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Cha D, Lee YW, Cho HJ. A Rare Case of Subcutaneous Emphysema following Lateral Pharyngoplasty for Obstructive Sleep Apnea. JOURNAL OF RHINOLOGY 2018. [DOI: 10.18787/jr.2018.25.2.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Dongchul Cha
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Young-woo Lee
- The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung-Ju Cho
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
- The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea
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Cervicofacial emphysema following Harmonic scalpel tonsillectomy: case report and comprehensive review of the literature. The Journal of Laryngology & Otology 2016; 131:177-180. [PMID: 27989246 DOI: 10.1017/s0022215116009671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Tonsillectomy is one of the most common surgical procedures performed worldwide. There are a handful of common complications, with bleeding being the most feared; however, rarer complications can present to a wide range of medical professionals. METHODS A 12-year-old girl presented with cervicofacial emphysema following tonsillectomy. This paper discusses the case and the management adopted, and presents the findings of a comprehensive literature review. RESULTS The patient made a full recovery, and was discharged after 3 days following conservative management with intravenous broad-spectrum antibiotics and supplemental low-flow oxygen. CONCLUSION This paper presents the first reported case of cervicofacial emphysema following Harmonic scalpel tonsillectomy. Although this is an exceptionally rare complication, it is potentially serious and warrants further description to improve awareness.
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Windfuhr JP. Malpractice claims and unintentional outcome of tonsil surgery and other standard procedures in otorhinolaryngology. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2013; 12:Doc08. [PMID: 24403976 PMCID: PMC3884543 DOI: 10.3205/cto000100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Septoplasty, tonsillectomy (with and without adenoidectomy) and cervical lymph node excision are amongst the most common 50 inpatient operations in Germany. Intracapsular tonsillectomies (i.e. tonsillotomies) are increasingly performed. The aim of this study was to evaluate technical traps and pitfalls as well as alleged medical malpractice associated with tonsillectomy (TE), adenoidectomy (AE), tonsillotomy (TT), septoplasty (SP) and cervical lymph node excision (LN). METHODS A questionnaire was sent to the Regional Medical Conciliation Boards, Medical Services of the Health Insurance Companies (MDK) and Regional Institutes of Forensic Medicine in Germany to collect anonymized cases of complications following TE, TT, AE, LN and SP. The results were discussed in the light of the contemporary medical literature and published trials and verdicts in Germany. RESULTS The response rate of our survey was 55.9%. The Institutes of Forensic Medicine contributed nine cases, 49 cases were submitted by the Regional Conciliation Boards and none by MDK. All forensic cases were associated with exsanguinations following tonsillectomy including two children (5 and 8 years of age) and seven adults (aged 20 to 69 years). The fatal post-tonsillectomy hemorrhage (PTH) had occurred 8.7 days on average; four patients experienced the bleeding episode at home (day 5, 8, 9 and 17, respectively). Repeated episodes of bleeding requiring surgical intervention had occurred in 6 patients. Three Conciliation Boards submitted decicions associated with TT (1), AE (4), LN (3), SP (16) and TE (25). Cases with lethal outcome were not registered. Only three of the 49 cases were assessed as surgical malpractice (6.1%) including lesion of the spinal accessory nerve, wrong indication for TE and dental lesion after insertion of the mouth gag. The review of the medico legal literature yielded 71 published verdicts after AE and TE (29), LN (28) and SP (14) of which 37 resulted in compensation of malpractice after LN (16; 57%), TE (10; 37%), SP (8; 57%) and AE (2; 100%). There were 16 cases of PTH amongst 27 trials after TE resulting either in death (5) or apallic syndrome (5). Bleeding complications had occurred on the day of surgery in only 2 patients. 16 trials were based on malpractice claims following SP encompassing lack of informed consent (6), anosmia (4), septal perforation (2), frontobasal injury (2) and dry nose (2). Trials after LN procedures were associated exclusively with a lesion of the spinal accessory nerve (28), including lack of informed consent in 19 cases. 49 cases (69%) were decided for the defendant, 22 (31%) were decided for the plaintiff with monetary compensation in 7 of 29 AE/TE-trials, 9 of 28 LN-trials and 6 of 14 SP-trials. Lack of informed consent was not registered for AE/TE but LN (11) and SP (2). CONCLUSION Complicated cases following TE, TT, ATE, SP and LN are not systematically collected in Germany. It can be assumed, that not every complicated case is published in the medical literature or law journals and therefore not obtainable for scientific research. Alleged medical malpracice is proven for less than 6% before trial stage. Approximately half of all cases result in a plaintiff verdict or settlement at court. Proper documentation of a thourough counselling, examination, indication, informed consent and follow-up assists the surgeon in litigation. An adequate complication management of PTH is essential, including instructions for the patients/parents, instructions for the medical staff and readily available surgical instruments. Successful outcome of life-threatening PTH is widely based on a proper airway management in an interdisciplinary approach. Electrosurgical tonsillectomy techniques were repeatedly labeled as a risk factor for bleeding complications following TE. Institutions should analyse the individual PTH rate on a yearly basis. Contradictory expert opinions and verdicts of the courts concerning spinal accesory nerve lesions following LN are due to a lack of a surgical standard.
