.

Recognition and management of perioperative serotonin syndrome

Lisa Wilson, Thomas Rooney, Reginald F. Baugh, Belinda Millington — 2011-12-01

Abstract: Mild forms of serotonin syndrome can potentially be fatal, if not recognized. The increased use of serotonergic agents makes the awareness of its prevalence, various presentations, diagnostic evaluation, and treatment a clinical imperative. It is important to note that serotonin syndrome can only be diagnosed clinically in the presence of 3 clinical criteria: mental status changes, autonomic manifestations, and neuromuscular abnormalities. This case report describes a patient who underwent an uncomplicated closed nasal fracture reduction and subsequently developed serotonin syndrome.

Comparative audiometric evaluation of hearing loss between the premenopausal and postmenopausal period in young women

Fatih Oghan, Hakan Coksuer — 2011-11-14

Abstract: Aim: The aim of this study was to determine the audiologic status and severity of hearing loss in different frequencies between the premenopausal and postmenopausal period in women.Materials and Methods: This prospective study involved 28 premenopausal and 27 postmenopausal women. Premenopausal and postmenopausal women were younger than 46 years. Age range for premenopausal and menopause patients was 37 to 46 years. The mean age of menopause women with sensorineural hearing loss in our study was not suitable for the age range of presbyacousis that is commonly seen. Each subject was tested with low- (250–2000 Hz) and high-frequency (4000–8000 Hz) audiometry. For each set of tests, mean values of air conduction at each frequency were calculated for the premenopausal and postmenopausal groups and compared.Results: The mean ages of the women on premenopausal and postmenopausal groups were 42.0 ± 2.4 and 43.4 ± 2.6 years, respectively. Duration of menopausal period in second group was 2.03 ± 0.85 years. The corresponding mean body mass indexes were 29.7 ± 2.9 and 31.1 ± 3.8 kg/m2. There was no statistical significance between the 2 groups in mean ages and mean body mass indexes. Hearing thresholds at low and high frequencies were analyzed between the 2 groups in . At low (250, 500, 1000, and 2000 Hz) and high frequencies (4000, 6000, and 8000 Hz), the mean air-conduction threshold values between the 2 groups were not statistically significant.Conclusion: Estrogen deficiency may not elevate hearing thresholds in early postmenopausal period; however, further studies of larger series are needed to confirm this.

Dichotic listening test in patients with chronic cerebellar disease

2011-12-01

Abstract: Purpose: The aim of the study was to identify alterations in the auditory processing of patients with chronic cerebellar disease using a dichotic listening test with alternating dissyllables, also known as the Staggered Spondaic Word (SSW) test.Materials and methods: A study involving a control group of 20 subjects and a study group of 18 patients with chronic cerebellar disease of both sexes aged between 9 and 56 years was performed. The SSW test was conducted in accordance with strict standard protocols along with the analysis procedures.Results: Findings revealed a statistically significant difference in the quantitative alterations on the SSW test in the study group compared with the control group (P < .001). Results of the qualitative evaluation showed no statistically significant differences between the study and control groups for order or auditory effects. However, a statistically significant difference for presence of inversions was identified, with the worse result in the study group.Conclusion: The present study identified quantitative and qualitative changes in auditory processing for decodifying, gradual memory loss, and organization modes on the dichotic listening test with alternating dissyllables (SSW) in individuals with chronic cerebellar disease.

Morphometric endoscopic study of the pharynx in patients with sleep apnea

2011-11-10

Abstract: Purpose: The aims of the study were to measure endoscopically the retrolingual pharynx during wakefulness and sleep before and after maxillomandibular advancement surgery and to quantify the changes observed.Materials and Methods: Eighteen patients with mild to severe grade obstructive sleep apnea hypopnea were evaluated during wakefulness while sitting and lying down and during induced sleep in dorsal decubitus while breathing naturally. Images of the retrolingual region of the pharynx were captured with a nasofibroscope and recorded on a DVD using the Sony Vegas 8.0 software (Sony Creative Software, Madison, WI). The images captured in greater and smaller aperture were measured with the Image J software (produced by Wayne Rasband, United States National Institutes of Health, Bethesda, MD) in linear anteroposterior and linear laterolateral areas. A correction factor was then applied to equalize the size of the images and thus compare them to one another.Results: The postoperative dimensions of the pharynx always increased significantly in all measurements compared with the preoperative ones. During induced sleep in dorsal decubitus, there was a greater gain in the area of smaller aperture (201.33%).Conclusions: The proposed method showed that the dimensions of the pharynx always increased significantly after surgery for maxillomandibular advancement, although the gain was not homogeneous in all dimensions and also varied according to state of consciousness. The greatest gain was observed in the area of smaller aperture with the patient in induced sleep, thus reducing the collapse of the pharynx.

