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Background: Globus pharyngeus, or globus, is characterised by the sensation of a lump or tightness in the throat. Symptoms can be persistent, difficult to treat and often reoccur. Globus is a common issue in the community, with lifetime prevalence occurring in up to 45% of the population., Objective: This article aims to provide a narrative review of potential causes of globus, as well as a suggested guideline for work-up and management in the primary care setting., Discussion: Causes for globus remain uncertain; however, current opinion focuses on a mixture of muscle tension and mucosal irritation. It is estimated that globus makes up 4% of all primary care referrals to otolaryngologists. There are a handful of proposed causes, with treatments often able to be initiated in the primary care setting. Although most causes are benign, it is important for clinicians to maintain suspicion for malignancy, because this is often the patient's main concern.

Tonsillar focal diseases (TFDs) are defined as "diseases caused by organic and/or functional damage in organs distant from tonsil, and the disease outcome is improved by tonsillectomy." Although several reports and reviews have shown the efficacy of tonsillectomy for TFDs, no guidelines for the clinical management of the diagnosis and treatment of TFDs have been reported. Therefore, the Society of Stomato-pharyngology established a committee to guide the clinical management of patients with TFDs, and the original guide was published in May 2023. This article summarizes the English version of the manuscript. We hope that the concept of TFDs will spread worldwide, and that one as many patients with TFDs will benefit from tonsillectomy., Competing Interests: Declaration of competing interest None of the authors has any financial support or other benefits from commercial sources for the work, nor any other financial interests that any of the authors may have, which could create a potential conflict of interest or the appearance of a conflict of interest with regard to the work., (Copyright © 2024. Published by Elsevier B.V.)

Pharyngocutaneous fistula is a critical complication of head and neck cancer reconstruction and it is often difficult to manage. We herein report two cases of pharyngocutaneous fistulas that developed after oropharyngeal reconstruction and were successfully treated with negative pressure wound therapy with instillation and dwell time (NPWTi-d), an advanced form of traditional NPWT. NPWTi-d may be a useful nonsurgical treatment for pharyngocutaneous fistula. Laryngoscope, 134:4573-4576, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: To evaluate the potential benefits of systemic corticosteroids as an adjuvant treatment for pediatric retropharyngeal abscess (RPA) and parapharyngeal abscess (PPA)., Methods: We retrospectively reviewed medical records of patients diagnosed with RPA and PPA who were admitted to Shenzhen Children's Hospital between January 2010 and January 2023. Data on demographic characteristics, clinical presentation, physical examination, laboratory data, use of corticosteroids, management, duration of hospital stay, need for surgical drainage, and complications were collected. Patients were divided into two groups: non-corticosteroid group (antibiotic only) and corticosteroid group (corticosteroid and antibiotic)., Results: A total of 111 patients were enrolled. There were 51 cases in non-corticosteroid group and 60 cases in corticosteroid group (10 cases received methylprednisolone and 50 cases received dexamethasone). There was no significant difference in sex, age, location of abscess, size of abscess and laboratory parameters at admission and discharge between the two groups. The surgical drainage rate was significantly lower in the corticosteroid group than in the non-corticosteroid group (p = 0.008). The hospital duration was also shorter in the corticosteroid group than in the non-corticosteroid group (p = 0.026). The hospitalization cost was significantly lower in the corticosteroid group than in the non-corticosteroid group (p = 0.000)., Conclusion: The use of systemic corticosteroids along with antibiotics in children with RPA and PPA may reduce the need for surgical drainage, shorten hospital duration, and decrease hospitalization cost. Further studies are needed to confirm these findings and determine the optimal timing, duration, and route of administration of corticosteroids., Competing Interests: Declaration of competing interest All authors declare that they have no conflict of interest., (Copyright © 2023. Published by Elsevier Inc.)

Objectives: To study the mechanisms of injury, clinical manifestations, radiological findings, management, and outcomes of traumatic retropharyngeal hematoma (RH)., Methods: We used the Preferred Reporting Items of Systematic Reviews guidelines to carry out a systematic literature review to identify all published cases of traumatic RH by searching the PubMed database. Articles published between 1988 and 2022 that reported traumatic RH were included. However, articles that reported non-traumatic RHs and non-English articles were excluded from this study., Results: Of the 62 articles screened, 56 were included. Most patients (55%) were above the mean age of 61.7. The majority of patients were male (69.7%). The main symptom was dyspnea (66.6%) and symptoms usually presented within 24 hours. Among the patients, 90.9% did not take anticoagulants or have coagulation disorders, and the main injury mechanism was falling (54.5%). Most of the computed tomography findings reported retropharyngeal (38%) and prevertebral (15%) hematoma. Meanwhile, magnetic resonance imaging revealed 2 masses in the retropharyngeal space and 2 RHs. With several treatment modalities, more than 50% of the cases were only observed (44 cases), and endotracheal intubation was the most commonly used airway management method (n=35)., Conclusion: Traumatic RH is often caused by falls, particularly in elderly patients. Dyspnea is the primary symptom, usually appearing within 24 hours. Cervical vertebral fractures are the leading cause, and observation is the most common treatment approach. PROSPERO Reg. No.: CRD42022349010 ., (Copyright: © Saudi Medical Journal.)

