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Seyedjavadeyn Z, Miratashi Yazdi SA, Samimiat A, Vahedi M. Thyrotoxicosis as a rare presentation in acute suppurative thyroiditis: a case report. J Med Case Rep 2023; 17:428. [PMID: 37833794 PMCID: PMC10576297 DOI: 10.1186/s13256-023-04119-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/04/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Acute suppurative thyroiditis is a rare and potentially life-threatening disease. A few cases of acute suppurative thyroiditis associated with thyrotoxicosis have been reported in adults. We report a case of acute suppurative thyroiditis that was associated with thyrotoxicosis. CASE PRESENTATION We report the case of a 49-year-old Iranian female presented with a painful neck swelling for a week. Computed tomography showed a well-defined gas-filled collection in the left thyroid lobe with an enhancing margin. The patient underwent two-phase surgery, first left thyroid abscess drainage and then total thyroidectomy. The result of histopathology examination was multinodular goiter with abscess formation without malignancy. CONCLUSION Abscess formation and thyrotoxicosis is a very rare condition that occurs at the same time in acute suppurative thyroiditis. Despite antibiotic therapy being the first line of treatment, surgery is also required when antibiotic therapy fails.
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Affiliation(s)
- Zeynab Seyedjavadeyn
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Alireza Samimiat
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Matin Vahedi
- Department of General Thoracic Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Bako P, Kovacs M, Uzsaly J, Burian A, Bodzai G, Nemeth A, Toth A, Szanyi I, Gerlinger I. Subtotal Petrosectomy and Cochlear Implantation in Children With Chronic Suppurative Otitis Media: A Single Institutional Experience. J Audiol Otol 2022; 26:214-222. [PMID: 36285467 PMCID: PMC9597276 DOI: 10.7874/jao.2022.00220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Chronic suppurative otitis media (CSOM) with or without cholesteatoma is a frequent chronic inflammatory condition in children, which may lead to severe hearing loss that affects speech development. Treatment of recurrent CSOM associated with unserviceable hearing requires a specialized approach with regard to disease eradication and hearing rehabilitation. In this study, we investigated the advantages of subtotal petrosectomy (SP) combined with cochlear implantation (CI) in children with CSOM associated with unserviceable hearing and describe our experience with regard to the efficacy of this method, together with a literature review. SUBJECTS AND METHODS SP with sequential or simultaneous CI was performed in three children (four ears), and postoperative audiometric data were recorded. RESULTS The study included two male and one female patient. Mean age at the time of SP was 10.75 years (7-13 years). Sequential implantation was performed in three ears. Facial nerve palsy occurred after SP in one patient. The latest word recognition scores of Cases 1, 2, and 3 were 80% (at 60 dB), 75% (at 60 dB), and 70% (at 50 dB) and 90% (at 50 dB), respectively. CONCLUSIONS SP with CI may be safe and reliable in children with CSOM associated with unserviceable hearing.
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Affiliation(s)
- Peter Bako
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary,Regenerative Science, Sport and Medicine Research Group, Szentágothai Research Centre, University of Pécs, Pécs, Hungary,Address for correspondence Peter Bako, MD, PhD Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, 2 Munkacsy Street, H-7621 Pécs, Hungary Tel +36-72507312 Fax +36-72312151 E-mail
| | - Marton Kovacs
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Janos Uzsaly
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Andras Burian
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Greta Bodzai
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Adrienn Nemeth
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Arnold Toth
- Department of Medical Imaging, Medical School, University of Pécs, Pécs, Hungary
| | - Istvan Szanyi
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Imre Gerlinger
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
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Sengul I, Sengul D. Puzzling Persistent Anterior Cervical Pain: to Be or Not to Be? Med Arch 2022; 75:395-396. [PMID: 35169365 PMCID: PMC8740669 DOI: 10.5455/medarh.2021.75.395-396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 10/21/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ilker Sengul
- Division of Endocrine Surgery, Giresun University Faculty of Medicine, TR28100 Giresun, Turkey.,Department of General Surgery, Giresun University Faculty of Medicine, TR28100 Giresun, Turkey
| | - Demet Sengul
- Department of Pathology, Giresun University Faculty of Medicine, TR28100 Giresun, Turkey
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Marques JAS, Sousa M, Leal LM, Spratley J, Santos M. Pediatric tympanoplasty: A paradigm shift? Acta Otorrinolaringol Esp (Engl Ed) 2021; 72:375-80. [PMID: 34844676 DOI: 10.1016/j.otoeng.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/22/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Pediatric tympanoplasty is still a matter of controversy. Many factors have been associated with the surgical outcome of tympanoplasty in children, including age, size and location of the perforation, surgical technique and Eustachian tube dysfunction. The optimal approach and timing of this surgery remains controversial. This study aims to evaluate the outcomes of pediatric tympanoplasty and analyze factors that may influence the success of this surgery. MATERIALS AND METHODS A retrospective review was conducted which included children from 5 to 15 years old that underwent tympanoplasty with or without ossiculoplasty for chronic tympanic perforation in a tertiary care university hospital over a 6-year period. Patients were divided in two age groups (5 to ≤10 years old and >10 to 15 years old). Children with cholesteatoma or that underwent simultaneous mastoidectomy were excluded. RESULTS 83 cases were included. Average age was 10.7±2.1 years and mean follow-up time was 9 months. Of the cases, 21.7% were revision surgeries. Successful closure of the tympanic membrane perforation was achieved in 76.9% of primary surgeries and 55.6% of revision surgeries. Most of the patients improved their conductive hearing-deficit. No statistical difference in graft failure was noted regarding age, presence of craniofacial dysmorphism and surgical approach. The use of simple graft (temporal muscle fascia or tragus perichondrium) was significantly superior in primary surgery (p<0.05). We also found a significant difference between the location of the perforation and revision surgery, with anterior perforations showing a higher risk (p<0.05). CONCLUSIONS Pediatric tympanoplasty is effective in repairing chronic tympanic perforations. In our study, accepted predictors of surgical outcome such as age and surgical approach were not associated with graft failure.
