Arch Otolaryngol
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Malignant hyperthermia (MH) may be triggered by exposure to commonly employed anesthetic agents and muscle relaxants, and often manifests itself during the period of anesthesia. Delayed-onset MH occurring one to four hours postoperatively has been described in isolated case reports. A case of delayed-onset MH occurred 11 hours following routine tonsillectomy and adenoidectomy. ⋯ Prompt intravenous administration of dantrolene sodium was therapeutic. Serial serum creatine phosphokinase evaluation verified the diagnosis of MH. The implications of delayed-onset MH and the importance of preoperative screening for potentially susceptible individuals are discussed.
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Arytenoid cartilage dislocations and avulsions are often seen as a part of severe laryngeal injuries due to blunt trauma. An uncommon type of injury is the unilateral degloving of an arytenoid cartilage following laterally directed trauma to the thyroid cartilage. It may occur without additional cartilaginous or mucosal damage. ⋯ It may retain mobility and be exposed only on adduction, or it may lose mobility due to dislocation and be tipped into the laryngeal lumen. Prognosis for vocal cord mobility and voice production is good for the degloving injury alone, but poor if the arytenoid cartilage is also dislocated. Cases are discussed to illustrate the mechanism, treatment, and outcome of such injuries.
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Acute infectious uvulitis is a rare condition. A case caused by Streptococcus pneumoniae occurred in a 56-year-old woman who also had coexisting epiglottitis. One other case of uvulitis reported in the literature has also been associated with acute epiglottitis. Because of potentially lethal complications, epiglottitis should be suspected in any patient who presents with acute painful swelling of the uvula.
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Aneurysms of the intrapetrous internal carotid artery are rarely encountered and can present difficult diagnostic problems. A review of the literature revealed 34 cases, and we now add a 35th. Presenting symptoms and signs are dependent on the direction of expansion of the aneurysm, with neurologic dysfunction typical of medial expansion, whereas lateral erosion often suggests a glomus tumor.
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Randomized Controlled Trial Comparative Study Clinical Trial
Alleviation of induced vertigo. Therapy with transdermal scopolamine and oral meclizine.
Twelve healthy subjects received seven-day treatments on a randomized, double-blind, crossover basis, of a transdermal scopolamine system, oral meclizine, and placebo, separated by one-week intervals. Just prior to each treatment, and on days 1 and 7 of each treatment, subjects received two warm (44 degrees C) caloric irrigations of each external auditory canal. Following each irrigation, subjects rated their vertigo symptoms. ⋯ Vertigo symptoms on day 1 of treatment were significantly less with transdermal scopolamine than oral meclizine or placebo and on day 7 were significantly less with both scopolamine and meclizine than the placebo. On day 1, meclizine did not reduce vertigo symptoms significantly when compared with the placebo. Drowsiness was greater with use of oral meclizine than transdermal scopolamine.