Background: Pharyngocutaneous fistula (PCF) is one of the most common complications of total laryngectomy. This study is to investigate the efficacy of a novel platform called transnasal negative pressure therapy (TNPT) in the management of PCF., Methods: We retrospectively reviewed 47 patients who underwent total laryngectomy between April 2015 and February 2021 and developed PCF in our hospital. We focused on the healing rate, dressing change frequency, and healing time between the TNPT and non-TNPT groups. The 2 years overall survival (OS) was compared through the log-rank test., Results: There were 18 patients in the TNPT group and 29 in the non-TNPT group. There was no significant between-group difference in the healing rate (chi-square test). However, the frequency of dressing changes was significantly lower (p < 0.001) and the healing time was significantly shorter (p = 0.0194) in the TNPT group than in the non-TNPT group. The 2-year OS rate was significantly higher in the TNPT group (p = 0.0473, log-rank test)., Conclusion: TNPT promoted wound healing after surgery for PCF and improved the 2-year OS rate. This tool is worthy of clinical application and promotion., (© 2023 Wiley Periodicals LLC.)

We report a case of Mycobacterium avium complex infection of the retropharyngeal space in a 20-month-old girl. We also summarize the published literature on the pathogenesis and management of nontuberculous mycobacterial infections of the retropharynx., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Pneumatic compression garment therapy (PCGT) has been established as treatment for postradiotherapy lymphedema, and its use in head and neck patients is becoming more common. Although effects on interstitial edema of the cervical soft tissues have been studied, effects on internal laryngopharyngeal edema, as well as associated symptoms of dysphagia and dysphonia, have yet to be published., Methods: We surveyed 7 patients treated with radiation for head and neck cancer (HNC) who had also been prescribed PCGT for cervical lymphedema. Patients were asked about subjective experience with the device, and also administered the Eating Assessment Tool-10 (EAT-10) and Voice Handicap Index-10 (VHI-10) surveys regarding their symptoms after using PCGT. Laryngoscopy videos from these same periods were also reviewed and scored using a validated tool for assessing laryngopharyngeal edema., Results: 85% of patients reported at least some improvement in dysphagia and dysphonia following PCGT. Average EAT-10 score after PCGT was 11.4 and average VHI-10 score after PCGT was 8.7. These compare more favorably to historical scores for the same questionnaires in similar patient populations. Laryngeal edema scores on endoscopic examination were not significantly different after at least 3 months of therapy (pre: 20.15, post: 20.21, P = .975); however, the utility of this result is limited by a low inter-rater reliability (Krippendorff α = .513)., Conclusions: While we are unable to show any difference in objective assessment of laryngopharyngeal edema on endoscopic examination in this small pilot study, patients report substantial subjective improvement in postradiotherapy dysphagia and dysphonia following cervical PCGT that warrants more formal investigation.

Mast cells (MCs) are involved in several biological processes, such as defense against pathogens, immunomodulation, tissue repair after injury, and angiogenesis. MCs have been shown to change from protective immune cells to potent pro-inflammatory cells, influencing the progression of many pathological conditions, including autoimmune diseases and cancers. The role of MCs in the pathogenesis of rhinopathies has often been underestimated, since previous studies have focused their attention on eosinophils and neutrophils, while MCs were considered involved exclusively in allergic rhinitis. However, recent nasal cytology findings have shown the involvement of MCs in several rhinopathies, such as NARMA, NARESMA, and CRSwNP. These recent evidences highlight the crucial role that MCs play in orchestrating the inflammation of the nasal mucosa, through complex biological mechanisms, not yet fully understood. In this context, a better understanding of these mechanisms is fundamental for practicing Precision Medicine, which requires careful population selection and stratification into subgroups based on the phenotype/endotype of the patients, in order to guarantee the patient a tailored therapy. Based on this background, further studies are needed to understand the pathophysiological mechanisms involving MCs and, consequently, to develop targeted therapies aimed to obtain a selective inhibition of tissue remodeling and preventing MC-mediated immune suppression., (© 2021 S. Karger AG, Basel.)

Background: Pharyngocutaneous fistula is a potential life-threatening complication following head and neck surgery. There is only limited evidence about the efficacy of vacuum-assisted closure (VAC) therapy and endoscopic vacuum-assisted closure (EndoVAC) therapy for the treatment of pharyngocutaneous fistulas., Methods: In this article, we report on a consecutive case series of six male patients with pharyngocutaneous fistula treated with a modified outside-in EndoVAC technique. We also present a review of the current related literature., Results: EndoVAC therapy alone was successful in five of the six patients (83.3%) with a median duration of EndoVAC therapy of 18.5 days (range: 7 to 32 days) and a median number of EndoVAC sponge changes of 4 (range: 1 to 9 changes). One patient needed additional reconstructive surgery after prior radiochemotherapy and jejunal transfer. No treatment-related complications were observed., Conclusion: EndoVAC therapy is an easy-to-perform, safe procedure for the treatment of pharyngocutaneous fistulae., (© 2021 The Authors. Head & Neck published by Wiley Periodicals LLC.)

