Endoscopic Resection of Sinonasal Inverted Papilloma: Systematic Review and Meta-Analysis.

Background Pure endoscopic surgery (functional endoscopic sinus surgery) has been increasingly replacing external approaches in the management of sinonasal inverted papillomas. Objective To analyze and compare the effectiveness of pure endoscopic procedure with external or combined procedures to paranasal inverted papillomas, including the experience from two institutions in North Greece, over a 20-year period. Methods Systematic literature searches of MEDLINE (1952-2016), EMBASE (1974-2016), and the Cochrane Central Register of Controlled Trials. Review of all English-language studies comparing endoscopic and open techniques. Odds ratios (ORs), risk ratio, 95% confidence intervals (CIs), and tests for heterogeneity were reported. Recurrence rates according to initial tumor stage. Results In total, 2451 patients had been enrolled in the 23 studies, published between 1992 and 2014. All the included articles are graded as level IV evidence. Among the 1526 patients of the endoscopic group, 212 (13.8%) had recurrence, with the mean time of recurrence to range from 14 to 46.6 months. In the external approach group, 111 (18.7%) of the 592 patients had recurrence, with the time of recurrence to range from 7 to 92 months. The recurrence rate in the combined approach group was 12.9%. The occurrence rate of recurrence attributable to the surgical choice was significantly different between endoscopic and external group (OR: 0.61; 95% CI: 0.40-0.92; P = 0.02; 14.9% vs. 18.8% in endoscopic and external group, respectively). Conclusions The present systematic review and meta-analysis indicates that endoscopic approach seems a favorable treatment option of sinonasal inverted papillomas and confirms the global recommendation that is the gold standard in the treatment of such nose lesions, revealing a lower recurrence rate compared to external approaches.

Revision Rhinoplasty: Retrospective Chart Review Analysis of Deformities and Surgical Maneuvers in Patients with Nasal Airway Obstruction-Five Years of Experience.

Nasal airway obstruction is one of the most frequent causes of revision rhinoplasty in patients after previous rhinoplasty procedure. Purpose of this study is to present the deformities and the surgical maneuvers conducted in revision rhinoplasty patients with functional complaint, anatomical sites at risk, and potential prophylactic maneuvers. This study is a retrospective chart review analysis of 46 consecutive revision rhinoplasty procedures in patients with nasal airway obstruction. Inclusion criteria were at least one previous rhinoplasty and nasal airway obstruction as the epicenter of patients' complaint. Thorough clinical examination to certify the obstruction was performed. Deformities noted were separated in three categories according to functional, cosmetic, and combination of functional and cosmetic implications. Surgical maneuvers conducted were reviewed. Deformities found were checked for statistically significant coexistences. The average patient age was 34.9 years. The mean number of previous septorhinoplasties was 1.33. Nasal ventilation obstruction mainly caused either by septum deviation or nasal valve dysfunction was identified in 91.3% of our patients. Surgical maneuvers conducted included placement of grafts in 89.1% of all cases, septoplasty in 76.1%, lateral wall support in 47.8%, and placement of spreader grafts in 39.1% of patients. The average preoperative Nasal Obstruction Symptom Evaluation (NOSE) score was 61 ± 15 and it improved substantially, even from month 1, postoperatively. Owing to high prevalence of nasal airway obstruction after primary or secondary rhinoplasty, we conducted the first retrospective chart review study to identify the most common deformities in revision rhinoplasty patients with nasal airway obstruction and the appropriate surgical maneuvers to address them. Septum deviation and nasal valve dysfunction were the two pillars of nasal airway obstruction in those patients.

Corticosteroids and vestibular exercises in vestibular neuritis. Single-blind randomized clinical trial.

IMPORTANCE The management of patients with unilateral acute vestibular neuritis (VN) has not been established to date. OBJECTIVE To compare the use of vestibular exercises vs corticosteroid therapy in the recovery of patients with acute VN. DESIGN, SETTING, AND PARTICIPANTS Prospective, single-blind, randomized clinical trial at a primary referral center. Among all patients with acute vertigo, those having VN were eligible for inclusion in the study. INTERVENTIONS Forty patients with acute VN were randomly assigned to perform vestibular exercises or to receive corticosteroid therapy. After a baseline examination, follow-up evaluations were performed at 1, 6, and 12 months. MAIN OUTCOMES AND MEASURES Efficacy outcomes included clinical, canal, and otolith recovery. Scores on the European Evaluation of Vertigo Scale and the Dizziness Handicap Inventory were used for the evaluation of clinical recovery. Findings of caloric irrigation and vestibular evoked myogenic potentials indicated canal and otolith improvement, respectively. RESULTS Comparing the 2 treatment groups, no statistically significant differences were found in clinical, canal, or otolith recovery. At the 6-month examination, the number of patients with complete disease resolution in the corticosteroids group was significantly higher than that in the vestibular exercises group. However, at the end of the follow-up period, 45%(9 of 20) of patients in the vestibular exercises group and 50% (10 of 20) of patients in the corticosteroids group had complete disease resolution (P > .05). CONCLUSIONS AND RELEVANCE Treating patients who have acute VN with vestibular exercises seems equivalently effective as treating them with corticosteroid therapy in clinical, caloric, and otolith recovery. Corticosteroid therapy seems to enhance earlier complete acute VN resolution, with no added benefit in the long-term prognosis.

