Carlos B. Ruah

Cavernous haemangioma of the facial nerve.

Facial nerve haemangiomas are probably the most frequent benign tumours involving the facial nerve in its intratemporal portion. Usually facial nerve dysfunction is present when these tumours are of extremely small size, the average tumour being less than 10 mm. We present a case of a 15 mm diameter cavernous haemangioma of the geniculate region, with histological findings of nerve infiltration, without facial nerve symptoms. The atypical clinical presentation justifies the report and subsequent literature review.

Eustachian tube teratoma and its terminological correctness

Teratomas are germ cell tumours usually found in the young and are characteristically composed of tissue foreign to the place where they arise. Two teratomas of the middle ear were first described in 1866 and since then, and to the best of our knowledge, 19 additional cases have been reported in the literature under different terms such as hairy congenital polyps, epidermoid cysts, dermoid cysts, hamartoma, cutaneous teratoma and teratomas. The difficulty in classifying germ cell tumours may explain the different terminologies encountered in the literature. The authors describe a case of teratoma of the eustachian tube presenting as a mass in the middle and external ear of a 10-week-old girl. Using this case, a review of the literature is performed in light of the new classification of germ cell tumours proposed by the World Health Organization (WHO). It is of note that most of the teratomas that present in the middle ear arise from, or involve, the eustachian tube.

Normal and metastatic melanin in the temporal bone

PURPOSE Malignant melanoma is known to metastasize to the temporal bone. However, melanocytes exist in the normal inner ear and may be difficult to distinguish from metastatic melanotic cells. This study describes distribution of normal melanin in the ear and metastatic melanoma to the temporal bone. MATERIALS AND METHODS Normal melanin distribution is described in 48 temporal bones from White (18), Native-American (19), and African-American (11) individuals and metastatic melanoma to the temporal bone is described in four cases (seven temporal bones). Temporal bones were removed at autopsy, fixed in 10% buffered formalin, and processed for routine celloidin embedding. Sections were cut at a thickness of 20 microns and every tenth section was stained with hematoxylin-eosin for light microscopic evaluation. RESULTS Normal melanin was found in the inner ear, mainly around terminal neural structures and blood vessels, and occurred in greater quantities in African-American individuals. Metastatic melanotic cells reached the temporal bone by hematological dissemination, and by neural invasion from the central nervous system. No correlation was found between histopathological findings and clinical symptoms of patients. CONCLUSIONS Metastatic melanoma to the temporal bone may be seen in the same areas as normal melanin. They may also be observed in bone marrow cells of the petrous bone and along the course of nerves of the internal auditory canal and cochlear vestibular labyrinth, either by following neural sheaths or blood vessels that run along the nerve. Metastatic disease to the temporal bone is often asymptomatic, or it may present with uncharacteristic symptoms that may delay diagnosis.

Validation of the SVHI into Portuguese from Portugal

Objective: 1) Evaluate the validity of the translated and culturally adapted version of the Singing Voice Handicap Index (SVHI) into Portuguese from Portugal. 2) Add another language to the list of the translated versions of this widely used voice questionnaire for singers. Method: In a parallel group design, 50 singers with different laryngeal pathologies and 25 singers with no laryngeal pathology completed the Portuguese version of the SVHI. Internal consistency reliability, test-retest reliability and construct validity were assessed as well as group differences. Results: Statistical analyses demonstrated high internal consistency reliability (Cronbach Alpha r = 0.93), test-retest reliability (Spearman correlation = 0.84, P < .01,) and construct validity (Spearman correlation = 0.62, P < .01) values. The control group received significantly lower scores than the pathological group (P < .05). Conclusion: The Portuguese version of the SVHI was shown to be a reliable and valid measure of voice handicap among Portuguese singers and can be added to the list of translated versions of this widely accepted and originally created American English voice evaluation instrument.

Paediatric otoscopy—clinical and histological correlation

Otoscopy is a subjective clinical method. Its subjectively has led physicians to verify its accuracy through correlations with findings of otomicroscopy, pneumatic otoscopy, tympanometry, and myringotomy. In the very young population, however, the interpretation of otoscopic findings become more difficult. To improve the interpretation of normal otoscopy in young children, an otoscopic-histological correlation was attempted in children up to nine years of age. Twenty-one temporal bones from 15 children aged from two days to nine years who had no evidence of otological disease or congenital anomalies were examined under light microscopy; the thickness of the pars flaccida, posterior superior quadrant, and umbo were measured. Twenty-five eardrums of 15 healthy children without past or present history of otological disease were examined using otoscopy; a photograph of each eardrum was obtained. Our study demonstrates that structural changes in the tympanic membrane during these years of childhood have a good correlation with otoscopic findings. Understanding normal histological changes in the paediatric eardrum may improve our interpretation of otoscopic findings.

Silent (subclinical) otitis media

Pathological findings in temporal bones, and clinical studies, have indicated a significant and not uncommon incidence of silent chronic otitis media. Definitions of chronic otitis media, according to various international classifications and usual textbook definitions, include a history of perforation and otorrhea. Many children and adults may present with chronic intractably pathological tissue that can fill the middle ear cleft, including the mastoid, behind an intact membrane, and can cause complications not only in the middle ear but in the inner ear, to include sensorineural hearing loss as well as endolymphatic hydrops. This important entity will be discussed from the surgical point of view, on the basis of surgical pathological studies.