Max L. Ronis

Presentation of the Internal Carotid Artery As a Tumor of the Middle Ear

Abstract The authors have encountered 3 cases in which the internal carotid artery presented as a tumor of the middle ear. All masses of the middle ear, especially pulsatile ones, should be investigated by arteriography prior to biopsy, and the location of the internal carotid artery in the carotid canal should be evaluated in relation to the middle ear. The use of the “vestibular line” may help in determining this relationship. Any vessel encroaching on this line should be viewed with extreme suspicion as possibly representing the middle ear mass.

Review of cyanoacrylate tissue glues with emphasis on their otorhinolaryngological applications

Cynnoacrylates were first synthesized by Ardis in 1949. However, it was not until Coover in 1959 discovered their adhesive properties that an interest arose in using these substances in surgical procedures.

Salicylate-induced changes in cat auditory nerve activity.

The purpose of this study was to measure, in the cat, spontaneous auditory nerve (AN) activity before and after injection with sodium salicylate. Ten cats were anesthetized, and the AN and round window (RW) were surgically exposed. Electrodes were applied to allow recording from three channels, including bipolar electrodes and monopolar electrodes located directly on the auditory nerve, in addition to an RW electrode. Spectral averaging of the spontaneous activity was performed before and during salicylate treatment. An increase in spectral activity near 200 Hz was noted in all cats by 3 hours after salicylate injection. This activity was present in bipolar, monopolar, and RW records, and was temporarily diminished or eliminated by injection of lidocaine. No such spectral changes were found in saline-injected control animals. These results show promise of developing a noninvasive, objective, quantitative measure of tinnitus for studies in animals and in man.

Once‐A‐Day therapy for sinusitis: A comparison study of cefixime and amoxicillin

The efficacy and safety of a once‐a‐day antibiotic in the treatment of sinusitis was studied. Two randomly assigned groups were treated with either once‐a‐day cefixime, a third generation cephalosporin, or amoxicillin three times a day.

Benign osteoblastoma of the temporal bone

We have described a benign osteoblastic lesion in the middle ear in a 13‐year‐old boy who presented with a gradual hearing loss in the right ear. The patient also described a beating or pulsating sensation in the right ear without other symptoms. The examination of the right ear revealed a mass lesion which occupied the medial portion of the canal and seemed to be arising from and in continuity with the posterior inferior wall of the external canal. The benign osteoblastoma rarely has malignant characteristics. Based on the experience of others, partial removal of the lesion was carried out by curettage preserving the integrity of the middle ear space and facial nerve. This is probably the first case report of such a lesion involving the temporal bone in the middle ear and we found it to be a most interesting and thought provoking lesion both by virtue of its presentation and management.

Synovial sarcoma of the cervical area

Synovial sarcoma is a malignant tumor which usually arises from the extremities. Involvement of the cervical area has been quite rare and to date only 12 cases have been reported. Two additional cases are reported in this paper and their management discussed. Case 1 is a 32‐year‐old white female with a submucosal mass of the right retromolar area displacing the tonsillar fossa and soft palate anteriorly. Surgical exploration revealed a well encapsulated mass separate from the parotid gland. Surgical excision was carried out on August 30, 1972. Pathological report was a synovial sarcoma. There has been no recurrence to date. Case 2 is a 34‐year‐old male with a 4 to 5 centimeter submandibular mass. Sialography and carotid arteriography were non‐contributory. Biopsy showed synovial sarcoma. On May 12, 1973, surgical excision of the mass was carried out with the ipsilateral attached greater corneal of the hyoid bone and right hypoglossal nerve which ran into the tumor. Postoperative X‐ray therapy was given. There is no recurrence to date. Discussion: Synovial sarcoma represents a type of mesenchymal tumor whose differention can mimic non‐neoplastic synovial membrane. Histologically the tumor contains two neoplastic cell types. These are described as the fibrosarcomatous element and the synovial element. The tumor usually has no true capsule and grows by expansion with adherance to surrounding structures. The rate of growth is slow but the long term prognosis is poor. Metastasis usually occurs via blood stream most commonly to the lungs. Regional lymph node metastasis occurs in areas outside of the head and neck but has not been recorded in synovial sarcoma of the head and neck to date. Surgical excision is agreed to be the mode of treatment. The value of X‐ray therapy is uncertain but Pack and Ariel were able to show their best results with a combination of surgical resection followed by postoperative X‐ray therapy. It has been suggested that synovial sarcoma of the head and neck may behave in a more benign manner than synovial sarcoma elsewhere. Long term follow‐up is not available in enough of the cervical sarcoma cases to determine if this is true. Until a more benign behavior is proven the tumor should be treated as an aggressive malignancy. Wide surgical excision is the treatment of choice. Postoperative X‐ray therapy should be considered.

The Tolosa-Hunt syndrome: a case report.

T h e Tolosa-Hunt syndrome (THS) consists of painful ophthalmoplegia caused by idiopathic chronic inflammation of the superior orbital fissure or cavernous sinus. The clinical picture of periorbital or hemicranial pain may include ipsilateral ocular motor nerve palsies, oculosympathetic paresis, and decreased sensation in the ophthalmic branch (V,) of the trigeminal nerve. Less commonly associated with this syndrome may be involvement of other cranial nerves, such as the maxillary (V,) or mandibular (V,) branches of the trigeminal nerve, the optic nerve, and the facial nerve. A historical perspective and illustrative case history are presented.

Progressive Mixed Type Hearing Loss in an Adult Male with Osteopetrosis

• Notably: • There are two case series in the Otolaryngology literature, but both are restricted to the infant and juvenile forms of the disease. • There is one large case series relating to the adulttype disease, but it is in the Orthopedics literature and only mentions hearing loss in passing. • There are two similar case reports in the international Otolaryngology literature relating to adulttype osteopetrosis and its otologic consequences.