Despite widespread use of antibiotics and surgical procedures for treating peritonsillar abscess (PTA), symptoms of severe inflammation such as pain and trismus during treatment result in patient dissatisfaction. The goal of this study was to perform a systematic review and meta-analysis of the efficacy of systemic steroids on the clinical course of PTA. Two reviewers independently searched the databases (MEDLINE, Scopus, and the Cochrane Database) from inception to December 2014. Studies comparing systemic administration of steroids (steroid group) with placebo (placebo group), where the outcomes of interest were pain, body temperature, hospitalization, and oral intake during the posttreatment period, were included. Baseline study characteristics, study quality data, numbers of patients in the steroid and control groups, and outcomes were extracted. Sufficient data for meta-analysis were retrieved for 3 trials with a total of 153 patients. Pain-related parameters (patient-reported scores and trismus), body temperature, and dysphagia during the first 24 hours after treatment were significantly improved in the steroid group compared with placebo group. The discharge rate during the first 5 days of the posttreatment period was significantly higher in the steroid group than the control group. However, although more patients in the steroid group returned to normal activities and dietary intake at 24 hours after treatment, the differences between the groups were not significant and disappeared after 48 hours. In the treatment of PTA, systemic administration of steroids with antibiotics could reduce pain-related symptoms, as well as provide a benefit with respect to the clinical course. However, further trials with well-designed research methodologies should be conducted to confirm our results.
Adrenal Cortex Hormones* ; Anti-Bacterial Agents ; Body Temperature ; Deglutition Disorders ; Hospitalization ; Humans ; Inflammation ; Peritonsillar Abscess* ; Steroids ; Trismus

The combined effects of inhaled irritant gases and heat in burn patients can result in the development of laryngotracheal strictures. Several factors could adversely affect the development of tracheal stenosis and cause the growth of granulation tissue. Yet the current treatment options for this condition are limited because of the paucity of case reports. We report here on a case of a patient who experienced recurrent upper tracheal stenosis after an inhalation injury. She displayed repetitive symptoms of stenosis even after several laryngomicrosurgeries and resection with end-to-end anastomosis. Finally, 5 yr after the burn injury, slide tracheoplasty was successfully performed and the postoperative check-up findings and the increased airway volume seen on imaging were all satisfactory.
Burns ; Burns, Inhalation ; Constriction, Pathologic ; Gases ; Granulation Tissue ; Hot Temperature ; Humans ; Inhalation ; Tracheal Stenosis

Basaloid squamous cell carcinoma (BSCC) is often founded in the head and neck region. However, BSCC in the sinonasal tract is rare. We report here on the case of a 58-yr-old woman who presented with nasal obstruction and epistaxis. Computed tomography and examination of the nasal cavity revealed a tumor mass that originated from the right inferior turbinate with erosion of the nasal floor. The tumor that was attached to the inferior turbinate, the lateral nasal wall and the eroded right side hard palate, and so all this was resected. Histopathologic examination of the excised tumor confirmed BSCC in the nasal cavity. We report here on a nasal cavity BSCC that was treated with partial maxillectomy only.
Carcinoma, Squamous Cell ; Cytochrome P-450 CYP1A1 ; Epistaxis ; Female ; Floors and Floorcoverings ; Head ; Humans ; Nasal Cavity ; Nasal Obstruction ; Neck ; Palate, Hard ; Turbinates

Otogenic pneumocephalus is a condition of intracranial air originating from the middle ear or mastoid air cells. This communication between the intracranial cavity and the pneumatic cavities is usually associated with trauma after cranial fractures or iatrogenic trauma. We present a rare case of otogenic pneumocephalus arising in the left posterior fossa from wellpneumatized mastoid air cells. The patient complained of roaring tinnitus that developed 29 months after ventriculoperitoneal shunt insertion due to brain tumor surgery. High resolution computed tomography scan of the temporal bones revealed a large pneumocephalus below the left tentorium, and a bony dehiscent route was clearly identified in a sagittal view. A left mastoidectomy with preservation of the posterior wall of the external auditory canal was performed, and the expected bony dehiscent site was identified in the posterior fossa dura plate, just posterior to the posterior semicircular canal, below the Donaldson's line. This communication was sealed with a temporalis muscle plug from the deep temporalis muscle fascia and bone dust. Pneumocephalus may be caused by negative intracranial pressure in a patient with very well-pneumatized mastoid bone, and it can be a possible cause of 'wind-like' sound in the ear.
Brain Neoplasms ; Dust ; Ear ; Ear Canal ; Ear, Middle ; Fascia ; Humans ; Intracranial Pressure ; Mastoid ; Muscles ; Pneumocephalus ; Semicircular Canals ; Temporal Bone ; Tinnitus ; Ventriculoperitoneal Shunt

