An Unusual Presentation of Angiolymphoid Hyperplasia with Eosinophilia as Postauricular Mass: A case Report.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare, benign, reactive vaso-proliferative condition in the dermal and subcutaneous tissues of the head and neck. A 28-year-old female presented with slow-growing painless swelling behind her left ear. FNAC revealed benign soft tissue neoplasm and histopathological examination after surgical excision revealed angiolymphoid hyperplasia with eosinophilia. ALHE origin has been variously attributed to prior trauma, hyperestrogenemia, infectious agents, atopy, reactive hyperplasia, and benign neoplasia. Retroauricular ALHE has been rarely reported. However, on the basis of our case report, it should be a viable differential diagnosis when large subcutaneous tumors of the head and neck are encountered. When big subcutaneous tumors of the head and neck are present, especially in females, a valid differential diagnosis for angiolymphoid hyperplasia with eosinophilia, a rare condition marked by dermal or subcutaneous endothelial cell proliferation, should also be considered.

Correlation Between Video-Otoendoscopy and Tympanograms of Patients with Acute Middle Ear Infections.

The tympanic membrane (TM) undergoes a number of pathological changes in middle ear disease which can be detected by a video-otoendoscope. Middle ear disease is also accompanied by changes in middle ear pressure which can be assessed by tympanometry. The objectives of this study were to find the correlation between video-otoendoscopy and tympanometry in acute middle ear infections and to deduce which of the two is more efficient and reliable for early diagnosis. 75 patients with AOM or OME were included over 1 year where each patient was followed for 21 days. Detailed history and clinical examination with videootoendoscope and tympanometry was done on each visit. Each TM was graded using OMGRADE scale. Symptoms and clinical findings consistent with acute otitis media were given a clinical score (CO Score). The results were collected and correlation between video-otoendoscopy and tympanometry was determined and their individual sensitivity, specificity and diagnostic accuracy was calculated. The sensitivity, specificity and diagnostic accuracy for tympanometry and video-otoendoscopy was calculated individually for each of the 4 visits and positive correlation between the 2 was found. Our study showed that tympanometry had a higher overall sensitivity than video-otoendoscopy. While, video-otoendoscopy showed a higher specificity than Tympanometry. Otoendoscopy is good for ruling out AOM/OME but cannot rule out persisting Middle Ear Effusion and Tympanometry is a better tool for detecting MEE but cannot differentiate well between AOM and OME. We found that tympanometry plus otoendoscopy together greatly increase the chances of detecting AOM and OME thus improving diagnostic accuracy, reducing financial costs associated with over or mis-diagnosis.

Audiological Evaluation in Hypothyroid Patients and Effect of Thyroxine Replacement Therapy.

To do the audiological evaluation of patients with hypothyroidism and to assess status of hearing after thyroxin replacement therapy (TRT). Two groups were included: a hypothyroidism group (HG, n = 50), and a control group (CG, n = 50). Parameters studied: anominesic data, duration of hypothyroidism, comorbidities, cochleovestibular symptoms, biochemical and hormonal exams (TSH, FT4 and FT3), pure tone audiometry, impendence audiometry and BERA as where required. Mean age of the patients in HG was 26.5 ± 10.4 years. Male/Female ratio was 2.39. All HG patients had altered TSH values and 8% had diminished T4 values. Cochleovestibular symptoms were more common in hypothyroid patients (48%) than control (20%) p value. Pure Tone Audiometric threshold was found higher in 34% of cases. Sensorineural hearing loss was most common (76.46%) compared to conductive and mixed hearing loss. BERA showed significant prolonged absolute peak latency of wave III, inter peak latency (IPL) of wave I-III and reduced amplitude of wave Ia and Va. After thyroxine replacement therapy there was statistically significant improvement in hearing threshold in 46.42% ears (p < 0.05), (if ≥ 5 dB hearing improvement consider as significant). The significant improvement was also found in BERA, in amplitude of wave Va. Site of involvement was at several levels, middle ear, cochlear or retro-cochlear. HG patients had more cochleovestibular symptoms, higher audiometric thresholds, increase in latency of wave III, IPL of I-III and reduced Ia and Va amplitude in the BERA. After TRT improvement in hearing threshold and BERA was found.