Resection of a giant bilateral retrovascular intrathoracic goiter causing severe upper airway obstruction, 2 years after subtotal thyroidectomy: a case report and review of the literature.

The intrathoracic (or substernal) goiter is more often benign; but it can be malignant in 2-22% of patients. There is history of prior thyroid surgery in 10% to more than 30% of patients. Intrathoracic goiters cause adjacent structure compression more frequently than the cervical goiters, due to the limited space of the thoracic cage. Compression of trachea, oesophagus, vascular and neural structures may cause dyspnoea, dysphagia, superior vena cava syndrome, subclavian vein thrombosis, hoarseness, and Horner's syndrome. There is usually progressive deterioration, but acute exacerbation may occur. The presence of a thoracic goiter (>50% of the mass below the thoracic inlet) is per se an indication for resection. Tracheal compression by (cervical or thoracic) goiter is also an indication for resection; early tracheal decompression is recommended particularly in symptomatic patients. In severe respiratory distress, intubation and semi-urgent operation may be required. With early intervention, most intrathoracic goiters can be removed through a cervical approach, while tracheomalacia is avoided. We hereby present successful and uncomplicated total thyroidectomy, through a median sternotomy, of a benign, gigantic, bilateral, retrovascular, posterior mediastinal, intrathoracic goiter, encircling the trachea, and causing severe respiratory distress in a 63 year old man with history of previous subtotal thyroidectomy.

Correlation of transiently evoked otoacoustic emission measures to auditory thresholds.

BACKGROUND: The presence of otoacoustic emissions is objective evidence of normal cochlear status. However, this test cannot be used to predict absolute auditory thresholds with accuracy. The criteria of normal otoacoustic emissions are not yet standardized and different measures of otoacoustic emissions have been used in various settings. In this study, the measures of reproducibility and otoacoustic emission amplitude are compared with regard to their correlation to pure-tone auditory (PTA) thresholds. MATERIAL/METHODS: One hundred and seventeen subjects with normal hearing were included in the study. Subjects with previous audiological, otolaryngologic, or vestibular disease were excluded. A complete ENT and audiological work-up was performed, including transiently evoked otoacoustic emissions (TEOAEs). The equipment used for TEOAE testing was a DP Echoport ILO 292 Otodynamics analyzer connected to a portable personal computer. A full 260 low-noise samples were averaged. Correlation between PTA thresholds and either overall TEOAE amplitude or whole reproducibility was estimated using multiple regression analysis. RESULTS: Correlation between acoustic thresholds at 250, 500, 1000, 2000, 4000 and 8000 Hz and either whole reproducibility or emission amplitude was highly significant for both measures. However, whole reproducibility was better correlated to acoustic thresholds at 250, 500, 1000, 2000, 4000 and 8000 Hz than was emission amplitude, and was more accurately predicted from multiple regression equations. CONCLUSIONS: Reproducibility measures performed better than TEOAE amplitude levels in the prediction of auditory thresholds.