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Objective:The purpose of the present study was to assess the rate of tympanic membrane perforation in patients with otomycosis and to discuss the literature regarding the difficulties in managing this condition.Data Sources:Literature review from 1999 to 2019, Web of Science, PubMed, and Medline.Study Selection:We searched for eligible articles concerning the clinical entity of tympanic membrane perforation secondary to otomycosis. Case series and clinical trials were the types of articles included for this review.Data Extraction:All the articles described in the study selection were used for this review.Data Synthesis:Statistical techniques were not used.Conclusion:Based on the available literature, it seems that tympanic membrane perforation secondary to otomycosis is not uncommon. The presence of this complication is associated with 2 problems: Antimycotic solutions are irritant to middle ear and may be ototoxic to the cochlea. Although most cases of fungus caused tympanic membrane (TM) perforation resolve with proper medical treatment, in a few patients a tympanoplasty may be required.

Head and neck squamous cell carcinoma (HNSCC), arising from the squamous epithelium, is the most common head and neck cancer (HNC). Smoking and alcohol are well known risk factors for HNSCC, while some high-risk human papilloma virus (HPV) subtypes were specifically identified as a high-risk factors for developing oropharyngeal squamous cell carcinoma (OPSCC). In this study, we have conducted a systematic review and meta-analysis in order to investigate the possible synergistic role of smoking and HPV in the development of HNSCC.We conducted a systematic search in two online databases PubMed and Cochrane Library, searching for studies published between 2010-2018. Sixteen studies met the inclusion criteria; a total of 2161 patients were included, comprising 1470 HPV-negative and 691 HPV-positive, respectively.The number of smokers between HPV-positive HNSCC patients (group A) and HPV-negative HNSCC patients (group B) was compared. We have found that smokers in HPV-positive group were statistically significantly less than smokers in HPV-negative group (OR=0.33 with 95% CI 0.18, 0.61). The test for overall effect was Z =3.61 (p=0.0003).Smoking is less common in HPV positive group than in HPV negative group, and so probably smoking does not play a major role in the pathogenesis of HPV-positive HNSCC as in the pathogenesis of HPV-negative HNSCC.

Canal wall down mastoidectomy is a surgical technique used for the eradication of middle ear disease. The remaining large mastoid bowl is associated with a number of issues; one of the main techniques that have been developed in order to avoid such problems is the obliteration of the mastoid cavity. The materials used for this reason are either biological or synthetic. The purpose of this survey is to review the published literature related to the therapeutic value of mastoid obliteration with synthetic materials. We searched Web of Science, PubMed, and MEDLINE from 2008 to 2018 using the criteria mastoid obliteration, canal wall down mastoidectomy, chronic otitis media, and cholesteatoma. The search focused on papers concerning the mastoid obliteration with synthetic material, as we focused on looking for outcomes and reported complications. Out of a total of 244 citations, 15 articles were identified, where patients underwent mastoid obliteration with synthetic materials. Most authors used bioactive glass as a filler material. Mastoid obliteration resulted in a decrease in the complications associated with the open mastoid cavity. On the basis of the available limited literature, it seems that mastoid obliteration with synthetic materials is a valuable and safe surgical technique for patients who undergo canal wall down mastoidectomy. The bioactive glass appears to be the most reliable synthetic material.

A wide spectrum of anterior and posterior segment ophthalmic injuries has been described secondary to instrumental vaginal deliveries, which may be self-limiting or cause a significant long-term vi...