Myeloid sarcoma is a rare condition that's caused by the aggregation of immature myeloid cells in leukemic patients. Myeloid sarcoma occurring in the temporal bone more frequently involves the mastoid bone than is the case for metastatic lesions arising from non-systemic malignancies. The disease is difficult to diagnose when it presents with symptoms that mimic otomastoiditis. However, an early diagnosis is important in order to achieve complete remission of the disease. Magnetic resonance imaging of the temporal bone is useful for making the diagnosis of myeloid sarcoma, and especially to evaluate the extent of disease. High-dose radio- or chemotherapies are the first-line approaches and possibly the only approaches to achieve complete remission and to cure the disease. With the aim of improving our understanding of myeloid sarcoma in the temporal bone, the present report describes our experience with 5 such cases and we compare the clinical features of these 5 patients with those clinical features of patients who have metastatic lesions.
Early Diagnosis ; Humans ; Hydrazines ; Magnetic Resonance Imaging ; Mastoid ; Myeloid Cells ; Sarcoma, Myeloid ; Temporal Bone

OBJECTIVES: This study was undertaken to confirm the clinical characteristics of recurrent pleomorphic adenoma (RPA), and to identify those factors that affect the development of malignant transformation (MT) from RPA. METHODS: The medical records of 270 patients, who were operated upon for parotid PA, were retrospectively reviewed. The pathologic specimens of a selected series of 23 patients were reviewed for histologic subtype and microscopic multi-nodularity. RESULTS: Mean age of initial operation in RPA without MT (RPA(-MT)) group was significantly lower than that of primary PA group. Mean age of the revision operation in RPA with MT (RPA(+MT)) group was significantly greater than that of RPA(-MT) group. Mean interval from operation to recurrence shortened after each revision operation. The risk of MT and additional recurrence increased significantly with recurrence. In RPA(-MT) group tumor recurrence occurred in 21.4% of patients despite a clear resection margin. CONCLUSION: The risk factors for MT may be an age of over 45 yr and multiple recurrences. However, younger patients are more at risk of recurrence. A clear resection margin cannot guarantee a cure in RPA, and it seems that parotid pleomorphic adenomas slowly gain malignant characteristics after repeated recurrences.
Adenoma, Pleomorphic ; Humans ; Medical Records ; Recurrence ; Retrospective Studies ; Risk Factors

OBJECTIVES: This study investigated the telomerase expression in peripheral blood mononuclear cells (PBMCs) and the relationship between the serum level of several soluble factors such as vascular endothelial growth factor (VEGF), hepatocyte growth factor, interleukin (IL)-6, IL-8, and matrix metallopeptidase-9 and the clinicopathological features of patients with head and neck squamous cell carcinoma (HNSCC). METHODS: Peripheral blood samples were collected from 50 HNSCC patients and 15 normal controls. The telomerase activity in the PBMCs was measured by Telomere Repeat Amplification Protocols. The serum levels of the soluble factors were analyzed by enzyme-linked immunosorbent assay. RESULTS: The expression of telomerase in the PBMCs of HNSCC patients was significantly correlated with the N and American Joint Committee on Cancer (AJCC) stages. The serum VEGF level was significantly higher in the patients with an advanced T stage, N stage and AJCC stage. Serum VEGF was significantly related with the expression of telomerase in the PBMCs. The telomerase expression and the VEGF expression were shown to be independent factors associated with poor survival. CONCLUSION: The telomerase expression in the PBMCs and the serum VEGF level of HNSCC patients were significantly correlated with the N stage, the AJCC stage and the prognosis.
Carcinoma, Squamous Cell ; Enzyme-Linked Immunosorbent Assay ; Head ; Hepatocyte Growth Factor ; Humans ; Interleukin-6 ; Interleukin-8 ; Interleukins ; Joints ; Neck ; Prognosis ; Telomerase ; Telomere ; Vascular Endothelial Growth Factor A ; Vascular Endothelial Growth Factors