Spontaneous retropharyngeal emphysema (SRE) is a rare condition, occurring in the absence of trauma. Symptoms usually include acute-onset odynophagia and dyspnea. This is an interesting case of a young, healthy woman who presented to an emergency department with benign upper respiratory symptoms but took a drastic turn while in the waiting room after being triaged. The features and implications of SRE are discussed in this case, including emergent thoracic surgery consultation and additional testing., Competing Interests: Disclosure: The author reports no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Parapharyngeal and retropharyngeal abscesses (PPA) in children are a rare pathology, for the diagnosis of which it is necessary to use additional instrumental examination methods. The tactics of treating patients remains a subject of discussion., Objective: To analyze the features of the clinic, diagnosis and treatment of PPA in children., Material and Methods: According to the hospital database, a retrospective analysis of the medical histories of children discharged from the clinic with a diagnosis of "J39.0 Retropharyngeal and parapharyngeal abscess" was carried out in the period from 01.01.14 to 31.12.19. In all cases, the diagnosis was confirmed by computed tomography (CT) data with contrast enhancement. Complaints at the time of treatment, anamnesis and instrumental diagnosis data, clinical features of the course of the disease and the effectiveness of treatment were analyzed., Results: 121 children were treated for PPA (average age 73±41 months; Me=52.5 months), which is 0.4% of all hospitalized in the otorhinolaryngological department, 0.7% of the number of emergency hospitalizations, 0.8% of the number of hospitalized children with pharyngeal diseases, and 8.3% of the number of patients with pharyngeal abscess. Abscesses were more often localized in the upper pharynx, at the level of the I-II cervical vertebrae (49.6% of all observations); abscesses were found least often in the pharyngeal space (5.8%), there was no statistically significant difference between the right-sided and left-sided location: 47.9% and 46.2%, respectively. Surgical treatment was performed in 98 (81%) patients in the presence of an abscess capsule or an abscess diameter of more than 2 cm according to CT; the remaining 23 (19%) children were treated conservatively. The opening of the abscess was performed endopharyngeal, in the case of a pronounced deep lateral location of the abscess and its proximity to large blood vessels - with access through the tonsillar niche after preliminary tonsillectomy (19.4% of those operated)., Conclusion: The final diagnosis of parapharyngeal and retropharyngeal abscess can be established by contrast-enhanced computed tomography. Conservative treatment is indicated for a limited group of patients at the initial stages of the disease, most patients need surgical treatment.

Background: Patients with COVID-19 who are intubated and require mechanical ventilation have been observed to have oropharyngeal bleeding necessitating otolaryngology intervention., Methods: We report five cases of oropharyngeal hemorrhage in COVID-19 patients on mechanical ventilation requiring evaluation by otolaryngologists at George Washington University Hospital (GWUH) and Boston Medical Center (BMC) from March to April 2020. Institutional Review Board at both institutions exempted this study from informed consent because there were no identifiable patient characteristics, photographs, or imaging studies included., Results: All five patients were managed conservatively; four required packing with Kerlix gauze by an otolaryngologist. Two patients had the additional requirement of extracorporeal membrane oxygenation (ECMO) and associated anticoagulation. Three patients improved with oropharyngeal packing; two had persistent bleeding. Three patients expired. Endotracheal tubes were repositioned less frequently due to the COVID-19 pandemic., Conclusions: Intubated patients with COVID-19 may have an increased risk of oropharyngeal hemorrhage. This may be due to anticoagulation, prolonged intubation, or decreased frequency of endotracheal tube repositioning. Otolaryngologists should wear appropriate PPE when managing this hemorrhagic complication., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Because of the difficulty of airtight sealing and risk of salivary contamination, negative-pressure wound therapy (NPWT) has rarely been applied for postoperative fistula following head and neck surgery; thus, its utility remains unclear., Methods: We applied NPWT in 34 patients who developed orocutaneous and pharyngocutaneous fistula after head and neck surgery. Here we retrospectively analyzed the utility of NPWT for managing those fistulas., Results: Thirty-two patients (94.1%) underwent NPWT as scheduled without adverse events. In 28 patients (82.4%), fistula closure was completed only by NPWT, and the mean period to fistula closure was 30.4 days. The mean period to closure did not differ significantly between fistulas with (21.7 days) and without (39.1 days) previous irradiation., Conclusions: Airtight sealing can be maintained and postoperative fistula can be closed by NPWT with a high success rate, even after previous irradiation. NPWT is an effective and minimally invasive treatment for postoperative fistula., (© 2019 Wiley Periodicals, Inc.)

In the current first report, it is shown how a post-laryngectomy pharyngocutaneous fistula was successfully closed by endoscopic negative pressure therapy (ENPT; also termed endoscopic vacuum therapy, EVT). The duration of negative pressure treatment was 14 days. Up until now, ENPT has been used for treatment of transmural defects in the rectum and esophagus. The new endoscopic method can also be used in the ENT field for closure of pharyngocutaneous fistulas.

Background: Characterization of the clinical signs, response to treatment and prognosis can be useful information for decision-making when evaluating cattle with pharyngeal trauma., Objective: To describe the signalment, history, clinicopathologic, endoscopic, ultrasonographic, radiographic, and postmortem findings as well as treatments and outcomes of cattle diagnosed with pharyngeal perforation/trauma., Animals: Review of medical records of cattle >1 month of age admitted to a Veterinary Teaching Hospital from 1995 to 2017., Methods: Retrospective study. Review of medical records of cattle with pharyngeal perforation/trauma identified by oral or endoscopic examination in hospital setting., Results: Twenty-seven out of 7550 (0.36%) cases met the inclusion criteria. Pharyngeal perforation/trauma was associated with the administration of a bolus in 24 (89%) cows and a magnet in 3 (11%) cases. The boluses contained monensin (n = 12), calcium salts (n = 5), iodine (n = 1), aspirin (n = 1), vitamins (n = 1), and an unknown product (n = 4). The primary clinical signs were dysphagia, swelling of the throatlatch, subcutaneous emphysema, swelling, and pain on palpation of the throatlatch. Seventeen (63%) cows were discharged whereas 10 (37%) were euthanized. Median time between the suspected traumatic event and hospital admission was 1 day (range: 0.5-3 days) and 2 days (range: 0.5-15) for surviving and nonsurviving cattle, respectively. All 5 cows that suffered pharyngeal trauma associated with administration of calcium salt bolus were euthanized., Conclusions and Clinical Importance: Pharyngeal trauma is a rare condition in cattle. Case fatality rate increases if not diagnosed and treated promptly. The nature of the penetrating foreign body influences the outcome., (© 2019 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.)