Comparison of Mandarin tone and speech perception between advanced combination encoder and continuous interleaved sampling speech-processing strategies in children

Chung-Feng Hwang, Hsiao-Chuan Chen, Chao-Hui Yang, Jyh-Ping Peng, Chia-Hui Weng — 2011-10-07

Abstract: Objective: This study was performed to compare cochlear implant (CI) users' performance in Mandarin speech and tone perception between 2 types of speech-processing strategies—advanced combination encoder (ACE) and continuous interleaved sampling (CIS)—under quiet and noisy conditions.Methods: This study involved 10 congenitally deaf children (age range, 5.7–15.3 years; mean, 9.2 years) who received the Nucleus 24-channel CI system cochlear device (CI24R; Cochlear Ltd, Lane Cove NSW, Australia). The subjects used ACE since switching on their CI devices. Speech and tone perception tests were administered under quiet and noisy (+5 dB signal-to-noise ratio) conditions with ACE and CIS strategies 20 minutes and 2 weeks apart.Results: Regardless of the strategy used, subjects showed significantly higher scores in speech perception than in tone recognition. Under noisy conditions, subjects had significantly higher tone identification scores with the CIS than the ACE strategy (P = .038). There was no significant difference in speech identification score between the strategies. Subjects showed significant higher tone identification and speech perception scores under quiet than noisy (+5 dB signal-to-noise ratio) conditions. Subjectively, 6 subjects preferred the ACE strategy, and the remaining 4 preferred the CIS strategy. The strategy preference of the subjects was related to speech perception performance rather than tone identification. A significant correlation was observed between tone identification and speech recognition, regardless of whether speech was evaluated by consonants (r = 0.669, P < .001), vowels (r = 0.426, P = .001), or sentences (r = 0.294, P = .023).Conclusion: There are only 4 patterns of tone in Mandarin, which is far fewer than the number of speech sounds. However, tone identification is poorer than speech perception. The CIS speech-processing strategy may improve tone identification under noisy conditions. Before improved speech strategies to code acoustic characteristics of tone can be developed, it would be worthwhile to try both CIS and ACE for CI users and to select the most suitable speech-processing strategy according to the subjective preference and objective performance.

Plunging ranula intruding into the parapharyngeal space treated with OK-432

Makoto Kinoshita, Wataru Kida, Haruka Nakahara — 2011-09-14

Abstract: We report a very rare case of a plunging ranula extending into the parapharyngeal space, which was treated successfully with OK-432. A 27-year-old woman presented with a 4-month history of right submandibular swelling. Based on computed tomography and magnetic resonance imaging findings, we established a diagnosis of plunging ranula intruding into the parapharyngeal space. The patient was treated with an intracystic OK-432 injection that was administered under ultrasonographic guidance. At 6 weeks after the injection, computed tomography showed complete disappearance of the cystic mass. No recurrence was noted during the 10-month follow-up.

Intravenous and topical intranasal bevacizumab (Avastin) in hereditary hemorrhagic telangiectasia

Brian T. Brinkerhoff, Nicholas W. Choong, Jonathan S. Treisman, David M. Poetker — 2011-09-14

Abstract: Current treatment of severe epistaxis in patients with hereditary hemorrhagic telangiectasia is not durable in reducing the frequency and severity of bleeds. Recent reports have demonstrated marked improvement of epistaxis with administration of either intravenous or topical bevacizumab. We present the long-term outcome of a patient who received repeated treatments of intravenous bevacizumab followed by maintenance intranasal bevacizumab. We demonstrate durable control of epistaxis with intranasal bevacizumab. This allows delivery of bevacizumab effectively, reduces cost, and obviates the risk of systemic adverse effects related to bevacizumab.

Carotid cavernous sinus fistula caused by dental implant–associated infection

Yuzaburo Shimizu, Satoshi Tsutsumi, Yukimasa Yasumoto, Masanori Ito — 2011-09-16

Abstract: A 61-year-old woman presented with painful ophthalmoplegia, Tolosa-Hunt syndrome. The patient had undergone a placement of dental implant 5 months before the presentation and had a local maxillary sinusitis 1 month later. She had not been aware of any preceding head trauma or infection. On examination, the patient showed serious right oculomotor nerve paresis and retro-orbital pain. Blood examination showed normal findings. Magnetic resonance imaging identified abnormal structure in the right cavernous sinus with flow void signals. Angiography revealed a carotid cavernous sinus fistula fed by the intracavernous branches of the internal carotid artery on both sides, right internal maxillary and middle meningeal arteries, and left ascending pharyngeal artery. The patient underwent coil embolization via both external carotid arteries. We assumed that local maxillary sinusitis caused by dental implant might spread hematogenously into the sphenoid and cavernous sinuses and formed a carotid cavernous sinus fistula, which presented with Tolosa-Hunt syndrome. Implant-associated infection has to be managed promptly with adequate manner before it spreads.

