[Primary tuberculosis of the middle ear: description of 2 cases and review of the literature]. / Tubercolosi primitiva dell'orecchio medio: descrizione di due casi e revisione della Letteratura.

Recently, a recrudescence of tuberculosis (TBC) as been found, even in Western world and in Italy, most likely in relation to the increase in immigration from developing countries and to the pathologies that cause immunodepression. The present paper reports two cases of primitive TBC of the middle ear, both coming under observation for facial paralysis. These cases highlight the clinical-therapeutic features of this disease, the difficulty in diagnosis and the need to include TBC in the differential diagnosis of phlogistic processes of the middle ear. The clinical-diagnostic features of presented cases focus attention on the consideration of TBC in the differential diagnosis of chronic otitis, particularly in presence of unusual symptoms, such as facial paralysis, and in case of otitis with rapid onset, unresponsive to conventional treatment. In one case, first examination of the ear showed normal tympanic membrane (absence of any tympanic perforation) and normal timpanometry; these facts steered diagnosis away from a middle ear phlogosis pathology. Both cases showed how radiological semeiology, CT and NMR are not enough to diagnose the nature of the disorder, particularly in case of cholesteatoma. Moreover, both patients were in good general conditions at the time of the examination, they didn't show history of previous immunodepression or other risk factors. The cases reported call attention to the aspecific characteristics of the onset of primitive tuberculous otitis media and difficulty in making a diagnosis. They underline the need for post-operative anti-tuberculous chemotherapy which provided a rapid and definitive resolution of infectious process.

[Antileukotrienes in the prevention of postoperative recurrence of nasal polyposis in ASA syndrome]. / Gli antileucotrieni nella prevenzione delle recidive post-chirurgiche della poliposi nasale in ASA-syndrome.

There is a high incidence of post-surgical recurrences of nasal polyps (NP) in patients suffering from the ASA Syndrome. The numerous theories as to the pathogenesis of the ASA Syndrome include an increase in lipoxygenase-mediated arachidonic acid metabolism, with the subsequent hyperproduction of leukotrienes (LT), and an inhibition of the cycloxygenase. Therefore, based on the information acquired on the immunobiological action mechanism of montelukast, a cysteinyl-LT receptor antagonist, it appeared worth testing the effectiveness of this substance in preventing post-surgical NP recurrences in a group of ASA Syndrome patients. After taking a case history, filling out a questionnaire scoring nasal symptoms, undergoing rhinoendoscopy and rhinomanometry, 40 patients suffering from ASA-Syndrome and NP (age range 30-72 years) were recruited for the study. They were uniformly classified according to Lund and Mackay using high resolution CT of the nose and paranasal sinuses performed after at least 1 month of nasal medical treatment. All the patients underwent microendoscopic anterior-posterior ethmoidectomy and bilateral maxillary antrostomy. After removing the nasal packing, the only treatment administered was 10 mg of montelukast/die for 6 months, with the drug suspended for 1 months after the first 3 months of treatment. The monthly follow-up included rhinoendoscopy, rhinomanometry and the questionnaire to score symptoms. After the seventh month a new CT was performed and compared with the pre-operative CT. In a control group of subjects, homogeneous with the test group, momethasone furoate nasal spray was administered at a dose of 100 mcg per nostril/die and loratadin tablets 10 mg/die. The results obtained in the patients treated with montelukast were analogous with those obtained in the second group, and during follow-up all patients showed total absence of any local recurrence, good nasal patency and no significant nasal symptom score on the questionnaire. In no case did the comparative CT, performed after the seventh month, show any signs of recurrence. The patients taking the montelukast reported a significant reduction in the use of steroids and bronchodilator inhalants during the course of the study than did the second group; indeed the number of asthmatic episodes dropped and they reported an improvement in the quality of life. Based on these results, the authors suggest that the use of montelukast in the treatment of post-surgical NP recurrences in ASA Syndrome is possible and advisable, even in synergetic association with the treatment administered to the second group. The positive results also support the hypothesis of altered arachidonic acid metabolism and call attention to the role of cysteinyl-LT in the pathogenesis of the ASA Syndrome.