A 14-year-old girl presented with a left upper eyelid diffuse swelling and an ipsilateral pseudoptosis (figure 1A). She had been referred by a general practitioner as an urgent case of orbital cellulitis. She had already received 2 days of treatment with oral clindamycin without improvement in symptoms. The patient’s general medical history was unremarkable. Her family owned two dogs and she had been bitten by them several times during playing. Nasal endoscopy was performed. No purulent secretions were found in the middle meatus. MRI showed a …

Objectives Pott's puffy tumor (PTT) is a frontal subperiosteal abscess associated with underlying frontal osteomyelitis. The purpose of the present study was to assess the rate of intracranial involvement in pediatric and adolescent patients with PPT and to discuss the diagnostic workup and the therapeutic features of this pathology. Methods We searched Web of Science, PubMed and MEDLINE from 1998 to 2018. The search focused on papers concerning the diagnostic procedure and therapeutic management of PTT. Statistical techniques were not used. Results We included 53 articles that described 92 pediatric and adolescent patients with PPT. The overall rate of intracranial complications was found to be 72%. Most authors used computed tomography for the diagnosis of PTT and its complications, either alone or in combination with magnetic resonance imaging. In 50% of cases, an endoscopic endonasal approach is used for the management of the underlying acute or chronic sinusitis. Conclusions On the basis of the available literature, it seems that the incidence rate of intracranial involvement in patients with PPT is quite high. Early diagnosis using the appropriate imaging raise the possibility of good recovery. Concerning the therapy of PTT, endoscopic sinus surgery could be considered as a valuable technique. The vast majority of patients treated appropriately recover without long-term neurologic complications and sequelae. Level of evidence 4 Laryngoscope, 130:225-231, 2020.

A three-year-old girl presented with a small opening at the anterior border of the right sternocleidomastoid muscle that had been there since birth ([Figure 1A][1]). On swallowing, the opening elevated, forming a cutaneous depression similar to a dimple ([Figure 1B][1]; a video [Appendix 1] is

A 65-year-old man with a history of hypertension presented with double vision. Examination revealed wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) (figure 1) and nonsymptomatic, pulse-synchronous, pulsatile proptosis of the left eye (video, [links.lww.com/WNL/A389][1]). According to the patient, there was a history of blunt head trauma in childhood and the pulsatile eye was present since then. CT revealed a meningocele into the left orbit due to a bony defect in the orbital roof (figure 2A). CT angiography ruled out a carotid-cavernous fistula. MRI showed an acute infarction at the midline of the midbrain tegmentum, which involved the medial longitudinal fasciculus bilaterally and caused the WEBINO (figure 2B).1 The pulsatile proptosis was attributed to the childhood head injury and due to the orbital roof fracture and associated meningocele pulsation of the brain vessels passed onto the CSF.2 [1]: http://links.lww.com/WNL/A389

1. Pyramidal lobe: a remnant of descent of the thyroid that usually arises from the isthmus. Present in up to 40% of population. 2. Posterior suspensory ligament of the thyroid (ligament of Berry): a condensation of the thyroid fascia. It is well vascularized, deriving a branch of the inferior thyroid artery. 3. Internal branch of superior laryngeal nerve (SLN): supplies sensation to the lower pharynx, supraglottic larynx, and base of tongue. 4. The internal branch of SLN travels medially to the carotid system, entering the posterior aspect of the thyrohyoid membrane. 5. External branch of SLN: provides motor innervation to the cricothyroid muscle. 6. The SLN’s external branch diverges from the superior pole vascular pedicle 1 cm or more above the superior aspect of the thyroid superior pole. 7. Recurrent laryngeal nerve (RLN): provides motor innervation to the inferior constrictor and all intrinsic laryngeal muscles except the cricothyroid. 8. The right RLN ascends the neck, traveling from lateral to medial, crossing the inferior thyroid artery. 9. The left RLN ascends in a more paratracheal position, crossing the distal branches of the inferior thyroid artery. 10. Tubercle of Zuckerkandl: a pyramidal extension of the thyroid gland, present at the most posterior side of each lobe. It is a reliable landmark for the RLN in thyroid surgery.

