Clinicoradiologic Characteristics of Temporal Bone Meningioma: Multicenter Retrospective Analysis.

OBJECTIVES/HYPOTHESIS: Meningioma is a neoplasm arising from cells related to the arachnoid villi. The aim of the present study was to explore the clinical and radiological characteristics of temporal bone meningioma (TBM) in a multicenter cohort. STUDY DESIGN: Retrospective cohort study. METHODS: Thirteen patients diagnosed with TBM at eight medical institutes between 1998 and 2018 were retrospectively enrolled. The clinical procedures, symptoms, signs, and images that led to the diagnosis of TBM were investigated for all patients. RESULTS: The most common symptom at the initial visit was hearing loss (n = 12/13, 92.3%). All patients exhibited unilateral TBMs with varied symptom durations (1-60 months). Four patients presented masses occupying the external auditory canal; the tympanic membrane (TM) could not be evaluated. The other nine patients did not show TM perforation despite the presence of inflammatory signs. The majority of patients exhibited unilateral conductive or mixed hearing loss. A retrospective review of temporal bone computed tomography (TBCT) images revealed findings suggestive of a tumor in all patients. However, three patients had been misdiagnosed with chronic otitis media and were subjected to tympanomastoidectomy (n = 3/7, 42.9%). TBCT findings that suggested TBM included diffuse trabecular hyperostosis in the middle and posterior cranial fossae and widening and destruction of the temporal bone in the jugular bulb area. CONCLUSIONS: TBM should be suspected if patients exhibit persistent inflammatory symptoms or signs involving intact TM or unilateral conductive or mixed hearing loss with trabecular hyperostosis or destruction of the temporal bone on computed tomography images. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:173-178, 2021.

Substance P and Calcitonin Gene-Related Peptide in the Glands of External Auditory Canal Skin.

OBJECTIVES: The earwax (cerumen) that covers external auditory canal (EAC) skin contains a mixture of ceruminous and sebaceous gland substances, such as lipids, peptides, and proteins. The components secreted from the ceruminous gland that is a modified sweat gland form cerumen and contain several antimicrobial factors. Since substance P (SP) and calcitonin gene-related peptide (CGRP), known as a secretagogue, have been found in sweat glands, our purpose was to determine the expression of SP and CGRP in the glands of EAC skin. METHODS: Sections of normal human EAC skins were immunostained for the presence of SP and CGRP using polyclonal antibodies. Immunoreactivity was detected using an avidin-biotin peroxidase complex method. RESULTS: SP staining was found in ceruminous gland acini and myoepithelial cells. But the SP staining was not found in the sebaceous glands and epidermal region. CGRP was strongly stained in the ceruminous gland and weakly in the sebaceous gland cells. Interestingly, most prominent staining of SP and CGRP was noted in the myoepithelial cells of the ceruminous gland. CONCLUSION: The findings in this study suggest that SP and CGRP are expressed in the glands of the EAC skin and secreted in the process of ceruminous gland secretion.

Can Intracapsular Tonsillectomy Be an Alternative to Classical Tonsillectomy? A Meta-analysis.

Objective Tonsillectomy is the most common operation performed in the otolaryngologic fields. Efforts have been made to reduce postoperative complications, and one of these is intracapsular tonsillectomy and adenoidectomy (ICTA), which leaves the tonsillar tissue with tonsillar capsule. This study aimed to evaluate intracapsular tonsillectomy compared with classical extracapsular tonsillectomy in terms of efficacy of the technique for managing obstructive sleep apnea (OSA) and reducing postoperative complications. Data Sources We performed a literature search using PubMed, EMBASE, and the Cochrane Library through December 2016. Review Methods Summarized risk ratio (RR), risk differences (RDs), and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were estimated by summarizing the risk estimates of each study using random-effects models that considered both within- and between-study variations. Results Our search included 15 randomized controlled studies. The RRs for postoperative bleeding and residual tonsils were, respectively, 0.44 ( P = .01) and 6.02 ( P = .0002). There were significant differences in postoperative pain ( P = .0022), need for analgesics ( P < .0001), days to normal diet ( P = .006), and days to normal activity ( P < .00001) between intracapsular tonsillectomy and extracapsular tonsillectomy. Conclusions Intracapsular tonsillectomy can effectively reduce postoperative pain and bleeding, which shortens the time required to return to normal life. There was no difference between microdebrider and coblator in intracapsular tonsillectomy regarding postoperative pain and bleeding. It can increase the risk of remnant tonsils; however, it does not increase the risk of recurrent infection.

Mumps Presenting as a Parotid Abscess.

