Langerhans cell histiocytosis presented as bilateral otitis media and mastoiditis.

Langerhans cell histiocytosis (LCH) is a rare disease that may affect multiple organs. The etiology of LCH remains unclear to date. It is currently believed that clonal accumulation and proliferation of CD1a-positive Langerhans cells are causative. The term LCH or histiocytosis X refers to three separate illnesses (listed in order of increasing severity): eosinophilic granuloma, Hand-Schüller-Christian disease and Letterer-Siwe disease. A seven-month-old boy presented with history of recurrent bilateral otitis media and rash and seborrheic areas on his scalp. Two days prior, his mother noticed a small lump over the right mastoid. Lateral skull X-ray (Schüller) was evidence for lytic lesion on right temporal bone. The computerized tomography scan showed inflammatory changes with bone erosion. During surgical exploration, fragile slightly yellowish tissue with necrotic areas was found that was determined as LCH on histology. Chemotherapy was subsequently initiated. The initial presentation of LCH with bilateral ear and skull involvement is a very rare condition. The signs and symptoms of otologic histiocytosis can mimic those of acute and chronic infectious ear disease. Only a surgically obtained biopsy leads to definitive diagnosis and appropriate therapy.

Microsatellite DNA instability in nasal cytology of COPD patients.

Genetic alterations in the microsatellite DNA level have been successfully detected in sputum samples of patients with COPD and have been shown to be disease specific. Furthermore, previous studies have shown that inflammation coexists in the nasal mucosa of patients with COPD. The aim of this study was to assess the presence of MSI in nasal cytological samples of patients with COPD comparing the results with sputum samples of the same individuals. Nasal brush samples, sputum samples obtained by induction, and peripheral blood from 20 patients with COPD were analyzed. DNA was extracted and analyzed for MSI using the following microsatellite markers: RH70958, D5S207, D6S344, D6S263, G29802, D13S71, D14S588, D14S292 and D17S250. Microsatellite analysis was also performed in 8 healthy non-smokers. MSI was detected in the sputum samples of 7 patients with COPD (35%). In contrast, no microsatellite DNA instability was noted in the nasal cytological samples of the same COPD patients. In addition, no genetic alteration was detected in the control group. These results suggest that MSI is a specific finding for the target organ of COPD, i.e. the lungs, despite the fact that inflammation coexists in the nasal mucosa of COPD patients. Our study supports the hypothesis that MSI could be an index of the somatic-acquired genetic alterations in the lungs of COPD patients.

Ligasure versus cold knife tonsillectomy.

OBJECTIVE: To assess parameters related to ligasure tonsillectomy (LT) versus cold knife tonsillectomy (CKT) procedure. STUDY DESIGN: Prospective randomized study. METHODS: A prospective study was conducted on 200 consecutive adult patients undergoing tonsillectomy. Indications included chronic tonsillitis and obstructive sleep apnea syndrome. Patients undergoing adenoidectomy, or any procedure together with tonsillectomy, and patients with peritonsillar abscess history or bleeding disorders were excluded. Patients were randomly assigned to either the LT or CKT group. Intraoperative bleeding, operative time, postoperative pain using a visual analogue scale, and complication rates were evaluated. RESULTS: The LT and CDT groups consisted of 108 and 92 individuals, respectively. In the LT group, there was no measurable intraoperative bleeding, whereas mean bleeding for CKT group was 125 mL. The mean operative time was 15 +/- 1.43 minutes for the LT group and 21 +/- 1.09 minutes for the CKT group (P < .001). The overall mean pain score for the LT group was 3.63, whereas for the CKT group it was 5.09 (P < .001). Primary hemorrhage occurred in one subject of the CKT group. Secondary postoperative hemorrhage was noticed two subjects of the LT group and two subjects of the CKT group. In 21 subjects of the LT group, limited peritonsillar edema was noticed. No other complication occurred in both groups. CONCLUSION: LT procedure provides sufficient hemostasis, lower postoperative pain, and reduced operative time, as well as safety against Creutzfeld Jakob disease transmission.

Benign paroxysmal positional vertigo: 10-year experience in treating 592 patients with canalith repositioning procedure.

OBJECTIVE: To assess the long-term efficacy of canalith repositioning procedure (CRP) in the treatment of patients with benign paroxysmal positional vertigo (BPPV). BACKGROUND: Alternative theories for the pathophysiology of BPPV have been redefined in the past few years. CRP is considered to be the standard technique for its management. However, long-term follow-up results have been minimally reported in the literature. PATIENTS/METHODS: Five hundred ninety-two patients, 290 (49%) men and 302 (51%) women, were enrolled in this prospective study; their ages ranged from 18 to 84 (mean 59) years. At the time of their first examination, patients reported the duration of symptoms varied from 1 day to 18 months. Inclusion criteria were patient history compatible with BPPV and positive provocative maneuver (either Dix-Hallpike or Roll test). A variant of Epley and Barbeque maneuver was used. The Epley maneuver was used for posterior and anterior canal involvement, and "Barbeque roll" was used for horizontal canal involvement. Short-term follow-up was obtained 48 hours and 7 days after initial treatment, whereas long-term follow-up was obtained at repeated 6 month intervals. RESULTS: The posterior semicircular canal was involved in 521 (88%) patients treated, whereas the horizontal and anterior semicircular canals were involved in 59 (10%) and 12 (2%) patients, respectively. Symptoms subsided immediately in 497 (84%) patients. In 77 (13%) patients, the Dix-Hallpike maneuver remained positive after 48 hours, and CRP was performed again. Patients' mean follow-up was 46 months; 544 (92%) of 592 patients treated reported no symptoms of vertigo. CONCLUSION: Our data, based on long-term follow-up, suggest that CRP remains an efficient and long-lasting noninvasive treatment for BPPV.

