The prevalence of congenital and early-onset hearing loss in Jordanian and Israeli infants.

The objective of the study was to investigate the prevalence of congenital and early-onset hearing loss, and the influence of the known risk factors for hearing loss on infants in Jordan and Israel. Subjects were a total of nearly 17,000 infants from both countries, including infants with and without risk factors for hearing loss. The hearing screening protocol included distortion product otoacoustic emission, followed in case of repeated OAE referral or high risk (HR) infant by diagnostic auditory brainstem responses. The results indicate that the prevalence and severity of hearing loss amongst Jordanian infants (1.37%) is remarkably higher as compared to the Israeli infants (0.48%). The overall prevalence of bilateral SNHL was seven times more in the Jordanian infants, 18 times in non-risk, and three times in the HR infants relative to the Israeli infants. Risk factors including family history, hyperbilirubinemia, bacterial meningitis, and associated syndromes were more prevalent amongst Jordanian infants. This unique study underscores the importance of sharing and exchanging information to create empirical data to guide health-care providers in adapting protocols to the local constraints in developing countries.

Carcinoma of the thyroid in children--a review.

Thyroid cancer is the third most common solid tumor in children and adolescents. A review was made of the data on 540 such patients reported from nine large centers renowned for their experience with thyroid cancer. In respect to the pathogenesis the only factor conclusively known to promote development of thyroid cancer in the pediatric age group is irradiation, as documented by the Chernobyl experience. The evidence indicates that thyroid carcinoma in the pediatric age group is a biologically independent and more aggressive entity than in adults; paradoxically the prognosis is good. In the great majority of cases the only presenting sign was a neck mass. In a high percentage (60-80%) there were also palpable lymph nodes. The findings regarding lung metastases were not clear-cut: in most series they were present in about 10%, with a high of 28% in one group and a low of 5% in another group. Papillary carcinoma or the follicular variant of papillary carcinoma were the dominant histologic types, pure follicular carcinoma being found much less frequently than among adults with thyroid cancer. Despite the relatively advanced stage of the disease upon diagnosis, only 13 patients died of the disease, 12 to 33 years postoperatively. Recurrence rates ranged between 10% to 35%, with involvement of the lateral neck, thyroidal bed or distant sites 3 to 33 years after treatment; most failures responded to further surgery or radioactive iodine. There is almost general agreement that surgical intervention should consist of total or near total thyroidectomy despite the high rates of recurrent laryngeal nerve paralysis and hypocalcemia. In regard to neck metastases less than radical surgery has proved during the years to be sufficiently effective. Radioactive iodine, used by all at some stage of management for treatment purposes, should be used prophylactically only after due consideration in view of possible teratogenicity.

Diagnostic imaging of fungal sinusitis: eleven new cases and literature review.

Fungal sinusitis should always be considered in the differential diagnosis of chronic or recurring sinusitis resistant to adequate medical treatment. A high index of suspicion is necessary for the diagnosis, and the clinical examination is rarely conclusive. The definitive diagnosis depends on the pathologist in most cases. We reviewed retrospectively the imaging findings, specifically computed tomography (CT) and magnetic resonance (MR), in a series of fungal sinusitis patients. Non-enhanced CT scan is more sensitive than conventional X-ray in detecting the classical focal areas of hyper-attenuation and calcification seen in soft-tissue masses of fungal sinusitis. MR findings of hypo-intense signals on T1-weighted sequences which progress to signal-void area on T2-weighted sequences, are characteristic features of fungal sinusitis; however, it is reserved for cases where intracranial invasion is suspected or CT findings are inconclusive.

Ultrasonography and ultrasound-guided fine-needle aspiration biopsy of head and neck lesions: a surgical perspective.