Hybrid carcinoma of the larynx: a case report (adenoid cystic and adenocarcinoma) and review of the literature.

Introduction. The nonsquamous carcinomas of the larynx are considered rare with the majority of malignant tumors in this area, reaching the rate of 95%, to be squamous cell neoplasms. Case Report. The case refers to a 53-year-old man that presented with symptomatology of motor nerve disease. During the evaluation of the neurologic disease, a subglottic mass of the larynx was revealed accidentally in the imaging examination. Under general anesthesia, we performed direct laryngoscopy and biopsy of the mass. The histopathologic examination revealed a hybrid carcinoma coexistence of two different carcinomas, an adenoid cystic carcinoma and an adenocarcinoma, not otherwise specified with poor differentiation. Regarding the therapeutic plan, the mass was considered inoperable due to its expansion to trachea and the patient received radiotherapy. Conclusions. Both the adenocarcinoma and adenoid cystic carcinoma are extremely rare types of malignant tumors in the larynx. The special interest of the present case is the coexistence of these two rare tumors in the same region of the larynx, being a hybrid tumor of the salivary glands in the larynx, which is the second reported case, based on our systematic literature review.

Lipochoristomas of the cerebellopontine angle and internal acoustic meatus: a seven-case review.

BACKGROUND: Intracranial lipomas are extremely rare tumors, with certain clinical and radiological characteristics. METHODS: We considered the diagnostic evaluation and treatment options of seven patients presenting with lipoma in the cerebellopontine angle or internal acoustic meatus in our department. RESULTS: Mean age was 51, with four out of seven cases being women. Balance disorders (vertigo, dizziness) were the predominant symptoms (in six out of seven patients), followed by hearing loss. The diagnosis of intracranial lipomas was based on the results of imaging studies, especially on magnetic resonance imaging. The management of lipomas of the CPA and of the IAM should initially be conservative, including close follow-up of the patient and evaluation of a potential change in tumor size. Surgical management of CPA lipomas should be reserved for patients with intractable clinical symptoms due to tumor overgrowth. CONCLUSIONS: Diagnosis of CPA and IAM lipomas is considered to be a clinical and imaging challenge. As the complete resection of such lipomas is a risky choice and taking into account the benign course of such tumors, the only absolute surgical indication should be uncontrolled tumor growth.

Duplication of the external auditory canal: two cases and a review of the literature.

The objective of the present paper is to describe the clinical presentation, diagnostic process, surgical treatment, and outcome of 2 patients with first branchial cleft anomaly. The first case was an 8-year-old girl presented with an elastic lesion located in the left infra-auricular area, in close relation with the lobule, duplicating the external auditory canal. The magnetic resonance imaging revealed a lesion, appearing as a rather well-circumscribed mass within the left parotid gland and duplicating the ear canal. A superficial parotidectomy was subsequently performed, with total excision of the cyst. The second patient was a 15-year-old girl presented with a congenital fistula of the right lateral neck. At superficial parotidectomy, a total excision of the fistula was performed. During the operation the tract was recorded to lay between the branches of the facial nerve, extending with a blind ending canal parallel to the external acoustic meatus. Conclusively, first branchial cleft anomalies are rare malformations with cervical, parotid, or auricular clinical manifestations. Diagnosis of first branchial cleft lesions is achieved mainly through careful physical examination. Complete surgical excision with wide exposure of the lesion is essential in order to achieve permanent cure and avoid recurrence.

Simultaneous metastatic papillary thyroid carcinoma and carcinoid of the small intestine in the cervical lymph node group.

BACKGROUND: Malignancies, primary or metastatic, and infections are the main causative factors that should be included in the differential diagnosis of cervical adenopathy. SUMMARY: We present a 56-year-old woman who was admitted to our department because of a supraclavicular mass. A neck dissection was performed and two different masses were excised. The histopathological examination showed that the larger mass (measuring 5 cm) was a block of lymph nodes with metastatic papillary carcinoma of the thyroid. In the adjacent fibroadipose tissue, two lymph nodes with metastatic carcinoid tumor were found. The smaller mass (measuring 2 cm) was a lymph node with metastatic carcinoid tumor. The patient underwent total thyroidectomy with ipsilateral radical neck dissection. Histopatological examination of the thyroid gland showed a lesion of papillary carcinoma, measuring 0.6 cm. No further lesions of carcinoid were found. CONCLUSIONS: To our knowledge, this is the first report of a coexistence of metastatic papillary thyroid carcinoma and intestinal carcinoid tumor in cervical lymph nodes.