We thank Lee et al. for the insightful comments on our Teaching Video NeuroImage on pulsatile proptosis and wall-eyed bilateral internuclear ophthalmoplegia (WEBINO).1 The causative lesions for bilateral WEBINO can be located in the tegmentum of pons, pons–midbrain, or midbrain, with some injuries almost bisecting the brainstem.2,3 As the MRI presented by Lee et al. discloses multiple hyperintense foci at the pontomesencephalic level, we reviewed the diffusion-weighted MRI, which shows a focal area of restricted diffusion at the midline of the pontine tegmentum beneath the floor of the fourth ventricle, which involves the medial longitudinal fasciculus (MLF) bilaterally (figure). The patient had presented 2 days after onset of diplopia and this lesion was consistent with an acute ischemic stroke. Although we indicated in the text and figure legend of the T2-weighted MRI that the infarction was located at the midline of the midbrain tegmentum,1 the arrow on the MRI had been placed more anteriorly by mistake. Hence, we agree with Lee et al. that, at the pontine level, the MLF is located just ventral to the fourth ventricle, and lesions of this area can lead to bilateral WEBINO.4

A 37-year-old woman presented to the department of otolaryngology with a 15-day history of frontal headache. The patient had been treated for sinusitis with a 10-day course of amoxicillin and clavulanic acid without any improvement. Five days before presentation, a well-defined, fluctuating forehead

A 12-year-old girl was referred with a 3-month history of a mass in the floor of the mouth and a swelling in the submental area. She had difficulty in chewing and swallowing solid foods. Examination revealed a solitary bluish mass in the left side of the floor of the mouth (figure 1A). It was non-tender, fluctuant, soft in consistency and non-mobile. The overlying mucosa showed no secondary changes. There were no inflammatory signs or associated lymphadenopathy. The …

Highlights • Anaplastic carcinoma arising in ectopic thyroid tissue is extremely rare. • Another possibility that should be taken into account in appearance of thyroid tissue in the lateral cervical region is the presence of a thyroid carcinoma metastasis. • FNA can contribute significantly to the accurate preoperative assessment of ectopic thyroid tissue, particularly if malignancy is suspected. • The presence of anaplastic carcinoma in the submandibular region without any evidence of primary tumor at the orthotopic thyroid gland may pose diagnostic difficulties., Introduction Thyroid carcinoma arising in an extrathyroid area is a rare entity. Presentation of case We report a case of anaplastic carcinoma in the submandibular region occurring in a 70-year-old woman. Discussion The location of the mass along with no evidence of primary tumor at the orthotopic thyroid gland posed a diagnostic dilemma: was this an ectopic thyroid carcinoma or rather a case of occult differentiated thyroid carcinoma metastasis that transformed to anaplastic carcinoma? Based on the histopathological findings we concluded that the tumor arised in ectopic thyroid tissue. Although the mass was completely resected, the patient died 10 months after diagnosis due to pulmonary metastases. Conclusion Conclusively, the possibility of ectopic thyroid tissue, with or without disease, should be considered in cases of a mass in the submandibular region.

Objective: To investigate the therapeutic efficacy of intratympanic dexamethasone combined with systemic prednisolone in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Study Design: Prospective, quasirandomized, multicenter clinical trial. Setting: One university hospital and 2 affiliated hospitals. Patients: A total of 92 eligible patients with ISSNHL were allocated into 2 groups. Patients in the control group were treated with systemic prednisolone alone. Patients of the combined treatment group received additionally 3 intratympanic dexamethasone injections within 5 days. Main Outcome Measures: The main outcome measures used were the differences between pretreatment and posttreatment pure-tone audiometry averages (PTAs) and speech discrimination scores (SDSs). Successful treatment was defined as a greater than 10 dB improvement in PTA and 15% in SDS. The final assessment of hearing was performed 3 months after completion of treatment. Results: Significant hearing recovery was observed in 31 (67.39%) of 46 cases, and in 24 (52.17%) of 46 control patients. Patients receiving combination therapy had a median improvement in PTA of 23.12 dB and a median increase in SDS of 32%. In the control group, the median hearing gain was 16.87 dB and 18%, respectively. The differences between the 2 groups were not statistically significant (p = 0.10 and p = 0.13). However, after performing a post hoc analysis by excluding individuals with profound hearing loss (PTA, >90 dB), the combined treatment group showed significant improvement compared with the control group (p = 0.04). No serious complications or adverse reactions were reported. Conclusion: The addition of intratympanic steroids to the conventional systemic steroid therapy may provide a safe and potentially effective therapeutic option in patients with mild-to-severe ISSNHL. © 2013, Otology & Neurotology, Inc.