A head and neck ultrasound-guided fine-needle aspiration clinic was set up to determine the role of ultrasound and ultrasound-guided fine-needle aspiration in the evaluation of patients with lesions in this region. One hundred ninety-five lesions were biopsied by ultrasound-guided fine-needle aspiration in 203 patients. Ultrasound detected 2 or more lesions in 14 (48%) of 29 patients with a clinically solitary thyroid nodule. Three (8.8%) of 34 lesions thought to be within the parotid gland were determined to be external. A pronounced learning curve was evident in the technique of ultrasound-guided fine-needle aspiration, particularly for nonpalpable disease. Adequacy of sampling for each 3-month period was 71%, 89%, and 94%, respectively. Seventy-four percent of central aspirations were satisfactory compared to 54% of peripheral aspirations. Ultrasound-guided fine-needle aspiration did not alter the clinical staging of metastatic neck disease in 8 patients having 10 neck dissections but proved useful in detecting nodal recurrence in 3 irradiated necks that did not proceed to surgery. The smallest node to harbor malignancy had 4-mm maximal axial diameter. We conclude that ultrasound and ultrasound-guided fine-needle aspiration are valuable adjuncts to the clinical examination.

Laryngeal verrucous carcinoma: a clinicopathologic study and detection of human papillomavirus using polymerase chain reaction.

Laryngeal verrucous carcinoma (LVC) is a rare, well-differentiated variant of squamous carcinoma with a low malignant potential. Human papillomavirus (HPV)-16 DNA has been identified in a small number of LVC and an etiologic relationship has been suggested. A correlative clinical and molecular pathological study was performed in order to determine the prevalence and typing of HPV DNA in LVC. Possible associations between patient and tumor subsets, and the presence of HPV DNA were also investigated. Formalin-fixed, paraffin-embedded tissue samples from 29 patients with LVC were examined by polymerase chain reaction (PCR) using DNA primers specific for HPV types 6b/11, 16, and 18. Overall, HPV DNA was detected in 13 (45%) of the cases. Of these, HPV-16 DNA, HPV-18 DNA, and both HPV-16 DNA and HPV-18 DNA were detected in 4 (14% overall; 31% of positive cases), 4, and 5 (17% overall; 38% of positive cases), respectively. HPV-6b/11 DNA was not detected in any LVCs. In 16 cases, no HPV DNA was detected. There was a trend toward HPV DNA detection in higher stage tumors. HPV DNA detection was unrelated to patient age, tumor site, or radiotherapeutic responsiveness. The detection of HPV DNA in 45% of LVCs suggests an association between the presence of HPV-16 DNA and HPV-18 DNA, and some LVCs.

Detection and typing of human papillomavirus in verrucous carcinoma of the oral cavity using the polymerase chain reaction.

OBJECTIVE: This study examined the prevalence and types of human papillomavirus (HPV) DNA in oral cavity verrucous carcinoma. DESIGN: This was of a retrospective screening study. Formalin-fixed, paraffin-embedded tissue samples were examined by the polymerase chain reaction using DNA primers specific for HPV types 6b/11, 16, and 18. SETTING: The majority of patients were seen at referral centers in Ontario, Canada. PATIENTS: This study examined 29 oral cavity verrucous carcinomas occurring in a sample of 25 patients from four institutions between 1966 and 1992. All tumors met standardized histologic diagnostic criteria of verrucous carcinoma. MAIN OUTCOME MEASURE: The prevalence of HPV 6b/11, 16, and 18 DNA was determined by the PCR technique. RESULTS: The HPV DNA was detected in 12 (48%) of 25 patients. The HPV 6b/11 DNA, HPV 16 DNA, HPV 18 DNA, and HPV 16 DNA plus HPV 18 DNA, were detected in one (4%), one (4%), nine (36%), and one (4%) cases, respectively. CONCLUSIONS: The detection of HPV 18 DNA in 40% of oral cavity verrucous carcinomas suggests an association between the presence of HPV 18 DNA and some oral cavity verrucous carcinomas. The etiologic and prognostic significance of HPV 18 for oral cavity verrucous carcinoma remains unanswered and will require further study.

Septic internal jugular vein thrombosis.

