Tonsillectomy as a routine treatment in cases of branchiogenic cancer

The pathogenesis of the branchiogenic cancer is still unknown. A number of authors think that it is a metastasis in the form of a cyst from a primary focus in the pharynx most often located in the palatal tonsil. Hence a conclusion is put forward to perform a tonsillectomy even when a tonsil is not clinically changed. The author presents a medical record of a patient with plano-epithelial carcinoma of a cyst from a primary focus in the pharynx most often located in the palatal tonsil. Hence a conclusion is put forward to perform a tonsillectomy even when a tonsil is not clinically changed. The author presents a medical record of a patient with plano-epithelial carcinoma of a lateral cervical cyst. It developed in the epithelium, sub-epithelium and in the palatal tonsil. The tonsillectomy was performed in spite of the clinically unchanged. This case indicates that cancer can develop simultaneously in the cyst wall and in the tonsil. The presence of the wall architecture elements typical of a lateral cervical cyst and the duct connecting the cyst with the wall of the pharynx indicates that it wasn't a metastasis from the focus in tha tonsil. The development of both these focuses could have resulted from the spreading of a lesion through continuity in the ascending way (a cyst-a tonsil) or through the descending way (a tonsil-a cyst). The author suggests that a branchiogenic cancer is an indication for a routine prophylactic ipsilateral tonsillectomy and neck dissection together with consecutive irradiation.     

An assessment of risk factors for the development of a second primary malignancy in the head and neck

This retrospective database study of 44,862 patients who had a history of a primary head and neck malignancy was conducted to identify any clinical variables that may predict the occurrence of a second primary head and neck malignancy. During a mean follow-up of 42.2 months, a second head and neck primary developed in 941 of these patients (2.1%). Statistical analyses revealed that a higher incidence of a second primary was associated with increased age and a location of the first primary in the larynx/hypopharynx, the oropharynx, a major salivary gland, or the nasopharynx. A lower incidence was associated with the presence of cervical nodal disease or treatment of the first primary with radiation therapy. Factors that had no effect on the risk of a second primary included sex, the size of the first primary tumor, a first-primary site in the oral cavity, and treatment of the first primary with cancer-directed surgery. The risk of a second primary head and neck cancer remained constant for at least 10 years.     

Pneumocephalus as a delayed mastoidectomy complication

We report the case of a 43-year-old woman who presented with a spontaneous pneumocephalus, 37 years after a mastoidectomy. Clinical examination showed a cerebrospinal fluid leak, meningeal herniation in the superior part of the middle ear, and an audible noise from her ear when she stood up due to the entrance of air into the cranium. A computed tomography scan and magnetic resonance imaging showed the complete destruction of the tegmen tympani and the pneumocephalus in the temporal lobe. The patient underwent an emergency operation via a double middle-ear and subtemporal approach. The meningoencephalocoele and pneumocephalus were probably due to long term pressure upon too thin a tegmen tympani. Pneumocephalus should be considered as a potential delayed post-operative complication of middle-ear surgery. Computed tomography and magnetic resonance imaging scanning supply accurate information and enable a planned surgical approach; they also allow a pathophysiological understanding and a correlation between the clinical signs and the radiological and peri-operative findings.     

The relationship between tinnitus pitch and the audiogram

We studied the relationship between tinnitus pitch and the audiogram in 195 patients. Patients with tone-like tinnitus reported a higher pitch (mean = 5385 Hz) compared to those with a noise-like quality (mean = 3266 Hz). Those with a flat audiogram were more likely to report: a noise-like tinnitus, a unilateral tinnitus, and have a pitch < 2000 Hz. The average duration of bilateral tinnitus (12 years) was longer than that of unilateral tinnitus (5 years). Older subjects reported a less severe tinnitus handicap questionnaire score. Patients with a notched audiogram often reported a pitch ≤8000 Hz. Subjects with normal hearing up to 8000 Hz tended to have a pitch ≥8000 Hz. We failed to find a relationship between the pitch and the edge of a high frequency hearing loss. Some individuals did exhibit a pitch at the low frequency edge of a hearing loss, but we could find no similar characteristics among these subjects. It is possible that a relationship between pitch and audiogram is present only in certain subgroups.     

