Sebaceous Carcinoma of the Middle Ear: A Case Report.

Here we present the first case of sebaceous carcinoma of the middle ear. We discuss the treatment course and post treatment results after 11 years of follow up. We further summarize the available literature of sebaceous carcinoma of the temporal bone, which prior to this case was exclusively limited to the external auditory canal. Laryngoscope, 2024.

Airway Involvement and Intervention in Non-ACE-Inhibitor-Induced Angioedema.

OBJECTIVES: Characterize the presentation of patients with non-angiotensin-converting enzyme inhibitor (ACEI)-induced angioedema and determine risk factors associated with patient disposition and possible need for airway intervention. METHODS: The medical records of adult patients in the Emergency Department (ED) and diagnosed with non-ACEI-induced angioedema over 4.5 years were included. Demographics, vital signs, etiology, timeline, presenting symptoms, physical exam including flexible laryngoscopy, medical management, and disposition were examined. Statistical analyses were conducted using SPSS V 23.0 software calculating and comparing means, standard deviations, medians, and correlation of categorical and ordinate variables. RESULTS: A total of 181 patients with non-ACEI-induced angioedema were evaluated with flexible laryngoscopy by otolaryngology. Notably, 11 patients (6.1%) required airway intervention and were successfully intubated. Statistically significant factors (p ≤ 0.05) associated with airway intervention included the diastolic blood pressure (DBP) and mean arterial pressure (MAP) (p = 0.006 and 0.01 respectively), symptoms of dysphonia (p = 0.018), the presence of oropharyngeal, supraglottic, and hypopharyngeal edema (p ≤ 0.001 for each site), and the number of edematous anatomic subsites documented on physical exam (p < 0.001). Other patient demographics, prior history of angioedema, heart rate, systolic blood pressure, symptom onset, number of symptoms at presentation, and medication administered in the ED did not correlate with airway intervention. CONCLUSION: Dysphonia, DBP, MAP, anatomic location of edema and edema in multiple sites are associated with airway intervention and a higher level of care in non-ACEI-induced angioedema and can be useful in risk assessment in patient management. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:2282-2287, 2024.

The parietal notch (Brammer's pointer): Accuracy of a surface landmark for temporal bone surgery.

Hypothesis: The parietal notch is a reliable surface landmark of the sigmoid sinus at the sinodural angle. Background: Currently no surface landmark approximates the anterior border of the sigmoid sinus. Additionally, the temporal line may not accurately identify the tegmen near the sinodural angle. This study examines the reliability of the parietal notch as a surface landmark of the sigmoid sinus at the sinodural angle. Methods: Forty-seven cadaveric temporal bones were used to identify the parietal notch by two observers. The parietal notch and sinodural angle were labeled with radiopaque markers, mounted on foam, and CT imaged in the axial plane. The horizontal and vertical distances between the labeled landmarks were measured using PACS software. Results: The parietal notch location was identified in 43/47 specimens. The notch was posterior to the sinodural angle in 90.6% and superior in 65% of the specimens. The average horizontal and vertical distance between the two landmarks was 6.1 mm (SD = 5.4) and 0.8 mm (SD = 8.7), respectively. In 60% of the specimens the parietal notch was within 6 mm of the sinodural angle in the horizontal dimension. Conclusions: The parietal notch is identified in most temporal bones. It also approximates the anterior boarder of the sigmoid sinus and level of the tegmen due to its proximity to the sinodural angle. The parietal notch helps to define the posterosuperior margins of a mastoid dissection and may assist surgeons during mastoid surgery.