Natasha Pollak

Schwannoma of the hard palate

Schwannomas are rare, benign neoplasms that can arise from any cranial, peripheral, or autonomic nerve that contains Schwann cells. Approximately 25% to 45% of all schwannomas occur in the head and neck. They occur most commonly in the eighth cranial nerve, but it has been reported that 20% to 58% arise in the oral cavity, with approximately 10% of these located on the hard palate. We report a case of schwannoma of the hard palate, present important pathologic considerations for diagnosis, and provide a review of the literature regarding extracranial schwannomas.

Management of inflammatory pseudotumor of the larynx.

A 33-year-old woman presented to Otolaryngology clinic with a 2to 3-month history of globus sensation, and progressive shortness of breath that evolved into stridor. Direct laryngoscopy and tracheoscopy was carried out, showing a large left subglottic polypoid lesion extending 2 cm below the true vocal cords that occluded 80% of the subglottic airway, and which exerted a “ball and valve” effect. A computed tomography (CT) showed a 12 13 mm mass in the subglottis (Fig 1). Tracheostomy as well as biopsy was carried out. The patient was started on 60 mg of prednisone daily for 6 weeks. The patient’s symptoms recurred and follow-up CT showed 11 6 12 mm subglottic mass. Radiation therapy was commenced 3 months after initial presentation. 20 Gy in 10 fractions was administered. Three months later, patient returned with stridor and direct laryngoscopy and tracheoscopy showed a persistent 1 cm mass in the subglottis. Biopsy of this mass was consistent with inflammatory pseudotumor. Open exci-

Episodic painful parotid swelling caused by sialodochitis with eosinophilic inflammation: a new entity.

Management of recurring parotid gland swelling is challenging because it presents in such a wide variety of disorders in all age groups. Chronic parotitis occurs mostly in middle age and is characterized by episodes of swelling, discomfort, and inflammation separated by variable periods in which the glands seem normal. Characteristically, an episode crescendos over one to three days and persists for several days, which is the time sequence for an acute infectious disease. However, some episodes last only hours and others span weeks. Most authors have clumped cases together in their series, but numerous entities undoubtedly exist within the clumps. We present a case of chronic parotitis that is unique in clinical and histologic features. A 34-year-old woman complained of gradually worsening episodic parotitis of two years duration unresponsive to antibiotics or systemic steroids. These almost-daily episodes were rapid in onset and resolution, over six to 12 hours, with symptoms of severe pain, parotid swelling, tenderness, and occasional angioedema of her cheek and eyelid. Either gland might be involved, but generally the attacks were unilateral and most frequently involved the right parotid gland. Massage of the gland expressed thick mucus from Stensen’s duct, which was swollen, firm, and exquisitely tender during the attacks. Between the episodes physical examination was essentially normal. The severity and frequency of these attacks were unresponsive to antibiotics, antihistamines, and a steroid burst. A prolonged course of steroids was tried as well, without improvement. Work-up for the known causes of parotitis was negative. A CT scan showed the parotid glands to be symmetrically hyperdense, mildly enlarged, and without calculi. Sialography showed a dilated Stensen’s duct with areas of constriction. Cytologic examination of the mucus expressed from the gland showed numerous squamous and glandular cells without atypia. SS-A and SS-B were negative; rheumatoid factor was less than 15; erythrocyte sedimentation rate was

Endometrioid Adenocarcinoma Metastatic to the Thyroid, Presenting Like Anaplastic Thyroid Cancer

Metastasis of uterine cancer to the head and neck is extremely rare. We report what we believe to be the first documented case of endometrioid adenocarcinoma metastasizing to the thyroid gland. An 80-year-old woman was referred to the otolaryngology service with a rapidly growing neck mass. The mass appeared to originate from the thyroid gland. Her clinical presentation was consistent with anaplastic thyroid carcinoma. A tracheostomy was performed. An open biopsy established the diagnosis of moderately differentiated adenocarcinoma, consistent with a gynecologic primary. The patient had undergone a hysterectomy 5 years prior for endometrioid adenocarcinoma. The thyroid tumor histology and immunophenotype corresponded well with her prior endometrial carcinoma, indicating that the thyroid mass was a metastasis from the endometrial primary. Radiotherapy appears to offer good local disease control in this rare case of endometrioid adenocarcinoma metastatic to the thyroid.

Blue Ear Cyst: A Rare Eccrine Hidrocystoma of the Ear Canal and Successful Endoscopic Excision

Aims. Hidrocystomas are benign cystic growths of the apocrine and eccrine sweat glands. These cystic lesions have been well documented on the face, head, and neck, but rarely in the external auditory canal. Presentation of Case. A 67-year-old woman presented with a bluish cystic mass partially occluding the external auditory canal and interfering with hearing aid use. Lesion was excised completely via a transcanal endoscopic approach with excellent cosmetic results, no canal stenosis, and no recurrence at 1-year follow-up. Discussion. We present a rare eccrine hidrocystoma of the external auditory canal and successful excision of this benign lesion. We describe the surgical management using a transcanal endoscopic approach and follow-up results. An eccrine gland cyst that presents as a mass occluding the external auditory canal is quite rare. There are only a few such cases reported in the literature. These masses can be mistaken for basal cell carcinomas or cholesterol granulomas but can be easily differentiated using histopathology. Conclusion. Eccrine hidrocystoma is a cystic lesion of sweat glands, rarely found in the external auditory canal. A characteristic bluish hue aids in diagnosis and surgical excision using ear endoscopy provides excellent control.

