Auditory and vestibular manifestations of Vogt-Koyanagi-Harada disease.

INTRODUCTION AND AIMS: Vogt-Koyanagi-Harada disease is a chronic disorder involving the eye and the central nervous, auditory, vestibular and integumentary systems. This study aimed to determine the auditory and vestibular manifestations of this disease. METHODS: Twenty-four patients diagnosed with Vogt-Koyanagi-Harada disease were assessed for auditory and vestibular dysfunction. RESULTS: Uveitis presents in all cases. Sensory hearing loss was present in 50 per cent of cases, tinnitus in 42 per cent, vertigo in 17 per cent and headache in 17 per cent. Nine patients received systemic steroids. Six patients who were treated early regained their hearing, but three patients whose treatment was delayed did not. One patient with bilateral profound hearing loss underwent cochlear implantation, and achieved excellent post-implantation hearing. CONCLUSION: There is a high incidence of cochlear and vestibular end-organ involvement in patients with Vogt-Koyanagi-Harada disease. The adequacy and timing of treatment has a significant effect on the disease outcome. Vogt-Koyanagi-Harada disease appears to affect the inner ear end-organ. Patients who develop bilateral profound sensory hearing loss are suitable candidates for cochlear implantation.

Reversible neuropraxic visual loss induced by allergic Aspergillus flavus sinomycosis.

This work reports a patient with visual loss treated successfully with surgical removal of the Aspergillus flavus sinomycosis. Vision was partially reversed within hours after surgery before starting planned corticosteroid therapy. The patient's visual acuity continued to improve steadily until it became equal to that of the other eye. The immediate gain in vision and continued improvement without corticosteroid therapy suggest a new hypothesis for visual loss induced by allergic sinonasal Aspergillosis. Simple mechanical pressure alone of the aspergillus mass over the nerve can produce visual loss, and this loss is reversed by removing the mass without corticosteroid therapy.

Otitis externa malignant. A case report and review of literature.

Otitis externa malignant (OEM) is a virulent infection if it is not diagnosed and treated promptly. Its mortality rate was reported to be 53% when there is associated facial nerve paralysis. It usually affects elderly diabetic patients, who present with deep-seated pain and other features of non-resolving otitis externa. It is mostly caused by Pseudomonas (P) aeruginosa and the treatment of choice is anti-Pseudomonas antibiotic. A 64-year-old diabetic male patient is described who presented with left ear pain and discharge for two months and did not respond to ordinary treatment. The patient also noticed a progressive facial weakness on the same side. The clinical presentation, investigations, treatment and follow-up of the OEM are discussed on the basis of our case and the review of the literature. The diagnosis of OEM is based on high index of suspicion and confirmed by histopathologic changes and radionuclide studies. Gallium 67 citrate scan is a sensitive way to diagnose and follow up the regression of the disease in response to the medical treatment. Ciprofloxacin is the treatment of choice; however, it has to be in accordance to culture and sensitivity results.

Current management of thyroglossal-duct remnant.

OBJECTIVE: Thyroglossal-duct remnant (TGDR) should be differentiated from ectopic thyroid prior to surgical excision. The purpose of this study is to discuss our experience with TGDR and review the role of technetium 99m-labelled sodium pertechnetate (99mTc), thyroid function test (TFT), ultrasound (US), and computerized tomography (CT) scan in the management of TGDR. METHODS AND RESULTS: This retrospective study comprised 24 (18 M:6 F) patients with TGDR, whose ages ranged between 3 and 52 years, 83.3% of whom were less than 30 years of age. The most common complaints were anterior neck swelling in 79% (19/24) and draining sinus in 37.5% (9/24). Other rare complaints include throat discomfort, hoarseness, and pain. Axial CT scan through the area of interest in four patients revealed intralaryngeal and extralaryngeal extension, with some cartilage destruction and pre-epiglottic extension in two patients. 99mTc and US and TFT demonstrated normal thyroid in 11 and 10 patient, respectively. Thyroid tissue element reported histologically in 58.3% (14/24) of cases. These 24 patients underwent 10 simple cyst excisions and 21 Sistrunk procedures. The rate of recurrence was 40% and 7%, respectively. CONCLUSION: When the thyroid gland can be identified in the normal position, coexistent ectopic thyroid is seldom found. However, when ectopic thyroid is suspected, 99mTc and TFT are valuable tests. Furthermore, CT scan may be profitable when there is evidence of laryngeal involvement. Sistrunk's procedure replaces simple cyst excision and continues to be the mainstay treatment of TGDR.