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Nielsen NØ, Nørlinger C, Greve T, Klug TE. Cervical suppurative lymphadenitis in children: microbiology, primary sites of infection, and evaluation of antibiotic treatment. Eur Arch Otorhinolaryngol 2021; 279:3053-3062. [PMID: 34623496 DOI: 10.1007/s00405-021-07115-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The significant pathogens associated with paediatric cervical suppurative lymphadenitis (CSL) are unclarified, and there is a lack of clinical evaluations of antibiotic regimens in paediatric CSL. We aimed to (1) explore the bacterial findings and the associated primary sites of infection in paediatric cases of CSL and (2) evaluate the clinical outcomes in patients treated with different antibiotic regimens. METHODS All children (< 18 years) treated for non-mycobacterium CSL at the Department of Otorhinolaryngology, Aarhus University Hospital, from 2001 to 2018 were retrospectively evaluated. RESULTS Eighty-five patients were included in the study. The prevalent isolates were S. aureus (57%), S. pyogenes (17%), non-haemolytic streptococci (11%), and F. necrophorum (3%). The primary sites of infection were identified in 30 (35%) patients. The most common sites were the oropharynx (n = 15), the middle ear (n = 10), and the skin (n = 5). All patients were treated with surgical incision and antibiotics. No statistically significant differences were found between patients treated with antibiotics covering streptococci (n = 60) versus antibiotics covering streptococci and S. aureus (n = 25) in terms of duration of hospitalisation (median 4 vs 4 days, p = 0.26), altered antibiotic treatment because of insufficient clinical or biochemical progress (7% vs 12%, p = 0.41), and abscess recurrence (8% vs 12%, p = 0.69). CONCLUSION S. aureus was the predominant pathogen in paediatric CSL at all cervical levels, and even in cases with evidence of primary site infection not normally associated with S. aureus. We were unable to underscore the importance of antibiotic treatment covering S. aureus based on evaluation of the clinical outcomes.
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Affiliation(s)
- Nicolai Østergaard Nielsen
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark.
| | - Christian Nørlinger
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
| | - Thomas Greve
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
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Marques JAS, Sousa M, Leal LM, Spratley J, Santos M. Pediatric tympanoplasty: A paradigm shift? Acta Otorrinolaringol Esp (Engl Ed) 2021; 72:S0001-6519(20)30197-7. [PMID: 33454086 DOI: 10.1016/j.otorri.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES Pediatric tympanoplasty is still a matter of controversy. Many factors have been associated with the surgical outcome of tympanoplasty in children, including age, size and location of the perforation, surgical technique and Eustachian tube dysfunction. The optimal approach and timing of this surgery remains controversial. This study aims to evaluate the outcomes of pediatric tympanoplasty and analyze factors that may influence the success of this surgery. MATERIALS AND METHODS A retrospective review was conducted which included children from 5 to 15 years old that underwent tympanoplasty with or without ossiculoplasty for chronic tympanic perforation in a tertiary care university hospital over a 6-year period. Patients were divided in two age groups (5 to ≤10 years old and >10 to 15 years old). Children with cholesteatoma or that underwent simultaneous mastoidectomy were excluded. RESULTS 83 cases were included. Average age was 10.7±2.1 years and mean follow-up time was 9 months. Of the cases, 21.7% were revision surgeries. Successful closure of the tympanic membrane perforation was achieved in 76.9% of primary surgeries and 55.6% of revision surgeries. Most of the patients improved their conductive hearing-deficit. No statistical difference in graft failure was noted regarding age, presence of craniofacial dysmorphism and surgical approach. The use of simple graft (temporal muscle fascia or tragus perichondrium) was significantly superior in primary surgery (p<0.05). We also found a significant difference between the location of the perforation and revision surgery, with anterior perforations showing a higher risk (p<0.05). CONCLUSIONS Pediatric tympanoplasty is effective in repairing chronic tympanic perforations. In our study, accepted predictors of surgical outcome such as age and surgical approach were not associated with graft failure.