Septic Internal Jugular Vein Thrombosis (SIJVT) is a rare but potentially life-threatening condition which necessitates early clinical recognition and rapid administration of appropriate therapy. Although termed by some authors a "forgotten disease" in the antibiotic era, this entity is still present but frequently overlooked. Deep neck infections, Lemierre syndrome, central venous catheterization and mastoiditis are the etiologies in this series. The diagnosis of SIJVT utilized CT and Doppler ultrasound imaging. The treatment included aggressive abscesses, necrotizing fasciitis, mastoiditis). Anti-coagulant agents were used in order to reduce the risks of pulmonary embolism.

CT imaging in the diagnosis and treatment of sinus disease: a partnership between the radiologist and the otolaryngologist.

We consider that the nasal cavity and the paranasal sinuses cannot be declared completely normal without a normal CT scan. While CT scans are clearly useful in the evaluation of patients with recurrent sinusitis, it is important to emphasize that they should not be employed exclusively for diagnosis. Nasal endoscopy and clinical evaluation still form the basis for the diagnosis of chronic and recurring sinusitis. The CT technique described should be used only to supplement the clinical data obtained during history-taking and the rhinoscopic/endoscopic examination and is essential before functional endoscopic sinus surgery. The complexity of the diagnostic process is simplified to patient benefit when the radiologist and the otolaryngologist form a functional interactive partnership.

Pre-operative localization of 25 consecutive parathyroid adenomas: a prospective imaging/surgical correlative study.

The successful diagnosis and surgical treatment of primary hyperparathyroidism due to parathyroid adenoma benefits significantly, in our experience, from a process of pre-operative imaging localization of the parathyroid adenoma. This prospective study evaluates a window of 25 consecutive patients who underwent pre-operative imaging localization prior to successful unilateral parathyroidectomy for parathyroid adenoma. All parathyroid adenomas were successfully localized by imaging, and subsequently documented photographically in surgical correlation, and pathologically confirmed. All patients were cured biochemically. Ultrasound accurately localized 92% of adenomas (100% in the neck and extrathyroidal) while radionuclide subtraction scanning identified 60% of a smaller subset. Both DSA and CT were successful in the two cases utilized, and MRI demonstrated four of five adenomas. The high yield of these pre-operative localization studies should make them an important consideration in the routine evaluation of patients undergoing surgery for possible parathyroid adenoma. Their usefulness in directing a conservative unilateral operation may result in time and cost savings, as well as reduced surgical exposure.

Observations on the natural history of a parotid epithelial-myoepithelial carcinoma of intercalated ducts.

A case report of a parotid epithelial-myoepithelial carcinoma (EMC) of intercalated ducts is presented. There were no changes in clinical characteristics or growth over a four-year period as documented by repeated clinical examination and serial ultrasounds. This neoplasm may be mistaken for an adenoid cystic carcinoma on fine needle aspiration and is believed to represent an adenocarcinoma of low malignant potential. The imperceptible growth of this epithelial-myoepithelial carcinoma is in accord with a low malignant potential.

A monomorphic adenoma of the minor salivary glands presenting at the base of the tongue: a case report and review of the literature.

A case of a monomorphic adenoma of the minor salivary glands situated at the base of the tongue in a 49-year-old female is reported. The patient had a prolonged clinical course of eight years' duration. The histopathologic, immunohistologic and ultra-structural findings are described. A review of the literature concerning minor salivary gland tumors and their location in the oral cavity is presented. This is the first case, to our knowledge, of a monomorphic adenoma presenting at the base of the tongue. The difficulties in its diagnosis are discussed specifically in regard to its location.

Nonpalpable occult and metastatic papillary thyroid carcinoma.

