Reticulohistiocytoma of the external auditory canal

We report the first documented case of reticulohistiocytoma of the external auditory canal in a 15-year-old male. Reticulohistiocytoma is a rare diagnosis in children. Reticulohistiocytoma, a benign lesion, belongs to a family of histiocytosis disorders which range from benign to malignant. Although histiocytic disorders are uncommon, they should be included in differential diagnosis of pediatric aural polyps.     

Paget's disease and fibrous dysplasia

Paget's disease and fibrous dysplasia are benign disorders that can involve the temporal bone and skull base. They commonly lead to otolaryngologic symptoms such as impingement of cranial nerves or the orbit or blockage of the external auditory canal or paranasal sinuses, although they can often be a challenge to diagnose because of their insidious presentation. Their benign nature and common presentation within the difficult-to-access confines of the skull base should lead the clinician to exercise caution in their treatment, reserving surgical intervention for either diagnosis or the relief of symptoms. As a better understanding of the etiology of these conditions develops and new pharmacotherapeutic agents are tested, it is likely that physicians will be able to turn to medical rather than surgical techniques to treat these disorders.     

Lymphoproliferative disorders of the head and neck

Lymphoproliferative disorders are the frequent cause of indeterminate processes in the head and neck region for which otolaryngologists are often consulted by colleagues seeking a diagnosis. Because a wide spectrum of diseases may be represented, tissue diagnosis is often required. Recent advances in tissue immunotyping and DNA probes permit more precise identification and classification of these disorders. Lymphoproliferative disorders may be subdivided into five categories: Hodgkin's disease, non-Hodgkin's lymphoma, histiocytosis X, benign reactive lymphoproliferative disorders, and plasma cell neoplasms. Representative cases are presented, along with a brief discussion of each category.     

A review of common dermatologic disorders of the external ear

Skin disorders of the external ear are common. Although audiologists will not necessarily treat these conditions, it is important for them to be aware of these disorders and refer patients to a specialist in some instances. This report summarizes eight of the most commonly encountered skin conditions with an emphasis on recognition and appropriate referral. The cutaneous disorders of the external ear discussed in the article are divided into benign, premalignant, and malignant groups.     

Infiltrating Lipomata of The Head and Neck

Recent discovery and subsequent excision of two histologically benign but unusual infiltrating intramuscular lipomas prompted a review of available literature and a collection of lipomatous disorders of interest to the head and neck surgeon. Such lesions may, by their position, cause significant symptoms. Other instances occur wherein their unusual location causes initial confusion in diagnosis. Finally, accurate histologic identification may be obscured by the inclusion of other tissues within the benign fatty tissue.     

Dysphonia in the aging: physiology versus disease.

A chart review from 151 dysphonic patients over the age of 60 was done to define aging related voice disorders. Overwhelmingly, patients suffered from dysphonia due to disease processes associated with aging rather than to physiologic aging alone. These include: 1. central neurological disorders affecting laryngeal function (e.g., stroke, Parkinson's disease, essential tremor, Alzheimer's disease); 2. benign vocal fold lesions (e.g., Reinke's edema, benign and dysplastic epithelial lesions); 3. inflammatory disorders (e.g., laryngitis sicca, medication effect); 4. laryngeal neoplasia; and 5. laryngeal paralysis. Typical laryngeal findings of vocal fold bowing and breathiness consistent with presbylarynges were present in only six patients. Presbylarynges is not a common disorder and should be a diagnosis of exclusion made only after careful medical and speech evaluation.     

Acquired von Willebrand's syndrome. Therapeutic and diagnostic implications

Acquired von Willebrand's syndrome is a newly recognized bleeding diathesis thought to be caused by autoantibodies to the von Willebrand factor. Acquired von Willebrand's syndrome has been reported in association with lymphoproliferative disorders and benign monoclonal gammopathies. Clinical features and laboratory abnormalities of this disease are similar to congenital von Willebrand's disease, but the optimal treatment may differ. We describe a 75-year-old man with chronic lymphocytic leukemia and recurrent epistaxis and also discuss the pathogenesis, diagnosis, and treatment of both the congenital and acquired disorders.     

