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Objective To report on the creation and administration of an online Script Concordance Test (SCT) for ear, nose, and throat (ENT), the ENT-SCT. Design Prospective study. Setting Two tertiary care university centers. Participants In total, 132 individuals were asked to test an ENT-SCT of 20 cases and 94 questions based on the major educational objectives of the ENT residency program. Main Outcome Measures Three levels of experience were tested: medical students, ENT residents, and board-certified otorhinolaryngologists as the expert panel. The test's construct validity—whether scores were related to clinical experience—was statistically analyzed. Reliability was estimated by the Cronbach α internal consistency coefficient. Participants' perception of the test was assessed with the use of a questionnaire. Results The 65 respondents with usable data were medical students (n = 21), ENT residents (n = 22), and experts (n = 22). Total mean (SD) test scores differed significantly: 76.81 (3.31) for the expert panel, 69.05 (4.35) for residents, and 58.29 (5.86) for students. The Cronbach α coefficient was 0.95. More than two-thirds of the participants found the test to be realistic and relevant for assessing clinical reasoning. The test was also considered fun, interesting, and intuitive. Conclusions The Web-based ENT-SCT is feasible, reliable, and useful for assessing clinical reasoning. This online assessment tool may have applications for residency programs and continuing medical education.

Synovial chondromatosis is a benign disease that only rarely affects the temporomandibular joint. When it does, disease is usually confined to the joint space itself but can occasionally extend beyond the joint capsule into the parotid gland, temporal bone, or cranium. The local clinical behavior, radiographic appearance, and histopathologic features can combine to create the appearance of a malignant lesion. We report a case of synovial chondromatosis that affected the temporomandibular joint and presented as an external auditory canal mass. The lesion was thought to be a chondrosarcoma prior to the definitive resection. Pitfalls in the diagnosis and management of synovial chondromatosis are discussed.

A 31-YEAR-OLD NORTH AFRICAN MAN PREsented with a 4-month history of headache. He reported several attacks of massive epistaxis, which had stopped spontaneously. His medical history was unremarkable, and he had no history of trauma. Fiberoptic examination showed an asymmetry of the roof of the rhinopharynx. The overlying mucosa was normal. No arterial beating was visualized on fiberoptic examination. There was no palpable cervical node. The findings of the rest of the head and neck examination were normal. The patient underwent standard computed tomography (Figure 1) and magnetic resonance imaging (Figure 2). What is your diagnosis?

Objective To determine the feasible conditions for exclusive endoscopic resection of juvenile nasopharyngeal angiofibroma. Design Retrospective study of 20 patients, with a mean follow-up of 22 months. Setting Six academic referral hospitals. Interventions All patients had a preoperative computed tomographic or magnetic resonance imaging scan and at least 1 follow-up computed tomographic and/or magnetic resonance imaging scan 6 or 12 months after surgery. Exclusive endoscopic removal was performed using conventional functional endoscopic sinus surgery instrumentation after preoperative embolization. Results Using Radkowski staging, 4, 7, and 9 patients had stage I, II and IIIA tumors, respectively. Seven patients were operated on for a recurrence after open surgery. Extension toward the sphenoid sinus, pterygomaxillary fossa, or infratemporal fossa could be removed. There was no attempt at endoscopic removal of deep skull base or temporal fossa invasion. The mean surgery duration was 135 minutes; mean dimensions of the tumor were 4.5 × 4 × 3 cm; and mean blood loss was 350 mL (median, 300 mL). No recurrences occurred in this series; there were small asymptomatic remnants in 2 cases. Conclusions An exclusively endoscopic management of juvenile nasopharyngeal angiofibroma appears to be effective for small to medium tumors. It should be considered as a first-choice option for these cases (in view of the minimal bleeding, shorter duration, and efficacy).

Background T lymphocytes expressing the γδ T-cell receptor represent a minority of normal T lymphocytes and are mostly located in the spleen or mucosa. Lymphomas expressing the γδ T-cell receptor are rare and usually present as hepatosplenic (negative for Epstein-Barr virus) disease. Primary lymphomas of the larynx are also rare. Objective To report the first case of primary laryngeal γδ T-cell lymphoma related to Epstein-Barr virus infection. Design Single-case study, including clinical, histological, immunohistochemical, and ultrastructural analysis, and in situ hybridization for Epstein-Barr virus–encoded small nuclear RNA. Patient An 88-year-old man presenting with a 6-month history of a cough followed by progressive dysphonia and a thickening of the left aspect of the aryepiglottic fold. Intervention Two weeks of treatment with corticosteroids and antibiotics, followed by radiotherapy and then chemotherapy with chlorambucil and corticosteroids. Outcome The patient died of heart failure 10 months after the onset of the disease. Results The tumor was laryngeal and disseminated to the skin over the parotid gland. Tumor cells were medium-sized T cells of cytotoxic immunophenotype, expressed the γδ T-cell receptor, and contained azurophilic granules and cytotoxiclike granules detected on electron microscopy. Epstein-Barr virus–encoded small nuclear RNA was detected in most tumor cells. Conclusions Lymphomas with a T-cell cytotoxic phenotype expressing the γδ T-cell receptor are rare, and this case appears to be the first to involve the larynx. The association between Epstein-Barr virus and T-cell lymphomas has been shown to be frequent in the upper respiratory tract and is confirmed in this case. This finding suggests that T cells in the upper respiratory tract may be more exposed to Epstein-Barr virus infections, perhaps because of their anatomical location.