Bilateral Candidal abscess of the parotid gland: A case report and literature review.

We report the case of a 75-year-old diabetic man who developed a bilateral abscess of the parotid gland. Although a bacterial parotitis was first suspected, cultures of fine-needle aspiration identified Candida albicans as the causal agent. Failure of medical treatment led us to perform a surgical drainage of the right abscess. The patient was then treated with oral fluconazole for 6 weeks, with complete recovery during follow-up. Of interest, the patient had a history of right superficial parotidectomy for a benign tumor 30 years ago. Despite the high prevalence of oral carriage, fungal abscesses of the parotid gland are extremely rare and have only been reported in a few cases. This might be due to the fungal toxicity of the salivary proteins, like histatins. To our knowledge, this is the first report of a Candida albicans abscess of the parotid gland developed bilaterally.

Diagnostic work-up of exercise-induced laryngeal obstruction.

PURPOSE: Exercise-induced laryngeal obstruction (EILO) is suspected when dyspnea associated with upper airway symptoms is triggered by exercise. This condition affects mainly adolescent athletes. Visualization of the obstruction, while the patient is experiencing the symptoms during continuous laryngoscopy during exercise (CLE-test) is the gold standard for diagnosing EILO. Our study aims to evaluate the prevalence of EILO in a population presenting exercise-induced inspiratory symptoms (EIIS) or uncontrolled asthma with exertional symptoms. The second objective was to evaluate the diagnostic strength of laryngology consultation (LC) and pulmonary function tests (PFTs). METHODS: All patients referred to our center for EIIS or uncontrolled asthma with exertional symptoms were included. EILO diagnosis was made if Maat score was > 2 for patients with CLE-test or if there were inspiratory anomalies on PFTs and LC. The sensitivity and specificity of LC and PFTs as diagnostic tools were calculated considering CLE-test as the gold standard. RESULTS: Sixty two patients were referred to our center for EIIS or uncontrolled asthma with exertional symptoms. EILO was diagnosed in 28 patients (56%) with associated asthma in 9 patients (18%). The sensibility and specificity of LC for supraglottic anomalies were 75% and 60%, respectively. The sensibility and specificity of PFTs were 61% and 89%, respectively. CONCLUSIONS: There was a high prevalence of EILO among patients with EIIS and uncontrolled asthma. Some clinical characteristics might guide the diagnosis. Nevertheless, CLE-test remained the gold standard for EILO diagnosis and identification of the dysfunctional upper airway site to provide specific management.

Benign recurrent vestibulopathy: MRI and vestibular tests results in a series of 128 cases.

PURPOSE: Benign recurrent vestibulopathy is a recent entity, close to probable Meniere's disease and vestibular-migraine. So far, no study has systematically investigated the presence of endolymphatic hydrops of the lateral semicircular canal in benign recurrent vestibulopathy using magnetic resonance imaging. The aim of this study was to determine magnetic resonance imaging data and vestibular test results in patients with benign recurrent vestibulopathy. METHODS: 128 patients with benign recurrent vestibulopathy included since 2010 were retrospectively analyzed. Patients had magnetic resonance imaging with a delayed acquisition, audiogram, head shaking test, caloric-test, skull-vibration-induced-nystagmus-test, video-head- impulse-test, and vestibular evoked myogenic potential. Endolymphatic hydrops presence was classified into four categories: cochlear, saccular, lateral semicircular canal and association with saccule. RESULTS: In benign reccurent vestibulopathy, 23% of cases showed an endolymphatic hydrops on magnetic resonance imaging, more frequently located in the lateral semicircular canal (59%) and related to the disease duration. The most often impaired tests were caloric-test (49%) with fluctuations of hypofunction in 67% and skull-vibration-induced-nystagmus-test (61%). No correlation between the caloric-test and the presence and location of the endolymphatic hydrops was observed. CONCLUSION: In our series of benign reccurent vestibulopathy, a rare endolymphatic hydrops was most often observed for the lateral semicircular canal and correlated with the seniority of the pathology. Hydrops identified at the magnetic resonance imaging was not correlated with the caloric-test results. Skull-vibration-induced-nystagmus-test and caloric-test were the most often modified vestibular tests.

The first description of cholesteatoma by Hippocrate.

INTRODUCTION: Although otolaryngology became a subspecialty only since the middle of the nineteenth century, many diseases of ENT system, their clinical symptoms, universality and potential seriousness have been described since over 3000 years ago. Texts of the medical school of Cos and its founder Hippocrates (460-370 BC) collected in the Corpus Hippocraticum also contain multiple case reports and treatments for ear diseases. The aim of this study is to analyse an extract of one of Hippocrates' treatise, which apparently describes the first case of cholesteotoma. MATERIAL AND METHODS: We analysed a case from Epidemic by Hippocrates (VII, V, 1-9) from its English translation. RESULTS: Analysis of the description of symptoms allows us to diagnose a complicated cholesteatoma with facial palsy and neuro-meningitis manifestation. CONCLUSION: The meticulously detailed observations of the corpus give us a precious insight into the early perception of diseases and their evolution. The study of its history is of high interest to the fields of medicine, especially otorhinolaryngology. It also highlights the diseases and the suffering the diseases have inflicted on mankind since antiquity.