Ljiljana Cvorovic

Prognostic model for predicting hearing recovery in idiopathic sudden sensorineural hearing loss.

Hypothesis: To aid in realistic counseling of patients at the time of their first visit concerning their chances for recovery, we created a simple prognostic model for predicting hearing recovery in idiopathic sudden sensorineural hearing loss (ISSHL). Background: An important element of research on ISSHL is to identify prognostic factors for this disease. Many studies have described predictive indicators to identify patients with a good prognosis needing no or minimal treatment. Only a few of these studies have included a model for calculating the probability for patient recovery, which may be important for clinical work, but these prognostic tables have not achieved widespread use clinically. Methods: Evaluation of an electronic patient data base of 541 patients with ISSHL. The standard treatment was carbogen inhalation (95% O2 and 5% CO2 8 times per day in duration of 30 min) and prednisone orally (100 mg in 1 morning dose) for 7 days. Factors that were analyzed included the patients age, the interval between the onset of symptoms and beginning of treatment, the presence or absence of vertigo and tinnitus, audiometric patterns, the severity of hearing loss, and hearing in the opposite ear. Hearing gain was expressed either as absolute hearing gain or as relative hearing gain. Significant recovery of hearing was defined as the final pure-tone audiometry of 30 dB or less (or the same as the pure-tone audiometry of the opposite ear). Results The absolute hearing gain was 15.1 dB. The mean relative hearing gain was 47%. Three hundred one (57%) patients had significant recovery of hearing, and 228 (43%) did not have significant recovery of hearing. Using step-wise multiple linear regression analysis, the most important factors for prognosis included severity of hearing loss, presence of vertigo, time between onset and treatment, the hearing of the other ear, and the audiogram shape (&bgr; coefficient was −0.216, −0.231, 0.211, 0.113, and −0.064, respectively; constant, 0.968). A recovery expectancy table was developed using the data from this study. Conclusion: Based on a retrospective analysis, prognostic indicators for hearing recovery in ISSHL were found to be severity of hearing loss, presence of vertigo, time between onset and treatment, the hearing of the other ear, and the audiogram shape. We created a model for calculating the probability for hearing recovery based on the analysis of 529 patients with unilateral ISSHL.

Randomized prospective trial of hyperbaric oxygen therapy and intratympanic steroid injection as salvage treatment of sudden sensorineural hearing loss.

Objective To compare the effects of hyperbaric oxygen (HBO) and intratympanic (IT) steroid injection on hearing after the failure of primary treatment in patients with idiopathic sudden sensorineural hearing loss (ISSHL). Study Design A prospective randomized trial. Setting Tertiary referral center. Patients Fifty patients with failure of primary therapy for ISSHL. Intervention(s) After primary treatment with systemic steroids and failure of therapy, defined as less than 10-dB hearing gain, 50 patients were enrolled in the study and received either hyperbaric oxygen or intratympanic steroid treatment. The patients were not matched and not similar. Main Outcome Measure(s) Hearing gain at 0.25, 0.5, 1, 2, and 4 kHz after treatment. Results There were significant differences between hearing thresholds at all frequencies before and after the HBO treatment. Similarly, there were significant differences between hearing thresholds at most frequencies (except 2 kHz) before and after the treatment in the IT group. The subgroups of patients with pure tone average less than 81 dB and were younger than 60 years had better response to HBO treatment than those with profound deafness and in the elderly. Conclusion HBO and IT steroid therapy could be successfully used as salvage therapies in patients with sudden deafness. Further study is needed to demonstrate superiority of one of the treatments.

Trichinella spiralis and laryngeal carcinoma: a case report

An uncommon presentation of Trichinella spiralis with squamous cell carcinoma of the larynx is reported. The possible carcinogenic potential of trichinosis and its management are discussed.

Unusual presentation of nodular fasciitis as a rapidly growing haemorrhagic temporal mass

Nodular fasciitis (NF), also called proliferative or infiltrative fasciitis is considered to be a benign reactive process of the soft tissues (subcutaneous tissue, muscle or fascia) rather than a true neoplasm. Although the extremities are the most common sites, it may arise anywhere in the body. Local excision presents the main treatment. This study presents a case of NF with a unique clinical presentation, an acute subcutaneous temporal hemorrhagic growth. Because temporal NF is more often dermally situated than NF involving other anatomic sites, it may present with superficial ulceration or bleeding and appear clinically unusual. Nodular fasciitis should be considered in the differential diagnosis of other benign or malignant tissue masses involving the temporal area.