Brainstem hemorrhage presented as audiovestibular syndromes

Chia-I Chou, Hung-Ching Lin, Kang-Chao Wu, Min-Tsan Shu — 2011-09-29

Abstract: Brainstem hemorrhage usually presented with acute multiple neurologic dysfunction, and the prognosis was poor. Rarely, it can manifest with audiovestibular symptoms only. Here, we report a case of brainstem hemorrhage involving the right middle cerebellar peduncle and dorsal lateral pons presented with constant nonpulsatile tinnitus and rotatory vertigo. We believed that rotatory nystagmus should be regarded as a central sign until proven otherwise even if the neurologic signs are subtle.

Posttraumatic synostosis between the thyroid cartilage and the cervical spine causing dysphagia

In Ho Han, Byung Kwan Choi, Soo Geun Wang, Jin Choon Lee — 2011-09-20

Abstract: A 64-year-old man, 7 years after cervical trauma, presented with severe dysphagia of 3-month duration. Computed tomography showed an unusual synostosis between the thyroid cartilage and the cervical spine at C5-6-7 on the right side. A barium swallow study revealed no laryngeal elevation during swallowing. Surgical resection of the bony fusion was performed, and the patient's dysphagia immediately improved without any complications. We report a case of delayed synostosis between the thyroid cartilage and the cervical spine causing severe dysphagia 7 years after cervical trauma. Surgical resection of the bony fusion resulted in immediate improvement of the dysphagia.

Mucoepidermoid carcinoma of the parotid infiltrating the chorda tympani nerve

Abhineet Lall, Hans-Rudolf Zenklusen, Thomas E. Linder — 2011-09-29

Abstract: We present here the first case report of a mucoepidermoid carcinoma of the parotid infiltrating the chorda tympani nerve and also discuss why an initial diagnosis of Bell palsy may be misleading.

Benign paroxysmal positional vertigo after use of noise-canceling headphones

Eric Dan-Goor, Monica Samra — 2011-10-05

Abstract: Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo. We describe a case of a woman presenting acutely with a severe episode of disabling positional vertigo. Although she had no known etiologic risk factors, this attack followed 12 hours of continuously wearing digital noise-canceling headphones. This is the first such reported association between BPPV and the use of this gadget. We also provide a short review of BPPV and speculate on the possible pathogenic mechanisms involved.

Postlaryngectomy dysphagia masking as velopharyngeal insufficiency: a simple solution for an anterior neopharyngeal diverticulum

2011-10-05

Abstract: Postlaryngectomy dysphagia is a common occurrence and can be a source of emotional distress that results in a decrease in quality of life among a patient population that is already exposed to considerable morbidity. One etiologic source that is less commonly reported as a source for postlaryngectomy dysphagia, and perhaps overlooked, is an anterior neopharyngeal diverticulum. Herein, we describe a postlaryngectomy dysphagia caused by a neopharyngeal diverticulum masking as velopharyngeal insufficiency of liquids. The liquid dysphagia was immediately relieved via transoral endoscopic approach using the Harmonic scalpel to resect and simultaneously coagulate the posterior wall.

