Otology

Delayed recovery of speech discrimination after fractionated stereotactic radiotherapy for vestibular schwannoma in neurofibromatosis 2

February 12, 2014     Michael Hoa, MD; Eric P. Wilkinson, MD; and William H. Slattery III, MD
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Abstract

Hearing loss commonly occurs after radiation therapy for an acoustic neuroma, and it is highly unusual for hearing to return after a prolonged period of time. We report the case of a 12-year-old boy with neurofibromatosis 2 who underwent fractionated stereotactic radiotherapy for the treatment of a left-sided vestibular schwannoma. Following treatment, he demonstrated an elevation of pure-tone audiometric thresholds and a sudden decrease in speech discrimination score (SDS) to 0%. However, 20 months postoperatively, his SDS suddenly and spontaneously rose to 92%, although there was no improvement in his speech reception threshold. We discuss the possible reasons for the unusual outcome in this patient.

Temporal bone fracture

January 21, 2014     Danielle M. Blake, BA; Senja Tomovic, MD; Robert W. Jyung, MD
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Transverse fractures account for approximately 20% of temporal bone fractures. They occur secondary to frontal or occipital head trauma, and they run perpendicular to the petrous pyramid.

Basaloid squamous cell carcinoma of the pinna: Report of a rare case

January 21, 2014     Anil Jain, MS; Ashish Katarkar, MS; Pankaj Shah, MS; Jignasa Bhalodia, MD; Sanyogita Jain, MD; Sapna Katarkar, DA
article

Abstract

Basaloid squamous cell carcinoma (BSCC) is rare. We report a case of BSCC in a 60-year-old woman who presented with a bleeding vascular growth on the left pinna. To the best of our knowledge, no case of BSCC of the pinna has been previously reported in the literature. We present this case to alert physicians that this highly aggressive variant of squamous cell carcinoma can appear on the pinna and therefore it should be considered in the differential diagnosis of lesions in this area.

Case report: Dermal inclusion cyst of the external auditory canal

December 20, 2013     Eric W. Cerrati, MD; Jonathan S. Kulbersh, MD; Paul R. Lambert, MD
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Abstract

Dermal inclusion cysts are benign masses that arise as the result of the entrapment of ectodermal components during embryogenesis. Their presenting symptoms are a direct result of the mass effect of the growing cyst. We describe the case of a 23-month-old girl who presented with a single, large dermal inclusion cyst in the external auditory canal. Our review of the literature revealed that only 2 other cases of a dermal inclusion cyst in this location have been previously reported.

Medial migration of a tympanostomy tube

December 20, 2013     Alejandro Vazquez, MD; Robert W. Jyung, MD
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Glial choristoma of the middle ear

December 20, 2013     Karen A. Shemanski, DO; Spencer E. Voth, DO; Lana B. Patitucci, DO; Yuxiang Ma, MD, PhD; Nikolay Popnikolov, MD, PhD; Christos D. Katsetos, MD, PhD; Robert T. Sataloff, MD, DMA, FACS
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Abstract

Glial choristomas are isolated masses of mature brain tissue that are found outside the spinal cord or cranial cavity. These masses are rare, especially in the middle ear. We describe the case of an 81-year-old man who presented with left-sided chronic otitis media, mastoiditis, hearing loss, tinnitus, and aural fullness. He was found to have a glial choristoma of the middle ear on the left. Otologic surgeons should be aware of the possibility of finding such a mass in the middle ear and be familiar with the differences in treatment between glial choristomas and the more common encephaloceles.

Vertebral artery dissection: An unusual cause of transient ataxia, vertigo, and sensorineural hearing loss

December 20, 2013     Leila L. Touil, MBChB; Glen James Watson, FRCS, DOHNS; Michael Small, FRCS
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Abstract

We present the case of a 33-year-old man who was admitted with intermittent ataxia, vertigo, and sensorineural hearing loss as a result of a vertebral artery dissection following minor neck trauma. Our aim is to highlight the importance of obtaining magnetic resonance imaging, magnetic resonance angiography, and/or duplex color-flow imaging when presented with a case of fluctuating vertigo and sensorineural hearing loss with side-specific ataxia. Likewise, it is important to obtain the input of neurologists to optimize a patient's prognosis and minimize long-term sequelae.

Bilateral middle cranial fossa encephaloceles presenting as conductive hearing loss

December 20, 2013     Colleen T. Plein, MD; Alexander J. Langerman, MD; Miriam I. Redleaf, MD
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Abstract

We report a case involving a patient with bilateral middle cranial fossa encephaloceles extending into the middle ear and causing conductive hearing loss. An obese, 47-year-old woman with a history of a seizure disorder presented with a slow-onset subjective hearing loss. Examination revealed opaque tympanic membranes, and audiometry showed a mixed hearing loss bilaterally. Myringotomy demonstrated soft tissue behind each tympanic membrane. Biopsy, computed tomography, magnetic resonance imaging, and mastoidectomy confirmed the diagnosis of bilateral middle cranial fossa encephaloceles. Bilateral encephaloceles are uncommon, and the resulting bilateral conductive hearing loss secondary to mechanical obstruction of ossicular vibration is even more rare. This patient's obesity and seizures perhaps contributed to her disease process.

Dehiscence of the high jugular bulb

October 23, 2013     Min-Tsan Shu, MD; Yu-Chun Chen, MD; Cheng-Chien Yang, MD; Kang-Chao Wu, MD
article

The conservative treatment for a high jugular bulb is regular follow-up with serial imaging studies to detect possible progression, even in asymptomatic cases.

Immunization guidelines for cochlear implant recipients

October 23, 2013     Barry E. Hirsch, MD
article

Patients who have a cochlear implant are considered to be at a higher risk of developing meningitis following otitis media. Whether this occurs along the electrode going from the middle ear into the cochlea or through a blood-borne pathway is unclear.

Extrusion of hydroxyapatite ossicular prosthesis

October 23, 2013     Danielle M. Blake, BA; Senja Tomovic, MD; Robert W. Jyung, MD
article

Extrusion of hydroxyapatite prostheses is unfortunately a common complication of middle ear surgery.

Medial canal fibrosis

September 18, 2013     Joseph A. Ursick, MD; John W. House, MD
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Medial canal fibrosis is an uncommon condition characterized by progressive stenosis of the bony external auditory canal.

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