Olfactory neuroblastoma (esthesioneuroblastoma): towards minimally invasive surgery and multi-modality treatment strategies - an updated critical review of the current literature.

Olfactory neuroblastoma (esthesioneuroblastoma) was first described by Berger and Luc in 1924. It is considered to be an uncommon malignancy of the nasal cavity. The tumor arises from the specialized sensory epithelial olfactory cells, normally situated at the upper part of the nasal cavity, including the superior nasal concha, the roof of the nose and the cribriform plate. The imaging modalities of choice are computed tomography (CT) and magnetic resonance imaging (MRI). Combination of surgery and radiotherapy (either conventional radiotherapy or stereotactic radiosurgery), with or without chemotherapy is considered to be the standard of care for primary site disease by the majority of researchers. Combined transfacial and neurosurgical conventional approaches are also adopted in many reported cases, mainly due to the endocranial extension and the close anatomic relationship of esthesioneuroblastomas with the ethmoid roof and cribriform plate. Recent literature supports that endoscopic resection correlates with similar oncologic control rates compared with conventional open surgery, provided that basic oncologic surgical principles with clearance of margins and intradural dissection (when required) are completely maintained.

Variation among pre-surgical CT assessments of chronic otitis media.

OBJECTIVE: To investigate the reliability of preoperative computed tomography (CT) in patients with chronic otitis media (COM) as assessed by otologist-ENT surgeons, compared with surgical findings and respective radiological assessments, and to identify areas of the middle ear that are difficult to evaluate reliably with preoperative CT. MATERIALS AND METHODS: Fifty patients with COM underwent preoperative temporal bone CT reported by a qualified radiologist. Each operating surgeon completed a standardized questionnaire regarding the status of 10 middle-ear structures after the operation. Two otologists blindly reviewed the scans. AC1-statistics between the radiology/otology report and the intra-operative findings were calculated. RESULTS: In the attic, malleus-incus complex, tympanic cavity, and round window niche, the otologists' assessments of CT scans corresponded better to intra-operative findings than did the respective radiology report. In the lateral semicircular canal and sigmoid sinus, the otologists' assessments also outperformed those of the radiologists in cases of erosion. Radiological assessments outperformed those of otologists in only one of 10 studied areas: confirmation of an unexposed dura in the tegmen area. The scutum and oval window represent difficult areas for which to obtain a reliable preoperative CT scan report. CONCLUSION: Otologists' assessments regarding the pre-surgical status of the temporal bone in COM appear more reliable than those of radiologists. This finding has serious implications in current clinical practice, and should be considered when designing strategies for Radiology Head & Neck training. The inherent limitations of CT may necessitate modifications to imaging and operating strategies.

Propranolol is an effective treatment for airway haemangiomas: a critical analysis and meta-analysis of published interventional studies.

Haemangiomas represent the most common benign tumours in infancy, affecting 1-2% of newborns. The present meta-analysis aimed to critically review the current evidence on the efficacy of propranolol in the management of airway haemangiomas, and explore potential adverse events and treatment failures. A literature review was performed in Medline and other available database sources, along with critical analysis of pooled data. Seventeen studies were included in the analysis. No study represented Level I evidence. The total number of treated patients was 61; 14 patients received propranolol as single-treatment. The comparative effectiveness of propranolol vs. systemic steroids was documented in 35 children, and showed superior outcome in the vast majority (94%, p < 0.001). The mean obstruction before propranolol administration was 72%, and after intervention was 20% (p < 0.001). The mean referral-age for children with airway haemangiomas was 2.4 months, the mean starting-age of propranolol treatment was 5.1 months and the mean follow-up period was 8.4 months. Four children failed to respond (6.5%), and in seven the haemangioma relapsed after discontinuation of treatment (11.5%). The results of the present study suggest that propranolol can be recommended for the treatment of airway haemangiomas, as it was found to be effective and outperformed the previously-considered gold standard treatment methods, with fewer side-effects. Immediate treatment with propranolol should be initiated once a diagnosis of symptomatic airway haemangioma is confirmed, and cardiovascular assessment has been performed. Children should remain on propranolol until the haemangioma enters the phase of involution. Active parental monitoring is essential to ensure treatment safety.

Bilateral Peritonsillar Abscesses: A Case Presentation and Review of the Current Literature with regard to the Controversies in Diagnosis and Treatment.

Although unilateral peritonsillar abscess is a common complication of acute bacterial tonsillitis, bilateral peritonsillar abscesses are quite rare. The incidence of unsuspected contralateral peritonsillar abscess identified at tonsillectomy has been reported to be between 1.9% and 24%, while the overall incidence of bilateral peritonsillar abscess is reported to reach 4.9%. Diagnosis can be based on clinical criteria or imaging techniques. As far as the treatment is concerned, it is generally accepted that the basic strategy consists of systemic antibiotics and drainage of the pus. We report the case of a 19-year-old girl, treated in the emergency room with a bilateral diagnostic needle aspiration followed by bilateral incision and drainage along with intravenous clindamycin plus anti-inflammatory agents and hydration. Following treatment, the patient progressively experienced a marked alleviation of her odynophagia. She was discharged 48 hours later on a 10-day course of clindamycin.

