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Factitious HIV infection in an otolaryngology patient
OtolaryngologyHead and Neck Surgery Volume 121 Number 2
tous portion is not similar to decompression of a simple laryngeal cyst, but it is still possible. (2) Adequate resuscitation equipment and vicinity of operation facility are of benefit to the safety during pediatric airway examination. (3) Careful and thorough examination for any mild symptom or sign are important for management of pediatric airway problems. 91 Assessment of the Vibrant Soundbridge Auditory Prosthesis
Scientific Posters P231
Results: To provide a definitive diagnosis, she underwent a hemithyroidectomy, Pathology revealed a primary benign neurilemoma, Antoni type A. No further treatment was necessary. We review the literature on primary neurogenic tumors of the thyroid and assess the role of imaging in evaluating these tumors. Conclusion: Primary neurilemoma of the thyroid gland is extremely rare. Diagnosis of this neoplasm can be challenging, and multiple tests may be conducted before a diagnosis is reached. When evaluating cases of "cold" nodules in the thyroid gland, neurogenic tumors should be considered.
CAROL BRAZIL MS; THOMAS A LITTMAN PHD; DOUGLAS D BACKOUS MD; Seattle WA
Objectives: Functional gain and real-ear measurements are widely used in evaluating and adjusting acoustic heating aids. However, the efficacy of these procedures has not been documented for use with semi-implantable auditory prostheses such as the Vibrant Soundbridge. Methods: Five patients implanted with the Vibrant Soundbridge were evaluated with their conventional hearing aid and then with the Soundbridge using real-ear measurements, functional gain, and speech audiometry. Questionnaires including the PHAP (Profile of Hearing Aid Performance; Cox and Gilmore, 1990) were also administered. Results: The effectiveness and usefulness of real-ear measurements with the Vibrant Soundbridge will be discussed. Subjects' performances with the Vibrant Soundbridge will be compared with their performances using their acoustic hearing aids. In addition, results from the subjective questionnaires comparing both devices will be addressed. Conclusion: Comparing both objective and subjective measures for implantable auditory prostheses is important for evaluating the effectiveness and clinical outcomes of this type of technology. 92 Primary Neurilemoma of the Thyroid Gland in a Child L MARK GUSTAFSON MD; JAMES H LIU MD; MICHAEL J RU1TER MD; ROBIN T COl-tON MD; Cincinnati OH
Objectives: Primary nonepithelial tumors of the thyroid gland are rare, and there are few reports of these neoplasms in the literature. To increase awareness of this unusual condition, we present the case of a child with a primary thyroid neurilemorea. The usefulness of diagnostic tests and the treatment of these neoplasms are discussed. Methods: We present the case of a 12-year-old girl with a nontender nodule in her right thyroid lobe. The mass had been there for several months and was asymptomatic. Thyroid function test results were normal. Two attempts at fine-needle aspiration were nondiagnostic. A C T scan revealed a 2- • 1.5cm hypodense mass in the thyroid. A thyroid scan showed a "cold" nodule in the right upper lobe.
93 Amplification of HSV-I DNA in Human Geniculate Ganglia from Inadequately Stored Temporal Bones MARCOS CARRENO MD; JOSE LUIS LLORENTE MD; MARIA D ONA MD; CARLOS SUAREZ MD; SANTIAGO MELON MD; Oviedo Asturias Spain
Objectives: Purpose of this study was to evaluate the utility of the PCR approach to detect small amounts of DNA from inadequately stored samples. In order to evaluate differences with fresh samples, the assay was applied to trigeminal ganglia obtained from autopsies. Methods: Geniculate ganglia were obtained from human temporal bones used in otosurgery dissection practices and stored in formaldehyde solution for years. Fresh trigeminal ganglia were obtained from autopsies. We looked for HSV-1 DNA in ganglia by amplification of a fragment of the glycoprotein D gene of HSV- 1 by a nested PCR approach. Results: A 138-base-pair product of the HSV-1 genome was amplified in 13 of 30 (43%) geniculate ganglia and in 11 of 15 trigeminal ganglia. We did not detect any inspecific amplification or contamination in controls. Conclusions: The study of temporal bones stored in suboptimal conditions is possible by a nested PCR assay. This expands the possibilities of neurotological research on archival material, although there are some limitations compared with fresh or optimally conserved samples. 94 Factitious HIV Infection in an Otolaryngology Patient PAUL W BAUER MD; C BRUCE MACDONALD MD; JOHN R STRAM MD; Waltham MA; Boston MA; Boston MA
Objectives: Cases of factitious HIV infection, HIV Munchausen's syndrome, and HIV malingering have appeared in the medical literature. Confirming HIV infection status is often difficult, complicated by patient confidentiality and lack of a hard copy of the results in the medical record. Patients infected with HIV come under the protection of the Americans with Disabilities Act and are entitled to its protection and benefits, even if they are asymptomatic. Knowledge
P232
OtolaryngologyHead and Neck Surgery August T999
Scientific Posters
that a patient is HIV seropositive often influences the decision-making process in light of their altered immune status. Otolaryngologists should have knowledge of this clinical entity. Methods: Case report and literature review of factitious HIV in an otolaryngology patient. Results: A 31-year-old woman transferred her care to our department because after becoming HIV positive she had difficulty obtaining otolaryngology care elsewhere. She was followed up in our clinic for 6 years prior to our discovery that she was HIV seronegative. During that time she was treated with multiple courses of oral antibiotics and underwent multiple surgical procedures. Conclusion: Factitious HIV is likely to become more common as the social and economic benefits available to these patients become more accessible. It is important that all otolaryngologist are aware of factitious HIV infection, the need to clearly document the presence of HIV infection before initiating care, and potential legal implications of not confirming the patient's serologic status.