Relations between audiometrical thresholds of potential cochlear implant patients and their performance in preoperative psycho-physical tests with electrical stimulation

Part of our selection procedure for cochlear implant candidates is the preoperative electrical stimulation of the cochlea. With a transtympanic needle, placed as closely as possible to the round window, the dynamic range for a number of frequencies is measured and a frequency identification test and a temporal difference limen test are carried out. Our first series of preoperative tests suggests a relationship between the audiometrical pure-tone thresholds, the dynamic range of electrical stimulation and the performance on the temporal difference and frequency identification test. For the preoperative electrical stimulation tests, a relatively good pure-tone average may indicate a wide dynamic range, a short temporal difference limen and a high score in the frequency identification test.     

Extramedullary hematopoiesis occurring as a nasal polyp in a man with a myeloproliferative disorder

We describe the case of a patient with a known myeloproliferative disorder who presented with epistaxis and what clinically appeared to be a nasal polyp. The mass was resected and proved to represent a focus of extramedullary hematopoiesis. The patient subsequently developed extramedullary hematopoiesis of the skin and the stomach wall. Following nasal polypectomy, he did well for a time, but he eventually died as a result of other complications of his disease. This unique case serves as a reminder that common rhinologic complaints can be a sign of significant and life-threatening pathology.     

Unusual cervical mass — A surgical dilemma and unfortunate sequelae

The differential diagnosis of a neck mass encompasses a broad range of possibilities including congenital cysts, inflammatory masses and both primary and metastatic neoplasms. A clear understanding of the normal anatomy of the neck and a high index of suspicion with a detailed history elicitation, proper physical examination and adjunctive test reports all lead to an accurate diagnosis. This is a case report of a thirty three year old lady who presented with a mass in the posterior triangle of neck with paraesthesia and mild weakness of the upper limb of the same side. The diagnostic evaluation revealed possibility of Schwannoma of the Brachial plexus and the surgical management posed a great surgical dilemma and led to cervical 5^th and 6^th trunk paralysis. We performed a second stage Sural nerve grafting.     

Large concha bullosa mucopyocele replacing the anterior ethmoid sinuses and contiguous with the frontal sinus

Concha bullosa, a pneumatized middle turbinate, is a common anatomic variant found in the paranasal sinuses. When a concha bullosa becomes obstructed, it can form a mucocele and, eventually, a mucopyocele if it becomes secondarily infected. This is a rare phenomenon; only 9 concha bullosa mucopyoceles have been previously reported in the English-language literature. We present the case of a large concha bullosa mucopyocele in a pediatric patient in which the concha bullosa replaced the anterior ethmoid sinuses and was contiguous with the frontal sinus.     

Recurrent meningitis secondary to idiopathic oval window csf leak

Bacterial meningitis remains a life-threatening infection even in the present antibiotic era; thus, any abnormality which predisposes a patient to a recurrence of this serious disease, must be identified and corrected. This report describes the history of a 12-year-old boy with a profound neurosensory hearing loss, a related absence of vestibular function and a Monclini-type of temporal bone dysplasia who developed recurrent episodes of meningitis which were due to an idiopathic cerebrospinal fluid otorrhea. Even though the meningitis was labyrinthogenic in origin, the patient did not experience the associated symptoms of hearing loss and/or vertigo since the affected inner ear was clinically unreactive. By surgically exploring the middle ear, the presence of a cerebrospinal fluid otorrhea was confirmed. The leak was observed to be coming from a defect in the stapes footplate, and it was controlled by firmly packing the inner ear vestibule with muscle. A remarkable similarity exists between the patient described above and the 15 previously reported cases of meningitis due to a spontaneous cerebrospinal fluid otorrhea. Generally, the problem occurred in young children, the average age being 6.4 years; male and female were equally afflicted. All 15 previously reported cases had a severe neurosensory hearing loss which was unilateral in 10 individuals and bilateral in the other five. In 11 of the case reports, the vestibular function was evaluated, and the labyrinth was noted to be unreactive in the affected ear. An associated congenital abnormality of the inner ear was described in 11 of the patients reviewed. Anatomically, in 13 cases, the leak was observed to be coming from the oval window area. Other affected sites included one report of a fissure of the promontory and one report of a defect in the roof of the eustachian tube. Multiple surgical procedures were required in 11 of the 15 patients in order to identify the exact source of the otorrhea and to seal it permanently. In three cases, the successful procedure was a middle ear exploration with stapedectomy and packing of the inner ear vestibule. Overall, a total of 36 operations was performed in the 15 patients reviewed. In conclusion, when the physician is confronted by a case of meningitis in a patient with a unilateral or bilateral total loss of hearing and vestibular function, the possible presence of an idiopathic cerebrospinal fluid leak should be considered, especially if radiographic studies demonstrate a temporal bone dysplasia. In these selected cases, if the etiology of the meningitis is obscure, a middle ear exploration should be performed both for diagnostic purposes as a means to ascertain definitely the presence of a leak and for therapeutic purposes to seal it effectively.     