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Affiliation(s)
- Joana A S Marques
- Department of Otorhinolaryngology - Centro Hospitalar Universitário São João, EPE, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Unit of Otorhinolaryngology - Department of Surgery and Physiology - Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Mafalda Sousa
- Department of Otorhinolaryngology - Centro Hospitalar Universitário São João, EPE, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Unit of Otorhinolaryngology - Department of Surgery and Physiology - Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Laurentino Mendes Leal
- Department of Otorhinolaryngology - Centro Hospitalar Universitário São João, EPE, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Unit of Otorhinolaryngology - Department of Surgery and Physiology - Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Jorge Spratley
- Department of Otorhinolaryngology - Centro Hospitalar Universitário São João, EPE, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Unit of Otorhinolaryngology - Department of Surgery and Physiology - Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Health Technologies and Services Research Center (CINTESIS), R. Dr. Plácido da Costa, 4200-450 Porto, Portugal
| | - Margarida Santos
- Department of Otorhinolaryngology - Centro Hospitalar Universitário São João, EPE, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
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Kaye AJ, Chin AT, Liang MC, Viau Colindres R. Hypervirulent Klebsiella pneumoniae infection in a woman with a CDH1 gene mutation. IDCases 2020; 23:e01000. [PMID: 33251111 PMCID: PMC7677705 DOI: 10.1016/j.idcr.2020.e01000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 11/12/2022] Open
Abstract
The CDH1 gene, which encodes E-cadherin, may be associated with cancer when mutated, but the significance of mutations in the context of infection is unknown. In this report, we describe a case of disseminated hypervirulent Klebsiella pneumoniae infection in a 49 year old Caucasian woman with a documented CDH1 mutation.
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Affiliation(s)
| | - Adam T Chin
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | | | - Roberto Viau Colindres
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA
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Engebretsen S, Patrick T, Helwig C, O'Niel M. Zygomatic air cells in connection with Luc's abscess. Int J Pediatr Otorhinolaryngol 2020; 138:110251. [PMID: 32861976 DOI: 10.1016/j.ijporl.2020.110251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION An uncommon complication of Acute Otitis Media (AOM) is a subperiosteal temporal infection known as Luc's abscess. Zygomatic air cells (ZACs) are an uncommon anatomic variant. CASE SERIES Two otherwise healthy male patients, aged six- and thirteen years-old presented with unilateral otalgia, swelling, trismus, and fever. Imaging revealed Luc's abscess near ZACs. Antibiotics, drainage and myringotomy tubes resulted in a full recovery. CONCLUSION In addition to the spread of soft tissue infection through the Notch of Rivinus, the presence of ZACs may provide a pathway for suppurative effusion and development into Luc's abscess.
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Affiliation(s)
- Steven Engebretsen
- Children's Hospital of Michigan, Department of Otolaryngology - Head and Neck Surgery, 3901 Beaubien, Detroit, MI, 48201, USA; Michigan State University, 3901 Beaubien, Detroit, MI, 48201, USA.
| | - Tyler Patrick
- Children's Hospital of Michigan, Department of Otolaryngology - Head and Neck Surgery, 3901 Beaubien, Detroit, MI, 48201, USA; Michigan State University, 3901 Beaubien, Detroit, MI, 48201, USA.
| | - Cecelia Helwig
- Children's Hospital of Michigan, Department of Otolaryngology - Head and Neck Surgery, 3901 Beaubien, Detroit, MI, 48201, USA; Wayne State University, 3901 Beaubien, Detroit, MI, 48201, USA.