Managing Cochlear Implant Complications

Program Description: This miniseminar is designed for otolaryngologists who include cochlear implants in the scope of their practice and would like to learn more about managing various intraoperative and postoperative complications, and special considerations as they inevitably arise. Particularly useful for otologic surgeons who have small to moderate cochlear implant case volumes, this seminar will address common as well as less common complications and provide a framework for systematically and effectively managing them. A panel of experts consists of four otologists who run busy, mature cochlear implant programs and have extensive experience in managing various implant-related issues. During the first hour, each panelist will give a brief presentation. Topics include: analyzing suspected device failures, evaluation and revision of inappropriate electrode placement, management of CSF gushers and leaks, management of skin ulceration, skin breakdown and device exposure, management of wound infection and device infection. The following half hour will be reserved for discussion of individual case scenarios. The moderator will present cases to the expert panel for discussion. Members of the audience are encouraged to participate in the discussion, ask questions, and present their own cases to the panel. Attendees will learn how to avoid common intraoperative complications and how to better manage complications when they do occur. The aim of this miniseminar is to allow the attendees to benefit from the experience of our panelists and provide them with “tried and true” techniques that can be implemented in their own cochlear implant programs, ultimately improving the scope and quality of cochlear implant services available nationally and internationally. Educational Objectives: 1) Identify and manage a variety of complications related to cochlear implants with more confidence. 2) Learn to evaluate suspected cochlear implant device failures and need for revisions. 3) Learn an operative technique for managing a CSF gusher.

S240 – Human Cochlear Implant Histopathology

Objectives 1) To exam the histopathology of multichannel cochlear implant temporal bones. 2) To evaluate the relationship of residual spiral ganglion cell counts to clinical hearing performance. Methods 8 temporal bones from 4 cochlear implant patients were examined histologically. Paired comparisons were made between implanted and nonimplanted temporal bones. Clinical performance data was obtained from patient charts. Results There were varying amounts of inflammation (fibrosis and ossification) in the basal turn of the cochlear in all implanted temporal bones. Trauma to the facial nerve at facial recess site was noticed in 1 case. Compared with nonimplanted ears, 2 implanted bones with less than 10-year duration of implantation had no significant changes of spiral ganglion cell population. One case with prolong implant duration (15 years) showed about 36% decrease of spiral ganglion cells at the implanted site. The case with best speech recognition (89% with CID sentence) had the highest residual spiral ganglion cells (30% of normal spiral ganglion cell population). 2 cases with poor clinical performance (< 10% with CID sentence) had the residual spiral ganglion cells at 11% and 22%. The case with moderate clinical performance (30% with CID sentence) had 14% of normal spiral ganglion cell population. Surviving dendrites varied from 5% to 30% among 4 cases with no relationship to clinical performance. Conclusions Our findings suggest prolonged implantation may affect spiral ganglion cell population. There is no reverse relationship between residual spiral ganglion cells in implanted temporal bones to clinical speech performance observed from our limited cases.

Management of inflammatory pseudotumor of the larynx: Report of two cases

Objectives: Inflammatory pseudotumor (plasma cell granuloma) of the larynx is a rare benign lesion with only 19 cases reported to date in the English-language literature. This paper reports 2 additional cases of inflammatory pseudotumor (IPT) of the larynx treated at the University of Missouri and summarizes the approaches to management of these lesions. Methods: One case of subglottic IPT was initially treated with radiation 20 Gy, then recurred and required open excision. A second case of glottic IPT was treated with endoscopic CO2 laser ablation and high dose prednisone. Results: On review of literature, most common approaches to management of IPT of the larynx are endoscopic excision (with or without laser), high dose steroids, radiation, and open excision. Three local recurrences were reported, 2 occurred after endoscopic excision and 1 after radiation at our institution. Conclusion: Considering the experience to date, the best approach to management of laryngeal IPT seems to be endoscopic excision with or without laser. This may be followed by high dose steroids for 6–12 weeks. If excision would result in significant function loss, a course of steroids alone may be attempted and has shown to have good success. Radiation therapy is used in treating laryngeal IPT based on success in treating IPT at other sites. In view of our experience, radiation therapy would not be a first line treatment option. Open excision and organ removal should be reserved for cases where anatomical considerations prohibit good endoscopic visualization and complete excision, or when malignancy cannot be excluded, respectively.