Timothy Beale

Long-Term Follow-up of Hearing Loss in Children and Young Adults With Enlarged Vestibular Aqueducts: Relationship to Radiologic Findings and Pendred Syndrome Diagnosis

Objective: To describe the long‐term audiologic findings in pediatric patients with enlarged vestibular aqueducts (EVAs). The relationship between the hearing loss (HL) and the dimensions of the EVA, enlarged endolymphatic duct (EED), or enlarged endolymphatic sac (EES) was also investigated. The influence of a Pendred syndrome (PS) diagnosis on the audiologic phenotype was also examined.

Olfactory neuroblastoma: A 35‐year experience and suggested follow‐up protocol

Objectives/Hypothesis To validate a follow-up protocol based on the long-term outcomes and recurrence rates in patients who have undergone surgical treatment for olfactory neuroblastoma. Methods A prospective review of all patients treated for olfactory neuroblastoma at our institution over a 35-year period. Results Ninety-five patients were treated from 1978 to 2013, with craniofacial (65 patients) or endoscopic resection (30 patients). Duration of follow-up ranged from 1 to 309 months (mean, 88.66 months). Fifty-six patients were alive and well, and 13 were alive with recurrent disease. Twenty-one patients had died of disease, and three had died of intercurrent disease. Overall survival was 83.4% at 5 years and 76.1% at 10 years. Disease-free survival at 5 years was 80% and at 10 years was 62.8%. A Cox regression analysis showed orbital extension and intracranial involvement to be significant independent factors affecting outcome. Local and regional recurrence occurred after an average of 49 months but with a range of 3 to 233 months. Conclusions In our series, olfactory neuroblastoma most commonly recurred within the first 4 years but can recur very late, after 19.4 years in one case. There is currently no universally accepted follow-up regime, but even late recurrence is eminently treatable. We therefore propose a protocol for lifelong follow-up with both clinical examination and serial imaging, including the neck and entire intracranial compartment. Level of Evidence 4 Laryngoscope, 124:1542–1549, 2014To validate a follow‐up protocol based on the long‐term outcomes and recurrence rates in patients who have undergone surgical treatment for olfactory neuroblastoma.

Salivary gland FNA cytology: role as a triage tool and an approach to pitfalls in cytomorphology.

To highlight the importance of salivary gland fine needle aspiration (FNA) cytology as a triage tool for surgery and to determine its sensitivity and specificity. To discuss the diagnostic pitfalls and potential role of ancillary techniques in diagnosis and prognosis.

Carcinoma Cuniculatum Arising in the Tongue

Carcinoma cuniculatum (CC) is a rare, distinct clinico-pathological variant of squamous cell carcinoma (SCC) that is defined histologically by the characteristic infiltrative pattern of a deep, broad, and complex proliferation of stratified squamous epithelium with keratin cores and keratin-filled crypts. Herein, we present a case report of CC of the oral tongue and discuss its diagnosis, management, and outcome, as well as briefly review the world literature. To our knowledge, this is the first documented case of CC of the tongue to be reported in the English literature. We draw attention to its clinico-pathological features and highlight that awareness of this entity as a distinct variant of SCC facilitates its correct management.

Head and neck cancer in the UK: what is expected of cytopathology?

Objective:  This review highlights the role of cytopathology in cancer management within UK Head and Neck Cancer Networks and informs on the issues raised by recent UK Department of Health documents and other UK professional guidance. UK guidance requires the formal involvement of cytopathologists within multidisciplinary cancer teams, with medical and non‐medical cytopathology staff setting up and running rapid access lump clinics, and support for image‐guided fine needle aspiration cytology (FNAC) services. UK guidance also makes recommendations for training, resources and quality control. This review also highlights the resource gap between best practice evidence‐based guidance for head and neck (HN) cancer services and existing UK provision for cytopathology, as evidenced by lack of availability of experienced staff and adequacy of training and quality control (QC). Finally, it stresses the importance in the UK of the Royal College of Pathologists’ guidance, which defines the need for training, the experience needed for new consultants, the requirements for audit and QC. The implications for the additional resources required for HN cancer cytopathology services are discussed. Recent professional guidance specifying the provision of HN cancer services in the UK includes a cytopathology service for cancer networks, such as rapid access FNAC clinics. Although these clinics already operate in some institutions, there are many institutions where they do not and where the provision of cytopathology services would have to be restructured. This would need the support of local cancer networks and their acceptance of the detailed requirements for cytopathology, including resources, training and QC. The standards are not defined locally, as Strategic Health Authorities and Primary Care Trusts have been instructed by the Department of Health to support, invest and implement them.