| | - Mallory O'Niel
- Children's Hospital of Michigan, Department of Otolaryngology - Head and Neck Surgery, 3901 Beaubien, Detroit, MI, 48201, USA; Michigan State University, 3901 Beaubien, Detroit, MI, 48201, USA; Wayne State University, 3901 Beaubien, Detroit, MI, 48201, USA. MO'
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Fang L, Xu J, Wang W, Huang Y. Auricular suppurative perichondritis secondary to exclusive endoscopic ear surgery for tympanoplasty: A case report and literature review. Am J Otolaryngol 2020; 41:102571. [PMID: 32590256 DOI: 10.1016/j.amjoto.2020.102571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 05/26/2020] [Indexed: 10/24/2022]
Abstract
Endoscope is an innovative method for otologists in middle ear surgery. Many previous studies have confirmed the safety and efficiency of the endoscopic technique, as a reliable therapeutic option with very low complication rates, clearly supporting the use of endoscopy in ear surgery. Auricular suppurative perichondritis secondary to exclusive endoscopic ear surgery for tympanoplasty is an extremely rare type of those without any previously reported cases. In this report, we describe the course of auricular suppurative perichondritis of a 55-year-old woman. The patient was ultimately healed through surgical debridement and postoperative dressing with no evidence of recurrence at two months follow-up. There were no auricle deformity or external auditory canal stenosis with six months following-up.
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Tsitsiou Y, Mantelakis A, Joshi A. Use of a sternocleidomastoid rotational and cervical-fascial advancement flap for closure of a persistent mastoid cutaneous fistula. J Laryngol Otol 2020; 134:1-3. [PMID: 32772935 DOI: 10.1017/s0022215120001498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Post-auricular mastoid fistula is a rare occurrence. It typically appears following repeated soft tissue injury, and is commonly caused by chronic suppurative otitis media and repeated surgical treatments. Management is challenging, with few reported successful surgical techniques, which often have limited applicability. CASE REPORT This paper presents the case of a 58-year-old male with a persistent right-sided post-auricular cutaneous mastoid fistula resulting from two previous mastoidectomies. Although the patient underwent two simple primary closures, the fistula recurred. This was successfully treated with a new technique utilising a sternocleidomastoid rotational and cervical-fascial advancement flap, which was completely healed at the one-year follow up without a recurrence of the fistula. CONCLUSION This novel technique provided definitive obliteration of a persistent cutaneous mastoid fistula. Utilising a double-layered flap and a facelift incision results in excellent functional and cosmetic outcomes.
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Affiliation(s)
- Y Tsitsiou
- Imperial School of Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - A Mantelakis
- Department of Ear, Nose and Throat Surgery, Lewisham and Greenwich NHS Trust, London, UK
| | - A Joshi
- Department of Ear, Nose and Throat Surgery, Lewisham and Greenwich NHS Trust, London, UK
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Abstract
Pyogenic flexor tenosynovitis is a closed-space infection that can lead to a devastating loss of finger and hand function. It can spread rapidly into the palm, distal forearm, other digits, and nearby joints. Healthy individuals may present with no signs of systemic illness and often deny any penetrating trauma or inoculation. Early diagnosis and prompt treatment are required to preserve the digit and prevent morbidity and loss of hand function. Many treatment options have been described, although all share 2 common principles: evacuation of the infection and tailored postoperative antibiotic treatment with close monitoring to ensure clinical improvement.
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Affiliation(s)
- Kanu Goyal
- Department of Orthopaedic Surgery, Hand & Upper Extremity Center, The Ohio State Wexner Medical Center, 915 Olentangy River Road, Suite 3200, Columbus, OH 43212, USA.
| | - Amy L Speeckaert
- Department of Orthopaedic Surgery, Hand & Upper Extremity Center, The Ohio State Wexner Medical Center, 915 Olentangy River Road, Suite 3200, Columbus, OH 43212, USA
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Agarwal A, Rastogi P. What factors contribute to Choi IV sequelae? A retrospective analysis of 15 septic hips. J Clin Orthop Trauma 2020; 11:S645-S649. [PMID: 32774042 PMCID: PMC7394802 DOI: 10.1016/j.jcot.2020.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Choi IV sequela is one of the most severe outcomes of septic hips. We undertook a retrospective chart review of 15 such hips in 13 patients to identify factors contributing to the formation of this sequelae. METHODS The study specifically focused on patient demographics (patient's age; time to arthrotomy from initial symptoms; causative organism; post arthrotomy duration when Choi IV changes were obvious) and radiological findings at the time of arthrotomy. RESULTS The average patient's age at time of infection was 2.9 years. Five children were infants. The time to arthrotomy from initial symptoms was mean 21.6 days. Multifocal involvement was seen in 2 patients. Concurrent arthritis and osteomyelitis was present in 8 (53%) and pathological subluxation or dislocation in 9 hips (60%). Methicillin-sensitive Staphylococcus aureus was isolated in 7 and Methicillin-resistant Staphylococcus aureus in 4 patients. The Choi IV findings were established on average 3.8 months post arthrotomy. CONCLUSIONS Delay in treatment, post septic dislocation and concurrent femoral osteomyelitis were factors associated with Choi IV septic sequelae. The pathology occurred irrespective of age.
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Affiliation(s)
- Anil Agarwal
- Corresponding author. Department of Orthopedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, 31, India.