Corticosteroids in the treatment of vestibular neuritis: a systematic review and meta-analysis.

OBJECTIVE: To systematically review and meta-analyze the results of all randomized controlled trials comparing corticosteroids with placebo for the treatment of patients with vestibular neuritis. DATA SOURCES: An electronic search was performed in MEDLINE, EMBASE, Cochrane Library, and CENTRAL databases, and then extensive hand-searching was performed for the identification of relevant studies. No time and language limitations were applied. STUDY SELECTION: Prospective randomized controlled trials comparing corticosteroids with placebo for the treatment of patients with vestibular neuritis. DATA EXTRACTION: Odds ratios (ORs), weighted mean differences (WMD), 95% confidence intervals (CIs), and tests for heterogeneity were reported. DATA SYNTHESIS: Four studies were eventually identified and systematically reviewed. Meta-analysis was feasible for 3 studies. Regarding the recovery of clinical symptoms, the proportion of patients with clinical recovery at 1 month after the initiation of therapy did not differ significantly between the corticosteroids and placebo groups (OR, 1.45; 95% CI, 0.26-8.01; p = 0.67). The proportion of patients with caloric complete recovery was significantly different between the corticosteroids and placebo groups both at 1 (OR, 12.64; 95% CI, 2.6-61.52; p = 0.002; heterogeneity, p = 0.53; fixed effects model) and 12 months (OR, 3.35; 95% CI, 1.45-7.76; p = 0.005; heterogeneity, p = 0.03; random effects model) after the initiation of therapy. The caloric extent of canal paresis at 12 months after the initiation of therapy seemed to differ significantly between patients who received corticosteroids and those who received placebo (WMD, -12.15; 95% CI, -19.85 to -4.46; p < 0.05; heterogeneity, p < 0.05; random effects model). CONCLUSION: The present systematic review and meta-analysis, based on the currently available evidence, suggests that corticosteroids improve only the caloric extent and recovery of canal paresis of patients with vestibular neuritis. At present, clinical recovery does not seem be better in patients receiving corticosteroids.

Extramedullary plasmacytoma of temporal bone: report of 2 cases and review of literature.

OBJECTIVE: The aim of the study was to report 2 cases of extramedullary plasmacytoma (EP) with localization to middle ear that were diagnosed and managed in our department. METHODS: The first patient was a 60-year-old man with progressive hearing loss, tinnitus, recurrent episodes of otalgia, and otorrhea in his right ear during the last 2 years. The second patient was a 66-year-old man who presented with aural fullness in his right ear and a mild pain in the region of right mastoid. Mild hearing loss and episodes of dizziness with sensation of falling for about 6 months were reported in the clinical history. CONCLUSIONS: The prognosis of EP is considered favorable in regard to the solitary bone plasmacytoma and multiple myeloma (MM). The differential diagnosis of EPs from other plasma cell dyscrasias and especially from MM is considered essential. It is a radiosensitive tumor and, especially for EPs of temporal bone, the combined treatment of surgery resection and postoperative radiation seems to provide the best local control and the lower risk of occurrence. The therapeutic strategy includes a close follow-up of the patients because of the risk of occurrence and/or dissemination into MM. The 10-year survival rate reaches 70% with the appropriate therapy.

Corticosteroids vs corticosteroids plus antiviral agents in the treatment of Bell palsy: a systematic review and meta-analysis.

OBJECTIVE: To review systematically and meta-analyze the results of all randomized controlled trials (RCTs) for the treatment of patients with Bell palsy with corticosteroids vs corticosteroids plus antiviral agents. DATA SOURCES: A MEDLINE, EMBASE, Cochrane Library, and CENTRAL database search, followed by extensive hand-searching for the identification of relevant studies. No time and language limitations were applied. STUDY SELECTION: Prospective RCTs on the treatment of patients with Bell palsy. DATA EXTRACTION: Odds ratios (ORs), 95% confidence intervals (CIs), and tests for heterogeneity were reported. DATA SYNTHESIS: Five studies were eventually identified and systematically reviewed. Meta-analysis was performed for 4 studies. Regarding the complete recovery rate of facial nerve paralysis 3 months after initiation of therapy, the current systematic review and meta-analysis suggests that the addition of an antiviral agent does not provide any benefit (OR, 1.03 [95% CI, 0.74-1.42]; P = .88). The same conclusion emerged at posterior (fourth, sixth, and ninth) months of assessment. Subgroup analysis, conducted on the basis of time point of therapy initiation, type of antiviral agent, and blindness of assessments did not change the results obtained. The occurrence rate of adverse effects attributable to therapy choice was not significantly different between patients receiving corticosteroids and those following combined treatment. CONCLUSION: The present systematic review and meta-analysis, based on the currently available evidence, suggests that the addition of an antiviral agent to corticosteroids for the treatment of Bell palsy is not associated with an increase in the complete recovery rate of the facial motor function.