Mechanisms of the symptoms of rhinosinusitis

The review discusses the physiological and pathophysiological mechanisms associated with the symptoms of acute and chronic rhinosinusitis. An understanding of symptom mechanisms is important for the clinical diagnosis of rhinosinusitis and is important in assessing the efficacy of surgical and medical treatments for rhinosinusitis. The review will discuss the four primary symptoms used to diagnose rhinosinusitis: nasal obstruction, nasal discharge, facial pain and loss of sense of smell; and the secondary symptoms, cough, sneezing, sore throat and voice changes, epiphora, fever, and psychological effects and fatigue. The review will highlight that our understanding of a key diagnostic symptoms facial pain is limited, and that the incidence of pain with rhinosinusitis is controversial. Sneezing is a common symptom of acute rhinosinusitis with allergy but is not normally described as symptom in chronic rhinosinusitis and this anomaly is in need of more research. The mechanism of unilateral nasal obstruction with rhinosinusitis is discussed.     

A case of myoepithelioma of the nasal cavity

Myoepithelioma is a rare tumor, most frequently located in the salivary gland. Case reports of extra-salivary myoepithelioma are sporadic, with only one case in the nasal cavity. A 68-year-old male patient presented with a myoepithelioma of the nasal cavity manifesting as nasal obstruction and epistaxis, which was treated successfully with endoscopic excision. Histological examination revealed myoepithelial cells and myxoid stroma, which confirmed the diagnosis of myoepithelioma. The behavioral pattern is similar to if not identical with that of the mixed tumor, pleomorphic adenoma, which is benign, but the potential for recurrence is always present, especially if complete resection is not achieved.     

Clinical characteristics and comparative study of different modalities of treatment of pseudocyst pinna

The aims of the article were to study the clinical characteristic of patients with pseudocysts and to compare different common modalities of treatment and introduce the concept of observation in pseudocyst management. Twenty-eight patients were diagnosed with pseudocyst of the auricle between June 2009 and June 2011 in a medical college hospital. The patients were divided into four groups each of seven patients on the basis of primary treatment offered. Four primary treatments offered were simple aspiration, aspiration with intralesional steroid, incision and drainage with removal of anterior cartilage leaflet with buttoning, and lastly, simple observation and reassurance. All 28 patients were male with involvement of right side more than left and no one had bilateral involvement. Adults in the age group of 30–40 were commonly affected. Most of the patients had history of significant trauma by security forces. Most common site of involvement was scaphoid and triangular fossa. The best form of treatment with minimum recurrence was incision and drainage with removal of anterior cartilage leaflet with buttoning. Simple observation as a treatment option was found to be as good as intralesional steroids. Pseudocyst of the pinna is a benign condition of unknown etiology affecting the pinna, commonly encountered in middle-aged men. It is a rare condition and is hardly encountered in routine ENT practice. Bilateral diseases are uncommon. Most common site of occurrence is triangular and scaphoid fossa. Many modalities of treatment have been recommended in literature with varied recurrence and failure rates. The best treatment is surgical deroofing followed by buttoning with minimum recurrences. An option of simple observation for 2–3?months should be discussed with each patient and was found to be as good as intralesional steroids.     

The role of brachytherapy in the treatment of squamous cell carcinoma of the head and neck

Brachytherapy is a form of intensive local irradiation, allowing effective protection of surrounding structures with preservation of organ function and results in a favorable therapeutic ratio. It can be used alone, adjuvantly after surgery, and as a local boost in combination with external-beam radiation therapy. This paper is a literature review on the role of brachytherapy in the management of head and neck cancers with a special emphasis on papers published in the last 5 years. Technical details, effectiveness and potential toxicities of brachytherapy when used in different combinations with other therapeutic modalities and tumor sites are presented. Brachytherapy is an attractive treatment option in the management of primary malignancies and recurrent tumors in previously irradiated areas of the head and neck. It is effective and safe, and results in good functional and oncological outcomes.     

