Otology

Painful rash of the auricle: Herpes zoster oticus

December 19, 2014     Chao-Yin Kuo, MD; Yuan-Yung Lin, MD; Chih-Hung Wang, MD, PhD
article

A PCR assay in addition to conventional serologic testing provides quick confirmation of the diagnosis of herpes zoster oticus infection.

Bilateral keratin horns arising from the tympanic membranes: A case report

February 2, 2015     Chu Qin Phua, MRCS, DOHNS; Vikas Malik, FRCS(ORL-HNS); Patrick Zaid Sheehan, FRCS(ORL)
article

Abstract

A keratin horn is a horn-like projection composed of dense keratotic material. It usually arises in sun-exposed areas of the body. It can be derived from a variety of underlying benign, premalignant, or malignant epidermal lesions. Risk factors associated with malignant change within a keratin horn include a wide base, male sex, and increasing age, in addition to an origin in a sun-exposed area. The mainstay of management is to obtain a biopsy from the base of the horn and subsequent excision if the histopathologic analysis suggests a malignancy. We report an extremely rare case of bilateral keratin horns arising from the tympanic membranes in a 64-year-old woman. To the best of our knowledge, this is the first report of its kind to be published in the English-language literature.

Salivary gland choristoma of the middle ear

February 2, 2015     Shubin Chen, MD; Yongxin Li, MD
article

Abstract

Salivary gland choristoma of the middle ear is a rare entity. It is believed to be a developmental abnormality that may be associated with anomalies of adjacent structures. We describe the case of a 6-year-old girl who had a salivary gland choristoma in the middle ear that was associated with an ossicular chain anomaly and a facial nerve anomaly. We discuss the clinical features and management of this condition, and we review the literature.

Vestibular dehiscence syndrome caused by a labyrinthine congenital cholesteatoma

February 2, 2015     Francesco Fiorino, MD; Francesca B. Pizzini, MD, PhD; Barbara Mattellini, MD; Franco Barbieri, MD
article

Abstract

A 40-year-old man presented with conductive hearing loss and pressure- and sound-related vestibular symptoms. Computed tomography and diffusion-weighted magnetic resonance imaging revealed the presence of a cholesteatoma involving the vestibular labyrinth. The patient underwent a canal-wall-up tympanoplasty, which revealed evidence of a disruption of the vestibular labyrinth and a wide dehiscence of the vestibule, which was immediately resurfaced. At the 2-month follow-up, the patient's pressure- and sound-related vestibular symptoms had disappeared. Pure-tone audiometry showed a reduction in the air-bone gap with a slight deterioration of bone conduction and an improvement in the air-conduction threshold. Fistulization of the otic capsule produces a “third window,” which can lead to a dehiscence syndrome. One possible cause is a cholesteatoma of the middle ear or petrous bone. When the vestibule is invaded by a cholesteatoma, hearing is almost invariably lost, either pre- or postoperatively. However, in our case, wide opening of the vestibule resulted in hearing preservation.

Absence of the long process of the incus

February 2, 2015     Christina H. Fang, BS; Robert W. Jyung, MD
article

A definitive diagnosis of an ossicular defect, such as absence of the incus long process, requires an exploratory tympanotomy.

Metastatic breast carcinoma presenting as unilateral pulsatile tinnitus: A case report

February 2, 2015     Andrew Moore, MRCS, DOHNS; Max Cunnane, BMBS, BMedSci; Jason C. Fleming, MRCS, DOHNS, MEd
article

Abstract

Pulsatile tinnitus is a rare symptom, yet it may herald life-threatening pathology in the absence of other symptoms or signs. Pulsatile tinnitus tends to imply a vascular cause, but metastatic disease also can present in this way. Clinicians should therefore adopt a specific diagnostic algorithm for pulsatile tinnitus and always consider the possibility of metastatic disease. A history of malignant disease and new cranial nerve palsies should raise clinical suspicion for skull base metastases. We describe the case of a 63-year-old woman presenting with unilateral subjective pulsatile tinnitus and a middle ear mass visible on otoscopy. Her background included the diagnosis of idiopathic unilateral vagal and hypoglossal nerve palsies 4 years previously, with normal magnetic resonance imaging (MRI). Repeat MRI and computed tomography imaging were consistent with metastatic breast carcinoma. This case raises important questions about imaging protocols and the role of serial scanning in patients at high risk of metastatic disease.

Spontaneous bilateral dural arteriovenous fistulas with pulsatile tinnitus

January 19, 2015     Tzu-Chieh Lin, MD; Hsiung-Kwang Chung, MD; Jeng-Nan Hsu, MD
article

Abstract

Pulsatile tinnitus with normal otoscopic findings often presents a diagnostic challenge to otolaryngologists and can be attributed to serious vascular malformations such as dural arteriovenous fistulas (DAVFs). Spontaneous DAVFs are relatively rare. A 65-year-old woman presented with sudden-onset subjective/objective pulsatile tinnitus on the right side that had persisted for 2 months. Angiography and magnetic resonance angiography revealed DAVF formation. Stereotactic radiosurgery was performed, and total remission of the DAVFs was achieved.