Objective: Given that financial considerations play an increasingly prominent role in clinical decision-making, we sought (1) to determine the cost-effectiveness of in-office biopsy for the patient, the provider, and the health-care system, and (2) to determine the diagnostic accuracy of in-office biopsy., Study Design: Retrospective, financial analyses were performed., Methods: Patients who underwent in-office (Current Procedural Terminology Code 31576) or operative biopsy (CPT Code 31535) for laryngopharyngeal lesions were included. Two financial analyses were performed: (1) the average cost of operating room (OR) versus in-office biopsy was calculated, and (2) a break-even analysis was calculated to determine the cost-effectiveness of in-office biopsy for the provider. In addition, the diagnostic accuracy of in-office biopsies and need for additional biopsies or procedures was recorded., Results: Of the 48 patients included in the current study, 28 underwent in-office biopsy. A pathologic sample was obtained in 26 of 28 (92.9%) biopsies performed in the office. Of these patients, 16 avoided subsequent OR procedures. The average per patient cost was $7000 and $11,000 for in-office and OR biopsy, respectively. Break-even analysis demonstrated that the provider could achieve a profit 2 years after purchase of the necessary equipment., Conclusion: In-office laryngopharyngeal biopsies are accurate and, overall, more cost-effective than OR biopsies. Purchase of the channeled, distal chip laryngoscope and biopsy forceps to perform in-office biopsies can be profitable for a provider with a videolaryngoscopy tower. In-office biopsy should be considered the initial diagnostic tool for suspected laryngopharyngeal malignancies noted on videolaryngoscopy., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Study Design: A multi-centre online survey to staff working in specialised and non-specialised acute units., Objectives: To identify clinical decisions and practices made for acute cervical spinal cord injury (CSCI) patients with respiratory impairments and oropharyngeal dysphagia., Settings: All hospital intensive care units in the UK that admit acute cervical spinal cord injury patients., Methods: Online distribution of a 35-question multiple-choice survey on the clinical management of ventilation, swallowing, nutrition, oral hygiene and communication for CSCI patients, to multi-disciplinary staff based in specialised and non-specialised intensive care units across UK., Results: Responses were received from 219 staff members based in 92 hospitals. Of the 77 units that admitted CSCI patients, 152 participants worked in non-specialised and 30 in specialised units. Non-specialised unit staff showed variations in clinical decisions for respiratory management compared to specialised units with limited use of vital capacity measures and graduated weaning programme, reliance on coughing to indicate aspiration, inconsistent manipulation of tracheostomy cuffs for speech and swallowing and limited use of instrumental assessments of swallowing. Those in specialised units employed a multi-discplinary approach to clinical management of nutritional needs., Conclusions: Variation in the clinical management of respiratory impairments and oropharyngeal dysphagia between specialised and non-specialised units have implications for patient outcomes and increase the risk of respiratory complications that impact mortality. The future development of clinical guidance is required to ensure best practice and consistent care across all units., Competing Interests: The authors declare that they have no conflict of interest.Ethical committee approval was received through Stanmore Research Ethics Committee (REC reference: 14.LO.1209) and NHS R&D as part of the doctoral study (JM) (IRAS: 129588).

Introduction: Pharyngocutaneous fistula is the most frequent complication of primary and secondary laryngectomy and pharyngolaryngectomy. It has an important impact on the patient, his entourage and the healthcare team. The risk factors for pharyngostoma are multiple and its treatment is not codified., Aim: To identify the various factors that may predispose to this complication and to describe the different therapeutic means to control it., Methods: This retrospective study examined 68 cases of laryngeal cancer treated by total laryngectomy or pharyngolaryngectomy at Salah Azaїez's head and neck oncologic surgery department between 2015 and 2017., Results: Most of our patients were male (97%) who were major consumer of tobacco and alcohol. The most common stage were T4aN0M0 (34%) and T4aN1M0 (22%). Regarding treatment, we found that 73.5% of patients were operated on by total laryngectomy, 17.7% of patients were operated on by total pharyngolaryngectomy and 8.8% of patients were operated on by square laryngectomy. Pharyngostoma was diagnosed in 20.5% of cases within an average of 15 days. Among the risk factors studied, those that were statistically correlated with the occurrence of CPF in univariate studies were pre-laryngeal infiltration (p = 0.006), postoperative CRP level (p= 0.017), extension to piriform recess (p = 0.009), TNM stage (p=0.039), an associated thyroid surgery (p = 0.020) and pharyngeal closure under tension (p=0.000). In multivariate studies, five of the risk factors identified in the univariate analysis were found. This testifies to their major role as a risk factor for pharyngostoma. These factors were pre-laryngeal infiltration (p=0.001), postoperative CRP level (p=0.000), piriform recess involvement (p=0.004) Associated thyroid surgery (p=0.012) and pharyngeal closure under tension (p = 0.000)., Conclusion: By identifying predictive factors for pharyngostoma, we can identify patients in which this complication may occur and manage the medical care means to prevent it more efficiently.