Giant Destructive Congenital Mastoid Cholesteatoma with Minimal Clinical Presentation

Congenital cholesteatoma (CC) is an epidermoid cyst arising from the squamous epithelial rest in the temporal bone. The reported sites of origin within the temporal bone include the middle ear, petrous apex, and external auditory canal, and the rarest is the mastoid process. CC is a benign, slowly progressive, non-self-limiting, very expansive and destructive mass. Usually, patients with CC of the mastoid region have dizziness and neck pain. We report the case of a patient with giant, extensive congenital cholesteatoma of mastoid origin with minimal clinical presentation.

The facial palsy as first symptom of the temporal bone lung cancer metastasis.

Lung cancer usually spreads by lymphatic or hematogenous route; around one fifth of newly diagnosed lung adenocarcinomas present with distant metastases in organs such as brain, adrenal glands, liver and bones.1 However, lung cancer metastases in the temporal bone are quite rare, and as such, present substantial diagnostic challenge. Clinical manifestations of metastatic disease in the temporal bone are usually obscure and may include symptoms such as hearing loss, tinnitus, vertigo, facial palsy, otalgia, otorrhea and headache. The occurrence of an osteolytic lesion in the temporal bone (even in the absence of a known primary tumor) should always be considered as a possible metastasis, especially in elderly patients. The authors present a rare case

