Castleman's disease of the neck: report of a case and review of the literature.

OBJECTIVES: Castleman's disease is an uncommon disease of benign lymph node hyperplasia primarily affecting the mediastinum, with the head and neck region being the second most common site. CASE REPORT: A 27-year-old woman was admitted to our department due to a left lateral cervical mass. After a complete clinical and imaging examination, a neck dissection was performed, in which a mass, size 3.5 x 2.7 x 4.5 cm, was excised. The patient was diagnosed with Castleman's disease of the neck after histopathological examination. CONCLUSIONS: The diagnosis of Castleman's disease is always a clinical challenge, as the patient commonly presents with nonspecific signs and symptoms resembling other lymphatic diseases. Consequently, Castleman's disease should be in the differential diagnosis of congenital, inflammatory, or neoplastic cervical alterations. A review of literature, including histopathological characteristics, differential diagnosis, and treatment options is also presented.

Far-advanced otosclerosis and cochlear implantation.

PROBLEMS/OBJECTIVES: To report the radiographic and surgical findings, speech perception performance, and complications of cochlear implantation for patients who were affected by far-advanced otosclerosis. METHODOLOGY: Five patients, 2 males and 3 females, with a family history of otosclerosis and who previously underwent stapedectomy to improve hearing were included in this study. CT scans of all ears were graded according to Rotteveel's grading system. All patients underwent cochlear implantation according to standard procedures. A control group of 10 non-otosclerotic postlingual implanted adults matched for age was used. RESULTS: On CT scanning, one patient had solely fenestral disease (type 1), 3 patients had localized retrofenestral disease (type 2), and 1 had diffuse retrofenestral disease with loss of the normal architecture of the cochlea (type 3). In all otosclerotic patients, the electrode array was fully inserted. However, in two patients (type 2 and 3) a thickened otic capsule was present and required more drilling than normal. One patient (type 3) experienced postoperatively facial nerve stimulation with normal fitting parameters. Otosclerotic patients showed excellent speech perception after implantation and obtained similar results to those achieved by the non-otosclerotic patients. CONCLUSIONS: Patients suffering from far-advanced otosclerosis may benefit from cochlear implantation and achieve speech performance scores comparable to non-otosclerotic implantees. Regarding surgery and facial nerve stimulation, attention should be taken to these cases in which the extension of otosclerosis is more severe on CT scanning (type 2 and mainly 3). Postoperative facial nerve stimulation can be managed successfully by resetting the current levels for comfort level.

[Spontaneous temporomandibular joint herniation into the external auditory canal]. / Hernie spontanée de l'articulation temporomandibulaire dans le conduit auditif externe.

OBJECTIVES: We report a rare case of spontaneous temporomandibular joint herniation into the external auditory canal. MATERIAL AND METHODS: A 42-year-old woman consulted for recurrent right otalgia. RESULTS: The clinical examination revealed a white mass of the anterior wall of the bony external auditory canal, very close to the tympanic annulus, which was replaced by an invagination of the skin of the canal when the patient opened her mouth, consistent with temporomandibular joint herniation into the external auditory canal. CONCLUSION: Inflammatory, malignant, and traumatic lesions are known as potential causes of temporomandibular joint herniation into the external auditory canal. Spontaneous herniations are much rare, and to the best of our knowledge this is the 15th case reported in the literature. This anomaly results from a patent foramen of Huschke. Main symptoms consist in otalgia and tinnitus. In half of the cases, they are minor and no treatment is necessary.

Polyarteritis nodosa and cochlear implantation.

Polyarteritis nodosa is a systemic disease which affects the small to medium-sized muscular arteries. Sudden or progressive, bilateral hearing loss is a presenting otologic manifestation. To date, no case of cochlear implantation in patients with polyarteritis nodosa has been reported. The authors present a case of polyarteritis nodosa (confirmed by biopsy) in a 71-year-old man with progressive, bilateral sensorineural hearing loss who underwent cochlear implantation. A successful full insertion of the Nucleus 3G electrode array was achieved without surgical or post-operative complications. The patient immediately showed a positive subjective response and, at three month post-operative evaluation, had gained useful open-set speech perception. A review of five temporal bone cases with hearing loss and polyarteritis nodosa revealed the possibility of fibrosis and ossification in the basal turn of the cochlea, of which the surgeon should be aware prior to cochlear implantation.