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Yadav SPS, Malik JS, Malik P, Sehgal PK, Gulia JS, Ranga RK. Studying the result of underlay myringoplasty using platelet-rich plasma. J Laryngol Otol 2018; 132:990-4. [PMID: 30370872 DOI: 10.1017/S0022215118001846] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Perforations of the tympanic membrane are treated with various surgical techniques and materials. This study aimed to determine the efficacy of platelet-rich plasma during underlay myringoplasty. METHODS The study included 40 patients. Autologous platelet-rich plasma was applied in-between temporalis fascia graft and tympanic membrane remnant during underlay myringoplasty in group 1 (n = 20). The outcome was evaluated after three months and compared with group 2 (n = 20), a control group that underwent routine underlay tympanoplasty. RESULTS After three months' follow up, graft uptake was 95 per cent in group 1 and 85 per cent in group 2 (p < 0.03). Mean hearing threshold gain was 18.62 dB in group 1 and 13.15 dB in group 2. This difference was statistically significant (p < 0.01). CONCLUSION Platelet-rich plasma, with its ease of preparation technique, availability, low cost, autologous nature and good graft uptake rate, justifies its use in tympanoplasty type I procedures.
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Abstract
BACKGROUND One hundred years ago, millions of British and Allied troops were fighting in the trenches of the Great War. With a tenth of soldiers losing their lives, hearing loss seemed a low priority; however, vast numbers of troops sustained significant hearing loss. METHOD A review was conducted of literature published between 1914 and 1925. RESULTS Soldiers were exposed to up to 185 dB of sustained noise from new, high-energy weapons, which caused 'labyrinthine concussion'. Traumatic injuries, non-organic hearing loss and malingering were also common. One source estimated that 2.4 per cent of the army was disabled by hearing loss. However, many British doctors viewed this 'soldier's deafness' as a temporary affliction, resulting in soldiers being labelled as malingerers or 'hysterical'. CONCLUSION Today, one can recognise that a scant evidence base and misconceptions influenced the mismanagement of hearing loss by otolaryngologists in World War I. However, noise-induced hearing loss is still very much a feature of armed conflict.
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Kimia AA, Rudloe TF, Aprahamian N, McNamara J, Roberson D, Landschaft A, Vaughn J, Harper MB. Predictors of a drainable suppurative adenitis among children presenting with cervical adenopathy. Am J Emerg Med 2018; 37:109-113. [PMID: 29754963 DOI: 10.1016/j.ajem.2018.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/25/2018] [Accepted: 05/05/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES We sought to identify predictors for a drainable suppurative adenitis [DSA] among patients presenting with acute cervical lymphadenitis. METHODS A retrospective cross sectional study of all patients admitted to an urban pediatric tertiary care emergency department over a 15 year period. Otherwise healthy patients who underwent imaging for an evaluation of cervical lymphadenitis were included. Cases were identified using a text-search module followed by manual review. We excluded immunocompromised patients and those with lymphadenopathy felt to be not directly infected (i.e. reactive) or that was not acute (symptom duration >28 days). Data collected included: age, gender, duration of symptoms, highest recorded temperature, physical exam findings, laboratory and imaging results, and surgical findings. A DSA was defined as >1.5 cm in diameter on imaging. We performed binary logistic regression to determine independent clinical predictors of a DSA. RESULTS Three hundred sixty-one patients met inclusion criteria. Three hundred six patients (85%) had a CT scan, 55 (15%) had an ultrasound and 33 (9%) had both. DSA was identified in 71 (20%) patients. Clinical features independently associated with a DSA included absence of clinical pharyngitis, WBC >15,000/mm3, age ≤3 years, anterior cervical chain location, largest palpable diameter on exam >3 cm and prior antibiotic treatment of >24 h. The presence of fever, skin erythema, or fluctuance on examination, was not found to be predictive of DSA. CONCLUSIONS We identified independent predictors of DSA among children presenting with cervical adenitis. Risk can be stratified into risk groups based on these clinical features.
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Yıldız BD, Özden S, Saylam B, Martlı F, Tez M. Simplified scoring system for prediction of mortality in acute suppurative cholangitis. Kaohsiung J Med Sci 2018; 34:415-419. [PMID: 30063015 DOI: 10.1016/j.kjms.2017.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 11/07/2017] [Accepted: 12/27/2017] [Indexed: 01/21/2023] Open
Abstract
Our objective in this study was to identify the factors contributing to mortality in acute suppurative cholangitis which could be tested easily in every emergency clinic. This is a retrospective study enrolling 104 patients with acute suppurative cholangitis. Demographic and laboratory data were collected for analysis. In univariant analysis red cell distribution width, total bilirubin level, intensive care unit admission was identified as statistically significant (p < 0.05) to predict mortality. Three variables were statistically significant in multivariate analysis: total bilirubin level equal to or more than 6.9 mg/dl, red cell distribution width equal to or more than 14.45%, and admission to intensive care unit. We found a new scoring system for prediction of mortality in acute suppurative cholangitis utilizing only three variables. This would serve as a simplified, rapid way to direct patients for advanced interventions instead of wasting time with more complicated and time consuming multi-variable scoring systems.