Parotid abscess is an uncommon condition in infants. It is frequently associated with prematurity, prolonged gavage feeding, and dehydration. Mumps is a viral disease caused by paramyxovirus. It frequently involves the parotid gland and is only rarely found in the pancreas, testis, or brain. The authors describe a rare case of a 10-month-old infant with mumps who developed the classical manifestations of unilateral acute parotitis progressing to formation of a parotid abscess that responded to 2 rounds of surgical drainage and antibiotic therapy.

The effect of acupuncture on postoperative nausea and vomiting after pediatric tonsillectomy: A meta-analysis and systematic review.

OBJECTIVES/HYPOTHESIS: Tonsillectomy is one of the most frequently performed pediatric surgical procedures worldwide. The complications of this procedure include postoperative nausea and vomiting (PONV) and pain; therefore, both the treatment and prevention of PONV are important. Classical antiemetics include drug therapies such as ondansetron, which are undesirable because they often carry a high cost and several side effects. Therefore, in this study we aimed to evaluate the antiemetic effect of acupuncture after pediatric tonsillectomy. METHODS: We searched for eligible articles that reported on the antiemetic effects of acupuncture after tonsillectomy using the three databases, MEDLINE, Embase, and Cochrane, through July 2015. We included full-length original articles with adequate data for evaluating the antiemetic effects on pediatric tonsillectomy in the form of a relative ratio. The Newcastle-Ottawa scale was used to assess the quality of case control and cohort studies, and the Cochrane risk of bias tool was employed for randomized controlled trials (RCTs). RESULTS: The search identified 415 publications. After screening, we selected eight articles for review (4 RCTs, 3 prospective cohorts, and 1 pilot study). A meta-analysis of acupuncture in pediatric tonsillectomy revealed that the number of patients with PONV was significantly reduced with acupuncture compared to the control group, with a risk ratio of 0.77 (95% confidence interval: 0.63-0.94, P < 0.05). CONCLUSION: When acupuncture at PC6 (neiguan) was used to prevent PONV after pediatric tonsillectomy, the risk ratio was significantly lower compared to that of conventional drug therapy. Although further randomized controlled trials are needed, acupuncture at PC6 is considered an economic and effective treatment for emesis after pediatric tonsillectomy. Laryngoscope, 126:1761-1767, 2016.

Atrial natriuretic peptide modulates auditory brainstem response of rat.

CONCLUSION: These findings suggest that Atrial natriuretic peptide (ANP) exhibits an inhibitory effect on auditory brainstem response (ABR) and is involved in the neuromodulation of the auditory nervous system. OBJECTIVES: ANP may alter electrophysiological properties of the cochlea and play a role in auditory action. METHODS: This study was undertaken to examine and clarify the role of ANP in the rat auditory system using ABR audiometry. The mean ABR thresholds and the latencies for wave II at the ABR threshold altered at given frequencies throughout the study. RESULTS: Intra-arterial infusion of ANP (0.1 mg/kg, 4 mg/kg, and 8 mg/kg; bolus injection) resulted in a significant increase in ABR thresholds. A significant shift in the ABR wave II latency was observed at lower frequency (1 kHz and 2 kHz). There was a little change in latency at 20 kHz. Increased amount of ANP significantly altered the ABR in rats.

Comparison of Arbekacin and Vancomycin in Treatment of Chronic Suppurative Otitis Media by Methicillin Resistant Staphylococcus aureus.

Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of ear infections. We attempted to evaluate the clinical usefulness of arbekacin in treating chronic suppurative otitis media (CSOM) by comparing its clinical efficacy and toxicity with those of vancomycin. Efficacy was classified according to bacterial elimination or bacteriologic failure and improved or failed clinical efficacy response. Ninety-five subjects were diagnosed with CSOM caused by MRSA. Twenty of these subjects were treated with arbekacin, and 36 with vancomycin. The bacteriological efficacy (bacterial elimination, arbekacin vs. vancomycin: 85.0% vs. 97.2%) and improved clinical efficacy (arbekacin vs. vancomycin; 90.0% vs. 97.2%) were not different between the two groups. However, the rate of complications was higher in the vancomycin group (33.3%) than in the arbekacin group (5.0%) (P=0.020). In addition, a total of 12 adverse reactions were observed in the vancomycin group; two for hepatotoxicity, one for nephrotoxicity, eight for leukopenia, two for skin rash, and one for drug fever. It is suggested that arbekacin be a good alternative drug to vancomycin in treatment of CSOM caused by MRSA.

Studies on distribution of α1-antitrypsin, lysozyme, lactoferrin, and mast cell enzymes in diseased middle ear mucosa.

