Active cushing syndrome patients have increased ectopic fat deposition and bone marrow fat content compared to cured patients and healthy subjects: a pilot 1H-MRS study.

OBJECTIVE: Glucocorticoid excess is one of the most important causes of bone disorders. Bone marrow fat (BMF) has been identified as a l new mediator of bone metabolism. Cushing syndrome (CS), is a main regulator of adipose tissue distribution but its impact on BMF is unknown. The objective of the study was to evaluate the effect of chronic hypercortisolism on BMF. DESIGN: This was a cross-sectional study. Seventeen active and seventeen cured ACTH-dependent CS patients along with seventeen controls (matched with the active group for age and sex) were included. METHODS: the BMF content of the femoral neck and L3 vertebrae were measured by 1H-MRS on a 3-Tesla wide-bore magnet. BMD was evaluated in patients using dual-energy X-ray absorptiometry. RESULTS: Active CS patients had higher BMF content both in the femur (82.5±2.6%) and vertebrae (70.1±5.1%) compared to the controls (70.8±3.6%, p=0.013 and 49.0±3.7% p=0.005, respectively). In cured CS patients (average remission time of 43 months), BMF content was not different from controls at both sites (72.3±2.9% (femur) and 46.7%±5.3% (L3)). BMF content was positively correlated with age, fasting plasma glucose, HbA1c, triglycerides and visceral adipose tissue in the whole cohort and negatively correlated with BMD values in the CS patients . CONCLUSIONS: Accumulation of BMF is induced by hypercortisolism. In remission patients BMF reached values of controls. Further studies are needed to determine whether this increase in marrow adiposity in CS is associated with bone loss.

Encephalocele with spontaneous CSF otorrhea.

Spontaneous encephalocele of the temporal bone is an uncommon condition (37 cases to date) associated with cerebrospinal fluid otorrhea. It results from a congenital dehiscence of the tegmen tympani and tegmen mastoideum. The AA. report 3 additional cases and review methods for diagnosing and surgical treatment.

Functional hearing results in revision stapes surgery.

OBJECTIVE: The object of our study was to review the results of 63 revision stapes surgeries performed from 1978 to 1994. RESULTS: The most common cause of failure was the displacement of the prosthesis, followed by ossicular chain problems and oval window fibrosis. Postoperative hearing improvement within a 20-dB air-bone gap was achieved in 58.7% of the patients. Hearing gain was closely linked to the operative findings. Better results occurred when prosthesis problems were found. Evaluation of the hearing results by using Glasgow benefit plot gave evidence of symmetric normal hearing in only 40% of the cases. CONCLUSIONS: Prevention of the cause of failure during the primary stapes surgeries, lessening the surgical trauma, seems to provide the most favorable hearing results.

Distortion-product otoacoustic emissions and glycerol on the guinea pig hydropic ear.

OBJECTIVE: The aim of the present work was to investigate the therapeutic effects of glycerol on the distortion-product otoacoustic emissions in guinea pigs in which experimental endolymphatic hydrops had been surgically induced. METHODS: Thirty albino guinea pigs were used. The experimental protocol considered three groups of guinea pigs (10 animals each). Group 1 received no drug treatment, while group 2 and 3 were given glycerol orally 0.75 and 0.50 g/kg of body weight once a day for 24 days. RESULTS: The animals treated with glycerol showed an improvement of the distortion-product emission responses in the middle frequencies. This effect was not observed in the higher frequency region. This effect was evident 7 days after glycerol administration in the guinea pigs treated with a dose of 0.75 g/kg. The 0.50 g/kg dosage gave evidence of ameliorating effects 14 days after treatment. CONCLUSION: Glycerol given orally resulted in an improvement of distortion-product otoacoustic emissions in the guinea pig. Further studies are necessary before the effect of such a treatment can be assessed in humans.

Glomus tumor in pediatric age.

Glomus tumor of the middle ear and mastoid is exceedingly rare in children. This report details our management of a 13-year-old boy affected by tympanic glomus complicated by chronic middle ear infection that obscured the tumor. A review of the English literature revealed only 12 other patients suffering from glomus tumor in pediatric age. Diagnosis, therapy and the differential characteristics of pediatric glomus are discussed.

Medial meatal fibrosis: current approach.