Blocked Nose, Nosebleeds, Ringing in the Ear: ENT Diseases During Pregnancy Abstract. In this overview the clinical pictures of ear, nose and throat diseases and their symptoms, which occur frequently but also particularly during pregnancy, are presented. In addition, the respective therapy options in this partially vulnerable phase of mother and child are discussed. The primary principle is 'as much as necessary, but as little as possible'. Even if the complaints often disappear with the birth of the child, there may be considerable suffering of the pregnant woman and therapy may be necessary. Moreover, an adequate therapy should be applied with all ENT diseases, even for those not specifically associated with pregnancy.

Since their discovery as the etiologic agents of cervical cancer in the mid-1970s, human papillomaviruses (HPVs) have been linked with a growing number of epithelial-derived tumors, including head and neck squamous cell carcinomas. HPV demonstrates a particular predilection for causing tumors of the oropharynx, with the majority of cases involving infection with high-oncogenic risk HPV-16. People living with HIV are at increased risk of infection with HPV- and HPV-related oral complications even with adequate control of their HIV infection with antiretroviral therapy. In this chapter, we discuss the molecular mechanisms that underlie HPV-mediated oncogenesis in the oropharynx. We also describe the progress that has been made in understanding the epidemiology of oral HPV infection and the determinants of oral HPV-related pathology. Finally, we examine what can be done to treat and prevent oral HPV infection, benign lesions, and cancer, particularly in the context of the HIV-positive patient.

Ear, nose and throat (ENT) comorbidities are common in patients with asthma and are frequently associated with poorer asthma outcomes. All these comorbidities are "treatable traits" in asthma. Identification and management of these disorders may spare medication usage and contribute to improved asthma control and quality of life, and a decrease in exacerbation rates.This review summarises recent data about the prevalence, clinical impact and treatment effects of ENT comorbidities in asthma including allergic rhinitis, chronic rhinosinusitis with and without nasal polyposis, aspirin-exacerbated respiratory disease, obstructive sleep apnoea and vocal cord dysfunction.Many of these comorbidities are possible to be managed by the pulmonologist, but the collaboration with the ENT specialist is essential for patients with chronic rhinosinusitis or vocal cord dysfunction. Further rigorous research is needed to study the efficacy of comorbidity treatment to improve asthma outcomes, in particular with the development of biotherapies in severe asthma that can also be beneficial in some ENT diseases., Competing Interests: Conflict of interest: A. Tiotiu has nothing to disclose. Conflict of interest: D. Plavec reports grants and personal fees from GlaxoSmithKline, personal fees from Menarini, Pliva, Belupo, AbbVie, Novartis, MSD, Chiesi and Revenio, personal fees and non-financial support from Boehringer Ingelheim, and non-financial support from Philips, outside the submitted work. Conflict of interest: S. Novakova has nothing to disclose. Conflict of interest: S. Mihaicuta has nothing to disclose. Conflict of interest: P. Novakova has nothing to disclose. Conflict of interest: M. Labor has nothing to disclose. Conflict of interest: A. Bikov has nothing to disclose., (Copyright ©ERS 2018.)

BACKGROUND Retropharyngeal hematoma is a relatively rare diagnosis that requires a high clinical suspicion and stabilization of the airway to prevent rapid deterioration. We report a case of a spontaneous retropharyngeal hematoma in an elderly patient with myelodysplastic syndrome and associated thrombocytopenia. CASE REPORT A 90-year-old man with myelodysplastic syndrome was brought to the Emergency Department with complaints of difficulty swallowing and muffled voice for 24 hours. Upon arrival, his vital signs and physical exam were unremarkable, except that when he was asked to take a sip of water, he could not swallow it. Complete blood count was remarkable for leukocytosis of 14.3×10³/mcL, hemoglobin of 9.0 gm/dL, and platelet count of 26×10³/mcL. Chest X-ray and lateral soft-tissue neck X-rays were grossly unremarkable. The patient was admitted for further evaluation and was scheduled for esophagogastroduodenoscopy. During intubation for esophagogastroduodenoscopy, the patient was noted to have significant airway narrowing. A subsequent CT scan revealed a 3×2×2 cm supraglottic hypodensity, thought to represent a retropharyngeal hematoma. The patient was transferred to the Intensive Care Unit (ICU) and received platelet transfusions. The ICU course was complicated by anemia, which necessitated transfusion of packed red blood cells. On hospital day 7, the patient reported resolution of his symptoms and was discharged home. CONCLUSIONS This case adds to the growing body of literature on spontaneous retropharyngeal hematomas. High clinical suspicion is warranted in patients who present with acute dysphagia, odynophagia, and dysphonia. Prompt imaging and airway management are vital in managing patients with this condition.

Globus is a non-painful sensation of a lump or a foreign body in the throat, and it frequently improves with eating. Although globus is a common symptom, only little is known about the etiology, and the causes have remained controversial. Previously, globus was labelled as a hysterical symptom. However, nowadays, the research has been mainly focused on somatic causes and it is suspected that the etiology is complex. Because of the unclear etiology, the diagnostics and treatment are varying, predisposing patients to possible unnecessary investigations. This review presents the current literature of globus: its etiology, diagnostics, and treatment. In addition, a special aim is to discuss the rational investigation methods in globus diagnostics and present a diagnostic algorithm based on recent researches.