Risk factors for Recurrent otitis media with effusion

Background : Tonsillectomy is the intervention to take out the palatine tonsils either whole or sub capsular, while adenoidectomy is the intervention of extraction of the adenoid gland which is commonly done with curettage method. Both interventions are done to eliminate repeated infections and also obstructions due to inflammation and hypertrophy of the tonsils and adenoids. This study was conducted to examine the indications of tonsillectomy and adenoidectomy in the Departement of Otorhinolaryngology and Head Neck Surgery Dr. Hasan Sadikin General Hospital Bandung in the period of January 2009–December 2011. Methods : A cross-sectional descriptive study was conducted in October–November of 2012 using 207 medical records of patients who had tonsillectomy and adenoidectomy executed in the Department of Otorhinolaryngology and Head Neck Surgery Dr. Hasan Sadikin General Hospital, Bandung in the period of January 2009–December 2011. Data collected were age, gender, main complaint, tonsil size, history of repeated infections, history of snoring as well as of Obstructive Sleep Apnea Syndrome (OSAS). The indication for tonsillectomy and adenoidectomy such as infection, obstruction and neoplasia was selected. Results : The indications of tonsillectomy and adenoidectomy were infection at 106 (51.2%) patients, obstruction at 100 (48.3%) patients, and neoplasia at 1 (0.05%) patient. Conclusions : The most numerous indications for tonsillectomy and tonsilloadenoidectomy in the Department of Otorhinolaryngology and Head Neck Surgery Dr. Hasan Sadikin General Hospital were infection. Keywords : Adenoid, adenoidectomy, indication, tonsil, tonsillectomy DOI : 10.15850/amj.v2n1.447Rhinoscleroma (RS) is a chronic specific disease of nose and upper respiratory passages caused by Klebsiella rhinoscleromatis bacilli. It is endemic in Egypt and in sporadic areas worldwide. Diagnosis of RS depends on identification of the pathognomonic Mickulicz cells (MCs) which is most prominent during granulomatous phase but spares or absent during catarrhal or sclerotic phases of the disease. This study aimed to identify the potential diagnostic features of nasal RS when MCs are absent. Nasal biopsies from 125 patients complaining of chronic nasal symptoms were retrieved for this study; including 72 chronic non specific inflammatory lesions and 53 RS diagnosed by PAS and Geimsa stains. The detailed histological differences among the two groups were measured statistically. RS was frequently a bilateral disease (P < 0.05) of young age (P < 0.001) with a female predominance (P < 0.05) and usually associated with nasal crustations (P < 0.001). Five strong histological indicators of RS were specified by univariate binary logistic regression analyses including squamous metaplasia (OR 27.2, P < 0.0001), dominance of plasma cells (OR 12.75, P < 0.0001), Russell bodies (OR 8.83, P < 0.0001), neutrophiles (OR 3.7, P < 0.001) and absence of oesinophiles (OR 12.0, P < 0.0001). According to Multivariate analysis, the diagnostic features of RS in absence of MCs can be classified into major criteria including dominance of plasma cells infiltration and absence of oesinophiles and minor criteria including young age, female gender, bilateral nasal involvement, nasal crustation, squamous metaplasia, Russell bodies, and neutrophiles. The diagnostic model using the two major criteria confirmed or excluded RS in 84.3% of the investigated cases.O the past decade, the role of endoscopic techniques in the excision of sinonasal neoplastic lesions has become widely recognized. One of these techniques that are widely implemented is endoscopic medial maxillectomy. In this presentation, a case series of 45 patients who underwent endoscopic medial maxillectomy is presented. The technical details, complications are outlined. It is concluded that endoscopic medial maxillectomy is an effective technique for benign and low grade malignant lesions arising from the medial part of the maxillary sinus.T carcinoma is the commonest primary endocrine-related malignancy. Despite this, the cancer-specific mortality remains low with an overall 10-year survival above 90%.With a diagnosis of papillary carcinoma, 40% to 60% of patients will develop nodal metastasis. Recurrent disease after curative treatment of DTC remains a major cause of patient morbidity and represents a management challenge for clinicians.There is considerable debate regarding elective nodal dissection in patients with well-differentiated thyroid carcinoma. Actually is one of the most controversial surgical subjects in head and neck malignancy in the recent times.T auditory system has a remarkable ability to modulate its activity relative to the acoustic environment, as a part of adaptation and survival. This is possible through the effective feedback mechanism involving two parallel auditory pathways, ascending and descending, which interact with a complex neuro-endocrine network. There is a physiological basis for the influence of hormones on auditory function, including stress-related hormones, the hormones of the circadian cycle and reproductive hormones. The ovarian steroids (oestrogen and progesterone) can modulate auditory function directly through the oestrogen receptors in the cochlea, as well as through the steroid receptors at different levels of the auditory system. There are also infinite possibilities for indirect effects of reproductive hormones on hearing. The research data on physiological variations in auditory function related to hormones, including oestrogen and progesterone, will be presented.Results: Patient presented with a 1 year history of a gradually enlarging left lateral neck mass accompanied by cough, hoarseness, weight loss and intermittent fever. Tuberculosis work-up was negative and was ruled out. Nasal endoscopy revealed a nasopharyngeal mass. Ultrasound of the neck was consistent with an evolving follicular neoplasm and fine needle aspiration biopsy was inconclusive. Due to risk factors in the patient’s profile, total thyroidectomy with bilateral selective neck dissection and nasopharyngeal biopsy were done. Final histopathology results were consistent with a tuberculous process. Patient was then started on anti-Koch’s regimen.O cancer cavity (OCC) is associated with high incidence of loco-regional recurrences, which account for the majority of treatment failures post-surgery and radiotherapy. The time-course of relapse manifestation and metastasis are unpredictable. Relapsed OCC represents a major clinical challenge in part due to their aggressive and invasive behaviors. Chemotherapy remains the only option for advanced OCC whenever salvage surgery or re-irradiation is not feasible, but its efficacy is limited as a result of the drug resistance development. Alternatives to use of different permutations of standard cytotoxic drugs or combinations with modulators of drug resistance have led to incremental therapeutic benefits. The introduction of targeted agents and biologics against selective targets that drive cancer progression has opened-up optimism to achieve superior therapeutic activity and overcome drug resistance because, unlike the non-selective cytotoxic, the target can be monitored at molecular levels to identify patients who can benefit from the drug. This presentation will discuss the multifactorial aspects of clinical drug resistance and emerging therapeutic approaches in recurrent OCC, emphasizing recent advances in targeted therapies, immunotherapy, and potential relevance of new concepts such as epithelial-mesenchymal transition and cancer stem cell hypothesis to drug resistance.

OTOLOGICAL MANIFESTATIONS OF TURNER SYNDROME: CLINICAL AND RADIOLOGICAL FINDINGS.

INTRODUCTION Turner syndrome is a chromosomal abnormality where all or a part of one of the X chromosomes is absent or it has other abnormalities. Besides characteristic abnormalities of short stature and infertility, women with Turner syndrome have increased risks for tumors of the central nervous system, especially meningioma and an otologic disease. Meningioma involving the middle ear is extremely rare, and this condition has never been published in association with Turner syndrome. CASE REPORT We present an otologic manifestation associated with other abnormalities in a patient with Turner syndrome and discuss diagnosis and possible treatment options. CONCLUSION Multidisciplinary team approach is essential in these patients in order to evaluate their vulnerability and define therapeutic priorities.