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Affiliation(s)
- Jochen P. Windfuhr
- Department of Otorhinolaryngology, Plastic Head and Neck Surgery, Kliniken Maria Hilf, Mönchengladbach, Germany
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Subcutaneous emphysema and pneumomediastinum after tonsillectomy. Case Rep Otolaryngol 2013; 2013:154857. [PMID: 24379978 PMCID: PMC3860152 DOI: 10.1155/2013/154857] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/23/2013] [Indexed: 02/06/2023] Open
Abstract
Cervicofacial subcutaneous emphysema is a rare complication of tonsillectomy that often resolves spontaneously but may progress to obstruct upper airways or spread to the thorax causing pneumomediastinum or pneumothorax. The mechanisms by which subcutaneous emphysema and pneumomediastinum may develop after tonsillectomy are poorly understood. A case of a 21-year-old female undergoing routine adenotonsillectomy, who developed cervicofacial emphysema and pneumomediastinum, is presented. Possible pathogenetic mechanisms and treatment options are discussed.
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Smyth CM, Sinnathuray AR, Hughes AE, Toner JG. Cochlear implantation in keratitis–ichthyosis–deafness syndrome – 10-year follow-up of two patients. Cochlear Implants Int 2013; 13:54-9. [PMID: 22340753 DOI: 10.1179/146701011x12950038111936] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- C M Smyth
- Department of Otolaryngology, Belfast City Hospital, UK.
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Chang YN, Lee JC, Chen JJ, Lin YS. A rare complication after microlaryngeal surgery: subcutaneous emphysema and pneumomediastinum. J Chin Med Assoc 2010; 73:268-70. [PMID: 20685596 DOI: 10.1016/s1726-4901(10)70058-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 03/10/2010] [Indexed: 11/30/2022] Open
Abstract
Microlaryngeal surgery is a common and relatively safe otorhinolaryngological surgery. Its common complications include pain and numbness of the tongue, bruising of the lip, and chipped teeth. However, reports of subcutaneous emphysema of the neck with pneumomediastinum following microlaryngeal surgery are rare. A 69-year-old female developed swelling of her left-side cheek and neck after microlaryngeal surgery for anterior glottic web. Palpation revealed subcutaneous emphysema and computed tomography demonstrated pneumomediastinum. The patient was managed conservatively, with complete resolution of symptoms within 2 weeks. Our observations suggest that emphysema likely resulted from increased intrapharyngeal pressure secondary to coughing, vomiting, straining, or manual ventilation after extubation provoked by disruption of the pharyngeal mucosa over the left anterior tonsillar pillar during insertion of the laryngoscope. Although microlaryngeal surgery is considered a relatively safe surgical procedure, it may be associated with significant complications. The procedure should be performed carefully to prevent mucosal injury.