Effect of low-level laser therapy in the treatment of cochlear tinnitus: A double-blind, placebo-controlled study

January 19, 2015     Mahboobeh Adami Dehkordi, MD; Sasan Einolghozati, MD; Seyyed Mohsen Ghasemi, PhD; Samaneh Abolbashari, MD; Mojtaba Meshkat, MSc; Hadi Behzad, MSc
article

Abstract

Many treatments for chronic tinnitus have been attempted, but the condition remains difficult to cure, especially in the case of cochlear tinnitus. We conducted a prospective, double-blind, placebo-controlled study to assess the effect of low-dose laser therapy on chronic cochlear tinnitus. Our study population was made up of 66 patients-33 who received active laser treatment (case group) and 33 who received inactive dummy treatment (control group). Patients in the laser group received 5 mV with a wavelength of 650 nm for 20 minutes a day, 5 days a week, for 4 weeks. The controls followed the same schedule, but they were “treated” with an inactive device. The degree of tinnitus was evaluated before and after treatment in each group in three ways: (1) the Tinnitus Severity Index (TSI), (2) a subjective 10-point self-assessment scale for tinnitus loudness, and (3) the Tinnitus Evaluation Test (TET). At study's end, we found no statistically significant differences between the case and control groups in the number of patients who experienced a reduction in TSI values (p = 0.589) or a reduction in subjective self-assessment scores (p = 0.475). Nor did we find any significant reductions in the loudness (p = 0.665) and frequency (p = 0.396) of tinnitus as determined by the TET. We conclude that 5-mV laser therapy with a wavelength of 650 nm is no better than placebo for improving hearing thresholds overall or for treating tinnitus with regard to age, sex, environmental noise level, and the duration of tinnitus.

Osteoradionecrosis of the temporal bone

January 19, 2015     Edmund W. Lee, BA; Robert W. Jyung, MD
article

The pathogenesis of osteoradionecrosis is not completely understood, but it has been thought that radiation causes tissues to become hypoxic, hypovascular, and hypocellular, leading to tissue breakdown and a nonhealing wound.

Contralateral hearing loss after vestibular schwannoma excision: A rare complication of neurotologic surgery

January 19, 2015     Robert H. Deeb, MD; Jack P. Rock, MD; Michael D. Seidman, MD, FACS
article

Abstract

We report a rare case of contralateral hearing loss after vestibular schwannoma excision in a 48-year-old man who underwent surgery via a suboccipital approach for removal of a nearly 2-cm lesion involving the right cerebellopontine angle. Postoperatively, the patient awoke with bilateral deafness, confirmed by both audiometry and spontaneous otoacoustic emissions. The patient was treated aggressively with high-dose intravenous steroids, vitamins E and C, and oxygen. Over the next several months he had gradual recovery of most of the hearing in his left (unoperated) ear. Contralateral hearing loss may develop after vestibular schwannoma excision; multiple pathophysiologic mechanisms for this occurrence have been proposed.

Simultaneous non-Hodgkin lymphoma of the external auditory canal and thyroid gland: A case report

December 19, 2014     BeeLian Khaw, MD; Shailendra Sivalingam, MS-ORL; Sitra Siri Pathamanathan, MBBS; Teck S. Tan, MBChB, MRCS; Manimalar Naicker, MPath
article

Approximately 25% of all cases of extranodal non-Hodgkin lymphoma (NHL) occur in the head and neck region; NHL of the external auditory canal (EAC) and thyroid gland are rare. Specific immunohistochemical staining of the excised tissue is required to confirm the final pathologic diagnosis. We report the case of a 53-year-old woman with underlying systemic lupus erythematosus and autoimmune hemolytic anemia that were in remission. She presented with chronic left ear pain, a mass in the left EAC, and rapid growth of an anterior neck swelling that had led to left vocal fold palsy. High-resolution computed tomography (CT) of the temporal bone and CT of the neck detected a mass lateral to the left tympanic membrane and another mass in the anterior neck that had infiltrated the thyroid gland. The patient was diagnosed with simultaneous B-cell lymphoma of the left EAC and thyroid gland. She was treated with chemotherapy. She responded well to treatment and was lost to follow-up after 1 year. To the best of our knowledge, the simultaneous occurrence of a lymphoma in the EAC and the thyroid has not been previously described in the literature.

Giant-cell tumor of the tendon sheath in the external auditory canal

October 17, 2014     Margherita Trani, MD; Massimo Zanni, MD; Paolo Gambelli, MD
article

Abstract

Giant-cell tumor of the tendon sheath (GCTTS) and pigmented villonodular synovitis belong to the same type of benign proliferative lesions originating in the synovia that usually affect the joints, bursae, and tendon sheaths. They frequently involve the hands, knees, ankles, and feet. We report a case of GCTTS in the external auditory canal in a 53-year-old woman who presented with hearing loss, fullness, and a sessile lesion protruding from the anterior wall of her external ear canal. The 1.5-cm diameter mass was spherical, well encapsulated, firm, and covered with normal skin. The lesion was completely excised, and the patient's symptoms resolved. No recurrence was detected at 2 years of follow-up.

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