Mastoiditis secondary to metastatic lung carcinoma: case report and literature review.

OBJECTIVE: We present a case report and systematic review of acute mastoiditis caused by metastatic lung cancer. CASE REPORT: A 62-year-old woman developed acute mastoiditis as a complication of otitis media. Cortical mastoidectomy revealed deposits of metastatic non-small cell lung carcinoma around the sigmoid sinus. The patient had previously received treatment for lung cancer, but was thought to be in remission. DISCUSSION: A literature review confirmed that this is the first reported case of mastoiditis caused by metastatic lung cancer. Only four similar case reports were identified: two caused by breast carcinoma, one by renal cell carcinoma and one by cholangiocarcinoma. Post-mortem histopathological studies suggest that temporal bone metastasis occurs in 22 per cent of oncology cases. CONCLUSION: This is the first reported case of mastoiditis caused by metastatic lung cancer. Metastasis to the temporal bone is not uncommon, but rarely causes mastoiditis.

Long-term outcome of children undergoing surgery for suspected perilymph fistula.

UNLABELLED: A number of authors have suggested that surgery for suspected perilymph fistula is effective in preventing deterioration of hearing and in improving hearing in some cases in the short term. We present long-term hearing outcome data from 35 children who underwent exploration for presumed perilymph fistula at The Children's Hospital, Sydney, Australia, between 1985 and 1992. METHODS: The pre-operative audiological data (mean of 500, 1000, 2000 and 4000 Hz results) were compared with the most recently available data (range two to 15 years) and the six-month post-operative data. RESULTS: The short-term results showed no significant change in hearing at six months, with a subsequent, statistically significant progression of hearing loss in both operated and non-operated ears (Wilcoxon signed rank test: operated ear, p < 0.017; non-operated ear, p < 0.009). CONCLUSION: In this case series, exploratory surgery for correction of suspected perilymph fistula did not prevent progression of long-term hearing loss.

Recurrence and malignant degeneration of 89 cases of inverted papilloma diagnosed in a non-tertiary referral population between 1975 and 1995: clinical predictors and p53 studies.

Eighty-nine patients with sinonasal inverted papilloma presenting between 1975 and 1995 were reviewed with the aims of studying predictors of tumour behaviour and correlating outcome with p53 expression. Correlation of clinical, radiological features and p53 status was made using chi2 and multiple logistic regression analysis with recurrence and malignant degeneration as the main outcome measures. Two patients had synchronous malignancy but no malignant degeneration was seen. There was no significant difference in recurrence between minor intranasal procedures and more extensive surgery for the first event. Younger patients were more likely to recur. (P = 0.0493, odds ratio 0.43). Those who smoked showed a trend towards multiple recurrence. p53 was expressed in 41% but did not predict recurrence. Morbidity was related to the extent of surgery. Inverted papilloma presenting to a non-tertiary centre is more benign than previously reported. Initial management by less extensive endoscopic surgery may reduce morbidity.

The acceptance of hearing aids for children with otitis media with effusion.

Conservative treatment for otitis media with effusion (OME) led us to consider the use of hearing aids as a way of managing the associated hearing loss. This study aimed to assess the compliance of patients and acceptance of hearing aids for the management of children with OME. Thirty-nine children who had been given binaural hearing aids to manage OME were assessed at routine follow-up after six months. A clinician who did not prescribe the aid administered a questionnaire to assess compliance, change in symptoms and acceptance of the aids. Thirty-eight parents thought the aids were easy to use and 25 (66 per cent) were completely satisfied with the management. Aided hearing improved by a mean of 17 dB (Range 10-30) over three frequencies, 0.5, 1.0, 2.0 Khz and all parents reported subjective hearing improvement in their children. The stigma of an aid was reported as minimal under the age of seven. Hearing aids provide a non-invasive way of managing the problems associated with OME which is acceptable to certain parents and children. Long-term effects of using aids need to be evaluated before they can be recommended.

Dry tap at myringotomy: a three-year study of 1688 children undergoing myringotomy.

One thousand six hundred and eighty-eight children undergoing myringotomy were studied to determine the rate of 'dry taps' and factors associated with a dry middle ear at operation. The percentage of bilateral dry taps was 16%. The dry tap rate was significantly higher in the following groups: older children, those with an A, C1 or C2 tympanogram at the time of listing, milder hearing loss, a preceding history of recurrent acute otitis media and operation performed during the summer or autumn. There was no significant relationship between the dry tap rate and the time on the waiting list, the gender of the child or the order in which right or left myringotomies were performed. Careful preoperative reassessment of any child with a type A, C1 or C2 tympanogram should be made to prevent unnecessary surgery. Separating those listed for treatment of recurrent acute otitis media from those with OME would prevent these being included in the overall dry tap rate.