OBJECTIVES: There is still debate concerning the reason for the high initial failure rate of positive airway pressure (PAP) treatment. The objective of this study is to investigate the factors of the initial adherence to PAP, with an emphasis on the role of upper airway narrowing. METHODS: The patients were divided into two groups according to the continuation of therapy within the first three months of treatment. The demographic and polysomnographic findings, the minimal nasal cross sectional area (MCA), the degree of palatine tonsilar hypertrophy (PTH) and the modified Mallampati grade of the oropharynx inlet (Orophx) were compared between the study groups. RESULTS: Among 36 patients, 23 continued the auto-adjusting positive airway pressure (APAP) therapy (the adherent group) and 13 discontinued APAP within three months (the non-adherent group). The apnea-hypopnea index (AHI) was significantly higher in the adherent group than in the non-adherent group (P<0.001). The AHI distributions of the two groups are extremely different. Thirteen of the 23 patients in the adherent group had an AHI of more than 60/hr, while none of the patients in the non-adherent group had an AHI of more than 60/hr. In the patients with an AHI from 15 to 60/hr, the MCA at the wide side of the nasal cavity and the sum of the MCAs of both sides were significantly larger in the adherent group than those values in the non-adherent group (P=0.004). The PTH and the Orophx were not significantly different between the two groups. CONCLUSION: AHI is a definite significant factor of adherence to APAP therapy. The dimension of the nasal cavity has an influence on initial APAP adherence in the patients who have a not too high level of AHI.
Acetaminophen ; Bays ; Compliance ; Continuous Positive Airway Pressure ; Humans ; Hypertrophy ; Nasal Cavity ; Oropharynx

OBJECTIVES: Respiratory epithelial cells are the first site of interaction of allergens with the immune system. The aim of this study was to examine the effect of epithelial cells, which were stimulated with house dust mite (HDM) extracts, on the immune response of peripheral blood mononuclear cells (PBMCs). METHODS: Primary nasal polyp epithelial cells were exposed to dermatophagoides pteronyssinus and dermatophagoides farina for 48 hr, and then the supernatant and cells were collected. After stimulation with HDM extract, the epithelial cells were co-cultured with PBMCs for 72 hr and then the supernatant was collected. We measured the interleukin (IL)-8 and granulocyte-macrophage colony stimulating factor to determine the activation of the epithelial cells. The tumor necrosis factor (TNF)-alpha, IL-5 and interferon-gamma were measured to evaluate the interaction between the epithelial cells and the PBMCs. The mRNA expression of intercellular adhesion molecule 1 (ICAM-1) was assessed using the anti-ICAM-1 antibody. RESULTS: The HDM extracts activated the nasal epithelial cells and enhanced the expression of ICAM-1 mRNA and cell membrane ICAM-1. When the activated epithelial cells were co-cultured with PBMCs, the PBMCs produced lager amounts of TNF-alpha and IL-5. However the cytokine production was not inhibited by pretreatment with ICAM-1 antibody. CONCLUSION: HDM allergens induce allergic inflammation by activating nasal epithelial cells, yet the interaction of the epitheila cells and the PBMCs may not be associated with an ICAM-1 medicated mechanism.
Allergens ; Cell Membrane ; Colony-Stimulating Factors ; Dermatophagoides pteronyssinus ; Dust ; Epithelial Cells ; Immune System ; Inflammation ; Intercellular Adhesion Molecule-1 ; Interferon-gamma ; Interleukin-5 ; Interleukins ; Nasal Polyps ; Pyroglyphidae ; RNA, Messenger ; Tumor Necrosis Factor-alpha

OBJECTIVES: To compare tinnitus patients who have normal hearing between 250 Hz and 8 kHz with normal controls with regard to the ability of each group to hear extended high-frequency pure tone thresholds. METHODS: We enrolled 18 tinnitus patients, each of whom had a threshold of HL <25 dB and threshold differences of <10 dB between ears at frequencies of 250 and 500 Hz and 1, 2, 4, and 8 kHz. We also enrolled age- and gender-matched normal volunteers (10 ears), for each patient. Extended high frequency pure tone audiometry was performed, and the mean hearing thresholds at 10, 12, 14, and 16 kHz of each tinnitus ear were compared with those of the 10 age- and sex-matched normal ears. RESULTS: Of the 18 patients with tinnitus, 12 had significantly increased hearing thresholds at more than one of the four high frequencies, compared with the normal group. When we assessed results according to frequency, we found that 8 patients had decreased hearing ability at 10 kHz, 10 at 12 kHz, 8 at 14 kHz, and 4 at 16 kHz. CONCLUSION: Some patients with tinnitus who have normal hearing below 8 kHz have decreased hearing ability at extended high-frequencies. Thus, the proportion of patients with tinnitus who have normal hearing over the entire audible range is smaller than in previous reports.
Audiometry ; Ear ; Hearing ; Hearing Loss ; Humans ; Tinnitus