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Affiliation(s)
| | - Sabri Özden
- Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Barış Saylam
- Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Fahri Martlı
- Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Mesut Tez
- Ankara Numune Education and Research Hospital, Ankara, Turkey.
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Mofatteh MR, Shahabian Moghaddam F, Yousefi M, Namaei MH. A study of bacterial pathogens and antibiotic susceptibility patterns in chronic suppurative otitis media. J Laryngol Otol 2018; 132:41-5. [PMID: 29151379 DOI: 10.1017/S0022215117002249] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the frequency of bacterial agents in chronic suppurative otitis media and the antibiotic susceptibility patterns of isolates among patients. METHODS A total of 185 patients clinically diagnosed with chronic suppurative otitis media were interviewed and middle-ear effusion samples were collected using sterile swabs. All bacterial isolates were identified by conventional microbiological methods. Antibiotic susceptibility patterns of the isolates were determined by Kirby-Bauer disc diffusion. RESULTS Staphylococci spp. (64.9 per cent) were the most prevalent bacteria isolated, followed by Klebsiella spp. (12.9 per cent) and Pseudomonas aeruginosa (10.3 per cent). The most effective antibiotic for treatment of bacterial chronic suppurative otitis media was ciprofloxacin. Statistical analysis showed no significant difference in bacterial infestations among chronic suppurative otitis media patients and the antimicrobial susceptibility patterns of the bacterial isolates based on gender and age (p > 0.05). CONCLUSION Our findings highlight the importance of a continuous and periodic evaluation of the bacteriological profile and antibiotic susceptibility patterns in chronic suppurative otitis media patients for efficacious treatment of the infection.
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Khattak SF, Sheikh NA, Aleem A, Farooq M, Nadeem K. Microbiological Profile From Middle Ear And Nasopharynx In Patients Suffering From Chronic Active Mucosal Otitis Media. J Ayub Med Coll Abbottabad 2017; 29:610-613. [PMID: 29330988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Chronic otitis media is described as a tympanic membrane perforation and ear discharge for more than six weeks duration. Ascending infection from the nasopharynx into the middle ear cleft has been attributed to prevent resolution of chronic otitis media. This research aims to determine the association between the microbiological flora of the nasopharynx with that of the middle ear in patients suffering from chronic (active) mucosal otitis media.. METHODS Our study is a hospital-based cross-sectional survey. It was conducted from December 2015 to February 2017 at the Department of ENT, Combined Military Hospital, Abbottabad. Ear and nasopharyngeal swabs were obtained from 65 patients of chronic active mucosal otitis media and sent for microbiological analysis. Microbiological culture and sensitivity test was performed to identify the microbial spectrum of each specimen. Performa bearing the result of otoscopy, aspirate and swabs were completed for middle ear and the nasopharyngeal culture with reference to each patient. Descriptive statistics and Pearson's chi square analysis were performed using SPSS-22. RESULTS Staphylococcus aureus and Pseudomonas aeruginosa are foremost microorganisms found in otorrhea culture isolated from patients of chronic active mucosal otitis media. Majority of the cultures from nasopharynx of these patients did not reveal any growth after incubation for 48 hours. CONCLUSIONS A statistically insignificant association exists between the microbiological spectrum of the middle ear and the nasopharynx of patients suffering from chronic active mucosal otitis media. Micro organisms' exposure from a perforated tympanic membrane remains leading cause of persistent otorrhea, rather than ascending infection through the Eustachian tube.