Laryngeal paragangliomas - controversies in diagnosis and management.

Paragangliomas of the larynx are rare neuroendocrine tumors with difficulties in diagnosis and management. A review of the literature was carried out, using Medline and other available databases. Electronic links and related books were also included. The most reliable diagnostic imaging procedures are MRI, CT scan, and octreotide scintigraphy. Complete surgical excision with the maximal possible preservation of the laryngeal function is the treatment of choice. Many different surgical techniques have been reported but open surgical procedures seem to provide better results with lower recurrence rates, although endoscopic approaches and laser surgery have also been used with variable results. The use of long-acting depot octreotide has been used for the relief of symptoms and stabilization of the disease, especially in inoperable lesions with positive initial octreotide scintigraphy imaging. Detailed preoperative assessment and treatment planning in individual basis are essential in the management of these tumors.

Adult laryngeal rhabdomyosarcoma: is aggressive treatment justified in all cases? A case report and review of the literature.

BACKGROUND: Adult laryngeal rhabdomyosarcomas are rare tumours commonly treated by laryngectomy. CASE REPORT: We present a case of subglottic laryngeal rhabdomyosarcoma in an elderly woman, treated by endoscopic resection. CONCLUSION: Despite the fact that this tumour is traditionally treated aggressively, this approach is not supported by the literature. Due to the varying biological behaviour of this tumour in adults, we believe that conservative surgical procedures or combination therapies should be preferred, rather than total laryngectomy.

Relative diagnostic importance of electronystagmography and magnetic resonance imaging in vestibular disorders.

OBJECTIVE: The aim of this study was to investigate the contribution of electronystagmography and magnetic resonance imaging to the aetiological diagnosis of vertigo and unsteadiness, in a population in which the history and clinical examination provide no conclusive diagnosis of the origin of the dysfunction (i.e. peripheral or central). PATIENTS AND METHODS: This retrospective study included 102 patients, who underwent full ENT clinical evaluation, history and neurotological assessment (including pure tone audiography, auditory brainstem response testing, electronystagmography and magnetic resonance imaging). RESULTS: Electronystagmography contributed to establishment of a diagnosis in 53/102 patients (52 per cent), whereas magnetic resonance imaging did the same in four of 102 patients (3.9 per cent). CONCLUSION: Electronystagmography remains the most useful examination for aetiological diagnosis of patients with vertigo and unsteadiness, since the actual number of patients with vertigo and unsteadiness of central origin is small (3.9 per cent), even in a population in which history and clinical examination may indicate an increased probability of central nervous system dysfunction.

Surgical correction of pinna malformations.

BACKGROUND: Auricle reconstruction is a surgical procedure described in the medical literature as early as 600 BC. The aim of the present paper is to review these attempts and their results. METHODS: Literature search and medical history books were used as scientific sources. RESULTS: More than 40 different cartilagenous, osseous or other alloplastic frame materials (autogenous tibial bone, iliac bone, mastoid bone, maternal auricular cartilage, autogenous nasoseptal cartilage, allogenous meniscus, autogenous meniscus and many more) have been used since 1891. From approximately 40 reconstruction procedures that had been proposed, only eight were still in use in the 1980s. The reason for abandoning the majority of these surgical techniques was the unacceptable aesthetic result. However, at the end of the 20th Century two new techniques were introduced. These techniques were designed by Satoru Nagata and Burt Brent. Both techniques provide cosmetic and functional results that are acceptable both to the patient and to the surgeon. CONCLUSIONS: Although the outcome of surgical auricle reconstruction was in general disappointing through the centuries, at the end of the 20th Century new surgical methods were established and at the present time auricle reconstruction can be attempted with acceptable results.

Topical antibiotic ear drops: are they safe?

A discharging ear is a very common condition for the general practitioner and the ENT surgeon. Oral and intravenous antibiotics have potential complications, are costly, and exhibit increasing resistance. This study explores the advantages and disadvantages of all common otic preparations and compares effectiveness, safety, cost and complication rates. In chronic otitis media (chronic discharging ears), topical antibiotics seem to be the treatment of choice by comparison with oral or intravenous antibiotics. Cultures and antibiograms do not correspond directly to clinical efficacy, as laboratory determination of resistance does not take into account the high concentration of antibiotics in local preparations. It is safer to use quinolone drops as a first-line treatment, but it is still possible to use short courses of other drops if quinolones are either unavailable or contraindicated (e.g. allergy), or when bacteria are resistant to them. However, in such a situation, a round window membrane involved in an established inflammatory process and therefore less permeable to the passage of topical preparations is the preferred setting, as ototoxicity is a potential complication, especially in the case of gentamicin, in which case patients should be warned accordingly.