Myofibroma of the cheek: a case report

Myofibromas are benign mesenchymal tumors that are commonly found in the dermis and subcutaneous tissues of the head and neck. Although most lesions are recognized during infancy and early childhood, several cases have been reported in older children and adults. We describe the case of a 9-year-old girl who presented with a solitary nodule in the left cheek and a history of minor trauma. Preoperative imaging detected the presence of a subcutaneous soft-tissue mass consistent with a soft-tissue neoplasm rather than a hematoma. Analysis of fine-needle aspiration material was nondiagnostic. Incisional biopsy revealed that the lesion was a myofibroma.     

Pott's puffy tumor in a 23-month-old: Youngest known case of a rare disease

This case report describes a child who developed Pott's puffy tumor and was treated at the Children's Mercy Hospital in Kansas City. In addition to a discussion of a case, a review of the literature was completed on this topic describing the typical embryology and development of the frontal sinus, and the epidemiology, diagnosis, and treatment of Pott's puffy tumor. The patient was a 23-month-old boy who developed Pott's puffy tumor after recovery from influenza. The patient presented to the hospital with progressing edema of the unilateral eye that spread bilaterally within a few days. A CT scan demonstrated pansinusitis, developed frontal sinuses, right periorbital cellulitis, and medial forehead subperiosteal abscess. Functional endoscopic sinus surgery and transcutaneous abscess drainage were urgently performed and the patient made a full recovery following a course of ertapenem and levofloxacin. The presence of a developed frontal sinus in a 23-month-old is an unexpected radiologic finding. This case represents the youngest patient reported in the literature to develop this rare complication of frontal sinusitis.     

Discovering Your Inner Bat: Echo–Acoustic Target Ranging in Humans

Echolocation is typically associated with bats and toothed whales. To date, only few studies have investigated echolocation in humans. Moreover, these experiments were conducted with real objects in real rooms; a configuration in which features of both vocal emissions and perceptual cues are difficult to analyse and control. We investigated human sonar target-ranging in virtual echo-acoustic space, using a short-latency, real-time convolution engine. Subjects produced tongue clicks, which were picked up by a headset microphone, digitally delayed, convolved with individual head-related transfer functions and played back through earphones, thus simulating a reflecting surface at a specific range in front of the subject. In an adaptive 2-AFC paradigm, we measured the perceptual sensitivity to changes of the range for reference ranges of 1.7, 3.4 or 6.8 m. In a follow-up experiment, a second simulated surface at a lateral position and a fixed range was added, expected to act either as an interfering masker or a useful reference. The psychophysical data show that the subjects were well capable to discriminate differences in the range of a frontal reflector. The range–discrimination thresholds were typically below 1 m and, for a reference range of 1.7 m, they were typically below 0.5 m. Performance improved when a second reflector was introduced at a lateral angle of 45°. A detailed analysis of the tongue clicks showed that the subjects typically produced short, broadband palatal clicks with durations between 3 and 15 ms, and sound levels between 60 and 108 dB. Typically, the tongue clicks had relatively high peak frequencies around 6 to 8 kHz. Through the combination of highly controlled psychophysical experiments in virtual space and a detailed analysis of both the subjects’ performance and their emitted tongue clicks, the current experiments provide insights into both vocal motor and sensory processes recruited by humans that aim to explore their environment by echolocation.     