Atypical Cogan's syndrome: report of two cases and revision of literature

Cogan's syndrome is a rare autoimmune disease with systemic involvement. It appears in young people and has two presentations: the typical form with keratitis, sudden deafness with or without vestibular syndrome, and the atypical form with different non keratitic ocular diseases and a great variety of systemic symptoms in relation with the autoimmune etiology of the process. Cogan's syndrome has a bad prognosis and deafness appears in 25% of the cases with the right treatment and in 60% of patients without treatment. The best treatment is systemic and ocular corticotherapy. The second treatment of choice is cyclophosphamide or cyclosporine A. We present two cases of atypical Cogan's syndrome with unilateral deafness in both.     

人前庭小管显微观察及三维结构重建

对初生婴儿和正常成人前庭小管（Ｖｅｓｔｉｂｕｌａｒａｑｕｅｄｕｃｔ，ＶＡ）行连续切片显微观察及计算机辅助的三维结构重建。结果表明，二者ＶＡ有明显差异：前者骨化不完全，近似直管形，峡部不明显；后者骨化完全，行程弯曲似倒“Ｊ”形，峡部明显。婴儿ＶＡ的容积、内表面积、长度及外口径均显著小于成人，其内口径则大致相等。表明婴儿幼稚型的ＶＡ必须在出生后经逐渐发育才能转变为成熟型的ＶＡ。ＶＡ的狭窄是其发育受阻的病理现象，其内含物内淋巴管及内淋巴囊发育不良，为易发生膜迷路积水的病理解剖因素之一。ＶＡ外口宽窄与整个ＶＡ发育一致，它是临床影像学检查ＶＡ以外口为标志的解剖学基础     

Value of Papanicolaou exfoliative cytology in diagnosis of cancers of the upper aerodigestive tract]

Exfoliative cytology of the pharynx and larynx is a valid tool in the diagnosis of tumours. It is useful in the follow-up of chronic epithelial lesions of these regions and after tumour therapy. Cytological findings in group "Pap III" demand careful follow-up possibly with biopsy. For all other groups a biopsy is only indicated if there is a strong clinical suspicion of a tumour in the individual case. The simple technique of exfoliative cytology makes it an important part of aftercare of patients with malignancy, especially squamous cell carcinoma of the pharynx and larynx. The validity of the method depends on the care with which the specimen is taken and on the experience of the investigator.     

The potential effect of widespread use of pneumococcal conjugate vaccines on the practice of pediatric otolaryngology: the case of acute otitis media

PURPOSE OF REVIEW: This review provides the otolaryngologist with the evolving understanding of various aspects of pneumococcal conjugate vaccines (PCVs) that are related to their effect on the respiratory tract RECENT FINDINGS: The efficacy of PCVs against invasive pneumococcal disease and pneumonia is well established and is documented in several well-conducted studies. However, the effect of PCVs on otitis media is less obvious and more complex. PCVs clearly reduce diseases caused by vaccine-type (VT) pneumococci, but replacement of VT serotypes by non-VT serotypes in nasopharyngeal carriage of Streptococcus pneumoniae is responsible for the increase in acute otitis media (AOM) caused by non-VT serotypes. Furthermore, an increased rate of AOM caused by Haemophilus influenzae and Moraxella catarrhalis was found. Since most antibiotic-resistance in S. pneumoniae is confined to VT serotypes, vaccine use also reduces antibiotic resistance. The reduction of carriage by PCVs is responsible for the reduction of spread of VT pneumococci (herd immunity). Thus a modification of AOM rather than just a simple reduction is seen with the widespread use of PCV. SUMMARY: Acute otitis media in the era of widespread use of PCV is modified. A disease with reduced VT serotypes, reduced antibiotic resistance, and a lower rate of sequelae is to be expected. However, replacement with potential virulent organisms and development of antibiotic resistance in non-VT pneumococci is a possibility that needs careful monitoring.     