CONCLUSION: Antimicrobial agents (AMAs) and mast cells in chronic otitis media (COM) may play a protective role in the pathogenesis of COM. Among them, our results indicated that lysozyme may be the most important parameter of the mucosa infectivity in COM. OBJECTIVES: AMAs include alpha 1-antitrypsin (α1-AT), lysozyme, and lactoferrin and exhibit innate immune activity that is known to play a critical role in mucosal defenses. In addition, proteases expressed in mast cells contribute to mucosal defenses. The aim of this study was to identify AMAs responsible for COM as well as their association with middle ear mucosal diseases. METHODS: Middle ear mucosa (MEM) was intraoperatively collected by biopsy from patients, diagnosed as COM without or with cholesteatoma, and immediately processed for immunohistochemical study to evaluate expression of AMAs and mast cell proteases (chymase and tryptase). RESULTS: The AMAs and mast cell enzymes were observed prominently in the chronic middle ear diseases whereas immunoreactivity of α1-AT and lysozyme was not significantly increased in the COM with cholesteatoma compared with that in COM without cholesteatoma. Lactoferrin was not detected in the diseased MEMs.

Incidentally detected middle ear osteoma: two cases reports and literature review.

Osteomas of the middle ear are rare benign neoplasms. To date, only a few cases have been reported. Osteomas of the middle ear are small, single, usually unilateral, peduncular growths, off-white in color, with a smooth or multilobular surface, asymptomatic or causing functional disorders. The most common symptom is conductive hearing loss because of impingement of the ossicular chain. Some cases are asymptomatic and are diagnosed incidentally. We present two cases of incidentally detected middle ear osteoma. Based on a review of the main articles in the literature and analysis of two cases managed in our department, we describe the clinical spectrum, etiology, and management of middle ear osteomas.

A case of generalized varicelliform eruption after herpes zoster oticus.

OBJECTIVE: To report the case of a healthy man with a previously unreported combination of generalized varicelliform eruption and herpes zoster oticus. PATIENT: A 44-year-old immunocompetent man who developed generalized varicelliform eruption after peripheral facial palsy with herpes zoster oticus without any underlying immunocompromised state. MAIN OUTCOME MEASURE: The skin lesion was improved during his hospitalization period. Facial palsy was completely cured after 2 months of treatment. CONCLUSION: Herpes zoster oticus occurs rarely and accounts for approximately 1% of all cases of herpes zoster and generalized varicelliform eruption occurs in 2% to 10% of unselected patients with herpes zoster. Most of these patients have an underlying condition that is associated with an immunocompromised state such as lymphoproliferative disease. Varicelliform eruptions are extremely rare among healthy patients without any underlying disease.

Bilateral sudden sensorineural hearing loss as an initial presentation of myelodysplastic syndrome.

This study reports an unusual case in which myelodysplastic syndrome presented bilateral sudden sensorineural hearing loss as the first symptom of the disease. The aural symptoms and signs such as tinnitus, dizziness, and hearing impairment of a hematologic disease are common. However, sudden hearing loss as the first manifestation of a hematologic disease is extremely rare. A 76-year-old woman presented with bilateral sudden hearing loss. The patient was found to have myelodysplastic syndrome during a workup for her hearing loss. Unfortunately, the patient's hearing loss did not improve after the medical treatment.

Synthesis of atrial natriuretic peptide in the rabbit inner ear.

OBJECTIVES/HYPOTHESIS: Atrial natriuretic peptide (ANP) exhibits natriuretic, diuretic, and vasorelaxant activity, maintaining fluid and electrolyte homeostasis. Although ANP is mainly synthesized and secreted in/from atrium, ANP has been found in various tissues including the rat inner ear. The aim of this study was to identify the synthesis of ANP in lateral cochlear wall tissues and the presence of ANP in perilymph using rabbits. STUDY DESIGN: In vivo study using a rabbit model. METHODS: Expression of ANP in the rabbit inner ear tissue and the presence of perilymph were examined by radioimmunoassay and polymerase chain reaction using an ANP polyclonal antibody and rat ANP primers, respectively. Characteristics of ANP and pro-ANP present in the inner ear were also evaluated by high-performance liquid chromatography (HPLC), comparing to rat cardiac ANP and pro-ANP. RESULTS: Immunoreactive ANP (ir-ANP) was found in the perilymph and lateral cochlear wall tissue of rabbits. The levels of ir-ANP in the perilymph were 5 to 16 ng/mL. Elusion profiles of HPLC showed two main peaks that were exactly matched with rat cardiac ANP and pro-ANP. Expression of ANP mRNA was also detected. CONCLUSIONS: Our findings suggest that ANP and its precursor protein are synthesized in the ear tissues and secreted to perilymph. This hormone may play a role in control of water and/or ion homeostasis of the fluids in the ear that are responsible for normal hearing.