Langerhans' cell histiocytosis of the temporal bone in children

OBJECTIVE: Langerhans' cell histiocytosis (LCH) is a rare pathology that implies an abnormal proliferation of these kinds of cells associated with a granular infiltration that affects different structures of the human body, including the temporal bone. The authors present their series of LCH of the temporal bone in children at the Sainte-Justine university hospital. The twofold objective of this study is to illustrate the clinical presentation, management and prognosis of this disease, and to compare these results with previously reported series. METHODS: A retrospective study was conducted between 1984 and 2007 with patients diagnosed and treated for a LCH of the temporal bone at the Sainte-Justine university hospital, a paediatric tertiary care center. A chart review was performed to obtain demographic, clinical, paraclinical, and therapeutic data. They were analysed and compared to other published series. Through a MEDLINE query, we found that since 1966, 50 articles dealing with a LCH of the temporal bone have been published. RESULTS: Fifty-nine cases of LCH were diagnosed and among them, 10 children had temporal bone involvement. They were four females and six males with a mean age of 3.28 years. The two most frequent clinical manifestations were the presence of a mass in the temporal region (70%) and otitis (60%). Two of our patients had a unifocal lesion of the temporal bone implicated. Eight patients had a multisystem involvement among which, two showed evidence of organ dysfunction. In 80% of cases, the diagnosis was made by immunohistochemical findings of the S-100 protein and/or the CD1 antigen. The common radiological finding on a skull CT scan is a lytic lesion in the temporal bone. Seven patients were treated by chemotherapy, two were treated by radiotherapy as a primary treatment, and one received radiotherapy for a recurrence on the pituitary gland. Finally, one patient was treated with local steroid injections. Two patients had a recurrence. All our patients were in total remission on a mean average of 1.6 years after the diagnosis. Our results concord with other studies in which the prognosis of unifocal bone disease is excellent and children with a multifocal disease have a survival rate of 65-100%. CONCLUSION: LCH is a rare disease. A high-index suspicion should be raised in the context of a temporal mass, chronic otitis, and otorrhea. A biopsy is recommended in the presence of a temporal bone lytic lesion. Chemotherapy is the preferred therapeutic modality.     

Pseudoaneurysm of the internal carotid artery revelated by epistaxis: report of two cases

OBJECTIVES: Pseudoaneurysms of the carotid artery are a rare but serious cause of epistaxis. They can be rapidly life-threatening. Usually resulting of a surgery or a traumatism, pseudoaneurysms can express themselves by recurrent epistaxis. Management of these epistaxis is discussed. METHODS: The authors present two cases and effect a review of the literature. RESULTS: The first patient presented with a pseudoaneurysm few days after a transsphenoidal surgery. The second patient presented with a pseudoaneurysm fourteen years after a radio-surgical treatment of an ethmoidal and frontal epidermoid carcinoma. Diagnosis was suspected during nasal endoscopy and confirmed in both cases with angio-CT and arteriography. The first patient underwent a selective embolization. The second patient had to have a carotid occlusion due to a sudden severe haemorrhage, resulting from a pseudoaneurysm rupture following the embolization attempt. CONCLUSION: Review of the literature confirms the indication of endovascular intervention. The optimal management is carotid occlusion, provided the patient can tolerate carotid test occlusion and the circle of Willis is satisfactory. In some cases, a preservative treatment may be possible, which could be either pseudoaneurysm embolization or the placement of a covered stent.     

Brain herniation into the middle ear following temporal bone fracture

Otorrhea of leaked cerebrospinal fluid and meningitis in a 33-year-old male originated from an encephalic herniation into the middle ear following traumatic temporal bone fracture. CT demonstrated a mixed-type fracture consisting of a longitudinal fracture and a posterior oblique fracture of the left temporal bone. The left tegmen tympani was broken into a bellows-like shape and a bone splinter from it had stuck in the epitympanum at the level of the incus body. Surgery via a middle cranial fossa approach confirmed penetration of the brain tissue between the incus and lateral semicircular canal. The diagnosis and management of this condition are discussed in the context of a literature review.     