Radiotherapeutic management of cancer of the glottis, University of Virginia, 1956-1971.

All patients with cancer of the glottis treated by radiotherapy with curative intent at the University of Virginia from 1956 through 1971 have been reviewed. Follow-up is complete through December, 1973. Results are presented by both stage and treatment policy and indicate that with our present methods of management a high degree of local control is achieved. The complications of treatment are examined, particularly those arising as a result of combined radiotherapy and surgery. A small number of cases have been salvaged following local recurrence and these are described in detail. Particularly striking has been the effectiveness of radiotherapy in the treatment of advanced (Stage III and IV) lesions. In this group 58 percent of the patients survive with their larynges intact. Considering the poor general condition and advanced nature of the lesions in these cases this result is important and may indicate the nature of future trends in treatment, namely radiotherapy, with surgery held in abeyance until there is overt recurrence.     

Toxicity of topical administration of lidocaine

It is frequently described in international literature the possibility of toxicity by local anesthesics. The lidocaine is one of them. The problems with its local use are more frequent and known but topic toxicity is also possible. We want to describe a case of toxicity by topical administration of lidocaine (Xylocain) which caused neurological disease with convulsions, and cardiological disease with ventricular fibrillation, in a patient who came for a thyroplasty. Patient's evolution was satisfactory.     

颈阔肌皮瓣在颈段食管狭窄重建术中的应用

目的 :探讨颈阔肌皮瓣在颈段食管狭窄重建术中的应用。方法 :采用单侧颈阔肌皮瓣行颈段食管狭窄重建术 33例。结果 :术后肌皮瓣全部存活。 3例发生吻合口瘘 ,加强更换敷料后愈合。术后随访 6～ 15 6个月 ,2例分别于术后 4和 6个月发生吻合口狭窄 ,分别经食管扩张和食管成形术治愈。所有患者均能经口进普食。纤维食管镜检查示肌皮瓣无糜烂及溃疡。结论 :颈阔肌皮瓣行颈段食管狭窄重建 ,具有创伤小 ,取材方便 ,操作简单 ,能Ⅰ期完成手术 ,并发症少 ,远期疗效满意等优点。     

Impact of evolution on the eustachian tube

I posit that humans appear to be the only species that develops otitis media. If animals in the wild had developed middle‐ear disease to any significant degree, they would have been selected out during evolution because they would not have survived their predators given the associated hearing loss. Why do humans have otitis media? Evolution has had a significant impact. It is well known that humans are born 12 months too early, which is the result of adaptations to bipedalism and our big brain that, over time, resulted in a relatively small female pelvic outlet compared with nonhuman primates. As a consequence of too early a birth, not only is our immune system immature, but the eustachian tube is too short and floppy in the first year of life. But why is otitis media still common in older individuals? What other adaptation is uniquely human? We developed speech that was associated with descent of the larynx and hyoid bone, which, along with a decrease in prognathism (i.e., facial flattening), resulted in a change in palatal morphology as compared with other primates. Comparative anatomic and physiologic studies have demonstrated significant differences between humans and monkeys, especially in the muscles of the eustachian tube. Paradoxic constriction, as apposed to dilation, on swallowing is a common tubal dysfunction in humans and certain monkey models with chronic middle‐ear effusion. My hypothesis is that chronic otitis media with effusion in patients with tubal constriction is a consequence of adaptation for speech and that, most likely, the levator veli palatini muscle is the cause.     

Liposarcoma of the neck. Report of a case

A case of lipoblastic liposarcoma of the neck is presented. The case is that of a 5-year-old female who underwent a modified neck dissection with a good result. A review of the literature reveals that this is an extremely rare tumor of the neck. It is usually found in the lower extremities, predominantly in adult males. Surgery is the treatment of choice. Lipoblastic liposarcoma is an extremely rare tumor when it occurs in the pediatric neck. Hudson and Saunders in their studies have shown that only 3 patients with this tumor have been reported since 1944. When a 5-year-old female presented with this primary neck mass, questions of diagnosis and treatment were raised. The following case report and discussion will demonstrate the diagnostic methods as well as the course of therapy followed in this type of lesion.     