Objective: To evaluate the imaging features, clinical presentation, operative methods complication and the surgical outcomes of the congenital pyriform sinus fistula(CPSF). Methods: The clinical data of 185 patients with CPSF treated from January 2013 to October 2017 at the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively. Results: The lesions were predominantly on the left side(170/185). Among 185 cases, 146 cases received endoscopic coblation cauterization, 27 cases had traditional open surgery, 8 cases underwent endoscopic coblation cauterization plus traditional open surgery, 2 cases for endoscopic chemocauterization, and 2 cases for endoscopic electrosection. Twenty-eight cases recurred, with a recurrence rate of 15.1%. Postoperative hoarseness occurred in 22 cases, disappeared within 0.5-6.0 months later. Conclusions: Patients with a history of recurrent cervical abscess should be highly suspect the existence of CPSF. Endoscopic coblation cauterization is a kind of surgical method with minimal injury, with low recurrence rate and low operative risk.

Retropharyngeal haematoma is a life-threatening clinical situation that can lead to a potential obstruction of the upper airway and requires rapid diagnosis. Clinicaly, it can be presented in different ways, depending on its size and growing speed. The first measure is to protect and manage the airway: in most cases this is a difficult airway situation. A retropharyngeal haematoma can be formed due to a previous traumatic history, with or without associated cervical fracture. Treatment of the haematoma is conservative in most cases, with close monitoring until it is reabsorbed in 3-4 weeks, although they can sometimes require surgical evacuation. We present the case of a patient who developed a large retropharyngeal haematoma after minor cervical trauma and describe an approach of the airway using the Airtraq® disposable optical laryngoscope., (Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: The present study aimed to compare the effects of bacterial cellulose used for closure of pharyngocutaneous fistulae, a complication of total laryngectomy, with those of primary sutures in a rat model., Methods: Thirty female Sprague-Dawley underwent experimental pharyngoesophagotomy and were grouped depending on the material used for pharyngocutaneous fistula closure: group I, which received primary sutures alone, group II, which received bacterial cellulose alone; and group III, which received both. After 7 days, the rats were sacrificed. Pharyngocutaneous fistula development was assessed, the gross wound was inspected, and histological examination was conducted., Results: Pharyngocutaneous fistulae developed in 12 rats (41%) in all: 6 from group I (21%), 4 from group II (14%) and 2 from group III (7%)., Conclusion: Fibroblast density and inflammatory cell infiltration were significantly greater in group III than group I. We concluded that bacterial cellulose may be useful for pharyngocutaneous fistula closure., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Pyriform sinus fistula is a rare clinical disease, often with recurrent acute suppurative thyroiditis or neck infection in children.The traditional method treatment is complete resection of the fistula with or without hemithyroidectomy in external cervical surgical approach, but in recent years, minimally invasive endoscopic occlusion of the internal opening for the treatment of pyriform sinus fistula is performed in many hospitals, including electrocautery, chemocautery, laser cauterization, biocauterization, and suture closure. Literatures about endoscopic management of pyriform sinus fistula in children are reviewed and various surgical methods, complications and success rate are evaluated.

Background: Pharyngocutaneous fistula is a common complication of laryngopharyngeal surgery and is associated with increased morbidity and mortality. Beyond the classical management, negative-pressure wound therapy (NPWT) can be an alternative and effective treatment., Clinical Report: Two patients with pT3N0M0 squamous cell carcinoma of pyriform sinus were subjected to total laryngectomy and pharyngoesophageal reconstruction of a circular (patient 1) and an anterior wall defect (patient 2) with radial forearm free flap and pectoralis major muscle flap, respectively. Both developed a pharyngocutaneous fistula and NPWT was used.A significant decrease of the fistula aperture and exudate was observed after 22 and 21 days of NPWT in patients 1 and 2, respectively. After that standard wound care was instituted and closure of the fistulae was accomplished in 5 and 7 days, respectively., Conclusion: Negative-pressure wound therapy can be an effective treatment for pharyngocutaneous fistula closure, either in the setting of fistulae that persist besides multiple surgical revisions using muscle flaps or as a first-line therapy when fistulae develops.

Radionecrosis is a late, and difficult to treat,complication of radiotherapy performed on head and neck tumours, and it is difficult to treat. This process causes significant damage, not only in the skin, but also in muscular, nervous, vascular, and bone structures. This, in turn, leads to airway and digestive tract involvement, as well as a functional loss and a cosmetic defect that usually requires reconstructive surgery. Therefore, this process is associated with a significant loss in the quality of life of patients and involves a long hospital stay for treatment, as well as the necessary support measures. This article describes the local treatment of pharyngocutaneous fistula secondary to radiation therapy of squamous cell carcinoma of the right oropharynx. The lesion appeared two months after completing this treatment and required surgical reconstruction with a myocutaneous flap to repair the tissue defect. In this context, an alginate wound dressing with silver was used, combined with a medium grip polyurethane foam with a silicone border. Within one month, there was autolytic debridement of all the necrotic tissue and the appearance of granulation tissue. At the same time, the infection was controlled, and a better management of the exudate was obtained, which provided a suitable surgical bed for the reconstruction., (Copyright © 2017 Elsevier España, S.L.U. All rights reserved.)

