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Comment & Response |

Cervical Osteomyelitis After Pharyngeal Surgical Manipulation—Reply ONLINE FIRST

Jill N. D’Souza, MD1; David Cognetti, MD1
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
JAMA Otolaryngol Head Neck Surg. Published online July 28, 2016. doi:10.1001/jamaoto.2016.1840
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In Reply We would like to thank Dr Govil et al1 for their insight into this potentially devastating diagnosis in patients with irradiated head and neck cancer, and for adding further patient data to be considered. Indeed, cervical spine spondylodiscitis can be a challenging diagnosis, especially when detected only on surveillance imaging in an otherwise asymptomatic patient.2 Esophageal dilation in patients with head and neck cancer is frequently undertaken to improve dysphagia, and up to 33% of patients may have an esophageal stricture visible on barium esophagogram.3 In the patient who has undergone radiation therapy, microperforations that may accompany esophagoscopy can have severe implications. Transient bacteremia associated with esophagoscopy with dilation has been estimated to occur in 45% to 100% of procedures4; however, there is no current consensus data regarding the use of perioperative antibiotics in the irradiated patient undergoing this procedure. The role of antibiotic prophylaxis in this patient population is also under discussion at this institution, and we wholeheartedly agree with the need for further study of the risk to benefit ratio of antibiotic prophylaxis in this setting.

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July 28, 2016
Nandini Govil, MD, MPH; Nicole C. Schmitt, MD; Seungwon Kim, MD
1Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
2Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Bethesda, Maryland
JAMA Otolaryngol Head Neck Surg. Published online July 28, 2016.;():. doi:10.1001/jamaoto.2016.1837.
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