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Laryngeal myxedema: An unusual etiology of infant stridor
Otolaryngology– Head and Neck Surgery Volume 131 Number 2
Management of Inflammatory Pseudotumor of the Larynx: Report of Two Cases Robert P Zitsch, III, MD (presenter); Natasha Pollak, MD; Timothy Ioy, MD Columbia MO; Columbia MO; Columbia MO
Objectives: Inflammatory pseudotumor (plasma cell granuloma) of the larynx is a rare benign lesion with only 19 cases reported to date in the English-language literature. This paper reports 2 additional cases of inflammatory pseudotumor (IPT) of the larynx treated at the University of Missouri and summarizes the approaches to management of these lesions. Methods: One case of subglottic IPT was initially treated with radiation 20 Gy, then recurred and required open excision. A second case of glottic IPT was treated with endoscopic CO2 laser ablation and high dose prednisone. Results: On review of literature, most common approaches to management of IPT of the larynx are endoscopic excision (with or without laser), high dose steroids, radiation, and open excision. Three local recurrences were reported, 2 occurred after endoscopic excision and 1 after radiation at our institution. Conclusion: Considering the experience to date, the best approach to management of laryngeal IPT seems to be endoscopic excision with or without laser. This may be followed by high dose steroids for 6 –12 weeks. If excision would result in significant function loss, a course of steroids alone may be attempted and has shown to have good success. Radiation therapy is used in treating laryngeal IPT based on success in treating IPT at other sites. In view of our experience, radiation therapy would not be a first line treatment option. Open excision and organ removal should be reserved for cases where anatomical considerations prohibit good endoscopic visualization and complete excision, or when malignancy cannot be excluded, respectively.
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toys, and may be unique. This information may also be of value in design and prevention. P170 Laryngeal Myxedema: An Unusual Etiology of Infant Stridor Jennifer Madalene Bager, MD (presenter); Mark F Sheridan, MD; Nici Eddy Bothwell, MD; Benjamin B Cable, MD Mililani HI; Huntington WV; Tamc HI; Kailua HI
Objectives: We report the clinical findings of a child with laryngeal myxedema and stridor due to untreated congenital hypothyroidism. A review of the literature regarding the incidence, radiologic findings, and clinical characteristics of this rare, but life-threatening disease are presented. Methods: Case presentation of a 7-month-old infant from Micronesia who presented to our service with stridor and severe hypoxemia. The clinical features of untreated congenital hypothyroidism will be presented along with a review of the literature. Results: A 7-month-old male was admitted to the pediatric service for stridor and hypoxemia. Examination of the infant revealed biphasic stridor in all positions, reduced oxygen saturation on room air, retractions, and grunting. On nasopharyngoscopic exam, the patient had diffuse edema of the larynx and supraglottis that obscured the normal anatomy. He also had diffuse hypotonia and generalized weakness. Thyroid function tests were obtained, and the patient was found to have severe hypothyroidism. He was started on levothyroxine therapy, and subsequently had a decrease in his laryngeal edema and improvement in his oxygenation. Conclusion: Although most stridor in infants is due to laryngomalacia, vocal cord paralysis, or congenital subglottic stenosis, less common etiologies are still encountered and must be kept within a broad differential diagnosis in order to achieve appropriate patient care.
P169
P171
Historical Foreign Body Collections
Eccrine Porocarcinoma of the Ear Mimicking Basaloid Squamous Cell Carcinoma
Sylvan E Stool, MD (presenter) Denver CO
Objectives: Foreign bodies of the air and food passages have been of interest to otolaryngologists for many years. Collections of these may be found in offices, hospitals, and some medical museums. Many have not been documented and are in danger of being lost when the collector retires. Methods: Through announcements, personal contacts, and presentations we wish to identify collections and document them with digital cameras and store them on web sites and CDs Results: We have identified and documented over 20 collections in offices and clinics in Europe, Asia, and the Americas. Some of these will be presented on the poster. Conclusion: Foreign body collections reflect many of the aspects of culture of the country such as foods, ornaments,
Carsten C Boedeker, MD (presenter); Iakovos Arapakis, MD; Gian Kayser, MD; Rainer Beck; Thomas Klenzner, MD Freiburg Germany; Freiburg Germany; Freiburg Germany; Freiburg Germany; Freiburg Germany
Objectives: Eccrine porocarcinoma (EP) is a rare malignant tumor arising from the eccrine sweat gland. EP of the ear is exceedingly rare; to our knowledge, only 5 cases have been reported in the American and European literature. We describe the unusual case of an EP arising in the left ear mimicking basaloid squamous cell carcinoma (SCC). Methods: A 60-year-old female patient presented with a verrucous, cauliflower-like tumor of her left ear. The patient claimed that the lesion had been present for almost 40 years. Computed tomography did not reveal any sign of bony de-