Objective: To investigate the therapeutic effect and potential reason for anxiety in pharyngeal paraesthesia in patients with different degrees of anxiety based on their characteristics. Method: All patients were divided into three groups according to self-rating anxiety scale(SAS)，including group 1（mild anxiety），group 2（moderate anxiety）and group 3（severe anxiety）.The characteristics,risk factors and prognosis in each group were compared and analyzed．Meanwhile，State-Trait Anxiety Inventory(STAI)was used to analyze anxiety state of all patients and healthy participates(Group 4)．SPSS13.0 statistical software was used for data analysis. Result: The proportions of female patients(54.05%) who had anxiety symptom were higher than those of male patients(45.95%).The proportions of moderate anxiety in female patients were higher( P <0.01),but those of mild anxiety were lower( P <0.01) compared with male patients. There was no gender difference about the proportions of severe anxiety. The patients aged 40-59 years had the highest proportions of anxiety(60.14%)and a higher proportions of moderate and severe anxiety compared with the patients aged 18~39 years and over 60 years old( P <0.05).However, there was no significant difference in proportions of different degrees of anxiety between the patients aged 18-39 years and over 60 years old( P >0.05).The proportions of mild anxiety in patients with 5-10 years duration and those of moderate anxiety in patients with the course of less than 5 years were all the highest.However, no difference was found in proportions of severe anxiety among different courses( P >0.05).The proportions of moderate anxiety(except mild and severe anxiety) in patients with no fixed occupation and no senior middle school education were higher than those in patients with fixed occupation and senior middle school education or above( P <0.05).But there were no relationships between the degrees of anxiety and other general conditions of patients,including marital status and live condition. Among different degrees of anxiety,the proportions of patients who feared cancer were all the highest, followed by stress and mental stimulation factors.The proportions of patients who feared cancer and felt stress were higher in severe anxiety than those in mild and moderate anxiety.But there was no significant difference between any two groups in other related factors,including mental stimulation factors, obsessive-compulsive disorder(OCD) and family history of psychosis.Male and female patients with different degrees of anxiety compared with healthy controls respectively,had significant difference in state anxiety(SAI) scores( P <0.05),but showed no significant difference in trait anxiety(T-AI) scores( P >0.05). Both recovery rates and total effective rates of mild and moderate anxiety were higher than those of severe anxiety( P <0.01).However,there was no difference between mild and moderate anxiety whether in recovery rates or in total effective rates ( P >0.05). Conclusion: Pharyngeal paraesthesia in patients with different degrees of anxiety has different clinical features and prognosis .The main cause of anxiety appears to be a long duration of treatment. No obvious anxiety potential was found in patients compared with normal people., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Congenital midline cervical cleft is a rare anomaly of the neck. This paper presents the case of a boy diagnosed with this disorder in which a preliminary orthodontic treatment was implemented. The craniofacial anomalies associated with this malformation produced a defect that could only be successfully treated through the implementation of orthodontic and surgical treatments. In this case, congenital midline cervical cleft was accompanied by certain disorders within the facial structures of the skull, primarily mandibular retrusion, flattening of the contour of the mandibular base, and a steep angle between the cranial base and the mandibular plane.

BACKGROUND Acute phlegmonous esophagogastritis is a life-threatening disease that may be combined with serious complications. We present the classical radiological and endoscopic features and treatment strategy of a middle-aged female patient suffering from acute phlegmonous esophagogastritis complicated with hypopharyngeal abscess, esophageal perforation, mediastinitis, and empyema. CASE REPORT A 60-year-old Taiwanese female presented at our hospital due to fever, fatigue, painful swallowing, and vague chest pain for 5 days. She had a past history of uncontrolled type 2 diabetes mellitus. On physical examination, general weakness, chest pain, odynophagia, and a fever up to 38.9°C were found. Positive laboratory findings included leukocytosis (leukocyte count of 14.58×10³/μL, neutrophils 76.8%) and serum glucose 348 mg/dL (HbA1c 11.3%). A diagnosis of acute phlegmonous esophagogastritis with hypopharyngeal abscess was made based on typical computed tomography image features and clinical signs of infection. The patient received empirical antibiotic therapy initially; however, esophageal perforation with mediastinitis and empyema developed after admission. Emergency surgery with drainage and debridement was performed and antibiotics were administered. She was discharged in a stable condition on the 56th day of hospitalization. Six months later, a delayed esophageal reconstruction was performed. The patient has performed well for 9 months to date since the initial diagnosis. CONCLUSIONS Acute phlegmonous esophagogastritis complicated with hypopharyngeal abscess and esophageal perforation is extremely rare, and requires immediate medical attention. This report serves to remind physicians of this rare entity and the potential complications that may manifest with acute phlegmonous esophagogastritis., Competing Interests: Conflicts of Interest: None declared

