As temporal bone imaging techniques continue to improve, it is likely that we will see an increase in the detection ofpneumolabyrinth. Several mechanisms have been proposed to explain how air enters the labyrinth. A small number of authors has reported an association between pneumolabyrinth and temporal bone fractures, perilymphatic fistulae, and displaced stapes prostheses. In this article, we describe a new case ofpneumolabyrinth that was seen as a late complication ofstapes surgery, and. we summarize what is known about this rare condition.
Figure I, initial strobovideolaryn goscopy shows the large bilobed granuloma overlyin g the medial surfa ce of the right arytenoid. Note the erythema of the arytenoids and the posterior cobblestoning despite the pati ent 's use of omeprazole twice daily. Also supp ortin g the diagnosis of persistent reflux laryngitis is the presence ofleft pseudosulcus vocalis (the sulcus ex tends into and beyond the left vocal process).A 60-year-old man with a history of non insulindependent diabetes mellitus, hypertension, and hypothyroidism also had a 6-year history of throat problems, a "gravelly and husky " voice, a loss of singing range at the high end , and vocal fatigue. The vocal dem ands of his occupation (director of dining services at a small college) were extensive; he also sang at his church and lectured at religious conferences. The patient experienced occasion al right-sided throat pain, morning and evening throat soreness, excessive throat clearing, and a bitter taste in the morning. He had been taking omeprazole twice daily for Figur e 2. Strob ovideola ryngoscopy 2 months f ollowing the pati ent 's initial visit sho ws the near-complete resolution of reflux signs and the substantial decrease in the size of the mass.the preceding 2 years, but it resulted in only a slight alleviation of his symptoms.On strobovideolaryngoscopy , the patient was noted to have signs of severe laryngopharyngeal reflux and a large bilobed granuloma overlying the medial surface of the vocal process of the right arytenoid (figure I). A 24-hour pH monitoring test obtained while the patient was taking 20 mg of omeprazole twice daily revealed four episodes of proximal acid exposure. Because the patient had exhibited signs of continuing laryngeal acid expo sure and damage, we increased the dosage of omeprazole to 40 mg Fro m the
Profound physiologic changes occur during pregnancy, and they can alter the pharmacodynamics ofan administered drug. Almost 85 % of women take at least one prescription medication during a pregnancy. Nearly every drug administered to a mother crosses the placenta, and fetal drug levels can reach 50 to 100% ofmaternal serum concentrations. Because many otolaryngologic conditions are associated with pregnancy, it is essential that otolaryngologists who care for gravid patients know which drugs are safe and avoid unnecessary prescriptions so that the best care can be delivered to the pregnant patient without harming her unborn child. In this article, we discuss the relative safety and efficacy ofvarious types of drugs frequently prescribed for pregnant women by otolaryngologists.
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