Microscopic versus endoscopic stapes surgery: systematic review and meta-analysis.

OBJECTIVE: To compare the efficacy and safety characteristics of endoscopic and microscopic stapes surgery based on current evidence. METHODS: A systematic literature search was conducted of three medical databases, focusing on randomised, controlled studies or observational studies. Data related to the efficacy and safety of each technique were extracted. Outcome data were summarised using the pooled mean differences or pooled odds ratios, along with their 95 per cent confidence intervals. RESULTS: Thirteen studies were included in the meta-analysis. Success rate was evaluated by estimating air-bone gap improvement; this revealed comparable outcomes for the two techniques (mean difference = -0.20; 95 per cent confidence interval = -0.53, 0.14). No statistically significant difference was detected concerning post-operative complications, except for dysgeusia (odds ratio = -1.12; 95 per cent confidence interval = -1.97, -0.28) and pain (odds ratio = -2.00; 95 per cent confidence interval = -2.97, -1.04), which favoured the endoscopic approach. CONCLUSION: Though both techniques result in commensurate outcomes concerning success rate, post-operative pain and dysgeusia favour the endoscopic approach. Further high-quality studies are needed to adequately compare the two methods.

Merkel cell carcinoma of the head and neck in the south-east of England.

Merkel cell carcinoma (MCC) is a rare and highly aggressive neuroendocrine malignancy of the skin. Its incidence is increasing with half of cases involving the head and neck. To the best of our knowledge, few large studies have been published in the UK, and to date this is the largest reported series of head and neck MCC. We retrospectively reviewed the outcomes of patients with MCC in three hospitals in the south-east of England over a 12-year period (2008-2019). Diagnosis was based on histological data following biopsy. Overall survival and disease-specific survival were calculated using Kaplan-Meier and log-rank tests. Fifty-eight patients met the inclusion criteria (24 stage I, 22 stage II, 9 stage III, and 3 unclassified). Median disease-free survival was 36 months (95% CI 0 to 77.2) and median overall survival 50 months (95% CI 29.9 to 70). Overall five-year survival was 34.4% (95% CI 17% to 52%) with two-year survival at 62% (95% CI 48% to 76%). Five-year disease-free survival was 26.7% (95% CI 17 to 52%) with two-year disease-free survival at 54% (95% CI 40% to 68%). To date, this is the largest UK based study reporting overall and disease-free survival associated with MCC of the head and neck. Half the patients presented late, and surgery was the mainstay of treatment, augmented by adjuvant radiotherapy. There is a need to better stratify patients at risk of developing metastatic disease, with the use of sentinel lymph node biopsy and positron-emission tomography-computed tomography (PET-CT), as immunotherapy and targeted agents are now available to treat advanced disease.

Neuroendocrine adenoma of the middle ear presented as paragaglioma: a case report.

BACKGROUND: Neuroendocrine adenoma of the middle ear (NAME) is a rare benign glandular tumor with neuroendocrine differentiation arising from the middle ear mucosa. The common symptoms and clinical findings of this tumor are usually non-specific. When the tumor appears as a reddish retrotympanic mass, it can be misdiagnosed to be a paraganglioma. CASE DESCRIPTION: A 38-year-old male presented with a 12-month history of left ear ​​fullness and tinnitus. Otoscopy revealed a reddish retrotympanic mass with an intact tympanic membrane. The imaging demonstrated a soft tissue mass adjacent to the eardrum and the ossicles, compatible with a paraganglioma. The mass was surgically removed through a posterior tympanotomy. The histological and immunohistochemical examination showed the specimen to be a neuroendocrine adenoma. Four years after the operation, the patient remains without any sign of recurrence. CONCLUSION: NAME is a rare tumor, mimicking tympanic paraganglioma, while its final diagnosis is only provided by histological and immunohistochemical analysis. HIPPOKRATIA 2017, 21(4): 201-203.

In the era of endoscopic sinus surgery, is there still a place for the Caldwell-Luc procedure?.

In the era of endoscopic sinus surgery, is there still a place for the Caldwell-Luc procedure? In this report, we present evidence in favor of the Caldwell-Luc approach to the maxillary antrum in selected cases where endoscopic techniques are inadequate to allow full resolution of the problem. Although this procedure is not as popular as it was in the past, its role in the management of benign paranasal sinus diseases is still important. We focus in particular on use of the Caldwell-Luc procedure for conditions such as fungal mycetoma, foreign body removal, empyema, and benign nasal tumours in areas that are not fully accessible by endoscopy alone. Advantages of this technique are its safety and simplicity; no special instrumentation is necessary. It can be performed with surgical equipment widely available in operating rooms in Greece and elsewhere.

Hypoglossal paresis as the only complication of malignant otitis externa.

BACKGROUND: Ipsilateral hypoglossal nerve (XII) paresis has never been reported as the first and only complication of malignant otitis external (MOE). CASE REPORT: A 73-year-old diabetic male with persistent left temporomandibular joint ache and ear fullness was admitted with the diagnosis of MOE. He received intravenous ciprofloxacin for 14 days and then continued with oral administration (per os). After two months, he returned with otalgia, swallowing difficulty, and ipsilateral XII paresis. He was re-admitted, received intravenous ciprofloxacin for 6 weeks, and continued with per os ciprofloxacin for 6 months. A Ga67-scan 6 months after the first admission revealed no active infection. Two years after his last admission, the patient still has XII paresis. There is no other cranial nerve involvement and inflammatory markers continue to be normal. CONCLUSION: Doctors should consider MOE in the differential diagnosis when there is XII paresis, especially in diabetic and immunocompromised patients.