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Affiliation(s)
- Ying-Nan Chang
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taiwan, R.O.C
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Hung MH, Shih PY, Yang YM, Lan JY, Fan SZ, Jeng CS. Cervicofacial subcutaneous emphysema following tonsillectomy: implications for anesthesiologists. ACTA ACUST UNITED AC 2010; 47:134-7. [PMID: 19762304 DOI: 10.1016/s1875-4597(09)60040-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cervicofacial subcutaneous emphysema is an unusual complication following tonsillectomy. We present a 37-year-old male patient who, after receiving tonsillectomy, developed cervicofacial subcutaneous emphysema immediately following endotracheal extubation. Valsalva maneuvers evidenced by coughing and straining of the patient, and positive pressure ventilation by mask to alleviate laryngospasm in an emergency were believed to induce and exacerbate the emphysema. Fortunately, the patient was re-intubated and protected from further complication of pneumomediastinum or pneumothorax. The emphysema resolved 7 days later with conservative treatment, including broad-spectrum antibiotics and abstention from enteral intake. This case serves as a reminder that an unusual and unexpected complication can occur in a routine procedure. Methods to prevent this complication are discussed.
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Affiliation(s)
- Ming-Hui Hung
- Department of Anesthesiology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan, R.O.C
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Cunha Fatureto M, Vieira dos Santos JP, Nunes Goulart PE, Andrade Maia S. [Spontaneous pneumomediastinum: asthma]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2008; 14:437-41. [PMID: 18528605 DOI: 10.1016/s0873-2159(15)30251-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Pneumomediastinum is defined as the presence of free air in the mediastinum, and the spontaneous occurs in the absence of diseases or precipitating factors. It is rare in adults, and it is more frequent in newborns. However, it occurs more in young adults, with an 8:1 relationship between men and women. It constitutes a rare finding in asthma, representing 1% of the cases. More frequent symptoms are chest pain and dyspnea. Diagnosis is made with image examinations, such as radiography and chest computed tomography. Treatment of choice is conservative, nonoperative, with a favourable prognosis in the majority of the cases. Our aim is to report a case of this pathology in a young adult seen in our service with chest pain and dyspnea. He underwent complementary examinations and the diagnosis was spontaneous pneumo- mediastinum. This patient was submitted to a conservative treatment with excellent clinical evolution. At the moment, he is asymptomatic and under routine clinical care.
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Unusual complications of tonsillectomy: a systematic review. Am J Otolaryngol 2007; 28:419-22. [PMID: 17980776 DOI: 10.1016/j.amjoto.2006.10.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2006] [Accepted: 10/31/2006] [Indexed: 11/21/2022]
Abstract
AIMS Common complications of tonsillectomy are well recognized and are frequently explained to patients during the process of informed consent. This systematic review serves as a reminder of the unusual complications of this routine procedure. METHODS Studies were located using systematic searches in Medline, Embase, Cinahl, and the Cochrane Library electronic databases, together with hand searching of key texts, references, and reviews relevant to the field. Keywords used included the terms tonsillectomy, complications, unusual, and rare. References from the relevant articles were also searched for. INCLUSION CRITERIA The review was limited to English-language articles. Because of the low incidence of these complications, all cases were included regardless of age. EXCLUSION CRITERIA Complications of tonsillectomy in children with various syndromes were excluded. RESULTS Based on our criteria, 20 articles were identified. Only 10 articles were found suitable for review. All articles were either single case reports or small case series. Because of the small study cohort, the patients' ages ranged widely, from 3 to 21 years, with no sex dominance. The complications were categorized into intraoperative and immediate postoperative (<24 hours), intermediate (<2 weeks), and long-term (>2 weeks) unusual complications. Rare complications reviewed include intraoperative vascular injury, subcutaneous emphysema, mediastinitis, Eagle syndrome, atlantoaxial subluxation, cervical osteomyelitis, and taste disorders. CONCLUSIONS It is important that the otolaryngologist is aware that although the complications discussed are rare and interesting, they are associated with significant morbidity and mortality risks. Tonsillectomy, a very common ear, nose, and throat procedure, may not be so straightforward after all.