Starting a medical 3D printing lab for otolaryngology-head and neck surgery collaboration

ObjectiveTo evaluate the different strategies for developing and maintaining a 3-dimensional (3D) printing lab.MethodsWe evaluated two printing labs and compared their structure, integration, and production.ResultsWhile one lab was initiated by a clinician and the other by a technical expert, both labs followed a similar series of steps to develop their lab. Each identified a key clinical need, developed a collaborative team, found financial support, and discovered options for sustainability.ConclusionsWhile there is no correct path for developing a 3D printing lab, depending on the existing infrastructure and the clinical need, one may choose a certain initial structure for a lab while following a list of common necessary steps.     

Ausgewählte aspirationscytologische Befunde bei einigen Tumoren im Bereich der Mundhöhle und der Speicheldrüsen

Summary The diagnostic usability of the fine-needle-aspiration-biopsy-cytology is demonstrated in 6 selected cases of salivary gland lesions and tumors in the oral cavity. For this purpose the cytological findings of an adenoid-cystic carcinoma and a mucoepidermoid tumor of the salivary gland as well as a myxoma, a giant cell epulis, a meningeoma and a metastasis of a hypernephroid carcinoma of the kidney in the oral cavity are shown and compared with the corresponding histological pictures.     

Brown bone tumor as the first manifestation of primary hyperparathyroidism

We report a clinical case of a 26 years old female who had a 2 years evolution chin tumour with hypercalcemia (11.8 mg/dl) and PTH (paratohormone) of 761 pg/ml. She underwent a CT scan and MRI of the mandible, as well as a biopsy followed by excision of the tumour by the maxilofacial surgeons. Our ENT Department asked for a Scintigraphy (Tc99s-mibi) and thoracic-cervical CT, which showed a lesion that turned out to be an adenoma of the lower right parathyroid gland after surgery and pathological examination. The patient suffered a Primary hyperparathyroidism that was the main stimulus for the Brown Tumour made up by macrophagos and multinuclear giant cells, being this the first manifestation of the metabolic disorder. This form of hyperparathyroidism is very rare in the clinic. We do a literature review to establish the differential diagnosis for such pathology.     

An immunohistochemical study of sinonasal hemangiopericytoma

We present herein the imaging and pathological features of a 28-year-old male with a sinonasal hemangiopericytoma-like tumor occupying the left nasal meatus. At the initial visit, a nasal polyp was suspected, but, as the patient was bleeding readily, an angiomatoid lesion was also regarded as a possible diagnosis.Based on a thorough histopathological analysis, a sinonasal hemangiopericytoma-like tumor was diagnosed. Hematoxylin and eosin staining also showed a mild degree of nuclear pleomorphism and a slight increase in mitotic activity, and immunohistochemical studies using anti-CD34, MIB-1, and Vimentin antibodies were useful for distinguishing the hemangiopericytoma-like tumor from true hemangiopericytoma and a solitary fibrous tumor.     

ERA-findings by "cortical hearing disorder" (author's transl)

Since about the last 2 years the late potential's component N1 (90--110 ms) as well as the early acoustically evoked potentials, appearing in a latency range of 1--8 ms and consisting of the nerve action potential (Pot. I) and the brain-stem potentials (Pot. II-V), were registered at some hearing impaired patients. This procedure enabled us to diagnose a "cortical hearing defect" at five patients: a) three children at an age of 2--3 years; they all have a slight cerebral damage, a hearing impairment and no speech-development; b) a 15 year old girl with a hearing impairment which is on the right side more severe than on the left side, as consequence of an encephalitis; and c) a 50 year old man suffering on both sides from a loss of temporal brain's substance and from a total deafness after an insult of both arteriae meningeae mediae. At all these patients the ERA-findings result in an almost normal behaviour of the bioelectrical transfer of the acoustic stimuli in the region of the brain-stem, whereas the late potential's component N1 showed a pathologic distortion. The ERA-results together with the anammesis make a "cortical hearing disorder" probable at these five patients. The audiograms and the ERA-characteristic lines are shown and discussed.