Psychosomatische Schwindelerkrankungen

Somatoform vertigo is one of the most frequent forms of vertigo, alongside neuropathia vestibularis and benign peripheral positional vertigo. False diagnoses often lead to patients suffering from symptoms for periods of months or even years, which imposes significant limitations on their working and private lives. An early interdisciplinary diagnosis and the consequent timely commencement of a specific psychosomatic therapy is thus essential. Somatoform vertigo can be caused by many different psychological disorders. The clinical symptomatology, diagnosis and differential diagnosis are described and illustrated by case vignettes. Risk factors and preventive measures are briefly summarized.     

Statistical observation of vertigo and dizziness patients]

Subjects visiting the Department of Otolaryngology at Suita Municipal Hospital reporting vertigo or dizziness numbered 664 women and 343 men from April 1999 to December 2000. As a city hospital, we play an important role in the diagnosis and treatment of acute vertigo or dizziness. The frequency of diagnosis of these cases was divided almost equally into 5 groups: (1) benign paroxysmal positional vertigo (BPPV) 23%; (2) suspected BPPV, 18%; (3) peripheral vestibular disorders other than BPPV, 22%; (4) disorders other than peripheral origin, 18%; and (5) undiagnosed, 19%. Based on our results, BPPV, other peripheral vestibular disorders, and disorders of other origins should be differentiated from the first screening. BPPV was most frequent and diagnosed by typical positioning nystagmus. Many other peripheral vestibular disorders were accompanied by nystagmus. It is also important to differentiate serious illnesses such as cerebrovascular disease (7%), space-occupying lesions in the posterior fossa (1.2%), and cardio-circulatory disease (3.6%).     

Diagnosis and initiating treatment for peripheral system disorders: imbalance and dizziness with normal hearing

Disorders affecting the peripheral vestibular system commonly involve the peripheral auditory system causing hearing loss. There are a number of disorders, however, that selectively involve the peripheral vestibular system causing dizziness without hearing loss. These disorders include benign paroxysmal positional vertigo, vestibular neuritis, recurrent vestibulopathy, familial vestibulopathy, and bilateral idiopathic vestibulopathy. This article reviews these disorders and their diagnosis and management.     

鼻眼相关疾病39例的诊治体会

目的：提高鼻眼相关疾病的诊治水平。方法：对３９例鼻眼相关疾病患者的临床资料进行回顾性分析。结果：３９例中，７例无鼻部症状，９例以眼部症状为主首诊眼科，１例首诊神经内科。炎性病变的鼻眼病变沟通方式以眶壁骨质吸收破坏为主；良性肿瘤及粘液囊肿鼻眼病变的互侵方式以眶壁受压移位、骨吸收破坏为主；恶性肿瘤鼻眼病变的互侵方式以骨质破坏为主；外伤性鼻眶骨折均为鼻窦与眶壁共壁所致。结论：鼻窦与眼眶关系密切，ＣＴ扫描     

Voice Handicap Index

BACKGROUND: The goal of this study was to assess and compare voice handicap in patients with benign organic and functional dysphonia. PATIENTS AND METHODS: Voice handicap was assessed using a German version of the Voice Handicap Index. A total of 108 German speaking patients, 64 women and 44 men aged 45.3+/-15.1 years with benign organic ( n=69) or functional ( n=39) voice disorders completed the questionnaire immediately after clinical examination and without knowing their individual diagnosis. Fifty individuals without voice complaints and normal voice status, 28 women and 22 men aged 47.1+/-15.5 years, served as controls. RESULTS: Significant differences ( P<0.001) were found between all dysphonic patients and the control group. When comparing dysphonic patients according to their gender and diagnosis group (organic or functional) no significant differences were detected. CONCLUSION: It can no longer be assumed that patients with functional voice disorders over emphasize their disease. The data obtained in this study prove that there are no gender specific differences in the way a voice disorder is experienced. There are also no differences in the way patients with a different language background experience their voice handicap.     