95
Oral Cancer in Machine Workers MATFHIAS TISCH MD; HEINZ MAIER MD; ARNO KELLER MD; Esetsberg Germany; UIm Germany; UIm Germany
Objectives: The incidence of job-related cancers in Germany has increased since 1978. Within the last decades a number of epidemiological studies provided evidence for the role of certain work-related substances and procedures as risk factors for developing head and neck cancers. The majority of these studies focused on laryngeal cancer, which is the most common type of cancer in the head and neck region. In the present poster, the results of a case control study on the role of occupational factors as risk factors for oral cancer are presented. Methods: The study involved 100 male patients with carcinomas of the oral cavity and 400 healthy male control subjects who were matched for age and residential area. Results: The proportion of persons employed as machine workers was significantly higher (22%) in the cancer group than in tile control group (8.5%). After adjustment for tobacco and alcohol consumption, an increased relative risk of oral cancer was estimated for machine workers (RR = 3.4; CI = 1.7-7.0). The detailed analysis of the single cases revealed that 96.3% of the machine workers had oral cancer but only 17.3% of the machine workers in the control group reported a longterm exposure to various dusts, especially metal dust (55.5% vs 9.7%), Conclusion.~The findings of this study indicate that exposure to various types of dust, especially metal dust, and also paints, lacquers, varnishes, and solvents may play a role in the increased oral cancer risk in machine workers.
96
Revision Choanal Atresia Repair: The Final Solution IAN K MCLEOD MD; ERIC A MAIR MD; Chester VA; Rockville MD
Objectives: Since the first description of choanal atresia in 1755, multiple surgical techniques have been proposed to repair the malformation. Today, the transnasal endoscopic method is the most widely accepted repair technique. The bony choanal plates are perforated, the lateral choanae are commonly drilled, and a portion of the vomer removed. Unfortunately, the problem of restenosis is a significant issue, and as a result, revision surgery may be a recurring theme in some children. We describe a successful revision endoscopic technique utilizing a microdebrider with straight and 120 ~ telescopes to permanently open the choanae without stenting. Methods: Described are 3 children (2-7 years old) with choanal atresia or stenosis who have collectively undergone 25 unsuccessful choanal procedures at various institutions. A microdebrider carefully removes the bony septum under direct nasal and intraoral telescopic visualization. No lateral drilling is performed. The cartilaginous septum is left intact. Results: Two year clinical and endoscopic follow-up on each child revealed a widely patent nasal airway with no complications (epistaxis, crusting, or re-stenosis). Synechiae or restenosis did not occur as circumferential mucosal stripping was avoided. No stenting was needed since the bony septum is removed. Conclusion: Near total endoscopic removal of the bony septum provides long-term nasal patency for revision choanal atresia/stenosis repairs. The endoscopic technique is aided by transnasal and transorat telescopic visualization with precise microdebrider septal removal. The technique is safe with no significant complications in our case series.