Medial meatal fibrosis is a rare entity which is linked to inflammatory and traumatic factors. This pathology significantly benefits from surgical management. Criteria for achieving successful results are strict and concern the complete removal of the fibrous tissue and covering of the bony canal with skin graft. The aim of this paper is to present our experience with this rare pathology and to discuss current approaches.

Facial neuroma and magnetic resonance imaging.

The aim of this paper is to present a new case of facial neuroma. Its clinical appearance was uncommon, displaying symptoms characterized by sudden facial paralysis. Diagnostic armamentarium is discussed emphasizing the importance of magnetic resonance imaging (MRI). Therapeutical strategy with the techniques of facial rehabilitation are contemplated.

Acute mastoiditis in pediatric age.

The object of the present paper is to review 39 cases of acute mastoiditis treated surgically at the 2nd and 4th ENT Clinics of the University of Rome 'La Sapienza'. The aetiological factors were investigated observing an association of the acute mastoid abscess with cholesteatoma. Moreover 5 patients developed mastoiditis after previous mastoid surgery. The rationale of surgical management is discussed.

Facial nerve monitoring in skull base surgery.

The purpose of this work was to compare pre- and post-operative facial nerve function between unmonitored and monitored cases of skull base lesions. The study involved 32 patients suffering from lateral skull base tumours (10 unmonitored and 22 monitored). Facial nerve function was monitored intraoperatively by an acoustic facial electromyographic system (NIM-2). Post-operative facial function was graded according to the House-Brackmann scale. In the group of monitored cases, facial nerve function was normal (Grade 1 or 2) in 79 per cent of the patients, while the unmonitored patients showed normal function in only 50 per cent of the cases. These results confirm previous observations that audible evoked electromyographic monitoring significantly reduces permanent facial nerve dysfunction.

Experimental endolymphatic hydrops and glycerol. Electrophysiologic study.

The object of the present study was to evaluate electrophysiologically the therapeutic effect of glycerol on the cochlear function of guinea pigs in which experimental hydrops had been surgically induced. Fifteen albino guinea pigs were used. Each animal was chronically implanted to follow the evolution of hearing. The experimental protocol considered 3 groups of guinea pigs (5 animals each). Group 1 received no drug treatment, while groups 2 and 3 were given glycerol orally at 0.75 and 0.50 g/kg of body weight once a day for 4 months. The audiograms of the animals treated with glycerol showed a statistically significant hearing improvement compared with the control group. Clinically, our results seem to support the view of those who favor the use of glycerol for the medical treatment of Meniere's disease at an early stage.

The contralateral ear after surgery in different otoneurosurgical or neurosurgical pathologies.

The present study was specifically designed to ascertain the effect that otoneurosurgical or neurosurgical approaches may have on the contralateral ear. 18 patients suffering from different histologic lesions were examined. Pure-tone audiometry was performed before and after surgery each postoperative day up to the fourteenth day. The audiograms were abnormal after surgery in all but one of the patients tested. This hearing loss was transitory and the recovery occurred completely within 3 months. These outcomes suggest that the hearing loss was linked to a loss of cerebrospinal fluid.

Primary adenoid cystic carcinoma of the middle ear and mastoid.

Two primary adenoid cystic carcinomas of the middle ear and mastoid are presented. This pathologic condition is uncommon and no large series exist in the literature. Adenoid cystic carcinoma could arise from ectopic salivary gland tissue located in the wall of the jugular bulb in proximity to the hypotympanum. These tumors demonstrate much invasion of bone and soft tissue. The surgical rationale in the management of this rare tumor is discussed.

Reconstruction of old radical cavities.

Various techniques and materials have been proposed to deal with problems connected with radical cavities including recurrence of inflammatory processes, requirement of regular medication, social inconvenience (i.e., inability to practice any water sport, work in adverse environment, etc.). The present paper details the results of revalidation of old radical cavities using as filling a mixture of tricalcium phosphate and hydroxyapatite granules. Three techniques were used in reconstruction of the posterior canal wall. In the first procedure, the material was incorporated with fibrin adhesive to fill the cavity. In the other two methods the ceramic granules were covered respectively with a sheet of bone pate-fibrin sealant or with septal cartilage homografts. Twenty-four patients with chronic discharging old radical cavities were operated with anatomic results of 91.7 percent successful graft taken. The functional results showed an air-bone gap less than 30 dB in 72.7 percent of the cases after 6 months. After 2 years hearing gain was satisfactory in 63.6 percent of the patients. The different methods of reconstruction of posterior canal wall did not influence these findings.