POSTERS
P168
Scientific Posters
Management of Inflammatory Pseudotumor of the Larynx: Report of Two Cases Robert P Zitsch, III, MD (presenter); Natasha Pollak, MD; Timothy Ioy, MD Columbia MO; Columbia MO; Columbia MO
Objectives: Inflammatory pseudotumor (plasma cell granuloma) of the larynx is a rare benign lesion with only 19 cases reported to date in the English-language literature. This paper reports 2 additional cases of inflammatory pseudotumor (IPT) of the larynx treated at the University of Missouri and summarizes the approaches to management of these lesions. Methods: One case of subglottic IPT was initially treated with radiation 20 Gy, then recurred and required open excision. A second case of glottic IPT was treated with endoscopic CO2 laser ablation and high dose prednisone. Results: On review of literature, most common approaches to management of IPT of the larynx are endoscopic excision (with or without laser), high dose steroids, radiation, and open excision. Three local recurrences were reported, 2 occurred after endoscopic excision and 1 after radiation at our institution. Conclusion: Considering the experience to date, the best approach to management of laryngeal IPT seems to be endoscopic excision with or without laser. This may be followed by high dose steroids for 6 –12 weeks. If excision would result in significant function loss, a course of steroids alone may be attempted and has shown to have good success. Radiation therapy is used in treating laryngeal IPT based on success in treating IPT at other sites. In view of our experience, radiation therapy would not be a first line treatment option. Open excision and organ removal should be reserved for cases where anatomical considerations prohibit good endoscopic visualization and complete excision, or when malignancy cannot be excluded, respectively.
P295
toys, and may be unique. This information may also be of value in design and prevention. P170 Laryngeal Myxedema: An Unusual Etiology of Infant Stridor Jennifer Madalene Bager, MD (presenter); Mark F Sheridan, MD; Nici Eddy Bothwell, MD; Benjamin B Cable, MD Mililani HI; Huntington WV; Tamc HI; Kailua HI
Objectives: We report the clinical findings of a child with laryngeal myxedema and stridor due to untreated congenital hypothyroidism. A review of the literature regarding the incidence, radiologic findings, and clinical characteristics of this rare, but life-threatening disease are presented. Methods: Case presentation of a 7-month-old infant from Micronesia who presented to our service with stridor and severe hypoxemia. The clinical features of untreated congenital hypothyroidism will be presented along with a review of the literature. Results: A 7-month-old male was admitted to the pediatric service for stridor and hypoxemia. Examination of the infant revealed biphasic stridor in all positions, reduced oxygen saturation on room air, retractions, and grunting. On nasopharyngoscopic exam, the patient had diffuse edema of the larynx and supraglottis that obscured the normal anatomy. He also had diffuse hypotonia and generalized weakness. Thyroid function tests were obtained, and the patient was found to have severe hypothyroidism. He was started on levothyroxine therapy, and subsequently had a decrease in his laryngeal edema and improvement in his oxygenation. Conclusion: Although most stridor in infants is due to laryngomalacia, vocal cord paralysis, or congenital subglottic stenosis, less common etiologies are still encountered and must be kept within a broad differential diagnosis in order to achieve appropriate patient care.
P169
P171
Historical Foreign Body Collections
Eccrine Porocarcinoma of the Ear Mimicking Basaloid Squamous Cell Carcinoma
Sylvan E Stool, MD (presenter) Denver CO
Objectives: Foreign bodies of the air and food passages have been of interest to otolaryngologists for many years. Collections of these may be found in offices, hospitals, and some medical museums. Many have not been documented and are in danger of being lost when the collector retires. Methods: Through announcements, personal contacts, and presentations we wish to identify collections and document them with digital cameras and store them on web sites and CDs Results: We have identified and documented over 20 collections in offices and clinics in Europe, Asia, and the Americas. Some of these will be presented on the poster. Conclusion: Foreign body collections reflect many of the aspects of culture of the country such as foods, ornaments,
Carsten C Boedeker, MD (presenter); Iakovos Arapakis, MD; Gian Kayser, MD; Rainer Beck; Thomas Klenzner, MD Freiburg Germany; Freiburg Germany; Freiburg Germany; Freiburg Germany; Freiburg Germany
Objectives: Eccrine porocarcinoma (EP) is a rare malignant tumor arising from the eccrine sweat gland. EP of the ear is exceedingly rare; to our knowledge, only 5 cases have been reported in the American and European literature. We describe the unusual case of an EP arising in the left ear mimicking basaloid squamous cell carcinoma (SCC). Methods: A 60-year-old female patient presented with a verrucous, cauliflower-like tumor of her left ear. The patient claimed that the lesion had been present for almost 40 years. Computed tomography did not reveal any sign of bony de-
POSTERS
P168
Scientific Posters