Milan B. Jovanovic

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.

An exophytic localized lymphoma of the tongue base.

A58-year-old man presented to the ENT department with a growth in his throat. He complained only of a foreign-body sensation and mild dysphagia. Indirect laryngoscopy showed a firm, smooth, exophytic, and ovoid-shaped 5 4 3 cm mass of the left tongue base (Fig 1). There was no surface ulceration or lesion bleeding. A CT scan confirmed a large well-circumscribed mass within the left side of the tongue base (Fig 2). He had no hepatosplenomegaly and other lymphadenopathy. A bone marrow biopsy showed no evidence of a tumor. A biopsy was performed, and a final diagnosis of primary non-Hodgkin’s lymphoma, diffuse large-cell type, B-cell origin was established. The patient was submitted to radiotherapy.

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.

[Making a diagnosis of different lesions of vocal fold mucosa by contact endoscopy--the first usage in our clinical practice].

During laryngomicroscopy, the superficial layers of vocal fold epithelium can be examined in vivo and in situ by contact endoscopy. Methylene blue is applied initially to stain the epihelial cells of the vocal folds. When in contact with mucosal tissue, this endoscope provides 60 and 150 times magnification and clear visualization of cellular patterns of the superficial epithelial layers. For the first time in our laryngological clinical practice, we confirmed a number of previosly established parametars such as regularity and arrangement of the epithelium, nucleus contour, and nucleus-cytoplasm ratio, what all enable recognition and easy evaluation of different clinical conditions such as chronic laryngitis, Reinkes edema, papiloma dysplasia or vocal fold carcinoma. The advantage of contact endoscopy in vivo and in situ allows for detailed scan and mapping of all cell changes of the whole mucosa surface. All these features definitely classify the contact endoscopy into additional diagnostic methods in laryngology.

Giant funicular intrapharyngeal schwannoma

Schwannoma is a rare solitary tumor of Schwann cell origin. The Schwann cell surrounds peripheral nerve tissue and is believed to originate from neural crest. Surgery presents main treatment for patients with schwannoma.

Neoplastic, hiperplastic or ectopic meningothelial islands?: Case report and short review of the literature

The case of concomitant occurrence of schwannoma of the ethmoid sinus and meningothelial hyperplasia in female patient without neurofibromatosis-2 is presented. The components of Schwannoma tissue and meningothelial hyperplasia cells islets were confirmed by histopathological and immunohistochemical examinations. Transitional zones of these two different tissues macroscopically as well as microscopically were not observed. Histological and immunohistochemical findings and possible pathogenesis of this uncommon tumor combination is discussed.