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Affiliation(s)
| | | | - Adil Aleem
- Department of ENT, Combined Military Hospital, Abbottabad, Pakistan
| | - Muhammad Farooq
- Department of ENT, Combined Military Hospital, Abbottabad, Pakistan
| | - Kanwal Nadeem
- Department of ENT, Combined Military Hospital, Abbottabad, Pakistan
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Amali A, Hosseinzadeh N, Samadi S, Nasiri S, Zebardast J. Sensorineural hearing loss in patients with chronic suppurative otitis media: Is there a significant correlation? Electron Physician 2017; 9:3823-3827. [PMID: 28465813 PMCID: PMC5410912 DOI: 10.19082/3823] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 01/11/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction Hearing loss as a sequel of chronic suppurative otitis media (CSOM) is often conductive, but recent studies have found an additional sensorineural component in these patients, thus demonstrating inner ear damage. The aim of the study was to determine the association between CSOM and sensorineural hearing loss (SNHL) and to assess the influence of patient’s age, duration of disease, and presence of cholesteatoma and ossicular erosion on the degree of SNHL. Methods In a retrospective study, the medical records of 119 patients who underwent surgery was reviewed. Seventy patients met the inclusion criteria of unilateral otorrhea, normal contralateral ear on otoscopy, and age between 10–65 years with no history of head trauma or ear surgery or familial hearing loss. Bone conduction (BC) thresholds for affected and contralateral ear were measured at frequencies of 500, 1000, 2000, and 4000 Hz. Data analysis was performed using SPSS 13 with independent-samples t-test, Pearson correlation test, and two-tailed analysis. A p ≤ 0.05 was considered statistically significant. Results Significant higher BC thresholds were found in the affected ear than in the normal ear for each frequency (p < 0.001), which increased with increasing frequency (7.00 dB at the 500 Hz and 9.71 dB at the 4000 Hz). There was a significant correlation between age and degree of SNHL (r = 0.422, p < 0.001) but no significant correlation was in duration of the disease (r = 0.119, p > 0.05). There was no relationship between presence of cholesteatoma and ossicular erosion with SNHL (p > 0.05). Conclusion These findings demonstrate that CSOM is associated with some degree of SNHL and cochlear damage, and higher frequencies are more affected. Aging can act as a precipitating factor in this pathological process.
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Affiliation(s)
- Amin Amali
- Associate Professor of Otorhinolaryngology, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Hosseinzadeh
- Medical Student, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahram Samadi
- Assistant Professor, Department of Anesthesiology and Intensive Care, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Nasiri
- Medical Student, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Jayran Zebardast
- Researcher Nurse, Deputy of research, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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20
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Abstract
Francisella tularensis, the causative organism in Tularemia, is a relatively rare disease. There are a few radiological clues to elucidate its presence when suspicion arises. There should be strong consideration for Tularemia in the differential of any patient with its classic symptoms, diffuse cervical lymphadenopathy with evidence of necrosis, and enlarged adenoids. Ultrasound may demonstrate suppurative lymphadenopathy suggestive of infection, as in the case presented. CT often will demonstrate the extent of lymphadenopathy. On chest radiography, tularemia pneumonia is often the presenting finding, which may demonstrate bilateral or lobar infiltrates. Additionally, hilar lymphadenopathy and pleural effusions are often associated findings. Cavitary lesions may be present, which are better delineated on CT scan. We present a case of a 7-year-old male who presented with a painful right-sided palpable neck mass for 9 days, who was diagnosed with Tularemia after numerous admissions.
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Affiliation(s)
- Neil Anand
- Department of Radiology, Morristown Medical Center, Morristown, NJ, USA
| | - Osmani Deochand
- Department of Radiology, Morristown Medical Center, Morristown, NJ, USA
| | - Robyn Murphy
- Department of Radiology, Morristown Medical Center, Morristown, NJ, USA
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Nemati S, Jafari Shakib R, Shakiba M, Araghi N, Azimi SZ. Allergic Rhinitis in Adults with Chronic Suppurative Otitis Media. Iran J Otorhinolaryngol 2015; 27:261-6. [PMID: 26788473 PMCID: PMC4710877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Chronic suppurative otitis media (CSOM) is considered one of the most common causes of acquired hearing impairment in developing countries. CSOM is a multifactorial persistent inflammatory disease of the middle ear. A distinct pathophysiologic mechanism linking allergic rhinitis (AR) and CSOM remains to evolve. The purpose of this study was to investigate the association between AR and CSOM in adults.This was a case-control study. MATERIALS AND METHODS The subjects were 62 adults (23 male, 39 female) with established CSOM and 61 healthy controls. CSOM was diagnosed when there was a history of chronic (persisting for at least 3 months) otorrhea, accumulation of mucopurulent exudates in the external auditory canal or middle ear and/or perforated tympanic membrane on otoscopy. All participants were evaluated for the presence of AR by clinical evaluation of allergic symptoms, and underwent a skin-prick test for 23 common regional allergens. Statistical analysis was performed using SPSS version 16. RESULTS The prevalence of clinical rhinitis (allergic and non-allergic) was significantly higher among the cases compared with controls (62.5% vs. 37.5%, P=0.02). The prevalence of AR (proven by positive skin-prick test) was also significantly higher among affected adults than controls (24.6% and 13.8%, respectively). Adjusting for age, a logistic regression model showed that there was a significant difference between the two groups. Patients with AR and non-AR were at 3.27- (95% CI=1.15-9.29; P=0.036) and 2.57-(95% CI=1.01-6.57; P=0.048) fold increased risk of developing CSOM, respectively, compared with healthy individuals. CONCLUSION The study showed a higher prevalence of AR in CSOM patients than in controls. It may be valuable to evaluate and control this factor in these patients.
