Frontal sinus cutaneous fistula: a complication of Pott's puffy tumor.
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Biomedical subjects
Publications and source records attributed to Menachem Gross.
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OBJECTIVE: Cochlear involvement manifested by sensorineural or mixed-type hearing loss (HL) has been reported to occur in 30-67% of patients suffering from myringitis bullosa (MB). The goal of this study was to investigate the incidence and nature of vestibular involvement in MB. MATERIAL AND METHODS: All adult patients presenting to Hadassah University Hospital with MB between 2000 and 2002 were evaluated for inner ear involvement. Audiometry, tympanometry and electronystagmography (ENG) were performed within the first 48 h after presentation. The affected ears were examined on a regular basis and audiometric studies were repeated every other day. ENG was not repeated but a detailed questionnaire was administered and a thorough physical examination performed to rule out persistent vestibular dysfunction. RESULTS: Thirteen patients (17 ears) were diagnosed as suffering from MB. All 13 patients reported HL in the affected ears and 7 (54%) reported a sensation of vertigo at presentation. Audiometric tests revealed HL in all 17 affected ears: sensorineural HL in 2, mixed-type HL in 12 and conductive HL in 3. ENG was normal in only two cases, both of whom did not suffer from vertigo. Four patients with no vestibular symptoms whatsoever had an abnormal electronystagmogram. All seven patients who complained of vertigo had an abnormal electronystagmogram and recovered fully after treatment. All but two patients recovered their auditory function. CONCLUSIONS: Not only is the cochlear part of the inner ear affected in patients suffering from MB, but the vestibular part as well. Sensorineural HL and vestibular abnormalities should both be considered as manifestations of MB.
OBJECTIVE: Parotid gland enlargement due to diffuse pathologic processes represents a diagnostic challenge for the surgeon. In such cases, fine-needle aspiration is inconclusive and superficial parotidectomy is usually performed. MATERIAL AND METHODS: The authors treated eight patients who underwent open incisional biopsy of the parotid gland with continuous monitoring of the facial nerve. RESULTS: In all cases, fine-needle aspiration cytology did not provide a definitive diagnosis while open incisional biopsy provided an accurate diagnosis of a lymphoproliferative disorder, with no operative complications. CONCLUSION: In certain infiltrative parotid diseases such as lymphoepithelial or lymphoproliferative diseases, when fine-needle aspiration biopsy is insufficient as tissue architecture is an important component of the pathological diagnosis, an open incisional biopsy can be considered. This procedure can provide an accurate histological diagnosis while avoiding superficial parotidectomy.
Basal cell adenocarcinoma (BCAC) is an extremely rare neoplasm in salivary glands, particularly minor glands. BCAC is a low-grade malignant tumor which has cytologic features of basal cell adenoma, together with infiltrative growth and perineural invasion. We describe the case of a 55-year-old man with a 3 x 3 cm2 right buccal BCAC, which was treated by means of transoral resection and postoperative adjuvant radiotherapy. The histologic features of this tumor demonstrate the differential diagnosis of basal cell tumors. It is necessary to differentiate BCAC from other basaloid cell tumors of the salivary glands due to differences in treatment and prognosis.
OBJECTIVES/HYPOTHESIS: Conflicting data exist in the literature regarding the role of mitomycin in the prevention and treatment of laryngotracheal stenosis. The purpose of the study was to assess the value of mitomycin in preventing repeat stenosis after endoscopic dilation surgery of well-established stenoses. STUDY DESIGN: Prospective controlled animal study. METHODS: Laryngotracheal stenosis was induced in 16 dogs. After a period of 3 months the dogs underwent endoscopic dilation and were randomly divided into two groups. The control group received immediate topical application of normal saline. Dogs in the mitomycin group received immediate topical application of 0.5 mg mitomycin. The animals were then observed for 3 more months before euthanasia. The laryngeal lumens were measured endoscopically at baseline, before dilation, and before euthanasia. A comparison was made between the two study groups by means of the Wilcoxon rank-sum test for change in the percentage of stenosis attained by the endoscopic dilation. RESULTS: Nine dogs were included in the control group, and seven in the mitomycin group. Group comparison for initial occlusion before endoscopic dilation using Wilcoxon rank-sum test showed no difference between the two groups (z = 0.16 [P =.87]). Three months after endoscopic dilation, no difference was observed between the two groups regarding the change in the percentage of occlusion (z = -0.21 [P =.83]). CONCLUSION: Mitomycin exerts a benefit equal to that of normal saline when applied to a well-established laryngotracheal stenosis in dogs and does not prevent repeat stenosis after endoscopic dilation surgery.
OBJECTIVE: The objective of this study was to describe the clinical manifestations; radiographic, audiometric, and retinal fluorescein angiography findings; pathogenesis and treatment of Susac syndrome with review of the literature. STUDY DESIGN: We conducted a retrospective case review. SETTING: This study was conducted at a tertiary referral center. PATIENT: A 50-year-old woman presented with recurrent episodes of neurologic symptoms, bilateral sensorineural hearing loss, and silent retinal artery occlusion. INTERVENTIONS: The patient underwent complete evaluation, including magnetic resonance image studies, audiometric tests, and retinal fluorescein angiography. She was treated initially with corticosteroids and later with other immunosuppressive agents. RESULTS: The patient was initially diagnosed with left sudden sensorineural hearing loss. Despite comprehensive clinical and laboratory studies that did not reveal systemic disease, 3 weeks later, the patient developed vertigo, sensorineural hearing loss, and tinnitus in the opposite ear. The neurologic involvement and the bilateral audiologic manifestations raised the possibility of Susac syndrome. CONCLUSION: Susac syndrome is a rare disorder of unknown origin characterized by the triad of encephalopathy, fluctuating hearing loss, and visual loss resulting from microangiopathy of the brain, cochlea, and retina. The multiple organ involvement seen in Susac syndrome raises a differential diagnosis ranging from autoimmune disease, through systemic vasculitis, to multiple sclerosis. Otolaryngologists should be aware of this syndrome as a result of the vestibulocochlear manifestations and the multidisciplinary evaluation that is required.
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Thyroid carcinoma usually presents as an asymptomatic thyroid nodule. Thyroid cancer may show microscopic vascular invasion; however, internal jugular vein tumor thrombus is a rare complication of thyroid cancer. A unique case of internal jugular vein tumor thrombus associated with thyroid carcinoma is presented and discussed.
Pneumolabyrinth or pneumocochlea are rarely found in temporal bone fractures. The presence of air in the inner ear is evidence of a pathological connection between the inner ear and the air-filled mastoid or middle ear cavities. A case of a pneumolabyrinth in a 2-years-old child is presented here. Diagnosis was made by means of a high resolution, thin sections computed tomography (CT) scan of the temporal bones, which is the imaging modality of choice in cases of otologic complaints after head trauma.
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