Introduction: Although adult tonsillectomy is common, it has a relatively high risk of perioperative airway adverse events. To identify and validate preoperative predictors of major airway adverse events in tonsillectomy and evaluate a predictive model. Methods: This single-center retrospective study included 218 adults undergoing tonsillectomy (Jan 2023 to Sep 2025). Patients were grouped by the occurrence of a composite airway event, which included difficult intubation, severe hypoxemia, postoperative airway intervention, or unplanned ICU admission. Univariate and multivariate logistic regression identified independent predictors. A nomogram-based model was developed. Data were split into training and validation sets. Performance was assessed using ROC curves, calibration plots, bootstrap resampling, and decision curve analysis (DCA). Results: Multivariate analysis identified body weight (OR=1.11), modified Mallampati classification (OR=2.55), and tonsil size grade (OR=3.74) as independent predictors. The model showed excellent discrimination with AUCs of 0.904 (training) and 0.924 (validation). At a cutoff of 0.244, the model showed 83.8% sensitivity and 84.8% specificity in the training set, and 88.9% sensitivity and 91.7% specificity in the validation set, with negative predictive values of 94.1% and 98.2%, respectively. High-risk patients had a 7.09-fold increased risk (95% CI: 2.35-27.04, P<0.001). The model was well-calibrated, and DCA indicated a net clinical benefit for threshold probabilities between 0.05 and 0.50. Conclusions: AA model incorporating body weight, modified Mallampati classification, and tonsil size demonstrated good discriminative performance and may serve as a useful preoperative screening tool for perioperative airway risk stratification in adults undergoing tonsillectomy. Its high negative predictive value may be particularly useful for identifying patients at relatively low risk, while high-risk predictions should be interpreted in conjunction with clinical assessment.
Background: Cholesteatoma-related posterior mastoid plate defects may provide a route for recurrent otogenic meningitis. Case Presentation: A 32-year-old man with chronic right otorrhea and two prior bacterial meningitis episodes had HRCT evidence of mastoid cholesteatoma and a focal posterior mastoid plate defect with dural exposure. A retroauricular canal-wall-up mastoidectomy was performed; matrix was dissected from intact posterior-fossa dura. The defect was repaired using a three-layer onlay construct of temporalis fascia, ipsilateral conchal cartilage, and free temporalis muscle. Histopathology confirmed cholesteatoma. No CSF sample was obtained at assessment because there were no features of active meningitis; historical culture and pathogen data were unavailable. The postoperative course was uncomplicated, with no CSF leak, facial nerve dysfunction, recurrent otorrhea, or meningitic symptoms through 12 months of clinical follow-up. Conclusion: Single-stage transmastoid triple-layer autologous reconstruction may restore separation between the mastoid cavity and posterior cranial fossa in cholesteatoma-associated posterior-fossa mastoid defects.
Subglottic hemangioma (SGH) is a rare but potentially fatal cause of infantile stridor that is frequently misdiagnosed as laryngomalacia, croup, or idiopathic subglottic stenosis. Circumferential involvement is an uncommon and particularly dangerous variant whose endoscopic appearance overlaps with that of other concentric subglottic lesions, including congenital cricoid cartilage malformation and idiopathic subglottic stenosis. We present a two-week-old female with a history of preterm birth (36 5/7 weeks) and progressive biphasic stridor, cyanosis, and increasing respiratory distress. Operative microlaryngoscopy and bronchoscopy demonstrated significant subglottic narrowing of uncertain etiology that was refractory to balloon dilation, and contrast-enhanced MRI of the neck demonstrated nonspecific airway narrowing without an identifiable mass. After multidisciplinary discussion with hematology and neonatology, empiric oral propranolol was initiated for presumed airway hemangioma. The infant’s stridor improved dramatically within five days and resolved completely; she was discharged after a one-month neonatal intensive care unit stay and remained asymptomatic at seven-month follow-up. This case illustrates the diagnostic ambiguity that can attend circumferential subglottic narrowing in the neonate and demonstrates that empiric propranolol can serve as both a diagnostic and therapeutic trial when imaging is unrevealing.
Rhinolithiasis is a rare and underrecognized etiology of chronic sinonasal obstruction and rhinorrhea. The clinical presentation of rhinolithiasis often mimics chronic rhinosinusitis, though often presenting with unilateral symptoms. While most reported cases of rhinolithiasis focus on the clinical presentation and management, the microbiologic characteristics of rhinoliths remain poorly described. We report the case of a 55-year-old male with an 18-year history of persistent right-sided nasal congestion and rhinorrhea. Following nasal endoscopy and computed tomography evaluation, he was diagnosed with rhinolithiasis, and surgical management was recommended. The patient was lost to follow-up and returned three years later with persistent symptoms, at which point he elected to undergo surgical removal of the rhinolith. The patient underwent right maxillary antrostomy with tissue removal, right total ethmoidectomy, right rhinolith and foreign body removal, septoplasty, and left inferior turbinate submucosal resection under general anesthesia, and he experienced complete resolution of symptoms. Microbiologic cultures of the specimen demonstrated polymicrobial anaerobic growth, including Bacteroides, Streptococcus, and Escherichia coli. While culture data from rhinoliths are rarely reported in the literature, the organisms recovered in this case are consistent with the established flora of chronic rhinosinusitis, suggesting that long-standing rhinolith-associated obstruction may generate a microbiologic environment similar to that of chronic rhinosinusitis more broadly. This case highlights the importance of microbiologic evaluation of rhinoliths, as prolonged obstruction complicated by anaerobic colonization may predispose to disease chronicity and complications.
Necrotizing fasciitis is a rare but potentially life-threatening infection requiring early recognition and immediate surgical management to prevent significant morbidity and mortality. We present a case of cervicothoracic necrotizing fasciitis arising from sternoclavicular (SC) septic arthritis requiring multidisciplinary management. A 47-year-old male with history of poorly controlled diabetes mellitus, congestive heart failure, obesity, and tobacco use presented with progressive shoulder, neck and chest pain, dysphagia, odynophagia, and hoarseness. Laboratory evaluation demonstrated marked leukocytosis and severe hyperglycemia. Computed tomography imaging demonstrated extensive subcutaneous emphysema extending from the SC joint into the anterior chest wall, mediatsinum and retropharyngeal space. He underwent emergent surgical exploration that confirmed necrotizing infection with involvement of the sternum, clavicular head, sternocleidomastoid muscle and medial pectoralis muscle. His hospital course required serial operative debridement, wound vacuum therapy, and eventual chest wall reconstruction with a pectoralis major muscle flap. Infection control was achieved through coordinated care involving otolaryngology, cardiothoracic surgery, infectious disease, and critical care teams. This case highlights the importance of maintaining a low suspicion threshold for necrotizing infections in high-risk patients presenting with neck pain, severe examination findings, and systemic symptoms. Early imaging, prompt surgery interventtion, and multidisciplinary management are essential for survival in cervicothoracic necrotizing fasciitis.
