Is corticosteroid a treatment choice for the management of peritonsillar abscess?

Objective

To investigate the effect of the single systemic use of corticosteroid following drainage procedure in patients with peritonsillar abscess (PTA).

A case of buccal abscess; originating from an ectopic accessory parotid gland?

We report a case of an abscess from an 'ectopic' accessory parotid gland in the cheek demonstrated by sialography and computed tomography (CT). The accessory parotid gland was ectopically located anterolateral to the masseter muscle and isolated from the main parotid gland. The orifice and ductal system of the ectopic accessory parotid gland were separated from those of Stensen's duct. The abscess developed from this ectopic accessory gland, and the main parotid gland was free of inflammation. Using sialography and CT, we confirmed the presence of this ectopic accessory gland.     

diagnosis and management of first branchial fistula: a study of 12 cases

To report authors' experiences in the diagnosis and treatments of congenital first branchial fistula (congenital auriculocervical fistula). Materials and Methods Twelve cases of congenital first branchial fistula were reviewed. Of these, 8 underwent fistulectomy with facial nerve dissection and partial parotidectomy and 4 underwent simple fistulectomy. Results The inner openings (upper opening) of fistulae lay in the following sites: inferioposterior wall at the junction of cartilaginous and bony segments of the auricular canal and inferior wall of cartilaginous auricular canal. The outer openings(lower opening) lay along the anterior border of upper sternocleidomastoid muscle, at the mastoid tip and posterior to the mandibular angle. Complete fistulae resection was achieved in all but one case. Eleven cases were followed for 5 year with no recurrence. Recurrence occurred in 1 case 6 months after the primary surgery and revision surgery was performed. Conclusions Pre-operative radiography for the location and course of the fistula is crucial for successful fistula resection, especially in cases with past infections. Facial nerve dissection should be done routinely for deeply located fistulae.     

Intratympanic gentamicin for Ménière's disease; a survey of current UK practice

Intratympanic gentamicin is increasingly used in the treatment of Ménière's disease. Many protocols have been published for its use, but there is little difference in outcome between them. The goal of the study was therefore to assess current UK practice in the use of intratympanic gentamicin. A postal and e-mail survey of consultant ENT surgeons in the UK was conducted. Of 34 consultants who regularly used intratympanic gentamicin, 21 used a protocol based upon a single intratympanic dose of gentamicin via a needle through the tympanic membrane and repeated after at least a week. The remaining 13 used either a regime of more frequent administration or attempted a more complicated route of delivery in an effort to improve reliability and selectivity of action. In the absence of evidence demonstrating benefit from regimens of increased complexity the majority of consultants are using the simplest possible protocol.     

A petrous bone destructive acoustic neurinoma: a tumor of far-lateral origin?

We report a case of an acoustic neurinoma that recurred more than 11 years after total tumor removal through the posterior cranial fossa. Recurrent tumor had obliterated the petrous bone, filled the middle ear, and was visible grossly at the external auditory meatus. The unique behavior of this tumor implied that the site of origin was within the labyrinth, beyond the fundus of the internal auditory canal and far lateral to the usual site of acustic neurinoma origin. We offer an hypothesis as to why these tumors occasionally recur, even after clinical total removal.     

Incidence of virus infection as a cause of Meniere’s disease or endolymphatic hydrops assessed by electrocochleography

Menieres disease (MD) may follow viral infection such as by neurotropic viruses known to invade the endolymphatic sac (ES) and provoke endolymphatic hydrops (EH). The objective of this study was to investigate whether neurotropic viruses may cause infection of the inner ear and provoke EH. Antiviral immunoglobulin (IgG) assay against herpes simplex 1 (HSV1), herpes simplex 2 (HSV2), adenovirus (ADV), varicella zoster virus (VZV) and cytomegalovirus (CMV) were performed in 109 patients with an advanced stage of MD and compared with those obtained from 26 patients operated on because of vestibular schwannoma (VS), who served as a control group, to evaluate whether there is an association between the IgG levels and the ECoGs summating potential/action potential ratio (SP/AP ratio) in the MD group. In MD patients, the IgG titre against VZV and ADV were significantly higher than in the control (schwannoma) group. However, no correlation was found between the IgG levels against ADV and VZV with the SP/AP ratio. Neurotropic viruses such VZV and ADV may play a role in the pathogenesis of MD, despite the absence of association between the levels of IgG titres and the SP/AP ratio     

Effectiveness of a structured questionnaire for diagnosis of Menière's disease in the first visit

A structured questionnaire of vertigo (SQV) was used to search patients with Menière's disease (MD) in the first visit. One-hundred consecutive outpatients that complained of dizziness or vertigo were studied. Diagnosis of MD was accepted if three investigators independently recorded it among a list of 29 diagnostic categories after reviewing the SQV. The AAO criteria for definite MD defined by the Committee on Hearing and Equilibrium after 10 months or more of follow-up were the gold standard to contrast questionnaire-based diagnosis. Seven patients were considered as MD with the SQV. The sensitivity (Sn), specificity (Sp) and positive predictive value of the SQV for definite MD were 80%, 97% and 57% respectively, being the false positive rate 3%. The probability for diagnosis of definite MD using the SQV in the first visit was 58% in a set up with a 5% of prevalence. The best predictor selected by all investigators was the presence of hearing loss (Sn 100%, Sp 85%, positive likelihood ratio 6.67). Because of the high specificity, the SQV of vertigo results a useful test to advance the diagnosis of definite MD.     