Which comes first? psychogenic dizziness versus otogenic anxiety

SUMMARY: OBJECTIVE To investigate the hypotheses that physical neurotologic conditions may trigger anxiety disorders (otogenic pattern of illness), that psychiatric disorders may produce dizziness (psychogenic pattern), and that risk factors for these syndromes may be identified.STUDY DESIGN Retrospective review of all patients (N = 132) treated at a tertiary care balance center from 1998 to 2002 for psychogenic dizziness with or without physical neurotologic illnesses.METHODS All patients underwent comprehensive neurotologic and psychiatric evaluations with attention to the longitudinal course of symptoms and risk factors for psychopathology. Patients were grouped according to the condition first causing dizziness. Risk factors were compared across groups.RESULTS Three equally prevalent patterns of illness were found: anxiety disorders as the sole cause of dizziness (33% of cases), neurotologic conditions exacerbating preexisting psychiatric disorders (34%), and neurotologic conditions triggering new anxiety or depressive disorders (33%). Panic disorder and agoraphobia were significantly more prevalent than less severe phobias in the first two groups, whereas the opposite pattern existed in the third group (P <.0001). More patients in the first two groups had risk factors for anxiety disorders (P <.05). Depression was not a primary cause of dizziness in any patient. Vestibular neuronitis, benign paroxysmal positional vertigo, and migraine were the most common neurotologic conditions.CONCLUSIONS These data support the hypothesis that physical neurotologic conditions may trigger psychopathology as often as primary anxiety disorders cause dizziness. A third pattern appears to be equally common wherein physical neurotologic conditions exacerbate preexisting psychiatric illnesses. Individuals at risk for anxiety disorders may be more likely to have primary psychopathology.     

Necrotizing lymphadenitis (Kikuchi-Fujimoto disease) as a rare cause of cervical lymphadenopathies. Diagnosis and differential diagnosis

BACKGROUND: The ENT specialist is often confronted with the inquiry as to the cause of lymph node enlargements. Common causes include inflammations, neoplastic, or autoimmune diseases. We report on three cases of Kikuchi-Fujimoto disease as a benign self-limiting lymphadenopathy of unknown etiology, which is usually found in young women between 20 and 30 years of age. Main symptoms are indolent or light tender, enlarged lymph nodes in the neck area. The correct diagnosis requires the histologic examination of the lymph node. Even for the experienced pathologist the differential diagnosis of malignant systemic disorders can be difficult. PATIENTS: Three female patients suffering from Kikuchi-Fujimoto disease were treated in our department between September 1997 and March 1998. RESULTS: All patients showed indolent and enlarged lymph nodes in the neck. In one case we were able to diagnose an acute cytomegalovirus infection; in another case an acute Epstein-Barr virus infection. After 3-5 months the symptoms disappeared spontaneously in all patients. In two of the three cases, histologic lymph node examination revealed T-cell lymphoma and Hodgkin's disease and in one case led to initial chemotherapeutic treatment. As a result of a second histologic examination, both diagnoses were reviewed and Kikuchi-Fujimoto disease was diagnosed. Chemotherapy was discontinued. CONCLUSIONS: Kikuchi-Fujimoto disease is a benign, self-limiting lymphadenopathy which is usually diagnosed in young women. Distinguishing Kikuchi-Fujimoto disease from malignant systemic disorders may even be difficult for pathologists using histological examination techniques and requires close cooperation between the ENT specialist and the pathologist. In order to minimize the risk of misdiagnosis and incorrect treatment, the ENT specialist should inform the pathologist about the differential diagnosis of Kikuchi-Fujimoto disease in such cases.     