97
Complications Following Thyroid Surgery JUAN I DE DIEGO MD; MARIA P PRIM MD; D HARDISSON MD; JAVIER GAVILAN MD; Madrid Spain
Objectives: To assess the incidence and factors related to the main complications after thyroid procedures. Methods: A prospective historical study on 675 patients surgically treated for thyroid gland diseases was performed. Recurrent laryngeal nerve (RLN) paralysis, hypocalcemia, serohematoma, wound infection, and postoperative hemorrhage were evaluated in each patient. The rate of RLN paralysis was calculated on nerves at risk (n = 890) and for hypocalcemia on patients undergoing bilateral procedures or unilateral procedures if they had previously undergone a contralateral operation (n = 321). Results: Permanent hypocalcemia occurred in 2.2% of the patients, whereas unilateral laryngeal nerve paralysis developed in 0.9%. Mortality was 0.1% in this series. The RLN paralysis
tous portion is not similar to decompression of a simple laryngeal cyst, but it is still possible. (2) Adequate resuscitation equipment and vicinity of operation facility are of benefit to the safety during pediatric airway examination. (3) Careful and thorough examination for any mild symptom or sign are important for management of pediatric airway problems. 91 Assessment of the Vibrant Soundbridge Auditory Prosthesis
Scientific Posters P231
Results: To provide a definitive diagnosis, she underwent a hemithyroidectomy, Pathology revealed a primary benign neurilemoma, Antoni type A. No further treatment was necessary. We review the literature on primary neurogenic tumors of the thyroid and assess the role of imaging in evaluating these tumors. Conclusion: Primary neurilemoma of the thyroid gland is extremely rare. Diagnosis of this neoplasm can be challenging, and multiple tests may be conducted before a diagnosis is reached. When evaluating cases of "cold" nodules in the thyroid gland, neurogenic tumors should be considered.
CAROL BRAZIL MS; THOMAS A LITTMAN PHD; DOUGLAS D BACKOUS MD; Seattle WA
Objectives: Functional gain and real-ear measurements are widely used in evaluating and adjusting acoustic heating aids. However, the efficacy of these procedures has not been documented for use with semi-implantable auditory prostheses such as the Vibrant Soundbridge. Methods: Five patients implanted with the Vibrant Soundbridge were evaluated with their conventional hearing aid and then with the Soundbridge using real-ear measurements, functional gain, and speech audiometry. Questionnaires including the PHAP (Profile of Hearing Aid Performance; Cox and Gilmore, 1990) were also administered. Results: The effectiveness and usefulness of real-ear measurements with the Vibrant Soundbridge will be discussed. Subjects' performances with the Vibrant Soundbridge will be compared with their performances using their acoustic hearing aids. In addition, results from the subjective questionnaires comparing both devices will be addressed. Conclusion: Comparing both objective and subjective measures for implantable auditory prostheses is important for evaluating the effectiveness and clinical outcomes of this type of technology. 92 Primary Neurilemoma of the Thyroid Gland in a Child L MARK GUSTAFSON MD; JAMES H LIU MD; MICHAEL J RU1TER MD; ROBIN T COl-tON MD; Cincinnati OH
Objectives: Primary nonepithelial tumors of the thyroid gland are rare, and there are few reports of these neoplasms in the literature. To increase awareness of this unusual condition, we present the case of a child with a primary thyroid neurilemorea. The usefulness of diagnostic tests and the treatment of these neoplasms are discussed. Methods: We present the case of a 12-year-old girl with a nontender nodule in her right thyroid lobe. The mass had been there for several months and was asymptomatic. Thyroid function test results were normal. Two attempts at fine-needle aspiration were nondiagnostic. A C T scan revealed a 2- • 1.5cm hypodense mass in the thyroid. A thyroid scan showed a "cold" nodule in the right upper lobe.
93 Amplification of HSV-I DNA in Human Geniculate Ganglia from Inadequately Stored Temporal Bones MARCOS CARRENO MD; JOSE LUIS LLORENTE MD; MARIA D ONA MD; CARLOS SUAREZ MD; SANTIAGO MELON MD; Oviedo Asturias Spain
Objectives: Purpose of this study was to evaluate the utility of the PCR approach to detect small amounts of DNA from inadequately stored samples. In order to evaluate differences with fresh samples, the assay was applied to trigeminal ganglia obtained from autopsies. Methods: Geniculate ganglia were obtained from human temporal bones used in otosurgery dissection practices and stored in formaldehyde solution for years. Fresh trigeminal ganglia were obtained from autopsies. We looked for HSV-1 DNA in ganglia by amplification of a fragment of the glycoprotein D gene of HSV- 1 by a nested PCR approach. Results: A 138-base-pair product of the HSV-1 genome was amplified in 13 of 30 (43%) geniculate ganglia and in 11 of 15 trigeminal ganglia. We did not detect any inspecific amplification or contamination in controls. Conclusions: The study of temporal bones stored in suboptimal conditions is possible by a nested PCR assay. This expands the possibilities of neurotological research on archival material, although there are some limitations compared with fresh or optimally conserved samples. 94 Factitious HIV Infection in an Otolaryngology Patient PAUL W BAUER MD; C BRUCE MACDONALD MD; JOHN R STRAM MD; Waltham MA; Boston MA; Boston MA
Objectives: Cases of factitious HIV infection, HIV Munchausen's syndrome, and HIV malingering have appeared in the medical literature. Confirming HIV infection status is often difficult, complicated by patient confidentiality and lack of a hard copy of the results in the medical record. Patients infected with HIV come under the protection of the Americans with Disabilities Act and are entitled to its protection and benefits, even if they are asymptomatic. Knowledge
P232
OtolaryngologyHead and Neck Surgery August T999
Scientific Posters
that a patient is HIV seropositive often influences the decision-making process in light of their altered immune status. Otolaryngologists should have knowledge of this clinical entity. Methods: Case report and literature review of factitious HIV in an otolaryngology patient. Results: A 31-year-old woman transferred her care to our department because after becoming HIV positive she had difficulty obtaining otolaryngology care elsewhere. She was followed up in our clinic for 6 years prior to our discovery that she was HIV seronegative. During that time she was treated with multiple courses of oral antibiotics and underwent multiple surgical procedures. Conclusion: Factitious HIV is likely to become more common as the social and economic benefits available to these patients become more accessible. It is important that all otolaryngologist are aware of factitious HIV infection, the need to clearly document the presence of HIV infection before initiating care, and potential legal implications of not confirming the patient's serologic status.
