Otology

Eosinophilic otitis media

February 12, 2014     Alejandro Vazquez, MD; Danielle M. Blake, BA; and Robert W. Jyung, MD
article

Eosinophilic otitis media is refractory to conventional therapy for otitis media and may lead to severe hearing impairment if not recognized promptly.

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.

A case of direct intracranial extension of tuberculous otitis media

February 12, 2014     Dong-Kee Kim, MD; Shi-Nae Park, MD, PhD; Kyung-Ho Park, MD, PhD; and Sang Won Yeo, MD, PhD
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Abstract

We describe a very rare case of tuberculous otitis media (TOM) with direct intracranial extension. The patient was a 55-year-old man who presented to our ENT clinic for evaluation of severe headaches and right-sided otorrhea. A biopsy of granulation tissue obtained from the right external auditory canal demonstrated chronic inflammation that was suggestive of mycobacterial infection. Magnetic resonance imaging of the brain indicated intracranial extension of TOM through a destroyed tegmen mastoideum. After 2 months of antituberculous medication, the headaches and otorrhea were controlled, and the swelling in the external ear canal subsided greatly. Rarely does TOM spread intracranially. In most such cases, intracranial extension of tuberculosis occurs as the result of hematogenous or lymphogenous spread. In rare cases, direct spread through destroyed bone can occur, as it did in our patient.

Recurrent auricular perichondritis in a child as the initial manifestation of insulin-dependent diabetes mellitus: A case report

February 12, 2014     Andria M. Caruso, MD; Macario Camacho Jr., MD; and Scott Brietzke, MD
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Abstract

An 8-year-old boy presented to our otolaryngology clinic three times in a 3-month period for treatment of acute auricular perichondritis. At each visit he was treated with an antibiotic, and he responded quickly in each case, with a complete resolution of his infection. The results of standard autoimmune laboratory tests were negative. Three months after his initial presentation, the patient developed the classic signs and symptoms of diabetes mellitus, including polydipsia, polyuria, and weight loss. He was diagnosed with and treated for type 1 (insulin-dependent) diabetes, and his recurrent infections ceased. There has been no recurrence over a 4-year follow-up period. This case report serves to illustrate the fact that recurrent infections may be the first sign of diabetes. Since diabetes and perichondritis are known to be associated, we recommend that for patients who present with recurrent episodes of perichondritis, a basic metabolic panel and measurement of the glycosylated hemoglobin level be added to standard autoimmune laboratory testing to possibly identify undiagnosed diabetes.

Nonmicroscopic reconstruction of subtotally amputated/torn auricles: Report of 3 cases

February 12, 2014     Shuaib K. Aremu, FWACS
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Abstract

Otolaryngologists are increasingly expected to perform a variety of minor surgical procedures in both elective and emergency situations. Surgical repair of the subtotally amputated/torn auricle, hitherto the realm of plastic surgeons, is a procedure that can be performed both at the clinic and in the emergency room, thereby sparing patients the inconvenience and cost of referral to another subspecialist. Presented in this article are 3 cases of traumatic tearing/amputation of the external ear: 1 caused by a motorbike accident, 1 caused by a human bite, and 1 by a machete. All three ears were successfully reconstructed nonmicrovascularly.

Temporal bone fracture

January 21, 2014     Danielle M. Blake, BA; Senja Tomovic, MD; Robert W. Jyung, MD
article

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
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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.

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.

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.

Medial migration of a tympanostomy tube

December 20, 2013     Alejandro Vazquez, MD; Robert W. Jyung, MD
article

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
article

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.

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
article

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.

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