Dragan Dankuc

Unilateral tinnitus as a single symptom of unusually large vestibular schwannoma

Introduction. Vestibular schwannomas are relatively rare tumors whose symptoms are based on its location and as the tumor grows, the symptoms usually advance. Case Report. An 18-year old patient was examined by an otolaryngologist due to buzzing in her right ear that had lasted for about 1 month. Her pure-tone audiometry findings showed slight asymmetry; a slight ascendant type sensorineural hearing loss was found in the right ear (25 dB HL at 125 Hz, 20 dB HL at 250 Hz, and 10 dB HL at other frequencies), while the threshold in the left ear was 15 dBHL at 125 Hz and 10 dB HL at other frequencies. Electronystagmography, otoacoustic emissions and auditory brain-stem responses suggested retrocochlear etiology of tinnitus. Magnetic resonance imaging examination revealed a large right cerebellopontine angle tumor, measuring 5 x 3 x 3 cm, which had shifted the brain stem laterally. Conclusion. Every case of unilateral tinnitus, asymmetric sensorineural hearing loss, or hypotonia of labyrinth not strictly accompanied by vertigo, needs to be further evaluated using a battery of audiologic tests whose findings may be normal. Audiologic tests should be repeated in cases of persistent symptoms and accompanied by cranial magnetic resonance imaging, which is today considered the gold standard for diagnosis of vestibular schwannoma.

Mastoiditis in children: A retrospective analysis of clinical characteristics

Introduction. Acute mastoiditis is the most common otogenic complication among infants and young children and is always considered a serious complication. In addition to determining the age at which mastoiditis usually occurred in children, the time of onset of clinical signs in relation to the onset of symptoms of middle ear inflammation, as well as the most common clinical signs of mastoiditis, the study has been aimed at finding out whether mastoiditis is of seasonal character. Material and Methods. A retrospective study of children surgically treated for mastoiditis was conducted at the Department of Ear, Nose and Throat Disease of the Clinical Center of Vojvodina in Novi Sad in the period January 1, 2002 - December 31, 2011. The sample included 56 children (30 boys - 53.57%, and 26 girls - 46.42%), up to 17 years of age. The obtained results were statistically analyzed and presented using Microfsot EXCEL for statistical analysis. Results. Mastoiditis is most common in children up to 2 years of age, 39/56 (69.82%). It has a seasonal character, with the peak season in the autumn-winter period, with a statistically significant difference compared to the spring-summer period (p = 0.0449, i.e. p<0.05). In 25 children (44.64%), the middle ear symptoms lasted up to three weeks before operation. Otomicroscopic findings showed that the tympanic membrane was thickened and stiff in 41 children (73.21%) and 9 children (16.07%) presented with thickened tympanic membrane and lowering of the posterior wall of the external auditory canal. Conclusion. Mastoiditis in children is most common among children up to 24 months of age. It has a seasonal tendency. In nearly half of the cases, clinical manifestations of mastoiditis appear 3 weeks after the onset of the first symptoms of middle ear inflammation, whereas the key otomicroscopic finding is stiffness and thickening of the tympanic membrane.

Hemangiomas of the external auditory canal:a literature review and two new case reports

AimThe aim of this paper is to present two case reports of patients with hemangiomas of the external auditory canal, and to overview all cases published in English language literature so far.MethodsTwo patients with hemangiomas of the external auditory canal have undergone clinical and morphofunctional examination, surgical procedures, histopathological examination, and postoperative follow up.ResultsIn a 38-year-old female patient transmeatal approach was used to remove the cavernous hemangioma of the external auditory canal. The postoperative period was eventless, with normal morphofunctional findings during a 5-month postoperative follow-up period. In the second patient, a 68-year-old female, a capillary-cavernous hemangioma was removed using retroauricular approach.ConclusionCavernous hemangiomas are rare lesions of the external auditory canal. In the morphological diagnosis, computed tomography of the temporal bones is the leading diagnostic procedure, along with otoendoscopy and endocranial magnetic resonance imaging which are important in evaluation of the spread of the lesion. Biopsy of vascular lesions is not recommended. Complete surgical excision of hemangioma of the external auditory canal is the therapy of choice with a minor risk of hearing impairment.