Study Design: This study is a retrospective database query to identify all anterior spinal approaches., Objectives: The objectives were to assess all patients with pharyngocutaneous fistulas (PCFs) after anterior cervical spine surgery., Summary of Background Data: Patients with the diagnosis of PCFs were treated at the University of Heidelberg Spine Medical Center, Spinal Cord Injury Unit and Department of Otolaryngology (Germany), between 2005 and 2011., Methods: We conducted a retrospective study on 5 patients with PCF after anterior cervical spine surgery between 2005 and 2011 and analyzed their therapy management and outcome on the basis of the radiologic data and patient charts., Results: Upon presentation, 4 patients were paraplegic. Two patients had PCF arising from 1 piriform sinus, 2 patients had PCF arising from the posterior pharyngeal wall and piriform sinus combined, and 1 patient had PCF arising only from the posterior pharyngeal wall. Two patients previously underwent unsuccessful surgical repair elsewhere and 1 patient underwent a prior radiation therapy. In 3 patients, speech and swallowing could be completely restored. Two patients died, both of whom were paraplegic. The patients were needed to undergo an average of 2 or 3 procedures for complete functional recovery of primary closure with various vascularized regional flaps and refining laser procedures supplemented with the negative pressure wound therapy wherever needed., Conclusions: On the basis of our experience, we are able to provide a treatment algorithm that indicates that chronic, as opposed to acute, fistulas require a primary surgical closure combined with a vascularized flap that should be accompanied by the immediate application of a negative pressure wound therapy. We also conclude that particularly in paraplegic patients suffering from this complication the risk for a fatal outcome is substantial.

The objective of the present study was to elaborate the program for differential diagnostics of acute pharyngeal diseases based on the 'ENT-Neuro' artificial neuronal network. The study group was formed by means of sampling patients with acute pharyngeal diseases from a set of case histories of the subjects presenting with acute inflammatory diseases. The data thus obtained were employed to develop the expert system to support the decision making process with the use of the 'ENT-Neuro' artificial neuronal network that allows to carry out diagnostics of various inflammatory diseases of the pharynx including the following nosological entities: paratonsillitis, parapharyngitis, acute tonsillitis, and acute pharyngitis, with the minimal probability of erroneous diagnosis (4%). The proposed expert system makes it possible to choose the optimal treatment strategy for the management of various pharyngeal diseases taking into consideration the severity of a concrete pathology and thereby to reduce to a minimum the risk of the related complications.

Retropharyngeal and parapharyngeal abscesses are the most common deep neck infections in the pediatric population. How best to treat these patients, be it intravenous antibiotics or immediate surgical incision and drainage, has long been debated. The purpose of this study was to evaluate patient and abscess characteristics associated with failure of medical treatment. We retrospectively examined 46 patients between 1999 and 2009 at Arnold Palmer Children's Hospital in Orlando. Patient charts were reviewed, and data collected included age, gender of the patient, size of the abscess, days of admission to the hospital, admission to the intensive care unit, and surgical intervention, if applicable. All patients first received 24 to 48 hours of IV antibiotics, at which point a clinical decision was made to proceed with surgery or continue conservative management. When comparing antibiotic treatment failure across age, gender, and abscess size, statistically significant correlation occurred only with the size of the abscess. Medical management was more likely to fail, and surgery needed, when abscesses were larger than 2 cm. Additionally, hospital stay was not statistically different between the medical and surgical groups. Our data demonstrate statistical significance for the ability to treat retro- and parapharyngeal abscesses 2 cm or less in diameter with IV antibiotics alone, without complications, and with a statistically similar average hospital stay compared with surgery. Abscesses larger than 2 cm may be managed medically, as well, but failure of antibiotic therapy alone is more likely, with surgical intervention more often required.

The aim of the study is to examine the utilization of hyperbaric oxygen treatment (HBOT) as an alternative to surgical treatment for non-healing postoperative phayngocutaneous fistula (POPCF). A retrospective study was conducted between 2012 and 2014 of referred patients who had failed conservative treatment for POPCF at other medical centers. Reevaluation at our department was followed by therapeutic management including daily HBOT. Eight male patients with a mean age of 62.3 years were included. The average period of conservative treatment was 1 month before admittance to our department. All patients were managed with HBOT and local debridement. Closure of the POPCF was proved by a barium swallow test in seven patients (87.5 %). HBOT is recommended for patients who have failed conservative treatment for POPCF post-laryngectomy, due to a high rate of successful (87.5 %) closure and should be considered as an alternative to surgical treatment.

Objective: A systematic review was performed to evaluate the safety and efficacy of different therapeutic interventions available for the management of isolated cricopharyngeal dysfunction., Methods: Studies were identified using the following databases: Ovid (Medline, Embase), the Cochrane Library, PubMed and Google Scholar. An initial search identified 339 articles. All titles and abstracts were reviewed. Fifty-six relevant articles were inspected in more detail; of these, 47 were included in the qualitative analysis., Results: No relevant randomised trials were found. A range of case series were used to perform a qualitative analysis. Botulinum toxin A injection and cricopharyngeal dilatation were associated with a higher risk of recurrence, but appear to be more suitable in elderly and co-morbid patients. In those patients requiring formal myotomy, endoscopic approaches appear to be as effective but less morbid when compared with classical open surgery., Conclusion: There is good evidence for the safety and efficacy of the different therapeutic options for isolated cricopharyngeal dysfunction. However, further studies are required to compare the efficacy of the various treatment modalities.

Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Perinatal imaging facilitates detection of congenital head and neck masses to plan fetal procedures which secure the airway. Ex utero intrapartum therapy (EXIT) procedures are preferred to protect the neonatal airway. Herein we present a case in which a neonate with a large oropharyngeal lymphovascular malformation was delivered and the airway successfully managed without an EXIT procedure using a multidisciplinary approach. Preparations for the non-EXIT delivery and critical airway management are described., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)