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.

Candidate odours for a short form odorant identification test.

Measurement of olfactory function is difficult and despite the availability of validated olfactory tests these are not in common use in general clinical practice. The mismatch between self-reported olfactory function and objective test response is well known, thus the need for adequate assessment of olfaction is not disputed. We aimed to determine which if any odour in a commercially available olfactory test could be identified by 70 % or more of normal subjects with a view to developing a shortened screening test for use in general otolaryngology and non-specialist clinics in the United Kingdom. Hospital staff and medical students, under 50 years of age were recruited. The tests were undertaken in a quiet room of neutral odour. Subjects were asked to self-identify 12 odorants presented consecutively and to record how strongly they perceived the odorants on a 4-point scale. One hundred and four participants correctly identified the odorant in 466 (37.3 %) of the 1,248 individual odorant identification tests. Peppermint, fish and coffee odours were identified by 88.5, 79.8 and 69.7 % of participants, respectively, without the advantage of a choice of name prompt. These supra-threshold test odour stimuli were perceived as present in all of the individual odour identification tests, but correct identification of the test odour was very much lower for the other nine test stimuli. Peppermint, fish and coffee are odours that should be evaluated further for inclusion in a short form olfactory identification test in a British population.

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.

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.

Tinnitus evoked by speech.

Modulation of tinnitus by a variety of somatosensory stimuli and alteration of gaze has been described. We present two cases of tinnitus induced by speech (voice). The tinnitus was troublesome in both patients, and both had hearing loss and ischemic changes in the central nervous system documented by magnetic resonance imaging. We discuss cross-modal plasticity and how it may explain the tinnitus in these two patients.

Pleomorphic adenoma of the parotid gland: is long-term follow-up needed?

INTRODUCTION: Pleomorphic adenoma is a slow-growing benign salivary tumour most commonly arising in the parotid gland. Macroscopically it has a surrounding capsule from which it can be enucleated-often the treatment used in the past. These tumours do not have a true capsule but can press surrounding normal salivary gland, frequently having finger-like extensions into the normal tissues. Recurrence, or more accurately residual disease, is thought to be due to these small islands of tumour which can be left behind at surgery, in particular enucleation which is associated with high recurrence rate. The current, most common practice is the excision of these tumours through superficial parotidectomy and postoperative follow-up. However, is long-term follow-up necessary and does it reduce the morbidity from tumour recurrence? METHODS: We reviewed the charts of 182 patients who underwent parotid surgery operated upon by a single surgeon (RKM) between 1973 and 1999. We included only 58 cases of pleomorphic adenomas removed by superficial parotidectomy. We excluded cases that had follow-up of less than 12 months and cases which had previous surgery elsewhere. Adequate tumour excision and the integrity of the capsule were ascertained intra-operatively, and this was confirmed by postoperative histology. RESULTS: In our study we had 34 females, mean age of 58, and 24 males, mean age of 50. The average follow-up was 6 years with a range of 1-23 years. We had no permanent facial nerve dysfunction, and we recorded only one recurrence (1.7%). CONCLUSION: Provided adequate excision of the tumour with intact capsule and histological confirmation are achieved, long-term follow-up is unnecessary and can be replaced by patient education and self-examination.