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Objective: A systematic review and meta-analysis of the evidence on balloon Eustachian tuboplasty (BET) as a treatment modality for Eustachian tube dysfunction (ETD). We followed the PRISMA guideline and registered with PROSPERO No. CRD42014009461., Data Sources: We searched 12 databases including PubMed and Embase from January 1, 2010, to April 7, 2014, for studies of BET., Endpoints: change in symptoms, middle ear pathology, eardrum status, Eustachian tube function tests, hearing, adverse events, complications, and health-related quality of life., Review Methods: Study quality was assessed using the modified Delphi technique quality appraisal tool for case series studies. Risk of bias was assessed using the Cochrane Collaboration's tool for assessing risk of bias., Results: Nine case series studies with 443 patients (642 tubes) were included. Population size n=4 (7 tubes) to n=210 (320 tubes). All studies were of poor quality and featured a high risk of bias. We found reduction of patient symptoms in ETD questionnaire (P<.001), postoperative normalization of the tympanic membrane, conversion of type B or type C into type A tympanograms, reduced mucosal inflammation, increased number of positive Valsalva test and Swallowing tests, improvement in Eustachian tube score, reduction in Sino-Nasal Outcome Test (SNOT)-22 score (P=.001), and increased quality of life (P=.001). No serious adverse events were found., Conclusion: The evidence of BET is poor and biased. No firm conclusions can be made to identify patients who will benefit from the procedure or to accurately predict surgical results. Randomized controlled trials or case-control trials are needed., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.)

Lemierre syndrome is a rare complication of acute tonsillitis. It is caused by the anaerobic bacterium Fusobacterium necrophorum and is characterized by bacteremia and septic thrombosis of the internal jugular vein. Dissemination of septic emboli may occur. The diagnosis can be difficult since different organs can be involved. We discuss a case of Lemierre syndrome in a 35-year-old woman with isolated thrombophlebitis of the facial vein and fusobacteria growth in blood culture. This case emphasizes the need for awareness of the condition.

Introduction: Infection markers are appreciated supplements in the clinical diagnosis of ear, nose and throat (ENT) infections. We aimed to examine the differential diagnostic usefulness of C-reactive protein (CRP), white blood cell count (WBC) and absolute neutrophil count (ANC) according to severity of middle ear and tonsillar infections., Material and Methods: This was a retrospective study including all patients admitted to the ENT Department, Aarhus University Hospital, from January 2001 to December 2008 and diagnosed with acute otitis media, mastoidismus, acute mastoiditis, acute tonsillitis, peritonsillar abscess, parapharyngeal abscess and necrotizing fasciitis., Results: A total of 1,773 patients were included. Between the tonsil subgroups, significant differences were found in CRP (p < 0.001), WBC (p < 0.001) and ANC (p < 0.001) levels. However, sensitivities and specificities related to differential diagnostics were low. In the middle ear group, no differences in CRP (p = 0.84), WBC (p = 0.46), and ANC (p = 0.72) levels were found. The number of CRP levels above the reference value was significantly higher than the corresponding number of WBC and ANC levels. A trend (non-significant) was found towards lower parameter levels in acute tonsillitis and peritonsillar abscess patients who grew Staphylococcus aureus compared with patients infected with other bacteria., Conclusion: CRP and ANC levels were related to severity of tonsillar-derived infections, but no such relation was found in infections with middle ear origin. None of the infection markers studied were useful for differential diagnostics., Funding: not relevant., Trial Registration: not relevant.

Adenotonsillectomy is a commonly performed procedure in otorhinolaryngology departments. A rare complication is cervicofacial subcutaneous emphysema, that often resolves spontaneously, but may progress to obstruct upper airways or spread to the thorax causing pneumomediastinum or pneumothorax and impair cardiorespiratory function. A case of cervicofacial emphysema in a young woman undergoing routine adenotonsillectomy is presented, and possible mechanisms and treatment options are discussed.