A case of delayed spontaneous aneurismal rupture after ear surgery under general anesthesia.

Many complications have been reported after ear surgery to treat chronic inflammation. These complications include facial nerve paralysis, perichondritis, injury of the dura or of the sigmoid sinus, cyst formation or mucocele in the healed mastoid cavity, and the recurrence of cholesteatoma, granulation tissue, or otorrhea. It might be believed that there could be no relation between ear surgery and spontaneous aneurysmal rupture, and only one other case of spontaneous aneurysmal rupture after ear surgery under general anesthesia has been previously reported in Korea. However, recently, the authors encountered a case of delayed spontaneous aneurysmal rupture 3 weeks after surgery. No problem was experienced during the operation, and it is suspected that an unidentified pre-existing aneurysm was responsible for the intracerebral hemorrhage.

Presence of hBD-1 and hBD-2 in human cerumen and external auditory canal skin.

CONCLUSION: Human beta-defensin-1 (hBD-1) and human beta-defensin-2 (hBD-2) antimicrobial peptides present in the cerumen, which is composed of exfoliated epithelial keratin and gland secretion, might provide the first line of defense against microbes in external auditory canal (EAC) skin. OBJECTIVES: Cerumen (earwax) plays a primary role in protecting the EAC skin and tympanic membrane. Even though the protection by antimicrobial peptides present in the skin secretion has been well established, little is known about the intrinsic role of the peptides in the EAC skin and cerumen. The aim of this study was to examine the presence of important antimicrobial peptides, hBD-1 and hBD-2, in the cerumen and EAC skin. MATERIALS AND METHODS: Cerumen was collected from 20 healthy adults, and the EAC skins were obtained from 12 patients who underwent middle ear surgery with canaloplasty. The presence of hBD-1 and hBD-2 was analyzed using immunohistochemistry and Western blotting. RESULTS: In the immunohistochemical study of the EAC skin, expression of hBD-1 and hBD-2 was observed in both the epithelium and the glands. The presence of hBD-1 and hBD-2 peptides in the cerumen was confirmed by Western blotting.

Hyaluronan and alpha-atrial natriuretic polypeptide in human nasal polyps: contributing factors to oedema formation and polyp growth?

OBJECTIVES: To identify and localize hyaluronan (HYA) and alpha-atrial natriuretic polypeptide (ANP) in human nasal polyps and to measure the HYA concentrations. MATERIAL AND METHODS: Twelve nasal polyps were collected during routine polypectomies and processed histochemically and biochemically to determine the occurrence of HYA. The distribution of ANP was investigated using an immunocytochemical method. RESULTS: HYA was unevenly distributed, being found abundantly in the surface epithelium and basement membrane and around fibres and vessels in the lamina propria. It was also present around seromucinous glands and in the secretion of cysts in the stroma. The HYA concentration was 1,000-fold higher than in serum. ANP was abundant in the apical part of ciliated surface epithelial cells and extracellularly in the basement membrane. In the stroma, ANP was confined to apical acinar cells of the seromucinous glands. CONCLUSIONS: Osmotically active HYA and numerous ANP-immunoreactive cells, active in fluid and/or ion transport functions, are present in human nasal polyps. These substances may well be involved in oedema formation and the successive growth of nasal polyps. The high concentrations of HYA in nasal polyps may be of clinical significance for the future development of a local enzyme treatment for nasal polyposis.

Ultrastructural characteristics of the round window membrane during pneumococcal otitis media in rat.

To understand better the pathogenesis of inner ear (IE) damage caused by otitis media (OM), the round window membrane(RWM) structure was investigated in a rat model for pneumococcal otitis media (POM). The RWM of 25 rats were evaluated light and electron microscopically on 1 day, 3 days, 6 days, 10 days, and 20 days after the unilateral inoculation of type 3 pneumococcus suspension into their middle ear cavities. The thickness of the RWM increased in various stages of the pneumococcus-evoked otitis media, compared with that of the normal. The thickening was most pronounced on day 1, being about 4 to 5 times greater than that of the normal RWM. All layers of the RWM were affected by the pneumococcal infection, but the major changes were confined to the subepithelial space close to the basement membrane (BM). Together with alterations to the BM, the most distinct pathological features were characterized by an increase and hypertrophy of fibroblasts in association with abundant collagen fibers. Elastic fibers observed close to the inner mesothelial layer under a high power magnification also increased during the experiment. These results will be relevant to a better understanding of the histologic implication of RWM in stages of acute otitis media involving pneumococcus-evoked otitis media.