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Management of benign middle ear tumors: A series of 7 cases

November 3, 2017  |  Z. Jason Qian, MD; Amy M. Coffey, MD; Kathleen M. O'Toole, MD; Anil K. Lalwani, MD


Benign middle ear tumors represent a rare group of neoplasms that vary widely in their pathology, anatomy, and clinical findings. These factors have made it difficult to establish guidelines for the resection of such tumors. Here we present 7 unique cases of these rare and diverse tumors and draw from our experience to recommend optimal surgical management. Based on our experience, a postauricular incision is necessary in nearly all cases. Mastoidectomy is required for tumors that extend into the mastoid cavity. Whenever exposure or hemostasis is believed to be inadequate with simple mastoidectomy, canal-wall-down mastoidectomy should be performed. Finally, disarticulation of the ossicular chain greatly facilitates tumor excision and should be performed early in the procedure.

A novel etiology for pneumolabyrinth after temporal bone fracture without otic capsule involvement

November 3, 2017  |  Thomas J. Muelleman, MD; Vidur Bhalla, MD; Hinrich Staecker, MD, PhD


Pneumolabyrinth has been considered an indicator of otic capsule involvement in temporal bone fractures. We present a novel theory for the etiology of pneumolabyrinth in a trauma patient without an otic capsule fracture: passage of intrathecal air into the labyrinth. Our patient experienced transient bilateral pneumolabyrinth after head trauma due to a motor vehicle collision. The patient was noted to have extensive pneumocephalus and a unilateral temporal bone fracture that spared the otic capsule. Initial computed tomography (CT) scans demonstrated air in the cochlea and both internal auditory canals. A high-resolution CT scan 6 hours later showed resolution of this air. Pneumolabyrinth may not be a sensitive indicator of otic capsule involvement in temporal bone fractures. In addition to middle ear sources, air in the labyrinth can also plausibly originate intrathecally, especially in the setting of pneumocephalus.

A controlled comparison of auditory steady-state responses and pure-tone audiometry in patients with hearing loss

November 3, 2017  |  Raman Wadhera, MS; Sharad Hernot, MS; Sat Paul Gulati, MS; Vijay Kalra, MS


We performed a prospective interventional study to evaluate correlations between hearing thresholds determined by pure-tone audiometry (PTA) and auditory steady-state response (ASSR) testing in two types of patients with hearing loss and a control group of persons with normal hearing. The study was conducted on 240 ears-80 ears with conductive hearing loss, 80 ears with sensorineural hearing loss, and 80 normal-hearing ears. We found that mean threshold differences between PTA results and ASSR testing at different frequencies did not exceed 15 dB in any group. Using Pearson correlation coefficient calculations, we determined that the two responses correlated better in patients with sensorineural hearing loss than in those with conductive hearing loss. We conclude that measuring ASSRs can be an excellent complement to other diagnostic methods in determining hearing thresholds.

Laryngeal hemangioma presenting as a laryngocele

November 3, 2017  |  Kevin Shaigany, MD; Sidrah M. Ahmad, MD; Nausheen Jamal, MD

Laryngeal hemangiomas and laryngoceles share similar characteristics and should be considered in the differential diagnosis.

Endoscopic view of a drainage pathway of a concha bullosa

November 3, 2017  |  Eiji Yanagisawa, MD, FACS; Dewey A. Christmas, MD; Joseph P. Mirante, MD, MBA, FACS

A concha bullosa does not require surgical intervention unless it creates obstructive problems with respiration or functional drainage problems.

"Live" tinnitus

November 3, 2017  |  Chia-Chun Liu, MD; Ming-Yee Lin, MD

Insects should be killed before removal with instrumentation, irrigation, or suction.

Myopericytoma of the neck originating in the middle scalene muscle: A case report

November 3, 2017  |  Mark B. Chaskes, MD, MBA; John W. Bishop, MD; Matthew Bobinski, MD, PhD; D. Gregory Farwell, MD


We report a case of myopericytoma of the neck. A 23-year-old woman noticed a small, nontender mass in her left supraclavicular fossa. The mass had grown over a period of 5 months, prompting her to seek evaluation. On examination, no motor or sensory deficits were present. Imaging suggested that a mass had originated in the middle scalene muscle. Computed-tomography-guided core needle biopsy demonstrated a spindle-cell neoplasm with smooth-muscle differentiation. Complete surgical excision was performed. Histopathologic and immunohistochemical evaluations of the tissue sample suggested a myopericytoma. Myopericytoma is an extremely rare tumor of the head and neck. To the best of our knowledge, this is the first reported case of a myopericytoma originating in a scalene muscle.

Clinical application of nasometry in patients with nasal obstruction

November 3, 2017  |  Georges Ziade, MD; Maher Kasti, MD; Doja Sarieddine, BS; Zein Saadeddine, BS; Abdul-Latif Hamdan, MD


The purpose of this case-control study is to report on the clinical application of nasometry as a diagnostic tool in patients with the symptom of nasal obstruction compared with subjects with no history of nasal obstruction. Thirty-eight adult patients (mean age: 28.1 years) complaining of nasal obstruction were enrolled in the study, and another group of 38 adults (mean age: 25.9 years) with no history of nasal obstruction served as controls. Demographic data, including age and sex, were collected. Patients were asked to read three passages; the Zoo passage, the Rainbow passage, and nasal sentences. Nasalance scores were reported on all subjects using a Nasometer II instrument. The control and patient groups each included 22 men and 16 women. No statistically significant difference in nasalance score was found between the study group and the control group in any of the Zoo passage, Rainbow passage and nasal sentences. We conclude that nasometry has limited value in the objective assessment of nasal obstruction as a symptom, which we attribute to nasal obstruction's not always reflecting the volume and pressure in the nasal cavity.

Guidelines for radiographic imaging of cranial neuropathies

November 3, 2017  |  Aliasgher Khaku, BS; Vijay Patel, BS; Thomas Zacharia, MD; David Goldenberg, MD; Johnathan McGinn, MD


Disruption of the complex pathways of the 12 cranial nerves can occur at any site along their course, and many, varied pathologic processes may initially manifest as dysfunction and neuropathy. Radiographic imaging (computed topography or magnetic resonance imaging) is frequently used to evaluate cranial neuropathies; however, indications for imaging and imaging method of choice vary considerably between the cranial nerves. The purpose of this review is to provide an analysis of the diagnostic yield and the most clinically appropriate means to evaluate cranial neuropathies using radiographic imaging. Using the PubMed MEDLINE NCBI database, a total of 49,079 articles' results were retrieved on September 20, 2014. Scholarly articles that discuss the etiology, incidence, and use of imaging in the context of evaluation and diagnostic yield of the 12 cranial nerves were evaluated for the purposes of this review. We combined primary research, guidelines, and best practice recommendations to create a practical framework for the radiographic evaluation of cranial neuropathies.

Nasal septum granuloma gravidarum

November 3, 2017  |  Daniel Thomas Ginat, MD, MS; Charles J. Schatz, MD, FACR

Granuloma gravidarum lesions tend to be highly vascular and demonstrate avid enhancement, but they do not have large draining veins.