Positron emission tomography of cortical centers of tinnitus.

Tinnitus is associated with a wide variety of disorders in the auditory system. Whether generated peripherally or centrally, tinnitus is believed to be associated with activity in specific cortical regions. The present study tested the hypothesis that these cortical centers subserve the generation, perception and processing of the tinnitus stimulus and that these processes are suppressed by lidocaine and masking. Positron emission tomography was used to map the tinnitus-specific central activity. By subtracting positron emission tomography images of regional cerebral blood flow distribution obtained during suppression of the tinnitus from positron emission tomography images obtained during the habitual tinnitus sensation, we were able to identify brain areas concerned with the cerebral representation of tinnitus. Increased neuronal activity caused by tinnitus occurred predominantly in the right hemisphere with significant foci in the middle frontal and middle temporal gyri, in addition to lateral and mesial posterior sites. The results are consistent with the hypothesis that the sensation of tinnitus is associated with activity in cortical regions functionally linked to subserve attention, emotion and memory. For the first time, the functional anatomy of conditions with and without the habitual tinnitus sensation was obtained and compared in the same subjects.     

An immunogold investigation of the distribution of calmodulin in the apex of cochlear hair cells

Calmodulin is found in the mechanosensitive stereociliary bundle of hair cells where it plays a role in various calcium-sensitive events associated with mechanoelectrical transduction. In this study, we have investigated the ultrastructural distribution of calmodulin in the apex of guinea-pig cochlear hair cells, using post-embedding immunogold labelling, in order to determine in more detail where calmodulin-dependent processes may be occurring. Labelling was found in the cuticular plate as well as the hair bundle, the rootlets of the stereocilia being more densely labelled than the surrounding filamentous matrix. In the bundle, labelling was found almost exclusively at the periphery rather than over the centre of the actin core of the stereocilia, and was clearly associated with the attachments of the lateral links that connect them to their nearest neighbours. It was also found to be denser towards the tips of stereocilia compared to other stereociliary regions and occurred consistently at either end of the tip link that connects stereocilia of adjacent rows. The contact region between stereocilia that is found just below the tip link was also clearly labelled. These concentrations of labelling in the bundle are likely to indicate sites where calmodulin is associated with calcium/calmodulin-sensitive proteins such as the various myosin isoforms and the plasma membrane ATPase (PMCA2a) that are known to occur there, and possibly with the transduction channels themselves. At least one of the myosin isoforms, myosin 1c, is thought to be associated with slow adaptation, and PMCA2a with control of calcium levels in the bundle. The concentration of calmodulin in the contact region further supports the suggestion that this is a functionally distinct region rather than a simple geometrical association between adjacent stereocilia.     

Aggressive fibromatosis of the neck treated with a combination of chemotherapy and indomethacin

Aggressive fibromatosis (desmoid tumor) of the neck is rare. When feasible, surgery is the best treatment option. However, complete excision with negative margins is not possible in most cases because of the involvement of vascular and nervous structures. Also, surgery results in poor functional and aesthetic outcomes. Sometimes debulking surgery with positive margins is performed, but the anatomy of the neck is a challenge for oncologic surgeons, and recurrences are not uncommon. Radiotherapy is seldom employed for the same reasons. On the other hand, systemic treatment with chemotherapy, hormone therapy, and noncytotoxic agents such as nonsteroidal anti-inflammatory drugs (NSAIDs) has been used with good results. We report a case of inoperable aggressive fibromatosis of the neck that was successfully treated for about 21 months with a combination of chemotherapy and the NSAID indomethacin. As far as we know, this is the first reported use of a combination of chemotherapy and an anti-inflammatory drug in the treatment of aggressive fibromatosis of the neck. We also review the literature on cases of aggressive fibromatosis of the neck that have been reported over the past 12 years.     