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Siedek V, Betz CS, Leunig A. [Cervical skin emphysema: a rare complication following tonsillectomy]. HNO 2006; 55:121-4. [PMID: 16528501 DOI: 10.1007/s00106-006-1389-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Emphysema of the subcutis or interstitial compartments of the neck or around the naso- oro- or hypopharynx is caused by a perforation. In most cases, it occurs after surgery in this area; spontaneous emphysema is very rare. The characteristic symptom is crepitation; the extension is best seen on a CT scan. Endoscopic control of the surgical area for other lesions is necessary. An anaerobic, gas producing infection must be ruled out. Antibiotics should be given prophylactically.
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Affiliation(s)
- V Siedek
- Klinik und Poliklinik für Hals-Nasen- Ohren-Heilkunde der Ludwig-Maximilians-Universität München, Klinikum Grosshadern, 81366, München.
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Shine NP, Sader C, Coates H. Cervicofacial emphysema and pneumomediastinum following pediatric adenotonsillectomy: a rare complication. Int J Pediatr Otorhinolaryngol 2005; 69:1579-82. [PMID: 15939486 DOI: 10.1016/j.ijporl.2005.04.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Accepted: 04/18/2005] [Indexed: 12/16/2022]
Abstract
Cervicofacial emphysema and pneumomediastinum are rarely observed sequelae of surgical intervention in the upper aerodigestive tract. It is a potentially life-threatening condition but the majority of cases are self-limiting and benign. Symptoms include chest pain, neck pain, dyspnea and odynophagia. A case occurring after adenotonsillar surgery in a 7-year-old child is presented. This report highlights this unusual complication and its potential to delay the postoperative recovery following adenotonsillectomy.
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Affiliation(s)
- Neville Patrick Shine
- Department of Pediatric Otolaryngology, Princess Margaret Hospital, Roberts Road, 20 Jarrad Street, Subiaco, Cottesloe, WA 6011, Australia.
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Abstract
Complications of tonsillectomy have been well documented. However, subcutaneous emphysema of the neck following tonsillectomy has rarely been described. We report a case of this complication in a young man who forcefully performed Valsalva's maneuver following a tonsillectomy.
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Affiliation(s)
- Nitesh Patel
- Department of Otolaryngology, Royal National Throat, Nose, and Ear Hospital, London
| | - Gerald Brookes
- Department of Otolaryngology, Royal National Throat, Nose, and Ear Hospital, London
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Nishino H, Kenmochi M, Kasugai S, Okada T, Ohashi T. Subcutaneous emphysema secondary to tonsillectomy: a case report. Auris Nasus Larynx 2003; 30 Suppl:S135-6. [PMID: 12543179 DOI: 10.1016/s0385-8146(02)00142-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report a patient in whom subcutaneous emphysema developed shortly after a tonsillectomy. A 55-year-old female with a chronic tonsillitis underwent a tonsillectomy, and about 8 h after surgery complained of swelling to the left side of the face and neck. There was crepitus and local tenderness in the left side of the neck. A CT scan revealed subcutaneous emphysema. The mechanisms underlying emphysema after tonsillectomy are discussed.
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Affiliation(s)
- Hirohito Nishino
- Department of Otolaryngology, St. Marianna University, Yokohama City Seibu Hospital, 1197-1 Yasashi-cho, Asahi-ku, 241-0811, Yokohama, Japan.
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Marioni G, De Filippis C, Tregnaghi A, Gaio E, Staffieri A. Cervical emphysema and pneumomediastinum after tonsillectomy: it can happen. Otolaryngol Head Neck Surg 2003; 128:298-300. [PMID: 12601334 DOI: 10.1067/mhn.2003.25] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Gino Marioni
- Department of Otolaryngology-Head and Neck Surgery and the Institute of Radiology, University of Padua, Padua, Italy.
