Association of the tumor necrosis factor-alpha -308 G/A polymorphism with nasal polyposis.

Nasal polyposis (NP) is a chronic inflammatory disease in which several molecular and cellular interactions play important roles. Tumor necrosis factor-alpha (TNF-alpha) is a major pro-inflammatory cytokine with a key role in immune inflammatory responses in NP. Altered levels of TNF-alpha, which may occur due to polymorphisms in the TNF-alpha promoter region, may also be associated with NP susceptibility. Given these facts, we investigated the possible association of the TNF-alpha -308 G/A single nucleotide polymorphism (SNP) with NP. In this study, 97 consecutive adult patients with NP and 95 age- and gender-matched controls were recruited. For identification of SNP, restriction fragment length polymorphism analysis after polymerase chain reaction was carried out. The NP group had a significantly higher rate of polymorphism compared to controls (p = 0.015). Logistic regression analysis revealed that the presence of the TNF-alpha -308 G/A SNP is an independent risk factor for NP development (OR, 3.68; CI, 1.27-10.7; p = 0.016). The presence of a mutation failed to influence disease severity on the basis of resistance to medical and/or surgical treatment. This study suggests a possible linkage of a SNP in the TNF-alpha promoter with NP. These results need to be confirmed with multicentre studies for more precise interpretation and corroborative studies for investigating the influence of polymorphism on transcriptional activity.

Sudden-onset life-threatening stridor in an adult caused by a laryngeal ductal cyst.

Laryngeal cysts are rare in adults; therefore, the majority of previous reports deal primarily with laryngeal cysts in infants and children. Ductal cysts of the larynx arise from the submucous glands when the ducts of these glands are occluded. They are most commonly located in the vallecula. In this report, we present a rare cause of life-threatening stridor in adults, a large ductal cyst of the larynx that was removed via endoscopic CO(2) laser resection. On the basis of clinical observations during the postoperative period, we conclude that endoscopic CO(2) laser resection is a reliable and safe method for removing cysts of the larynx. It is also a cost-effective procedure that minimizes hospitalization time and the need for tracheotomy.

Amyloidosis of the larynx: a case report.

A 75-year-old female patient presented with hoarseness and foreign body sensation in the back of her throat of one-month history. Direct laryngoscopy showed bilateral, yellow, hyperemic masses on the left false vocal fold and laryngeal ventricle. Both true vocal folds were mobile. Excisional biopsies of the right false vocal fold and ventricle showed extracellular, insoluble, fibrillar protein accumulation, consistent with amyloidosis. There was no evidence for neoplasm. Serum and urine electrophoreses were negative. The work-up for systemic amyloidosis and multiple myeloma were negative. Treatment was limited to surgical excision. No complications developed within a six-month follow-up period.

Current diagnosis and treatment of laryngocele in adults.

OBJECTIVE: To evaluate the treatment outcome of a series of laryngoceles and to comment on the current diagnosis and management of laryngoceles. STUDY DESIGN AND SETTING: A retrospective review of charts, radiological and histopathological notes, videolaryngostroboscopic records, and acoustic voice analyses of patients with laryngocele treated over a 10-year period was undertaken. RESULTS: Seven patients had internal laryngoceles; one had external; another one had combined laryngocele. Patients with internal laryngocele underwent endoscopic CO2 laser resection, while those with external or combined laryngocele were treated via external approach. Quality of voice was improved and no recurrences were encountered during the follow-up. No evidence of laryngeal cancer was found on the histological examinations. CONCLUSION: Endoscopic CO2 laser resection of internal laryngocele provides a reliable and cost-effective method that minimizes hospitalization and the need for tracheotomy. We believe that advances in the applications of laser in microlaryngosurgery will alter the traditional management of all type of laryngoceles.

Unilateral hearing loss as a presenting manifestation of granulocytic sarcoma (chloroma).

OBJECTIVE: To present a case of acute granulocytic sarcoma of the cerebellopontine angle whose presenting symptom was sudden onset unilateral sensorineural hearing loss. STUDY DESIGN: Case report and review of the literature (MEDLINE, 1962-2005). METHODS: A 34-year-old female patient with acute myeloid leukemia on remission admitted because of sudden hearing loss in her right ear for 10 days. She had experienced occasional tinnitus, ear fullness, and dizziness for a couple of months. After confirmation of her audiometric findings with auditory brainstem responses, the patient was put on a treatment regimen for sudden hearing loss. RESULTS: On the second day of treatment, she developed ipsilateral facial paralysis, hoarseness caused by ipsilateral vocal fold paralysis, and nystagmus. Magnetic resonance imaging of the cranium revealed findings consistent with granulocytic sarcoma at the cerebellopontine angle, infiltrating the internal acoustic canal. As increased intracranial pressure symptoms developed subsequently, subtotal tumor resection was performed. However, the patient was lost, with Cushing's triad at the second postoperative month during postoperative chemotherapy. CONCLUSION: Although up to 40% of leukemic patients may have otologic symptoms, sudden onset of sensorineural hearing loss is very rare. The patient presented in this report is the first reported case with a granulocytic sarcoma of the cerebellopontine angle who presented with acute sensorineural hearing loss. Despite the rarity of such a case, we would like to emphasize that leukemia must be kept in mind as an etiologic factor in sensorineural hearing loss and suggest that complete blood count and temporal bone imaging be routinely obtained.