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Embryonal rhabdosarcoma of the middle ear and mastoid.

Two cases of embryonal rhabdomyosarcoma, arising from the middle ear, are described. It is a rare mesenchymal tumour of childhood, with a very poor prognosis. The literature is briefly reviewed and the difficulties encountered in diagnosis are outlined.

Child↗

Surgical management of tumors of the middle ear and mastoid.

The author has presented the two most common tumors of the ear, cancer of the ear and glomus tumors. Most experience has been with extensive carcinomas involving the temporal bone and indeed the author has treated 132 cases with cancer of the ear, of which 105 cases were resectable. The total experience yielded a cure rate of 28 per cent. The best management program should entail an en bloc resection of the temporal bone followed by post-operative radiation therapy. Glomus tumors are generally benign and when confined to the middle ear present no surgical problem. However, when extension occurs into the jugular bulb region and into the jugular vein, the surgery becomes more formidable and the extent of the tumor should be established before surgery. Wide surgical exposure should avoid entering into the tumor prematurely and thereby compromising a total resection. Advanced extension of the tumor intracranially mandates a combined neurosurgical and otolaryngological approach. Radiotherapy, while not destroying the glomus tumor, will shrink down the size of the tumor by causing thrombosis in its blood vessels and subsequent fibrosis of the tumor itself. The management of each tumor should be individualized according to its size, location, and the general status and age of the patient.

Adenocarcinoma↗

Post-operative roentgenological findings and changes after mastoid obliteration.

This study consisted of the evaluation of the plain X-ray findings of films taken at early follow-up (mean 1.5 months after surgery) and at late follow-up (4-14 years after the early films) of 211 ears which had been operated on radically and obliterated. Residual cells which were detected on the basis of the early films were associated with a more frequent occurrence of post-operative infection and were thus hallmarks of a poorer prognosis. Changes in the bone surrounding the surgical cavity and the radiological quality of the walls of the surgical cavity, the presence of new bone formation in the cavity and other radiological features did not yield useful information about post-operative complications. New bone formation was associated with a smaller amount of post-operative cavitation. Post-operative X-ray examination of the obliterated ear is a prognostically useful examination, but it does not significantly contribute further to the information available by clinical and otomicroscopic examination in regards to the complications of infection and cholesteatoma.

Adult↗

Tuberculous mastoiditis.

Two cases of aural tuberculosis in Caucasian adults are described. Stress is laid on the need to consider tuberculosis in cases of chronic otitis presenting unusual features. Lack of suspicion of tuberculosis frequently leads to long delays in diagnosis and subsequent needless disability.

Female↗