Giant destructive sinonasal polyposis.

INTRODUCTION: Authors report their clinical experience in managing a 46-year-old male patient with long lasting nose breathing difficulties caused by nasal obstruction due to a large bilateral tumor masses in both nasal cavities. CASE OUTLINE: Physical examination, laboratory and biochemistry analyses, as well as computed tomography showed an inhomogeneous soft-tissue tumor mass completely filling both nasal cavities, maxillary, ethmoidal, sphenoidal, and frontal sinuses on both sides, accompanied by destruction of bony walls of all sinuses. Preoperative histopathology analysis showed a polyp with squamous metaplasia.The gigantic polypoid mass was removed by bicoronal approach to the frontal and ethmoidal sinuses and by direct approach to the maxillary sinuses and nasal cavity. Definite histopathology analysis confirmed the initial diagnosis, but the presence of fungal hyphae in allergic mucus was also observed. CONCLUSION: Polypoid growth in the nose rarely grow to such gigantic dimensions that it causes destruction of all walls of paranasal sinuses. Considering so far published reports from the literature, the presented case is among the biggest nasal polyps reported until now.

Epithelial-myoepithelial carcinoma--review of clinicopathological and immunohistochemical features.

INTRODUCTION: Epithelial-myoepithelial carcinoma is a low-grade malignant salivary gland neoplasm with a biphasic cell population that encompasses around 1% of all salivary neoplasms. METHOD: We present different cases of epithelial-myoepithelial carcinoma, with special emphasis on histopathology, differential diagnosis, relevant prognostic factors and follow-up. RESULT: This study included 8 patients who were diagnosed with epithelial-myoepithelial carcinoma and treated surgically including a follow-up period of at least 19 months. CONCLUSION: Clinical and histopathological characteristics of these rare tumors are extremely valuable for accurate diagnosis and further therapy planning.

Unintentional conversion of benign paroxysmal positional vertigo caused by repositioning procedures for canalithiasis: transitional BPPV.

BPPV when diagnosed before any repositioning procedure is called primary BPPV. Primary BPPV canalithiasis treatment with repositioning procedures sometimes results in unintentional conversion of BPPV form: transitional BPPV. Objectives were to find transitional BPPV forms, how they influence relative rate of canal involvement and how to be treated. This study is a retrospective case review performed at an ambulatory, tertiary referral center. Participants were 189 consecutive BPPV patients. Main outcome measures were detection of transitional BPPV, outcome of repositioning procedures for transitional canalithiasis BPPV and spontaneous recovery for transitional cupulolithiasis BPPV. Canal distribution of primary BPPV was: posterior canal (Pc): 85.7% (162/189), horizontal canal (Hc): 11.6% (22/189), anterior canal (Ac): 2.6% (5/189); taken together with transitional BPPV it was: Pc: 71.3% (164/230), Hc: 26.5% (61/230), Ac: 2.2% (5/230). Transitional BPPV forms were: Hc canalithiasis 58% (24/41), Hc cupulolithiasis 37% (15/41) and common crux reentry 5% (2/41). Treated with barbecue maneuver transitional Hc canalithiasis cases either resolved in 58% (14/24) or transitioned further to transitional Hc cupulolithiasis in 42% (10/24). In follow-up of transitional Hc cupulolithiasis we confirmed spontaneous recovery in 14/15 cases in less than 2 days. The most frequent transitional BPPV form was Hc canalithiasis so it raises importance of barbecue maneuver treatment. Second most frequent was transitional Hc cupulolithiasis which very quickly spontaneously recovers and does not require any intervention. The rarest found transitional BPPV form was common crux reentry which is treated by Canalith repositioning procedure. Transitional BPPV taken together with primary BPPV may decrease relative rate of Pc BPPV, considerably increase relative rate of Hc BPPV and negligibly influence relative rate of Ac BPPV. Transitional BPPV forms can be produced by repositioning maneuvers (transitional Hc cupulolithiasis) or by the subsequent controlling positional test (transitional Hc canalithiasis and common crux reentry); underlying mechanisms are discussed.

Conductive hearing loss in patients with active acromegaly.

OBJECTIVE: There have been rare conflicting results reported concerning possible higher frequency of hearing loss in acromegalic patients. Our goal was to determine whether there is higher frequency of conductive hearing loss in acromegalics and what may cause it if there is any. STUDY DESIGN: Prospective study. SETTING: Tertiary referral center. PATIENTS: Thirty previously untreated patients with acromegaly were compared with 20 age- and sex-matched healthy control subjects. INTERVENTIONS: In all subjects: Otomicroscopy, tuning fork tests, audiometry tympanometry, cochleostapedial reflex, otoacoustic emissions. In acromegalics: endocrinologic assessment, MRI and if necessary, epipharyngoscopy. MAIN OUTCOME MEASURES: We searched for: 1) Signs of ossicle fixation: absence of stapedial reflex in the presence of normal tympanogram, conductive hearing loss, and absence of or grossly disturbed OAE; 2) Disturbances of middle ear ventilation: excessive negative pressure (tympanogram type C), or middle ear effusion (tympanogram type B). RESULTS: The only statistically significant difference between untreated acromegalics and healthy subjects was the presence of middle ear ventilation problem: 7/30 acromegalics (23%) in comparison to none out of 20 healthy controls (0%), p = 0.033. The acromegalics with middle ear ventilation problem were significantly older, had longer duration of the disease, and lower mean growth hormone (GH) levels in comparison with acromegalics without this problem (51.6 +/- 1.7 vs. 44.4 +/- 2.5 years, 11.6 +/- 2.4 vs. 7.7 +/- 0.4 years, 21.68 +/- 4.89 vs. 49.98 +/- 12.54 microg/L respectively). CONCLUSION: Patients with active acromegaly have more frequent middle ear ventilation problem than normal population, especially those with longer duration of the disease. Possible causes are discussed.