Progressive transformation of germinal centers: review of histopathologic and clinical features

BACKGROUND: Although progressive transformation of germinal centers (PTGC) in lymph nodes was defined as an entity almost three decade ago, it is not well known to surgical and head and neck pathologists. PTGC may be mistaken for focal nodular lymphocyte predominant Hodgkin's Disease (NLPHD). OBJECTIVE: To review the histopathologic and clinical features of PTGC, and PTGC's relationship with lymphoid neoplasia in pediatric and adult populations. HISTOPATHOLOGIC FEATURES: PTGC occurs in 10-15% of enlarged lymph nodes with reactive follicular hyperplasia. PTGC is characterized as a nodule, which is three to five times the size of a typical reactive follicle, with mantle zone small B-cells infiltrating the residual germinal center. Epithelioid histiocytic clusters, immunoblasts, mononuclear cells, and eosinophils may also be present. Solitary or multiple nodules may be found. The immunophenotypes of both PTGC and NLPHD may be identical (CD45+, CD20+, CD15-, CD30-). The nodules in PTGC are relatively well defined, with those in NLPHD being more irregular. CLINICAL FEATURES: PTGC occurs in children (20%, mean age 11 years) and adults (80%, mean age 28 years), with a male predominance (3:1). PTGC is associated with Hodgkin's disease (HD) in 30-35% of patients. PTGC may precede, follow, or be concurrent with HD. Recurrent PTGC is more common in children (50 vs. 23%). Cervical lymph nodes account for almost 50% of cases, with oral cavity involvement also reported. CONCLUSION: PTGC occurs frequently in lymph nodes with reactive follicular hyperplasia, may resemble focal NLPHD, and has a nebulous association with NLPHD. PTGC is not considered a premalignant condition.     

The ultrastructure of cholesterol granuloma of the middle ear: an electron microscope study.

The ultrastructure of giant cells in cholesterol granuloma is described, with particular reference to their role in the absorption of cholesterol needles. Cholesterol is a highly resistant substance in its crystalline form and it is confirmed that the giant cells are endowed with endoplasmic structures and organelles and are partly crowded with lysosomes, as evidence of the active role of the giant cells in the absorption and removal of cholesterol formed in the granuloma from blood, mucus or necrotic material.     

Imaging diagnosis of parotid diseases--a comparison of methods

Thirty-five patients with parotid gland disorders were ultrasonographically examined with a "small parts" scanner, as well as with high-resolution computed tomography, and conventional and digital subtracted sialography. The results were compared with clinical, surgical, and pathomorphological data. In cases of parotid gland masses, the sensitivity of sonography, CT, and sialography was 100%, 81%, and 70% respectively, while in cases of sialadenitis, sensitivity was 38%, 50%, and 75%. The image-quality of digital subtracted sialography was superior to conventional sialography in 94% of cases, the same in 6%, and inferior in none of the cases. It is concluded that in all cases of parotid gland diseases ultrasound should be the first imaging method. If a tumor is confirmed, no further pretherapeutic imaging will be necessary in most cases. If a tumor is not confirmed, digital subtracted sialography should be employed to visualize inflammatory changes.     

A new in vitro method of drug assay of nasal blood vessels

If nasal mucosa is removed from the dog's septum, mounted in a muscle bath and treated with a small dose of a nasal decongestant, the mucosa contracts, It appears, from the nature of the tissue and the nature of the drug responses, that nasal vascular smooth muscle is the contracting element. If the nasal mucosa is treated with a vasodilating agent, such as histamine, there is no relaxation response unless the mucosa is first pretreated with a vasoconstricting agent such as epinephrine. Both vasoconstricting and vasodilating drugs induce dose-related responses. It appears that this new preparation may be useful to assay drug effects in the absence of nervous and humoral control.