95
Oral Cancer in Machine Workers MATFHIAS TISCH MD; HEINZ MAIER MD; ARNO KELLER MD; Esetsberg Germany; UIm Germany; UIm Germany
Objectives: The incidence of job-related cancers in Germany has increased since 1978. Within the last decades a number of epidemiological studies provided evidence for the role of certain work-related substances and procedures as risk factors for developing head and neck cancers. The majority of these studies focused on laryngeal cancer, which is the most common type of cancer in the head and neck region. In the present poster, the results of a case control study on the role of occupational factors as risk factors for oral cancer are presented. Methods: The study involved 100 male patients with carcinomas of the oral cavity and 400 healthy male control subjects who were matched for age and residential area. Results: The proportion of persons employed as machine workers was significantly higher (22%) in the cancer group than in tile control group (8.5%). After adjustment for tobacco and alcohol consumption, an increased relative risk of oral cancer was estimated for machine workers (RR = 3.4; CI = 1.7-7.0). The detailed analysis of the single cases revealed that 96.3% of the machine workers had oral cancer but only 17.3% of the machine workers in the control group reported a longterm exposure to various dusts, especially metal dust (55.5% vs 9.7%), Conclusion.~The findings of this study indicate that exposure to various types of dust, especially metal dust, and also paints, lacquers, varnishes, and solvents may play a role in the increased oral cancer risk in machine workers.
96
Revision Choanal Atresia Repair: The Final Solution IAN K MCLEOD MD; ERIC A MAIR MD; Chester VA; Rockville MD
Objectives: Since the first description of choanal atresia in 1755, multiple surgical techniques have been proposed to repair the malformation. Today, the transnasal endoscopic method is the most widely accepted repair technique. The bony choanal plates are perforated, the lateral choanae are commonly drilled, and a portion of the vomer removed. Unfortunately, the problem of restenosis is a significant issue, and as a result, revision surgery may be a recurring theme in some children. We describe a successful revision endoscopic technique utilizing a microdebrider with straight and 120 ~ telescopes to permanently open the choanae without stenting. Methods: Described are 3 children (2-7 years old) with choanal atresia or stenosis who have collectively undergone 25 unsuccessful choanal procedures at various institutions. A microdebrider carefully removes the bony septum under direct nasal and intraoral telescopic visualization. No lateral drilling is performed. The cartilaginous septum is left intact. Results: Two year clinical and endoscopic follow-up on each child revealed a widely patent nasal airway with no complications (epistaxis, crusting, or re-stenosis). Synechiae or restenosis did not occur as circumferential mucosal stripping was avoided. No stenting was needed since the bony septum is removed. Conclusion: Near total endoscopic removal of the bony septum provides long-term nasal patency for revision choanal atresia/stenosis repairs. The endoscopic technique is aided by transnasal and transorat telescopic visualization with precise microdebrider septal removal. The technique is safe with no significant complications in our case series.
97
Complications Following Thyroid Surgery JUAN I DE DIEGO MD; MARIA P PRIM MD; D HARDISSON MD; JAVIER GAVILAN MD; Madrid Spain
Objectives: To assess the incidence and factors related to the main complications after thyroid procedures. Methods: A prospective historical study on 675 patients surgically treated for thyroid gland diseases was performed. Recurrent laryngeal nerve (RLN) paralysis, hypocalcemia, serohematoma, wound infection, and postoperative hemorrhage were evaluated in each patient. The rate of RLN paralysis was calculated on nerves at risk (n = 890) and for hypocalcemia on patients undergoing bilateral procedures or unilateral procedures if they had previously undergone a contralateral operation (n = 321). Results: Permanent hypocalcemia occurred in 2.2% of the patients, whereas unilateral laryngeal nerve paralysis developed in 0.9%. Mortality was 0.1% in this series. The RLN paralysis