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Affiliation(s)
- Shadman Nemati
- Sinonasal Diseases Research Centre, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran.
| | - Reza Jafari Shakib
- Department of Immunology, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Maryam Shakiba
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of medical Sciences, Tehran, Iran.
| | - Nematollah Araghi
- Department of Otolaryngology, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran.
| | - Seyyede Zeinab Azimi
- Sinonasal Diseases Research Centre, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran.,Corresponding Author: Sinonasal Diseases Research Centre, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran. Tel: +98-9113379430, E-mail:
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George MM, Goswamy J, Penney SE. Embolic suppurative thyroiditis with concurrent carcinoma in pregnancy: lessons in management through a case report. Thyroid Res 2015; 8:3. [PMID: 25741383 PMCID: PMC4349691 DOI: 10.1186/s13044-015-0015-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 02/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The thyroid undergoes a variety of physiological changes during pregnancy. The relatively low iodine levels seen in pregnancy have been implicated in thyroid growth during this time. Management of thyroid cancer in pregnancy is not immediately apparent. Furthermore, acute suppurative thyroiditis is rare and this is attributed to the glands innate immunity. We thoroughly review the evidence regarding management of thyroid abscess and thyroid malignancy during pregnancy and illustrate it via an extremely rare case of an embolic thyroid abscess highlighting an underlying carcinoma in a pregnant woman. CASE A 29-year old female was found to have a thyroid mass during an antenatal assessment. Following a wound infection from Caesarian section she developed a rapidly progressive thyroid abscess. Incision and drainage of the abscess, and subsequent histology revealed papillary carcinoma. She subsequently underwent both total thyroidectomy with level 6 dissection and radio-iodine ablation post-natally. CONCLUSION The literature is inconsistent regarding pregnancy as a risk factor for thyroid cancer, but overall it has been suggested as equally or slightly more frequent than in the non-pregnant population. Thyroid mass investigation should be as for the non-pregnant population. In the first trimester any endocrine surgery is associated with miscarriage, whereas these risks are reduced in second trimester. Importantly, there is no survival benefit in undergoing papillary carcinoma surgery in the third trimester versus early post partum and the risks of premature labour may outweigh any benefit gained by operating early. Most importantly, acute suppurative thyroiditis is rare entity and clinicians should have a low threshold for suspicion of underlying malignancy in these patients. This is especially true in the pregnant population who may be especially susceptible whilst undergoing hypertrophic thyroid changes.
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Affiliation(s)
- Manish M George
- Department of Otolaryngology-Head and Neck Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL United Kingdom
| | - Jay Goswamy
- Department of Otolaryngology-Head and Neck Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL United Kingdom
| | - Susannah E Penney
- Department of Otolaryngology-Head and Neck Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL United Kingdom
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Seo JH, Park YH, Yang SW, Kim HY. Refractory acute suppurative thyroiditis secondary to pyriform sinus fistula. Ann Pediatr Endocrinol Metab 2014; 19:104-7. [PMID: 25077095 PMCID: PMC4114048 DOI: 10.6065/apem.2014.19.2.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 05/02/2014] [Accepted: 06/10/2014] [Indexed: 11/20/2022] Open
Abstract
Acute suppurative thyroiditis is a rare disease because the thyroid gland is remarkably resistant to infection. We present a 2-year-old girl with refractory acute suppurative thyroiditis due to a pyriform sinus fistula (PSF). She complained of fever and painful anterior neck swelling. Her condition did not completely improved by multiple parenteral antibiotics along with incision and drainage. Barium esophagogram to detect PSF demonstrated no specific finding. Computed tomography scan showed air bubble superior to the left thyroid gland which indicated a possible fistula connected to the pyriform sinus. An intraoperative laryngoscopy revealed a 2-mm-sized fistula opening. The fistula was successfully treated by chemocauterization with trichloroacetic acid.
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Affiliation(s)
- Jee Hyue Seo
- Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Korea
| | - Yong Hoon Park
- Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Korea
| | - Sei Won Yang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Young Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Akgun C, Peker E, Akbayram S, Dogan M, Tuncer O, Kirimi E. A 3-day-old boy with a right preauricular swelling. Eur J Pediatr 2010; 169:637-8. [PMID: 20082098 DOI: 10.1007/s00431-009-1114-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 11/17/2009] [Indexed: 10/20/2022]
Abstract
A 3-day-old boy was admitted for right preauricular swelling. Examination showed a toxic looking neonate with poor neonatal reflexes. There was erythema and swelling of 4 × 3 cm at the level of the right cheek. Laboratory investigation pointed to a bacterial infection. With parenteral antibiotics, the lesion resolved completely.
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