Case report: atypical presentation of jugular foramen mass

Megan Wilson, James Dale Browne, Tim Martin, Carol Geer — 2011-12-08

Abstract: Introduction: Jugular foramen lesions are often associated with pathology of adjacent structures due to either compression or direct invasion. Common presenting symptoms include pulsatile tinnitus, a neck mass, hearing loss, and cranial nerve palsies, leading to changes in taste, vocal cord paralysis, dysphagia, and sternocleidomastoid/trapezius weakness (A. Hakuba, K. Hashi, K. Fujitani, et al., Jugular foramen neurinomas. Surg Neurol 1979; 11:83-94). This patient was found to have a jugular foramen mass after presenting with the unusual constellation of visual changes and headache.Case presentation: A jugular foramen mass in a young woman was discovered after presenting with visual changes and headache; the patient was found to have papilledema on initial examination. Otologic and head and neck examination were normal. Subsequent imaging demonstrated a mass at the right jugular foramen with compression of this structure; a contralateral transverse sinus stenosis was also seen. This latter abnormality (along with obstruction of the jugular foramen) impeded venous drainage leading to papilledema and visual changes.Discussion: In a patient presenting with papilledema and severe headache with an associated jugular foramen mass, a multidisciplinary approach benefits the patient with input from interventional neuroradiology, neurosurgery, and neuro-ophthalmology. Venous outflow was compromised through the left stenotic transverse sinus, and the normal outflow on the right side through the jugular bulb was impeded by the tumor; obstructions of both led to symptomatic impeded venous outflow. This compromise in venous outflow led to an increase in superior sagittal sinus pressure, with subsequent increase in intracranial pressure and resultant papilledema. In an attempt to increase blood flow, an angioplasty was performed on the patient's affected transverse sinus. In addition, symptomatology consistent with pseudotumor cerebri prompted the use of acetazolamide for medical management. After both therapies, the patient's symptoms dramatically improved and were stable. The tumor has also remained stable, with no immediate need for surgical resection, stereotactic radiation, or consideration of an intraluminal transverse sinus stent placement or shunting.Conclusion: The unique presentation of a jugular foramen mass in a young woman leading to papilledema highlights the need for high clinical suspicion of potential etiologies necessary for diagnosis. Despite the benign nature of her disease process, an unusual constellation of anatomical factors lead to the need for acute intervention.

Topical timolol for the treatment of epistaxis in hereditary hemorrhagic telangiectasia

Scott E. Olitsky — 2011-11-14

Epistaxis is the most common problem affecting patients with hereditary hemorrhagic telangiectasia (HHT). Approximately 90% of patients with HHT experience epistaxis that can range in severity from a social nuisance to life-threatening hemorrhages. Until recently, the treatment of significant epistaxis in these patients consisted of surgery. Surgical options have included laser photocoagulation, septal dermoplasty, and modified Young's procedure . Recently, the vascular endothelial growth factor (VEGF) inhibitor bevacizumab has shown promise as a medical treatment for HHT-related epistaxis .

Corrigendum

2012-05-01

In the March-April 2012 issue of the journal American Journal of Otolaryngology, in the article titled “Superior semicircular canal dehiscence: a possible pathway for intracranial spread of infection” (2012;33:263-265; doi:10.1016/j.amjoto.2011.05.006), an error had occurred in the Case report section. An incorrect milligram was reported for pentoxifylline. The correct version is “pentoxifylline (100 mg in 100 mL of saline solution, twice a day)”.

Editorial Board

2012-05-01

Guidelines for Contributing Authors

2012-05-01

American Journal of Otolaryngology - Head and Neck Medicine and Surgery

Treatment of bilateral vocal cord paralysis following permanent recurrent laryngeal nerve injury

Role of positron emission tomography in management of sinonasal neoplasms—a single institution's experience

Vallecular cyst in an infant: does your specimen show D2-40 immunoreactivity?

Thyroid hemiagenesis: a case series and review of the literature

Arytenoid adduction combined with medialization laryngoplasty under general anesthesia using a laryngeal mask airway

Clinical features and surgical outcomes of congenital choanal atresia: factors influencing success from 20-year review in an institute

Clinical manifestations and prognosis of patients with Ramsay Hunt syndrome

Recognition and management of perioperative serotonin syndrome

Comparative audiometric evaluation of hearing loss between the premenopausal and postmenopausal period in young women

Dichotic listening test in patients with chronic cerebellar disease

Morphometric endoscopic study of the pharynx in patients with sleep apnea

Comparison of Mandarin tone and speech perception between advanced combination encoder and continuous interleaved sampling speech-processing strategies in children

Plunging ranula intruding into the parapharyngeal space treated with OK-432

Intravenous and topical intranasal bevacizumab (Avastin) in hereditary hemorrhagic telangiectasia

Carotid cavernous sinus fistula caused by dental implant–associated infection

Brainstem hemorrhage presented as audiovestibular syndromes

Posttraumatic synostosis between the thyroid cartilage and the cervical spine causing dysphagia

Mucoepidermoid carcinoma of the parotid infiltrating the chorda tympani nerve

Benign paroxysmal positional vertigo after use of noise-canceling headphones

Postlaryngectomy dysphagia masking as velopharyngeal insufficiency: a simple solution for an anterior neopharyngeal diverticulum

Case report: atypical presentation of jugular foramen mass

Topical timolol for the treatment of epistaxis in hereditary hemorrhagic telangiectasia

Corrigendum

Editorial Board

Table of Contents

Guidelines for Contributing Authors