Lymphatic malformation of the epiglottis—A case report and review of the literature

A 2-year-old male with a new onset dysphagia was diagnosed with a huge multicystic lesion of the epiglottis. The patient was urgently operated and several cysts were resected using cold steel instruments under microscopic view. Histopathology was consistent with lymphatic malformation. Surgery resulted in total symptoms resolution and on 1 year follow-up the patient remained free of recurrence.This is the first report of epiglottic lymphatic malformation.     

Bell's palsy and tinnitus during pregnancy: predictors of pre-eclampsia? Three cases and a detailed review of the literature

We present two cases of Bell's palsy, and another with tinnitus, all in association with pre-eclampsia in the third trimester of pregnancy. We also systematically reviewed the published literature on both Bell's palsy and tinnitus in pregnancy and the puerperium using Medline from January 1966 to October 1998, and searched through the references from review articles and original research publications for further studies. Studies were limited to those published in the English language. We then pooled the rates of occurrence for Bell's palsy according to trimester of pregnancy, and postpartum, as well as the associated prevalence of pre-eclampsia or gestational hypertension. We found that the majority of cases of Bell's palsy arose during the third trimester (pooled event rate 71.1%, 95% confidence interval (CI) 64.1-77.2), while almost none arose in the first trimester. During the postpartum period, the distribution of Bell's palsy was 21.3% (95% CI 15.7-28.1) of all cases, with the majority arising within days of delivery. Gestational hypertension or pre-eclampsia was present in 22.2% of cases (95% CI 12.5-36.4), well above the 5% rate in the general population. Only one paper provided data on tinnitus in pregnancy, with the distribution equal across all three trimesters. When compared to non-pregnant controls, the odds ratio for the development of tinnitus during pregnancy was 2.8 (95% CI 1.0-8.1). In conclusion, Bell's palsy, and perhaps, tinnitus, occur more frequently during the third trimester of pregnancy. Both may be presenting prodromal signs of underlying early pre-eclampsia. The pathophysiologic mechanism relating these two entities to pre-eclampsia is also discussed.     

Hürthle cells carcinoma. Report of two operated cases and review of the literature

Hürthle cells carcinomas are considered a variant of folicular carcinomas and represent about 2% of all malignant thyroid tumours. We report 2 cases of 2 women of 46 and 43 years old confirmed by histological exam after total thyroidectomy with good postoperative evolution. The presence of capsular and vascular invasion is the most important criteria to distinguish this entity from the Hürthle cells adenomas.     

Synchronous bilateral epithelial–myoepithelial carcinoma of the parotid gland: case report and review of the literature

Synchronous bilateral malignancy in the parotid glands is extremely rare. The English literature reveals nine case reports. The most common synchronous bilateral malignancies are acinic cell carcinoma. Epithelial–myoepithelial carcinoma is an uncommon neoplasm comprising 1% of all salivary gland tumours. In this case report, we describe, to our best of knowledge, the first case of a patient with a synchronous bilateral epithelial–myoepithelial carcinoma of the parotid gland. The clinical histopathological and immunohistochemical peculiarities are elucidated. Imaging studies like ultrasonography are mandatory for both parotid glands and upper necks in the clinical presence of a unilateral parotid gland tumour.     

Solitary fibrous tumor of the orbit—two cases and a review of the literature

Solitary fibrous tumors of the orbit (SFT) are mesenchymal lesions that can develop either as malignant or benign neoplasias. We describe the histological features leading to the diagnosis in two females and review the current literature. Diagnosis of SFT only can be performed by histological examination, since clinical signs and radiological features are not specific enough. Even a malignant or benign course cannot be predicted, since clinical and radiological features do not correlate with histological signs of malignancy and vice versa. Radical resection is the treatment of choice, since no other treatment option has been proven to be efficient.     

Polypoid type of laryngeal sarcoidosis – case report and review of the literature

A 45-year-old mentally retarded woman was discovered to produce a stridor upon inhalation. Fiberoptic laryngoscopic study revealed a smooth-surfaced, wide, and pedunculated tumor on the right arytenoid and the right aryepiglottic fold. Histopathological study revealed that the tumor was characterized by granulomatous inflammation. The condition was diagnosed as laryngeal sarcoidosis. The tumor was resected surgically. Surgical resection of the tumor and injection of corticosteroid should be performed for polypoid-type laryngeal sarcoidosis. The case is discussed in detail, along with a review of the literature pertaining to sarcoidosis of the larynx. Received: 13 December 1999 / Accepted: 6 April 2000     

Is superior canal dehiscence congenital or acquired? A case report and review of the literature

This article presents a detailed case report of a patient who was diagnosed with superior canal dehiscence at 37 years of age, but who had a suspicious history for that syndrome from at least 10 years of age. The authors hypothesize several reasons for this late diagnosis, with the goal of helping pediatricians, otolaryngologists, and neurologists consider this syndrome in their differential diagnosis of children, adolescents, or adults experiencing dizziness.     

The large vestibular aqueduct – case report and review of the literature

Patients with a large vestibular aqueduct (LVA) suffer from a loss of hearing in childhood at an early onset. An acute loss of hearing can be precipitated by minor head trauma. Until now there seems to be no sufficient therapy for stopping the progression of a loss of hearing. It has been shown that a cochlear implantation is a worthwhile procedure if the patient is almost deaf. We report the case of a patient with a bilateral LVA. A loss of hearing was confirmed at the age of 16 months. Exposure to loud noise triggered an acute progression of the hearing loss. At the age of 18 years, LVA was confirmed radiologically, revealing an enlarged endolymphatic duct and sac in MRI scans and an enlarged vestibular aqueduct in the CT scan. We successfully performed a cochlear implant (MED-EL, Combi 40+ flex). Proceeding from this case report, the paper reviews the literature on LVA.     

