Susac syndrome is a rare and potentially devastating disease. Hearing loss is quite variable. Low- and mid-range frequencies seem to be most commonly affected. Patients whose hearing loss meets criteria should be considered for cochlear implantation.

We describe an exceedingly rare case of bilateral simultaneous metastatic palatine tonsil SCCA. This finding raises the question regarding the need for bilateral tonsillectomy in the case of the unknown primary or proven tonsil carcinoma with HPV positivity.

A n 11-year-old male had a history of intubation for respiratory support after a motor vehicle accident. Three weeks after extubation, it was noted that he had biphasic stridor. Flexible laryngoscopy revealed a vocal fold granuloma. The child was taken to the operating room where the granuloma was successfully and atraumatically removed. Secondarily, the child was noted to have a grade 2 subglottic stenosis. A 3.7-mm bronchoscope was placed through the subglottis, and tracheal polyps were noted down the entire tracheal column (Fig 1). The child was awakened from anesthesia and sent to the pediatric intensive care unit for airway observation. Decadron (Merck & Co,Whitehouse Station, NJ) was administered for 72 hours. The stridor improved but persisted. On reexamination in the operating room, the tracheal polyps were noted to have subsided. A single-stage laryngotracheal reconstruction with an anterior rib cartilage graft was performed successfully for the subglottic stenosis. The patient was followed without further sequelae or recurrence for 2 years. This report was institutional review board approved.

gested that this new surgical technique prevented further deterioration of hearing loss and became a pivotal treatment of PLF.