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The Departmentof Otolaryngology–Head and NeckSurgeryat theUniversityof Cincinnati evaluatesandseespatientsfromaroundtheUnitedStatesandtheworld.Allreadersofthis bookworldwidearewelcometocontactusforconsultationsorreferrals,asyoumightneed. Pleaseusethefollowingcontactinformation(andmentionthatyouareareader): toscheduleconsults/referralsforAdultENT: directphonenumber:+1-513-475-8400 email: [email protected] website:www.uchealth.com/ent toscheduleconsults/referralsforPediatricENT: directphonenumber:+1-513-636-4355 email: [email protected] website:www.cincinnatichildrens.org/ent Otolaryngology Cases The University of Cincinnati Clinical Portfolio Second Edition MylesL.Pensak,MD,FACS H.B.BroidyProfessorandChairman DepartmentofOtolaryngology—HeadandNeckSurgery ProfessorofNeurologicSurgery UniversityofCincinnatiAcademicHealthCenter Cincinnati,Ohio CatherineK.Hart,MD AssistantProfessor DepartmentofOtolaryngology—HeadandNeckSurgery UniversityofCincinnatiAcademicHealthCenter DivisionofPediatricOtolaryngology—HeadandNeckSurgery CincinnatiChildren’sHospitalMedicalCenter Cincinnati,Ohio YashJ.Patil,MD,FACS AssociateProfessor DepartmentofOtolaryngology—HeadandNeckSurgery UniversityofCincinnatiAcademicHealthCenter Cincinnati,Ohio 137illustrations Thieme NewYork(cid:127)Stuttgart(cid:127)Delhi(cid:127)RiodeJaneiro ExecutiveEditor:TimothyY.Hiscock Important note: Medicine is an ever-changing science ManagingEditor:J.OwenZurhellenIV undergoingcontinualdevelopment.Researchandclinical EditorialAssistant:KeithPalumbo experience are continuallyexpanding ourknowledge, in Director,EditorialServices:MaryJoCasey particular our knowledge of proper treatment and drug ProductionEditor:TorstenScheihagen therapy.Insofarasthisbookmentionsanydosageorappli- InternationalProductionDirector:AndreasSchabert cation,readersmayrestassuredthattheauthors,editors, EditorialDirector:SueHodgson andpublishershavemadeeveryefforttoensurethatsuch InternationalMarketingDirector:FionaHenderson referencesareinaccordancewiththestateofknowledgeat InternationalSalesDirector:LouisaTurrell thetimeofproductionofthebook. DirectorofInstitutionalSales:AdamBernacki Nevertheless,thisdoesnotinvolve,imply,orexpressany Senior Vice President and Chief Operating Officer: Sarah guaranteeorresponsibilityonthepartofthepublishersin Vanderbilt respecttoanydosageinstructionsandformsofapplications President:BrianD.Scanlan stated in the book. Every user is requested to examine Printer:ReplikaPressPvt.Ltd. carefully the manufacturers’ leaflets accompanying each drugandtocheck,ifnecessaryinconsultationwithaphy- LibraryofCongressCataloging-in-PublicationData sicianorspecialist,whetherthedosageschedulesmentioned Names:Pensak,MylesL.,editor.|Hart,CatherineK.,editor.| thereinorthecontraindicationsstatedbythemanufacturers Patil,YashJ.,editor.|UniversityofCincinnati.Department differfromthestatementsmadeinthepresentbook.Such ofOtolaryngologyandMaxillofacialSurgery. examinationisparticularlyimportantwithdrugsthatare Title:Otolaryngologycases:theUniversityofCincinnati eitherrarelyusedorhavebeennewlyreleasedonthemarket. clinicalportfolio/[editedby]MylesL.Pensak,Catherine Everydosagescheduleoreveryformofapplicationusedis K.Hart,YashJ.Patil. entirelyattheuser’sownriskandresponsibility.Theauthors Description:Secondedition.|NewYork:Thieme,[2018]| andpublishersrequesteveryusertoreporttothepublishers Includesbibliographicalreferencesandindex. anydiscrepanciesorinaccuraciesnoticed.Iferrorsinthis Identifiers:LCCN2016049909(print)|LCCN2016050231 workarefoundafterpublication,erratawillbepostedat (ebook)|ISBN9781626234192(softcover:alk.paper)| www.thieme.comontheproductdescriptionpage. ISBN9781626234202(eISBN)|ISBN9781626234208 Some of the product names, patents, and registered Subjects:|MESH:OtorhinolaryngologicDiseases| designsreferredtointhisbookareinfactregisteredtrade- Otolaryngology|Diagnosis,Differential|CaseReports marksorproprietarynameseventhoughspecificreference Classification:LCCRF56(print)|LCCRF56(ebook)|NLM tothisfactisnotalwaysmadeinthetext.Therefore,the WV150|DDC617.5/1–dc23 appearanceofanamewithoutdesignationasproprietaryis LCrecordavailableathttps://lccn.loc.gov/2016049909 nottobeconstruedasarepresentationbythepublisherthat itisinthepublicdomain. Copyright©2018byThiemeMedicalPublishers,Inc. ThiemePublishersNewYork 333SeventhAvenue,NewYork,NY10001USA +18007823488,[email protected] ThiemePublishersStuttgart Rüdigerstrasse14,70469Stuttgart,Germany +49[0]7118931421,[email protected] ThiemePublishersDelhi A-12,SecondFloor,Sector-2,Noida-201301 UttarPradesh,India +911204556600,[email protected] ThiemePublishersRiodeJaneiro,ThiemePublicaçõesLtda. EdifícioRodolphodePaoli,25ºandar Av.NiloPeçanha,50–Sala2508 RiodeJaneiro20020-906Brasil +55213172-2297/+55213172-1896 Thisbook,includingallpartsthereof,islegallyprotectedby Coverdesign:ThiemePublishingGroup copyright.Anyuse,exploitation,orcommercializationout- TypesettingbyDiTechProcessSolutions sidethenarrowlimitssetbycopyrightlegislationwithoutthe PrintedinIndiabyReplikaPressPvt.Ltd. 54321 publisher’sconsentisillegalandliabletoprosecution.This applies in particular to photostat reproduction, copying, ISBN978-1-62623-419-2 mimeographingorduplicationofanykind,translating,prep- Alsoavailableasane-book: aration of microfilms, and electronic data processing and eISBN978-1-62623-420-8 storage. Thissecondeditionisdedicatedtothecaringsupportandprofessionalstaffwhomwe,thephysiciansof theDepartmentofOtolaryngology–HeadandNeckSurgery,arefortunatetoworkbesideinthedaily careofourpatientsatUCHealth,CincinnatiChildren’sHospitalMedicalCenter,andtheVAMedicalCenter.