Leiomyoma of the external auditory canal—a case report and brief review of the literature

Leiomyoma usually originates from the uterus and alimentary tract, but rarely from the soft tissue of the head and neck. It is extremely rare that leiomyoma appears in the external auditory canal. A 47-year-old male with left external auditory canal leiomyoma presented with conductive hearing impairment and post-auricular swelling. Tumor excision was successful via a retroauricular approach. The pathological examination demonstrated a vascular leiomyoma without malignant change. To date, including our case, only three cases of external auditory canal leiomyoma have been reported. The tumor occurs mainly in adult males aged around 50 and should be included in the differential diagnoses for external auditory canal tumor. The proper treatment of choice is complete excision. In case of an external auditory canal tumor, even if it is believed to be benign before surgery, precise pathologic examination is required to exclude the possibility of malignancy.     

Is epistaxis associated with arterial hypertension? A systematic review of the literature

Both epistaxis and hypertension are frequent problems in the adult population. The relationship between the level of arterial pressure and incidence of epistaxis in a patient with hypertension is a question that appears frequently in the clinical practice. A systematic review of the literature regarding the relation of arterial hypertension with epistaxis was performed through MEDLINE and EMBASE. All studies, whether examining the correlation of arterial pressure at presentation of a patient with nasal bleeding or the repercussion of episodes of epistaxis in hypertensive patients, were included in this review. Studies were evaluated independently by two reviewers according to a standard evaluation form. Overall, nine studies fulfilled our inclusion criteria. Five of them were single-group (patient) studies, while the remaining four included a control group. In eight studies, the patient group included patients with epistaxis, while one focused on hypertensive patients. Six out of nine studies agree that arterial pressure is higher at the time of epistaxis, as compared to the control group or to the general population. Seven out of nine studies conclude that there is cross-correlation between arterial pressure and the actual incident of epistaxis. The presence of high arterial blood pressure during the actual episode of nasal bleeding cannot establish a causative relationship with epistaxis, because of confounding stress and possible white coat phenomenon, but may lead to initial diagnosis of an already installed arterial hypertension.     

Atypical mycobacterial tuberculosis--a diagnostic and therapeutic dilemma? Case reports and review of the literature

In immunocompetent preschool children cervical lymphadenitis is a common clinical presentation of atypical mycobacteria. Its rapid diagnosis and treatment is still a challenge, because accurate diagnostic procedures for atypical mycobacteria are still not yet available in routine practice. Two children suffered from craniojugular (16 months old girl) and infraauricular (2.5 years old boy) located neck masses which showed resistance to the medical treatment. In the first case an abscess splitting took place initially, followed by an anti-tubercular drug treatment and necessary surgical reintervention. In the second case surgical removal of all involved lymph nodes, infiltrated surrounding soft tissue and involved skin areas were followed by medical treatment. In both cases presumed infection with mycobacterium tuberculosis was not confirmed, but atypical mycobacteria could be isolated both. In the first case atypical mycobacterium could be specified as mycobacterium avium complex and in the second case as mycobacterium malmoense. Both bacilli showed sensitivity towards medical treatment with clarithromycin, whereby in one case only the surgical reintervention led to a complete removal of clinical symptomatic. In cases of presumed tuberculous neck lymph node infections differential diagnosis of an atypical mycobacterial lymphadenitis should always be supposed, because medical and surgical treatment differ fundamentally.     

Otitis media with effusion: disease or defense? A review of the literature

Many studies of otitis media with effusion (OME) have been published, most of them dealing with risk factors. The literature correlates this condition with various patient characteristics and socio-economic factors, but none of these have been identified as the sole causative factor. A review of the literature suggests that otitis media with effusion is a response to pathogenic bacteria and thus a normal protective reaction of the body. Therefore, the decision on whether or not treatment is indicated should take the natural course of that response into account. In light of the literature reviewed here, we conclude that there is usually no need to treat middle ear effusion in young children.     

Psychogenic mutation of the voice. Comparative analysis of objective and subjective methods of diagnostics

The present work had the following objectives: 1) to determine (using a computer program) the fundamental frequency or F0 of the colloquial speech and sonorous cough in the patients with psychogenic mutation of the voice, 2) to obtain subjective (audile) estimation of the quality of their voice, and 3) to develop relevant diagnostic criteria. The study included 10 men aged from 14 to 40 years diagnosed with mutational falsetto (n=5) and incomplete mutation of the voice (n=5). The quality of the voice was independently estimated by three experts. All the patients were exmined using laryngoscopy and laryngostroboscopy. It was demonstrated that mutational falsetto can be diagnosed by subjective estimation of the quality of voice whereas diagnostics of partial voice mutation is possible only with the use of a computer. The author concludes that the fundamental frequency (F0) of sonorous cough is an important diagnostic criterion for psychogenic voice mutation.     

Gradenigo's syndrome: Is fusobacterium different? Two cases and review of the literature

Gradenigo's syndrome is a rare but life threatening complication of acute otitis media (AOM), which includes a classic triad of otitis media, deep facial pain and ipsilateral abducens nerve paralysis. The incidence of Fusobacterium necrophorum infections has increased in recent years. We describe two cases of Gradenigo's syndrome caused by F. necrophorum. Additional four cases were identified in a review of the literature. Gradenigo's syndrome as well as other neurologic complications should be considered in cases of complicated acute otitis media. F. necrophorum should be empirically treated while awaiting culture results.