We evaluated a series of 5 patients-3 men and 2 women, aged 39 to 70 years (mean: 54.4)-with a granular cell tumor (GCT) of the head and neck in an effort to better define the clinical presentation, imaging characteristics, and surgical management of this type of tumor. In all cases, the diagnosis was established by pathologic analysis. There were 2 cases of laryngeal GCT and 1 case each of GCT arising in the nostril, hypopharynx, and the tongue base. The clinical findings were variable, depending on the location and extent of each lesion. Four of these patients underwent endoscopic examination, and in 2 cases computed tomography was performed. Treatment included wide surgical excision of the lesion in all cases. Otolaryngologists should be familiar with this unusual tumor. Although an accurate preoperative diagnosis is extremely difficult to make, appropriate therapeutic intervention is associated with a cure rate that is quite high.

OBJECTIVE: Administration of steroids systematically is considered to be the most commonly accepted treatment for idiopathic sudden sensorineural hearing loss (ISSNHL). In recent years there has been increasing scientific interest in treating ISSNHL by means of local steroid delivery. Usually, intratympanic steroids are used in three main protocols, as initial treatment, as adjunctive treatment given concomitantly with systemic steroids and as salvage treatment after failure of standard therapy. The purpose of this review is to examine the published literature regarding the therapeutic value of each method of treatment and to seek answers about the best delivery technique and the optimal administration schedule. DATA SOURCES: Literature review from 1996 to 2009, PubMed and Medline. STUDY SELECTION: We searched for trials concerning clinical evaluation of intratympanic steroids in ISSNHL patients, as a salvage treatment, as a first line therapy and in combination with the conventional therapy. Randomized and non-randomized case control studies and case series studies were the types of trials available for review. DATA EXTRACTION: All the articles described in the study selection were used for this review. DATA SYNTHESIS: Statistical techniques were not used. CONCLUSION: On the basis of the available literature, it seems that topical steroids can be a valuable solution for ISSNHL patients who either cannot tolerate systemic steroid therapy or are refractory to it. Concerning the combined therapy, due to the controversial results of the existing studies, it cannot be determined yet whether this treatment protocol could yield superior results as a first line therapy. The need for establishment of standard criteria of hearing recovery should be underlined.

A 56-year-old postmenopausal obese woman presented with a 6-month history of right-sided rhinorrhoea. There was no history of head trauma or surgery. On clinical examination drops of clear fluid were falling from her right nostril when bending forward (online supplementary video 1). Nasal endoscopy identified no pathology. The fluid was positive for beta-2 transferrin. There was no evidence of papilloedema and the opening pressure was normal.1 Imaging demonstrated a right cribriform plate defect (figure 1). Endoscopic …

Satellite lesions are a sign of aggressive disease and require a thorough evaluation for metastases.

A 16-year-old girl presented with a one-year history of a mass in her right cheek that became apparent only with teeth-clenching ([Figure 1A and B][1]; video available at [www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.140364/-/DC1][2]). The lesion was soft, well-defined and painless. It measured 3 × 2

Adenoidectomy and tonsillectomy (TE) is the standard treatment for obstructive sleep-disordered breathing (SDB) in children with adenotonsillar hypertrophy. Tonsilloplasty (TP) is a new surgical technique that includes partial TE. The purpose of this study was to assess the short- and long-term outcomes of TP compared to TE.A comparison study.Children with SDB and tonsillar hypertrophy underwent TP or TE. The two groups were compared regarding immediate postoperative course and long-term effects.Fifty-one children (age, 6.3 ± 2.5 years) underwent TE, and 50 children (age, 5.9 ± 2.1 years) had TP. The TP group had significantly less intraoperative bleeding compared to the TE group (25.6 ± 8.2 vs. 38.3 ± 12.3 mL, P.001). Subjects with TP were pain free earlier than children with TE (4.5 ± 0.4 vs. 7.7 ± 0.4 days, P.001) and returned to a normal diet sooner (3.8 ± 0.2 vs. 7.1 ± 0.3 days, P.001). By the 3rd to 4th postoperative night, upper airway obstruction was relieved in all participants. Six years postoperatively, 48 of 51 children in the TE group and 43 of 50 children in the TP group participated in a telephone survey. No significant differences were found between the two groups regarding the frequency of recurrent snoring (30.2% in TP vs. 25% in TE), apneas (4.7% vs. 0%), and upper airway infections per year (P.05).TP is an alternative surgical method for treatment of SDB related to tonsillar hypertrophy with favorable postoperative course and comparable long-term results.2c.

Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive variant of squamous cell carcinoma that mainly arises in the upper aerodigestive tract. The tonsil is a rare site of BSCC development and only fourteen cases have been reported in the international literature. We report here on the case of a 56-year-old man who presented with mild dysphagia. Computed tomography and examination of the oropharynx revealed a suspicious-looking, bulky mass on the right tonsil. Histopathological examination confirmed the presence of BSCC. The patient had cervical lymph node metastases and pulmonary metastases and was treated with chemotherapy and concurrent radiation. Despite the metastases the patient is still alive 3 years after the initial diagnosis.

Summary Objective Auditory neuropathy (AN) has been a well-accepted clinical entity during the last years. Though we are able to diagnose AN reliably, little is known concerning its epidemiology, etiology and prognosis. This study is aimed at presenting a particular characteristic of the disease, namely its potential transient behaviour, observed in a group of high risk neonates suffering from AN. The ensuing clinical implications are underlined. Method From 1995 to 2004, 1150 high risk (HR) neonates were subjected consecutively to audiological evaluation by auditory brain stem responses (ABR), participating in a targeted hearing screening program for HR neonates. All neonates with ABR threshold >40 dBnHL and middle ear free from disease underwent otoacoustic emissions (OAEs) testing as well. Children with elevated ABR thresholds were scheduled for re-examination after 4–6 months. Only infants demonstrating considerably elevated thresholds (>70 dBnHL), absent or atypical ABR in combination with normal OAEs were considered as suffering from AN. Results One hundred and seventy-seven neonates showed elevated ABR thresholds (15.4%). Seventy-nine of them demonstrated ABR thresholds ≥75 dBnHL, absent or strongly atypical waveforms at maximum test intensity and among them 25 displayed findings consistent with AN. Follow-up examination revealed a resolution of AN in 13 out of 20 infants retested, that is a restoration of ABR to normal and typical OAEs recordings. Using multiple logistic regression, we found that low birth weight may represent a reliable predictor for clinical recovery of AN infants. Conclusion This article bring to light the temporary character that AN could show in HR neonates and especially in those with low birth weight. Based on the results of our study, the higher the birth weight, the less likely it is for neonates to recover from AN. From a practical point of view, these findings suggest that hearing screening protocols for HR neonates should be revised in both their methodology and time of application. Finally, the decision for amplification or cochlear implantation in HR infants with AN should be made very carefully and well after the 6th month of age, since the maturation process may still be in progress.

A 64-year-old woman presented with a medial canthal mass in her left eye, which was accompanied only by mild epiphora. There was no history of dacryocystitis, bloody tears, midfacial trauma or surgery. Physical examination showed a non-inflammatory, subcutaneous, immobile mass below the level of the medial canthal tendon. Lacrimal irrigation demonstrated blockage at the nasolacrimal duct. A CT revealed a non-enhancing, low density, cystic lesion in the inferomedial aspect of the left orbit without bony erosion, which was compatible with an idiopathic acquired dacryocystocele. The patient underwent endonasal endoscopic dacryocystorhinostomy (DCR) and silicone intubation. Epiphora resolved immediately after surgery. Two years after surgery, the patient has had no recurrence of either the epiphora or the orbital. Idiopathic acquired dacryocystocele associated only with epiphora without accompanying dacryocystitis although rare should be considered in the differential diagnosis of acquired non-inflammatory medial canthal masses. Endonasal endoscopic DCR represents a safe and effective treatment.