Vocal process granuloma.

Vocal process granuloma or contact ulcer is uncommon disease in which there is chronic irritation and granulation tissue formation at the posterior third of the vocal folds. Thirteen patients (11 men and two women) with vocal process granuloma were enrolled in this study; cases of intubation granuloma were excluded. The most frequent complaints were throat irritation, frequent throat clearing and voice change. Forty-seven percent of patients had a recurrence two to four months after surgery. Computed tomography (CT) of the larynx in four patients showed arytenoid sclerosis on the involved side and disclosed moderate enhancement of the vocal fold granuloma after contrast injection in one. Three patients had hyperacidity and four had hyperfunctioning granulomas: two used their voices excessively and the other two had bilateral sulcus vocalis. To our knowledge this is the first report of sulcus vocalis with vocal process granuloma, and of enhanced vocal process granuloma.

Internal jugular phlebectasia.

BACKGROUND: Anterior neck mass which appears on straining should be differentiated from laryngocele, jugular venous system phlebectasia and superior mediastinal cysts or masses. Internal jugular phlebectasia is a fusiform dilatation of the internal jugular vein. PURPOSE: this is an attempt to elucidate the etiology, clinical features, diagnosis, treatment and review of the literature about this rare venous lesion. METHODS: an 11 year old boy presented with soft neck swelling on the right side which appeared on straining. The diagnosis was confirmed on the bases of ultrasonography combined with Doppler flow imaging and spiral computerized tomography scan with contrast. The patient was treated conservatively and followed up for 21 months without any changes. CONCLUSION: internal jugular phlebectasia is a rare disease, which mostly involves the right side. It is usually a childhood disease and believed to be of congenital origin. It can occur at any age and affects both genders. Nevertheless no single case was reported in a young adult male. The diagnosis was made on a clinical basis and confirmed by less invasive radiologic technique. The investigations of choice are Doppler ultrasonography and spiral computerized tomography scan with contrast. Even though most of these lesions have been excised surgically, the treatment of choice should be conservative as long as it is asymptomatic.

Deep-neck space abscesses.

OBJECTIVE: Despite a reduction in the incidence, deep-neck space infections are still seen today with definite potential for significant morbidity and even mortality. DESIGN: The authors present their experience in the management of 16 patients with 19 deep-neck space abscesses. The distribution of the abscesses were: 5 Ludwig's angina, 4 parapharyngeal abscesses, 3 retropharyngeal abscesses, 3 in the sub-mandibular triangle, 3 in the deep anterior triangle, and 1 in the deep posterior triangle. RESULTS: The source of infection was odontogenic in six patients, pharyngeal in three, otogenic in one, and could not be identified in the other six patients. Most cases presented with pain and neck swelling. Plain x-ray films, computed tomography, ultrasonography, and magnetic resonance imaging were the main diagnostic procedures. Positive culture was obtained in only nine cases (56.2%). No predominant single organism was identified. Antimicrobial therapy and surgical drainage were the mainstay of treatment. Two cases were complicated by internal jugular-vein thrombophlebitis. All the patients survived without major residual sequelae. CONCLUSIONS: The etiology, presentation, and management of deep-neck space infections are briefly reviewed.

Maxillary sinus mucopyocele in children: a case report and review of literature.

PURPOSE: To review the pathophysiology, clinical features, radiological findings, and treatment of this rare disease. CLINICAL FINDINGS: This report is about a 30-month-old child who is, to our knowledge, the youngest patient without cystic fibrosis with maxillary sinus mucopyocele. It is very unusual to see these problems in the pediatric age group. CONCLUSION: Children with paranasal sinus mucocele or mucopyocele deserve screening for cystic fibrosis, even though it can occur in the absence of cystic fibrosis.