The results of palpation, ultrasound, and detailed pathology were compared in 50 patients undergoing total thyroidectomy. Of the 211 nodules recognized by pathology, palpation detected 24% and ultrasound detected 43%. There were 14 patients with palpable papillary carcinomas, and 12 of these 14 had metastatic foci in other portions of the gland. Metastatic foci would have been left in 10 patients if only a lobectomy had been performed and would have been left in 6 patients if only a subtotal thyroidectomy (as defined in this report) had been performed. Of the 33 patients with benign palpable nodules, 5 had occult papillary carcinomas. In 2 of those 5 patients, the occult carcinomas would not have been removed if a less-than-total thyroidectomy had been performed. The significance of these occult and metastatic papillary carcinomas is discussed.

Schwannoma of the intrasternomastoid portion of the spinal accessory nerve: sophisticated pre-operative MRI diagnosis and appropriate surgical management.

In 1986, the authors reported the CT imaging findings which were specific for the diagnosis of schwannoma of the intrasternomastoid portion of the spinal accessory nerve. This successful imaging diagnosis led to appropriate surgical management with preservation of motor nerve function. In this manuscript, magnetic resonance imaging (MRI) was utilized to correctly diagnose the identical lesion, again with the same satisfactory surgical results. Both the CT and MRI findings are unique and specific, and the purpose of this short manuscript is to identify the MRI findings and link these to the previously recorded CT radiographic signs.

Stromal calcification in choanal polyp.

A 50-year-old man, presenting with headache, was suspected of having a malignant nasopharyngeal tumor on the basis of his CT results. A CT scan revealed diffuse calcification in a large nasopharyngeal polyp. Xeroradiography of the specimen demonstrated the calcifications to extend centrally along the stroma. The histology and the radiologic features of this choanal polyp, resulting from diffuse central calcification of the stroma, are a unique feature that might mimic malignancy.

Role of modern imaging in decision-making for elective neck dissection.

This study examines patterns of early metastatic spread as recorded in 19 clinically negative, histologically positive (occult) neck dissection specimens. Microscopic metastatic deposits were detected in this study in nodes measuring 10 mm and less. No nodes with extension of tumor beyond the capsule and into adjacent structures were noted. Central necrosis was detected in only one node. We suggest that the first stages of metastatic disease as evaluated by the pathologist in clinically occult nodes are minimal and may easily evade the eyes of both pathologists and radiologists. Imaging proved to be efficacious in upstaging clinically occult necks that were previously irradiated.

Detection of occult nasopharyngeal primary tumours by means of in situ hybridization.

Detection of nasopharyngeal carcinoma primaries in patients presenting with neck node metastases may sometimes demand considerable efforts. By using the 'in situ hybridization' technique, we manage to identify the Epstein-Barr virus in neck metastases secondary to nasopharyngeal carcinomas. We propose that such identification in neck node metastases where the primary lesion is unknown indicates a nasopharyngeal primary.

Parotid gland and parapharyngeal space imaging--the surgical significance.

Wise head and neck surgeons, for whom parotid gland surgery constitutes a substantial portion of their case load, make full use of the radiologist and cytologist in arriving at a rational pre-operative diagnosis. They utilize the skill of these allied consultants to qualify (by histology) and quantify (by staging) diffuse and mass lesions of the parotid gland (and subjacent parapharyngeal space) in order to evolve an effective surgical, radiation or other treatment plan. They understand the basic principles of diagnostic imaging and apply them to the clinical problem at hand. They minimize diagnostic and intra-operative "surprises", reduce intra-operative and post-operative complications and generally have a more "informed" patient and patient's family. The purpose of this manuscript is to discuss a contemporary role for diagnostic imaging in neoplastic (and other) diseases of the parotid gland and subjacent parapharyngeal space. Not all lesions of the parotid gland require imaging, although a pre-operative clinical photograph, including evidence of facial nerve function, is always welcome. Other lesions may need diagnostic imaging, from simple to complex and sophisticated, depending upon the problem. Properly used, effective and selective diagnostic imaging can improve the surgeon's confidence by providing a more realistic provisional diagnosis and a better pre-operative staging process and treatment plan, thereby avoiding the surgically unexpected and facilitating prognosis.