A comparison of electrocochleography and high-pass noise masking of auditory brainstem response for diagnosis of Ménière's disease

Abstract Objective: To study differences between electrocochleography (ECochG) and cochlear hydrops analysis masking procedure (CHAMP) in diagnosis of Ménière's disease. Design: Retrospective case review from a tertiary referral center. Study sample: Thirty patients suspected to have Ménière's disease were assessed by ECochG and CHAMP tests. Results: Positivity of ECochG with SP/AP amplitude ratio >.40 or >.35 was compared with CHAMP V-delay or CHAMP R × D. Positive ECochG results were found in 43% (>.40 SP/AP ratio) and 63% (>.35 SP/AP ratio) of patients, comparing to positive CHAMP V delay in 27% and CHAMP R × D in 30% of patients. A significant difference (p <.01) was found between ECochG and CHAMP in diagnostic sensitivity. Also, a positive inter-aural correlation was found in CHAMP results (p <.003), but not in ECochG (p =.082) results. Conclusions: ECochG is a more sensitive test than CHAMP in detecting the presence of endolymphatic hydrops in Ménière's patients. CHAMP covaried interaurally in unilateral Ménière's patients whereas ECochG did not.     

A comparison of electrocochleography and high-pass noise masking of auditory brainstem response for diagnosis of Ménière's disease

Abstract

Objective: To study differences between electrocochleography (ECochG) and cochlear hydrops analysis masking procedure (CHAMP) in diagnosis of Ménière's disease. Design: Retrospective case review from a tertiary referral center. Study sample: Thirty patients suspected to have Ménière's disease were assessed by ECochG and CHAMP tests. Results: Positivity of ECochG with SP/AP amplitude ratio >.40 or >.35 was compared with CHAMP V-delay or CHAMP R × D. Positive ECochG results were found in 43% (>.40 SP/AP ratio) and 63% (>.35 SP/AP ratio) of patients, comparing to positive CHAMP V delay in 27% and CHAMP R × D in 30% of patients. A significant difference (p <.01) was found between ECochG and CHAMP in diagnostic sensitivity. Also, a positive inter-aural correlation was found in CHAMP results (p <.003), but not in ECochG (p =.082) results. Conclusions: ECochG is a more sensitive test than CHAMP in detecting the presence of endolymphatic hydrops in Ménière's patients. CHAMP covaried interaurally in unilateral Ménière's patients whereas ECochG did not.     

Type III–IV laryngotracheoesophageal cleft: Report of a successfully treated case

This report presents a case of Stage III laryngotracheoesophageal cleft (LTEC). It is, to our knowledge, the fourth case in which the patient is still alive twenty months after surgery. We herein describe an initial symptomatology dominated by a bubbling hypersalivation, our surgical technique using a pleural shred of interposition and an endoscopic check during the operation and, finally, the clinical development dominated by a food intake refusal which was progressively improved through psychiatricic help.     

The cardiovascular aspects of a Ménière's disease population – A pilot study

IntroductionMD is considered a rare disease. An adequate model that explains MD's pathophysiology is not well established. Recently, the vascular theory of the disease has been revived.ObjectivesTo characterize a MD population according to its cardiovascular risk and correlate it to the MD clinical course.MethodsIn this retrospective chart study the data of 31 MD patients observed between January 2017 and April 2018 in a tertiary university hospital were reviewed. Patients included in the study were diagnosed according to the Bárány Society criteria. Lost follow-ups, patients with autoimmune disease, atopy or allergy, major psychiatric disease and migraine were excluded. Age, gender, cardiovascular risk factors, audiometric and vestibular parameters, occurrence of MD attacks in the previous 6 months, vestibular medication in course and time course of MD were recorded and compared between groups (with and without cardiovascular risk factors).Results31 patients (61.3% females) mean aged 60.3 years (±9.7) were studied. 74% of the population had at least one risk factor and 51.6% of patients had attacks in the last 6 months. There was a statistically significant difference in the occurrence of MD attacks in the last 6 months (p = 0.014) between MD patients with and without risk factors. Mean PTA thresholds were higher and speech discrimination was lower in individuals with more cardiovascular risk factors.ConclusionsTreatment of MD focusing on vascular risk factors may allow a better control of symptoms and result in a decreased need for ablative procedures in this disorder.     

Acute rhinosinusitis – are we forgetting the possibility of a dental origin? A retrospective study of 385 patients

Abstract

Background: Odontogenic sinusitis (OS) is a common but underdiagnosed form of acute rhinosinusitis (ARS). OS carries no specific characteristics, but unilateral symptoms and certain microbiological as well as radiological findings indicate odontogenic origin.

Aims/objectives: We studied the proportion of OS in ARS patients, the presence and associations of unilateral symptoms, and possible OS microbial and radiological findings. In addition, we investigated how this condition is recognised among ear, nose and throat specialists and radiologists.

Materials and methods: All 676 ARS patients treated in the Department of Otorhinolaryngology at Helsinki University Hospital in 2013 were retrospectively enrolled. The data were collected from patients’ hospital medical records, the laboratory database and radiological reports.

Results: Odontogenic origin of ARS was suspected in 59 (15.3%) patients. Altogether (29.9%) 115 patients complained of unilateral symptoms and these were found to associate with probable oral microbial findings (p?<?.001). These findings covered 20.2% of isolates. Teeth were mentioned in 89.6% of the radiological reports.

Conclusions and significance: OS is common among patients with ARS, and good diagnostic tools already exist in routine practice. Microbial and radiological findings should be carefully evaluated, especially in cases of unilateral symptoms.