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Harada T, Ishida K, Endo M, Takahashi M, Sakai M. Recurrent extrusion of cochlear implant at an interval of 5 years. Otol Neurotol 2003; 24:83-5. [PMID: 12544034 DOI: 10.1097/00129492-200301000-00017] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe two different types of device extrusion occurring in the same patient 1 and 6 years after cochlear implantation and to discuss the relation between the two extrusions and problems of cochlear implantation in patients with chronic suppurative otitis media. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENT AND INTERVENTIONS: The patient was a 52-year-old man with profound hearing loss in the right ear caused by chronic otitis media and deafness in the left ear caused by removal of an acoustic neuroma. Surgery for cleaning the tympanic cavity and reconstruction of the bony canal after previous radical mastoidectomy was performed in the right ear first. One year later, cochlear implantation was performed in this ear. RESULTS One year after implantation, the anterior edge of the internal device of cochlear implant was exposed along the skin incision. This site was stable after corrective surgery. Five years after this operation, however, the posterior edge of the internal device extruded, accompanied by infection around the device. CONCLUSION The two extrusions occurred with a long interval in between and at two different sites. The first extrusion occurred along the skin incision, and the second extrusion occurred away from the skin incision with infection around the device. The authors assumed that the first and the second extrusion occurred independently; the first extrusion was caused by insufficient blood supply resulting from scar formation from repeated mastoid operations and by pressure on the skin from the internal and external devices, and the second extrusion was caused by proliferated tissue pushing the device upward and against the skin as a result of chronic middle ear infection. The clinical course indicates that sufficiently long follow-up periods are needed to determine the usefulness of the prevention techniques for cochlear implantation in patients with chronic suppurative otitis media.
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Affiliation(s)
- Tatsuhiko Harada
- Department of Otolaryngology, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
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Szymko-Bennett YM, Russell LJ, Bale SJ, Griffith AJ. Auditory manifestations of Keratitis-Ichthyosis-Deafness (KID) syndrome. Laryngoscope 2002; 112:272-80. [PMID: 11889383 DOI: 10.1097/00005537-200202000-00014] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Evaluation of the auditory manifestations of Keratitis-Ichthyosis-Deafness (KID) syndrome, a rare genodermatosis characterized by follicular hyperkeratosis, vascularizing keratitis, and congenital hearing loss. STUDY DESIGN Five individuals with sporadic KID syndrome were evaluated in the outpatient audiology clinic at the Warren Grant Magnuson Clinical Center of the National Institutes of Health. METHODS Audiologic examinations included pure-tone audiometry, speech audiometry, and middle ear immittance testing. Auditory brainstem responses and otoacoustic emissions were analyzed in 2 subjects. RESULTS Four subjects had prelingual, bilateral, profound sensorineural hearing loss, whereas the fifth subject had significant residual hearing that exhibited no progression on serial audiograms. All 5 subjects had a history of non-erosive keratosis obturans and cutaneous cysts in the external ear canals that prevented continuous use of ear molds. CONCLUSIONS The sensorineural hearing loss in KID syndrome is generally prelingual and profound. This combination of auditory and cutaneous phenotypes is similar to those previously reported for KID syndrome. KID syndrome presents a difficult challenge for communication rehabilitation because keratitis may impair the perception of sign and spoken language, and the cutaneous manifestations routinely curtail use of external amplification devices.
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Affiliation(s)
- Yvonne M Szymko-Bennett
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA.
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Miman MC, Ozturan O, Durmus M, Kalcioglu MT, Gedik E. Cervical subcutaneous emphysema: an unusual complication of adenotonsillectomy. Paediatr Anaesth 2001; 11:491-3. [PMID: 11442871 DOI: 10.1046/j.1460-9592.2001.00707.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Removal of the tonsils and adenoid tissue because of recurrent infection and/or respiratory obstruction is one of the most commonly performed operations. A rare complication during this intervention is subcutaneous surgical emphysema. The awareness of anaesthesiologists and otolaryngological surgeons will protect the patient from serious consequences. We report our experience with this complication and provide a review of the literature.
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Affiliation(s)
- M C Miman
- Department of Anesthesiology, Turgut Ozal Medical Center, Inonu University Medical Faculty, 44300 Malatya, Turkey.
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