Chronic lymphocytic leukemia of the oropharyngeal cavity and paranasal sinuses: a case series and literature review.

BACKGROUND: Chronic lymphocytic leukemia (CLL) is an indolent B-lineage neoplasm responsible for 30% of all leukemias. The median age of onset is 67 years with a male predominance of 2:1. Localized infiltration in the oropharynx and paranasal sinuses is exceptionally rare. The aims of this study were (1) to add an additional case series of CLL with involvement of the oropharynx and paranasal sinuses to the literature and (2) to determine incidence and demographic data. METHODS: Retrospective chart review from 1990 to 2014. RESULTS: Five cases were found in our case series, representing 0.74% of the total number of cases analyzed (5/680). Sixteen additional cases were identified through literature review, resulting in a total of 21 cases of CLL (13 men, 8 women) with involvement of the oropharynx (n = 15) and paranasal sinuses (n = 6). The average age of patients with CLL in the oropharynx was 62 years whereas in the paranasal sinuses it was 52 years (p = 0.16). The average age of female cases was 62 years and the average age of male cases was 58 years (p = 0.63). Almost 85% (84.6%) of men had oropharynx invasion vs 50% of females (p = 0.15), which suggests a nonsignificant trend. CONCLUSION: The results of our study indicate that CLL infiltrates the oropharynx or paranasal sinuses in less than 1% of CLL cases. Although there seems to be no age bias between invasion in the oropharynx and the paranasal sinuses, there is a trend whereby women appear more likely to experience invasion of the paranasal sinuses.

Preserved low-frequency hearing following 20-mm cochlear implantation.

OBJECTIVE: To determine the preservation of pure tone thresholds for a series of cochlear implant patients who underwent atraumatic round window insertion with a new thin 22-mm electrode to a 20-mm depth. STUDY DESIGN: Retrospective, within-subject repeated measures design. SETTING: Tertiary care hospital. PATIENTS: Nine sequential cochlear implant patients with functional preoperative acoustic hearing (defined as low-frequency pure tone average thresholds ≤90 dB). INTERVENTION: Therapeutic. MAIN OUTCOME MEASURE: Pure tone thresholds after cochlear implantation. RESULTS: Low-frequency hearing preservation was achieved in all cases. Less than 10 dB average change was seen for low-frequency pure tone average measures (125, 250, 500, and 1,000 Hz) at 6 and 12 months following cochlear implantation. CONCLUSIONS: Atraumatic round window insertion with a thin 22-mm electrode to a 20-mm depth results in dramatically high levels of acoustic hearing preservation among CI patients.

Preventing complications in pediatric cochlear implantation.

PURPOSE OF REVIEW: This review addresses four key areas of controversy in the prevention of common complications of pediatric cochlear implant surgery: reducing meningitis risk, managing acute otitis media (AOM) in the cochlear implant population, assessing the optimum age for implanting a child to take advantage of the critical periods of language acquisition, and managing the social risk in defining ethical issues still surrounding cochlear implant in children. RECENT FINDINGS: Improved surgical techniques and the replacement of Prenvar-7 with Prenvar-13 significantly reduce the risk of cochlear implant related meningitis. AOM within 2 months of cochlear implant placement requires aggressive management to reduce the risk of complication. Tympanostomy tubes do not increase the risk of otitis media or meningitis and should be used when appropriate according to accepted AOM standards. Although the controversy over cochlear implant and the dissolution of Deaf Culture is decreasing, the use of cochlear implant in children remains an area for open dialogue between groups to ensure children are treated appropriately. Discussions ought to be based on fact and scientific evidence. SUMMARY: Although cochlear implants remain the gold standard for hearing restoration in children with severe to profound hearing loss, several issues remain controversial and are in need of further scientific exploration.