Mycoplasma pneumoniae and Chlamydophila pneumoniae: a comparative study in patients with nasal polyposis and healthy controls.

INTRODUCTION: The role played by Mycoplasma pneumoniae and Chlamydophila pneumoniae in the pathogenesis of chronic rhinosinusitis with nasal polyps has been the object of ongoing debate. We used real-time polymerase chain reaction to investigate the prevalence of both microorganisms in the nasal tissue samples of patients and controls. METHODS: We extracted DNA from nasal polyp samples obtained during functional endoscopic sinus surgery and the inferior turbinate samples of controls undergoing septoplasty. We used the highly sensitive real-time polymerase chain reaction to detect the presence of M pneumoniae and C pneumoniae DNA. RESULTS: Patients with chronic rhinosinusitis with nasal polyps consisted of 62 individuals (39 men; mean age 51 years); the control group consisted of 24 individuals (13 men; mean age 45 years). All samples from both groups were negative for M pneumoniae and C pneumoniae DNA. CONCLUSION: We have demonstrated that the likelihood of M pneumoniae and C pneumoniae acting as an ongoing inflammatory stimulus in chronic rhinosinusitis with nasal polyps is slim.

The use of the Ligasure vessel sealing system in head and neck surgery: a report on six years of experience and a review of the literature.

BACKGROUND: The Ligasure Vessel Sealing System (LVSS) is a bipolar electrosurgical device with integrated active feedback control, sealing vessels up to 7 mm in diameter. It facilitates surgery by achieving the efficient haemostasis of blood vessels encountered during dissection, and allowing the rapid and secure division of vascularised tissues, while minimising thermal injury to adjacent tissues. OBJECTIVE: To report on our experience and review studies relating to the use of LVSS in Otolaryngology-Head and Neck Surgery. TYPE OF REVIEW: Retrospective series. Search strategy and evaluation method: LVSS has been widely used in our department since 2002. All patient records relating to the use of LVSS were reviewed, and compared to surgical procedures done by our team without the use of LVSS, with special regard to operation time and post-operative complications. Furthermore, a Medline search and thorough review was conducted for all pertinent articles on LVSS in Otolaryngology-Head and Neck Surgery, and those articles were reviewed. RESULTS: In our department, LVSS is used for thyroidectomy, laryngectomy, neck dissection, parotidectomy, tonsillectomy procedures, congenital cysts, thryroglossal cysts, and excisions of submandibular gland and parapharyngeal space tumours. LVSS provided sufficient haemostasis, operating time was shorter, and post-operative complications did not differ compared to similar surgical procedures performed without the LVSS. The Medline search revealed 16 studies published by other colleagues regarding the use of LVSS in Otolaryngology Head and Neck Surgery procedures (15 studies in thyroid and 1 study in parotid surgery). The results published were similar to ours. CONCLUSIONS: The use of LVSS in Otolaryngology-Head and Neck Surgery may have several advantages over standard methods. It is a reliable and safe device, providing sufficient haemostasis and reducing operating time.

Tolosa-Hunt syndrome misdiagnosed as sinusitis complication.

OBJECTIVE: Tolosa-Hunt syndrome is a rare condition of painful ophthalmoplegia combined with ipsilateral ocular motor nerve palsies, caused by non-specific granulomatous inflammation in the cavernous sinus, superior orbital fissure or orbit. A case of Tolosa-Hunt syndrome misdiagnosed as sinusitis orbital complication is reported. CASE REPORT: A patient suffering from left periorbital pain, upper eyelid oedema and ptosis, and horizontal diplopia, diagnosed as sinusitis orbital complication, was referred to our department. Clinical evaluation revealed only a left VIth nerve paresis. Haematological studies, cerebrospinal fluid tests and computed tomography scanning were negative. A magnetic resonance imaging (MRI) scan showed enhancement of the left cavernous sinus. Corticosteroid therapy was commenced, and within three days all symptoms disappeared. A diagnosis of Tolosa-Hunt syndrome was made. Follow-up MRI studies were normal. CONCLUSION: Tolosa-Hunt syndrome, although rare, is a nosological entity that otolaryngologists must bear in mind. Magnetic resonance imaging studies are essential in the diagnosis and follow up of these patients, in order to avoid a mistaken Tolosa-Hunt syndrome diagnosis.

Cocaine versus tetracaine in septoplasty: a prospective, randomized, controlled trial.

BACKGROUND: Successful local anaesthesia is of critical importance for the success of septoplasty, and many surgeons prefer to use cocaine for this purpose. The aim of this study was to evaluate the efficacy of cocaine 4 per cent solution, compared with tetracaine 2 per cent plus adrenaline, as a local anaesthetic for patients undergoing septoplasty. METHODS: From December 2002 to February 2005, a prospective, randomized, controlled trial was conducted. One hundred and eight patients underwent septoplasty under local anaesthesia. Patients were randomly classified into group A and group B, in which was used respectively cocaine 4 per cent solution and tetracaine 2 per cent solution plus adrenaline. A visual analogue scale was used to evaluate the severity of patients' pain during their procedure. RESULTS: Group B (tetracaine; mean rank=43.77) reported significantly less pain (p<0.001) compared with group A (cocaine; mean rank=65.23). CONCLUSIONS: On the basis of these findings, we recommend tetracaine as the first choice anaesthetic for nasal septoplasty; the use of cocaine should be limited.