[Estimating the prognosis of peripheral facial paralysis: is the minimal nerve excitability test still up to date?]. / Prognoseabschätzung der peripheren Fazialisparese: Ist der Minimal-Nerve-Excitability-Test noch zeitgemäss?

BACKGROUND: In this retrospective study, we assessed the long-term prognostic value of the minimal nerve excitability test (NET) by comparing the results it yielded with the House-Brackmann (HB) index in patients with the most common types of facial paralysis, Bell's palsy and traumatic facial palsy. PATIENTS AND METHODS: Three hundred and fifty patients aged 9-85 years (mean age 42.4 years; 156 male and 194 female), all of whom were treated initially with the same steroid therapy, entered on study. Patients in whom decompression surgery had been performed were excluded so as to avoid falsely optimistic prognoses. The 350 study patients were divided into two groups: group 1 was made up of 250 with Bell's palsy and group 2, of 100 with nonpenetrating traumatic facial palsy following temporal bone fracture. The NET was conducted repeatedly in all patients for 3 weeks from the start of day 3 of treatment, the value recorded on day 14 being used in the evaluation. For each patient, the result of the NET was recorded as 'normal', 'diminished' or 'without response' according to the difference between the two sides of the face. The final HB grading was determined after 1 year to check for the agreement between the electrical prognosis and the clinical outcome and thus the reliability of the prognosis indicated by the NET. RESULTS: The results indicate that a normal NET forecast a satisfactory outcome that could be classed as HB I-II in almost all the patients in both groups. Among patients who had no response on NET, 85% of those with Bell's palsy and 90% of those with traumatic facial palsy failed to recover nerve function. Diminished nerve excitability proved to be a sign of a relatively favourable prognosis: 74% of patients in each group recovered normal facial function. CONCLUSION: The NET is a method of investigation that is easily applied and can make a positive contribution to the assessment of prognosis in Bell's palsy and in traumatic facial palsy, reflecting the functional state of the facial nerve reliably in most of cases.

Facial electroneurography on the contralateral side in unilateral Bell's palsy.

In this study, ten patients who exhibited severe unilateral Bell's palsy of the House-Brackmann grade V underwent facial electroneurography (ENoG) on the contralateral, healthy side. Serial ENoG was conducted in seven consecutive sessions within 6 months at a given current intensity level of stimulation. According to our results, all the patients presented a rise in the maximum compound-action potential (MCAP) amplitude on the healthy side within 20 to 45 days from the onset of the palsy and shortly after the onset of the recovery of the facial function. This was attributed to the central contralateral compensatory process, which restores balanced facial function. Based on our data, a hypothetical model is shown, which demonstrates the clinical course of the contralateral MCAP values and reflects the plasticity effect of the central nervous system after the onset of Bell's palsy.

Test-retest reliability of vestibular autorotation testing in healthy subjects.

Vestibulo-ocular reflex rotational chair testing in the high-frequency range is seldom performed because it requires specialized and powerful systems. But today a new method of sweep-frequency vestibulo-ocular reflex testing, the Vestibular Autorotation Test system (Western Systems Research, Inc., Pasadena, Calif.), based on active head movements increasing from 2 to 6 Hz, is available on the market. The goal of this study was to evaluate the test-retest variability of this test in healthy subjects. Twelve young adults (22 to 42 years old) without any history of auditory or vestibular dysfunction were included in the study. Subjects underwent five tests under standardized conditions with a 1-week interval. Each test consisted of three measurements of the gain and phase of the vestibulo-ocular reflex in the horizontal and vertical planes. Statistical analysis shows that the test-retest reliability of the Vestibular Autorotation Test is poor. Therefore this method cannot be used routinely to evaluate precise vestibulo-ocular reflex anomalies.