Maxillary sinus haematoma

The maxillary sinus haematoma is an uncommon cause of a maxillary sinus mass. It presents with a variety of symptoms, the most common being epistaxis. Although histologically benign, it may be clinically progressive. Radiological findings can range from a benign appearance to a more aggressive process, including bony erosion. Surgical evacuation is the mainstay of therapy. We describe our experience in managing this condition and review available literature on the subject.

Feasibility of vocal fold abduction and adduction assessment using cine-MRI.

AbstractObjectiveDetermine feasibility of vocal fold (VF) abduction and adduction assessment by cine magnetic resonance imaging (cine-MRI)MethodsCine-MRI of the VF was performed on five healthy and nine unilateral VF paralysis (UVFP) participants using an axial gradient echo acquisition with temporal resolution of 0.7 s. VFs were continuously imaged with cine-MRI during a 10-s period of quiet respiration and phonation. Scanning was repeated twice within an individual session and then once again at a 1-week interval. Asymmetry of VF position during phonation (VF phonation asymmetry, VFPa) and respiration (VF respiration asymmetry, VFRa) was determined. Percentage reduction in total glottal area between respiration and phonation (VF abduction potential, VFAP) was derived to measure overall mobility. An un-paired t-test was used to compare differences between groups. Intra-session, inter-session and inter-reader repeatability of the quantitative metrics was evaluated using intraclass correlation coefficient (ICC).ResultsVF position asymmetry (VFPa and VFRa) was greater (p=0.012; p=0.001) and overall mobility (VFAP) was lower (p=0.008) in UVFP patients compared with healthy participants. ICC of repeatability of all metrics was good, ranged from 0.82 to 0.95 except for the inter-session VFPa (0.44).ConclusionCine-MRI is feasible for assessing VF abduction and adduction. Derived quantitative metrics have good repeatability.Key points• Cine-MRI is used to assess vocal folds (VFs) mobility: abduction and adduction. • New quantitative metrics are derived from VF position and abduction potential. • Cine-MRI able to depict the difference between normal and abnormal VF mobility. • Cine-MRI derived quantitative metrics have good repeatability.

Visual loss in patients with sphenoethmoidal cells.

BACKGROUND A sphenoethmoidal cell is a posterior ethmoid cell that pneumatises superiorly and/or laterally to the sphenoid sinus. Disease within such a cell may cause visual symptoms because of the close relationship of the optic nerve. CASE REPORTS This paper reports four cases of chronic rhinosinusitis involving a sphenoethmoidal cell, two with visual loss. The management of such cases is discussed and the current literature is reviewed. CONCLUSION Pathology within a sphenoethmoidal cell must be considered in cases of optic neuropathy. The presence of these cells may be relevant even in cases of seemingly uncomplicated rhinosinusitis as they are associated with a higher rate of optic nerve protrusion and dehiscence.

Diseases of the Temporal Bone

High-resolution CT is best suited to look at the external and middle ear but can also provide information about ‘the inner ear’. For many years multi-detector CT (MDCT) was the method of choice [1, 2], but recently high-end cone beam CT (CBCT) started to challenge MDCT. CBCT not only provides similar information at a substantially lower dose but high-end CBCTs are also able to produce images with a spatial resolution down to 125 μm. Subtle bone structures like the footplate, crura of the stapes, walls of the tympanic segment of the facial nerve canal, tegmen tympani, etc. can be visualised in a more reliable way at this resolution and open possibilities to more accurately depict pathology associated with these structures. An additional advantage is that images can be displayed in any plane without quality loss which is not the case on reformatted MDCT images. Therefore the difference between MDCT and CBCT even becomes more obvious on coronal or double-oblique images.