[Mastoid osteomas: review of literature and presentation of 2 clinical cases]. / Gli osteomi della mastoide: revisione della letteratura e presentazione di due casi clinici.

The authors report two cases of mastoid osteoma in patients at the "S. Filippo Neri" Hospital in Rome, Italy. The literature on this topic is critically reviewed. This review includes the 48 cases between 1875 and 1955 reported by Kecht, as well as the 92 cases Probst reported in 1991 in a review running from 1861. The literature published since 1991 has presented eight cases which, when added to the two presented here and the 92 indicated by Probst, total 102 cases of mastoid osteoma. The most widely accepted theories on the etiopathogenesis of mastoid osteoma are presented. These include: embryogenesis, metaplasia, inflammation, and trauma. The conclusions underline the complications of this disorder which are mainly linked to osteoma growth, and the importance of the differential diagnosis with other mastoid lesions for which prognosis is poorer.

[Mucocele of sphenoid sinus: presentation of 3 cases]. / Il mucocele del seno sfenoidale: presentazione di tre casi clinici.

Sphenoidal mucoceles are equally distributed between males and females occur rarely and have an incidence of 1%. Their low incidence is certainly to be ascribed to their deep position with respect to the superior respiratory tract as well as to the characteristics of the mucosa coating of the sinus (where the scarce muciparous component does not cause drainage problems). During endocranial manifestation, it is important to make a differential diagnosis between tumors at the base of the skull and adenomas of the hypophysis. The most feasible etiopathogenetic hypotheses are insufficient drainage of the sinus, cystic degeneration of the ghiandolar epithelium, presence of embryonal remnants and previous surgery. The Authors report three cases of mucoceles located in the sphenoid, two of which with destruction of the sellar floor and upward invasion, one with posterior invasion and involvement of the clivus. Sphenoidal mucoceles generally tend to spread more frequently in an anterior-inferior fashion with invasion of the etmoid, the nasal fossae and the rhinopharynx. In some cases we observe upward invasion with destruction of the sellar floor, as in the first two patients. There may by an invasion in the orbital cavity when spreading occurs sideways. More rarely, the intermediate cranial fossa is invaded through the lateral wall and the posterior cranial fossa through the posterior wall. Therefore, it is evident that an early diagnosis is always desirable because it may spare the patient the neurological manifestations resulting from the evolution of the disease. The treatment for a sphenoidal mucocele is surgical. The Authors report a synthesis of the surgical techniques most frequently used by otorhinolaryngologist and neurosurgeons, and present a critical analysis of the cases presented.

[Rare manifestation of nasal polyposis in the Peutz-Jeghers syndrome]. / Rare manifestazioni della poliposi nasale nella sindrome di Peutz-Jeghers.

We are relating a case of the Peutz-Jeghers syndrome, a disease characterized by hamartomatous polyposis and by mucocutaneous melanic pigmentation, in a rare variant identified by the presence of nasal polyposis. At the objective E.N.T. examination, the patient's nasal fossae were completely obstructed by translucid masses of a polypoid appearance and, moreover, a melanic pigmentation of the cutis, of the perilabial mucosa and of the oral cavity was encountered. At the X-ray examination and, later, during the operation, also the right maxillary sinus appeared completely obstructed by polypoid masses. At the histologic examination, such polypoid neoformations were quite similar to common polyps of an inflammatory nature and, so, absolutely without any peculiar structural features. The nasal polyposis in patients suffering from the Peutz-Jeghers syndrome has been mentioned by Peutz since his first observation but it has been seldom described in the subsequent publications, even in relation to the presentation of rare causes to Congresses and Magazines of an exclusively gastroenterological interest, in which the main concern was that of identifying both the clinical and histological aspects of gastrointestinal hamartomatous polyposis and the correlation between the syndrome and the formation of malignant neoplasias in other organs to the prejudice of the secondary manifestations of the disease. Nevertheless, the nasal polyposis and, at any rate, the tendency to the formation of polyps in other districts (urinary tract, bronchi) are described among the less important features also in gastroenterological treatises of most recent publication. Clinical observations, even occasional, are completely missing in the E.N.T. ambit.(ABSTRACT TRUNCATED AT 250 WORDS)