Absent stapedial reflex: otosclerosis or middle ear tumor?

We present an unusual case in which a patient diagnosed as having otosclerosis on the basis of clinical and audiologic findings actually had a middle ear facial nerve schwannoma. To the best of our knowledge, this is the first reported case in English literature in which a facial nerve schwannoma presented with conductive deafness of gradual onset and absent stapedial reflex with a normally functioning facial nerve. We also include a review of the literature.

Borrelia tonsillitis: common symptoms but uncommon organism.

We present a severe case of acute tonsillitis caused by Borrelia vincenti. B. vincenti does not only cause Plaut-Vincent's angina, but also a more localised infection of the tonsil.

Otolaryngological manifestations of 'Muckle-Wells syndrome'.

We present a follow-up of a cohort of three cases of Muckle-Wells syndrome (MWS). The aim of this report is to characterise the symptoms of this rare autosomal dominant condition with respect to the ENT practice. A retrospective analysis of the clinical features of MWS from our outpatient follow-up record of the three patients diagnosed with MWS. An extensive literature search was performed, using Medline through Pub Med (1950-2010), EMBASE (1980-2009) and Ovid (1958-2009). Retrospective case note study. In the present cohort, progressive sensorineural hearing loss was the main presentation and has been followed up over 10 years (median). The spectrum of head and neck presentation from the world literature was reviewed and includes hypothyroidism, amyloid goitre, cervical lymphadenopathy, and facial rash. This is the first documented report of the Otolaryngological features of the MWS in the English ENT literature. An awareness of this rare syndrome is essential in order to diagnose this uncommon syndrome and thus to plan for a long-term follow-up.

Bilateral solitary maxillary sinus neurofibroma.

We present a case of simultaneous bilateral neurofibroma of the maxillary sinuses. To the best of our knowledge, this is the first reported case of solitary neurofibromas arising from maxillary antra bilaterally and independently.

Benign extracranial nerve sheath tumors of the skull base: postoperative morbidity and management.

The purposes of this retrospective case series study were to examine the outcome of the operative treatment of extracranial nerve sheath tumors (NSTs) of the skull base and to learn the optimal management. The study was conducted at a university teaching hospital and a regional referral center. A total of 19 cases of benign extracranial NSTs of the skull base who presented to the otolaryngology department over a period of 10 years were studied regarding the clinical, radiological, and pathological features and the operative and postoperative management. In the majority, these tumors originated from cranial nerves; postoperative complications were frequent and depended on the nerve of origin. Postoperative nerve deficit was apparent in 10 cases, and a second operation was necessary in 8 cases. The greatest postoperative morbidity was associated with the parapharyngeal NSTs (i.e., dysphagia in 30%, dysphonia in 30%, and Horner's syndrome in 20% of cases). The conclusion from this study is that high postoperative morbidity resulting from surgery on skull base NSTs demands an integrated approach between the otolaryngologist, plastic surgeon, neurosurgeon, speech therapist, physiotherapist, dietician, and occupational therapist and a clear strategy of long-term follow-up.

The presenting features of middle ear facial nerve sheath tumors: a clinical review.

Facial nerve sheath tumors are the most common middle ear benign neoplasms. Four facial nerve sheath tumors in the middle ear were diagnosed in our department over a 12-year period, and we described our experience in the management of these tumors. A thorough review of the English literature on middle ear peripheral nerve sheath tumors has been conducted, and the findings of this review are presented and discussed. We have paid particular attention to the presenting features of these tumors with the aim of enhancing diagnostic ability.

Aetiopathology of maxillary swelling--a 3-year prospective study.

A wide variety of lesions and not necessarily a malignant tumour can cause maxillary swelling. Non-specificity of clinical and radiological features of these maxillary lesions makes their diagnosis difficult. Review of literature adds a little regarding the aetiopathological distribution of the various lesions causing maxillary swelling. We present our finding regarding the relative distribution of various conditions causing maxillary swelling. The awareness of the spectrum of pathology related to maxillary swelling is essential for correct diagnosis and treatment. Forty-eight patients who presented with a swelling of the maxilla to our hospital between May 1998 and April 2001 were prospectively studied regarding the clinical presentations, radiological features and histological findings. Maxillary swelling was found to be caused by malignant tumours in 54.2%, benign neoplasms in 22.9% and non-neoplastic lesions in 22.9%. Overall squamous cell carcinoma (22.9%) was the commonest lesion, tumour of vascular origin was the commonest benign neoplasm and odontogenic cyst was the commonest among the non-neoplastic lesions.

Extracranial head and neck schwannomas--a 10-year review.

OBJECTIVES: To present our experience in managing a large case series of extracranial schwannomas highlighting presenting features, diagnostic difficulties, and outcomes associated with surgical treatment of these tumours. METHOD: A retrospective case note study of 31 patients with a diagnosis of extracranial schwannoma seen in the Department of Otolaryngology, Head and Neck Surgery at Southmead Hospital, a tertiary referral centre and University hospital between 1 June 1993 and 30 May 2003. RESULTS: The commonest anatomical location was in the neck (42%) and an isolated neck lump was the commonest presentation (77%). Pressure symptoms were the next most common mode of presentation, and were often a helpful indicator of the nerve of origin. The nerve of origin was identified in 47% of patients who underwent surgery. Immunohistochemistry was a useful tool in the diagnosis of these tumours and magnetic resonance imaging was the preferred imaging technique to delineate their extent. The most significant postoperative morbidity was associated with the schwannomas of the vagus nerve, sympathetic chain, hypoglossal nerve, glossopharyngeal nerve and the facial nerve. CONCLUSION: Schwannomas can present in a wide variety of sites within the head and neck region and therefore it is important that otolaryngologists and head-neck surgeons are familiar with the more common sites of presentation and the potential difficulties associated with the diagnosis and management of these tumours. Adequate imaging should be carried out preoperatively to gain as much information as possible about the individual tumour and allow informed patient counseling regarding to potential risks and morbidity of surgical intervention.

Relative distribution of the tumours of ear, nose and throat in the paediatric patients.

OBJECTIVE: The purpose of this study is to observe the type and anatomical distribution of various tumours of the otolaryngological region in the paediatric age group of patients. METHODS: A prospective study was carried out over a period of 2 years between May 2001 and April 2003 in a Teaching Hospital and tertiary referral centre in India. Patients 15 years of age or under who presented with a tumour of the otolaryngological region to the department of Otolaryngology were included in this study. Lymphoma of the cervical lymph nodes was not included in this study. Site of origin and histology of the tumours were noted. The minimum follow-up period was 18 months. RESULTS: Forty-three patients of above age group with a neoplasm of the otolaryngological region were managed in our department, the incidence was 0.5%. The ratio of benign to malignant lesion was 7.6:1. Juvenile nasopharyngeal angiofibroma was the commonest tumour (11 cases, 26%) and embryonal rhabdomyosarcoma was the commonest malignant tumour (3 cases, 7%). The commonest site of neoplasm was the nose and paranasal sinuses (13 cases, 30%). CONCLUSION: A tumour in the otolaryngological site in the paediatric population is rare, the incidence being 1 in 200 new cases in the age group of 15 years or under, 12% of the tumours were malignant. Awareness of relative distribution of neoplastic lesions is valuable for early detection and correct management. This study indicates that the distribution of otolaryngological tumours in the Indian subcontinent is different from the western countries, particularly the juvenile nasopharyngeal angiofibroma and laryngeal papilloma.