电声门图测试对声带占位性病变的筛查价值

目的 探讨电声门图(electroglottography，EGG)测试在声带占位性病变中的筛查价值。方法 对134例声门型喉癌、167例声带良性病变(包括113例声带息肉、17例声带囊肿和37例声带白斑)及62名健康志愿者进行EGG测试，进行组间和组内比较，分析EGG测试的敏感性和特异性。结果 声带良性病变和喉癌组EGG波形和参数多数异常，与健康组之间有显著性差异，且良恶性病变组间亦有差异。但良性病变组内即息肉、囊肿和白斑之间，以及喉癌组内不同T分期之间EGG波形和参数差异多数无统计学意义。结论 电声门图测试在声带占位性病变的筛查中具有较高的敏感性，对区分良恶性病变亦有一定的特异性，但对病变类型和期别的划分无价值。     

Madelung's disease--the problem of treating benign growths of the adipose tissue

Symmetric, sometimes monstrous fat deposits occur in this rare benign disease. They can extend from the neck to the shoulders and from the mandible to the clavicle. The authors have treated 3 patients during the last 4 years. One of them was sent as an inpatient with the diagnosis of lymphadenitis. The aetiology is unknown. Some metabolic disorders (gout, diabetes mellitus, hypertriglyceridemia) are discussed as causes. Alcoholism seems to be an important factor. Surgical removal of the fat deposits is the therapy of choice despite the tendency to recur which is described in the literature.     

Physical complaints in dysphonic patients

BACKGROUND: In previous studies, patients with benign organic and functional voice disorders were shown to suffer from physical complaints. The present study focuses on a specific nosologic classification of these disorders in the sense of diagnosing a somatoform illness. PATIENTS AND METHODS: Eighty patients (50 women, 30 men) aged 44+/-11 years (18-60), suffering from various voice disorders (functional: n=18 women, n=13 men; organic: n=32 women, n=17 men), were examined after informed consent. Physical complaints were assessed using the Giessen Complaint Questionnaire GBB-24. Age and gender matched normal controls were taken from the literature. Data were analyzed using the non parametric two-by-two four-field-test. RESULTS: The individual diagnosis of dysphonic women showed pathologic values in all subscales except limb complaints. The individual diagnosis of men showed pathologic values in the limb complaints subscale (P<0.05).When comparing functional and organic disorders, no significant difference (P>0.05) was found in neither of the gender groups. DISCUSSION AND CONCLUSIONS: Depending on gender and type of voice disorder, dysphonic patients suffer from different physical complaints. Both patients with functional and organic disorders are affected. Therefore, it does not seem justified to classify functional voice disorders as somatoform disorders.     

Neuromuscular disorders of the larynx.

The voice may be affected adversely by a variety of neuromuscular disorders, including movement disorders, paralysis, and degenerative conditions of the central and peripheral nervous system. The diagnosis of these conditions usually requires high-technology tools, and the results of treatment are variable. Diagnostic considerations, aspects of a complete neurologic examination, an examination of the basic organization of neural control as it relates to the larynx, and treatment options are provided in this article.     

Immunoblastic sarcoma of the nasal cavity

Summary Malignant lymphoma is primarily a disease of interest to haematologists, but it occasionally presents a problem for otorhinolaryngologists. Sinonasal lymphomas are rare and potentially radiocurable malignant neoplasms. At initial presentation, the disease is most often localized in the sinonasal region and, with rare exceptions, the dominating cytohistological type is the immunoblastic sarcoma (B-cell type), previously termed reticulum cell sarcoma. The clinical manifestations may mimic more common and benign conditions and the diagnosis may be difficult. The present paper emphasizes the need for biopsy to be performed early and carefully even in the case of apparently benign lesions.     

Benign parotid diseases of childhood

A 25-year retrospective study of 63 pediatric surgical cases of benign parotid disease was done. Inflammatory disorders accounted for 34 of the cases. The remaining 29 non-inflammatory conditions included vasoformative, solid, and cystic lesions and were nearly always asymptomatic.