Otorhinolaryngologic Diseases

A previously healthy 16-year-old boy presents for evaluation of a slightly pruritic, nontender, generalized rash.

An 18-year-old woman with a history of allergic rhinitis and moderate persistent asthma presented with right-sided nasal congestion of 6 months’ duration. Her symptoms persisted despite her usual allergy medications, allergen immunotherapy, and 2 courses of antibiotics. A sinus CT scan showed complete opacification of the right maxillary sinus with increased attenuation of the mucin. Allergic fungal rhinosinusitis was suspected, and an otolaryngologist was contacted.

A 55-year-old woman seen because of new lump under right side of her jaw; present for 24 hours. Associated neck discomfort causing dysphagia, and also a raspy turn to the voice; both much worse in last 12 hours. No dyspnea. No sore throat.

abstract: Common causes of poorly controlled asthma include nonadherence to long-term inhaler therapy; environmental exposures; and uncontrolled comorbidities, such as allergic rhinitis. Adherence can be limited by many factors, including inadequate patient education, medication cost, prior failed treatment, poor physician-patient relationship, unrealistic expectations for therapy, and depression. For patients who have a poor perception of their symptoms, emphasizing the "disconnect" between symptoms and pulmonary function can help motivate them to monitor themselves with a peak flow meter and to adjust their medication accordingly. For patients with allergic triggers, instituting allergen-specific environmental controls can decrease symptoms and urgent care visits for asthma. Chronic rhinosinusitis and gastroesophageal reflux disease can also contribute to difficult-to-control asthma, and treatment of these comorbidities can help reduce asthma symptoms. (J Respir Dis. 2007;28(9):365-369)

Acute invasive fungal rhinosinus- itis occurs predominantly in immunocompromised patients, such as those with neutropenia and transplant recipients. The diagnosis requires biopsy, but permanent section can be time-consuming and result in a delay in treatment. Ghadiali and colleagues conducted a study to evaluate the accuracy of frozen-section biopsy in this setting.

abstract: In the treatment of certain allergies, sublingual immunotherapy (SLIT) may represent an attractive alternative to subcutaneous immunotherapy (SCIT) because of its lower risk of systemic reactions. The most common adverse reactions are local symptoms, such as oral "itchiness." GI complaints, rhinoconjunctivitis, urticaria, and asthma are uncommon reactions to this therapy, and no fatalities have been reported. In contrast to SCIT, accelerated induction schedules for SLIT do not appear to be associated with an increased risk of systemic reactions. SLIT may present an opportunity for broadening the use of immunotherapy by extending it to patients who are not candidates for SCIT because they dislike injections, find the frequent visits to the physician's office inconvenient, or are concerned with the safety of SCIT. The optimal effective dose and dosing schedule need to be established before a cost-benefit analysis can be performed. (J Respir Dis. 2007;28(6):237-243)

SEUOL, Korea -- The average body mass index in a group of children with otitis media with effusion was about 35% higher than among those with no history of ear infection, found researchers here.

abstract: Subcutaneous allergen immunotherapy is clearly beneficial in the treatment of select patients with allergic rhinitis or asthma. However, this therapy is underused, partly because it requires administration in a medical facility. Sublingual immunotherapy (SLIT) may be a promising alternative; it appears to be associated with fewer adverse effects, which suggests that it might be administered at home. Currently, there is no FDA-approved formulation for SLIT in the United States. However, allergists are showing increased interest in this therapy, and an approved formulation may be available in the near future. A number of studies have shown the clinical efficacy of SLIT, but many questions remain unanswered, including the effective dose, optimal treatment schedules, and overall duration of treatment. (J Respir Dis. 2007;28(4):162-168)

MEMPHIS, Tenn. -- Clinicians may one day give children a nasal spray of viral enzymes to prevent acute otitis media, researchers said here.

In addition to causing classic symptoms such as heartburn, gastroesophageal reflux (GER) is thought to cause a number of non-GI symptoms, such as cough and sore throat. Animal studies also suggest that GER may cause eustachian tube dysfunction. Now, a study from Japan indicates that there may be a link between GER and otitis media with effusion (OME) in adults.