The use of the Ligasure Vessel Sealing System in parotid gland surgery.

OBJECTIVE: To evaluate the role of the Ligasuretrade mark Vessel Sealing System (LVSS; Valleylab, Boulder, CO) in parotid surgery. STUDY DESIGN: A prospective study was conducted on 12 consecutive patients undergoing superficial parotidectomy, performed by using the LVSS device as the primary means of ligation. Inclusion criteria included parotid mass with no preoperative suspicion of malignancy, and no extension to the deep lobe of the parotid gland. Efficacy of hemostasis, cut-closure time, and postoperative complications were assessed. Results were compared with a historical control group, including cases on which the LVSS was not available. RESULTS: LVSS proved effective in providing ligation and hemostasis. There was a mean time gain of 52 minutes, compared with our historical control group. No postoperative bleeding, seroma, salivary fistula, or Frey syndrome were observed. One case of transient facial weakness occurred, which was completely resolved within 6 months. CONCLUSION: LVSS is a safe device for parotid gland surgery, providing sufficient hemostasis and reducing operative time. EBM RATING: B-2.

Laser-assisted tympanostomy in pediatric patients with serous otitis media.

OBJECTIVES: To evaluate prognostic factors related with cure rate, in pediatric patients with serous otitis media treated with laser-assisted tympanostomy without ventilation tubes, in a single institution. PATIENTS AND METHOD: The procedure was performed on 124 ears in 88 individuals, from 3 to 14 years old. External auditory canal anatomy, type of anesthesia, tympanic membrane and middle ear fluid characteristics, myringotomy size, and laser parameters, in relation to cure rate, were accordingly studied. RESULTS: The overall cure rate by ear at the end of the 2-month follow-up period was 54.83%, whereas 45.17% still suffered from otitis media. Multivariate statistical analysis demonstrated that the presence of a thick tympanic membrane is significantly correlated with pure outcome in children with serous otitis media, when laser-assisted tympanostomy without ventilation tubes is performed favoring a worse cure rate (P < 0.023). Other parameters did not statistically correlate with the outcome. A 41% parental dissatisfaction rate was noticed. CONCLUSION: This study addresses selection bias for children with serous otitis media, candidates for laser-assisted tympanostomy. These are related to the duration of serous otitis media, the condition of middle ear mucosa, the thickness of the tympanic membrane, the type of anesthesia, and the cost of laser apparatus. There is likely to be a causal relationship between outcome and tympanic membrane appearance in children undergoing laser-assisted tympanostomy.

Tonsillectomy using the Ligasure vessel sealing system. A preliminary report.

OBJECTIVE: To evaluate and introduce a new method of tonsillectomy with the use of Ligasure vessel sealing system (LVSS) in pediatric population. METHOD: A prospective study was conducted on children undergoing tonsillectomy with the use of LVSS. Indications included chronic tonsillitis, peritonsilar abscess history, and obstructive sleep apnea syndrome. Patients undergoing adenoidectomy, or any procedure together with tonsillectomy, and patients with bleeding disorders were excluded. Among the available head-pieces, the 'Precise' instrument was used, both as haemostatic and dissection tool. Intraoperative bleeding, operative time, and complication rates, were evaluated. RESULTS: Our series consisted of 83 children among 103 patients undergone LVSS tonsillectomy. There was no measurable bleeding during surgery in any of the cases. In 18 children limited peritonsilar edema was noticed. No postoperative hemorrhage or other complication occurred. Mean operative time was 16 min. CONCLUSIONS: LVSS was found quite effective and safe, providing sufficient haemostasis, minimal intraoperative blood loss, and safety against the variant Creutzfeld-Jakob disease transmission.

Transtympanic iontophoresis of gadopentetate dimeglumine: Preliminary results.

OBJECTIVE: We sought to demonstrate the feasibility of using iontophoresis to deliver pharmaceutical agents into the middle and inner ear for the treatment of middle and inner ear diseases, which is proved in this study by the successful iontophoresis of the ferromagnetic contrast agent gadopentetate dimeglumine. Study design and setting Eight rabbits were iontophoresed using gadopentetate dimeglumine solution 469 mg/mL. Then, all rabbits underwent magnetic resonance imaging for the detection of gadopentetate dimeglumine in the middle and inner ear structures. The study was conducted in the tertiary referral center the University Hospital of Crete. RESULTS: The high signal intensity of the gadopentetate dimeglumine solution was demonstrated within the middle ear cavity and inner ear structures of all iontophoresed ears and in none of the noniontophoresed ones. CONCLUSIONS: Transtympanic iontophoresis could be an effective method for the passage of pharmaceutical agents into the middle and inner ear for the treatment of middle and inner ear diseases.

Otorhinolaryngology or otolaryngology? An etymological approach.

The variety and the confusion over the name of many medical terms, including otorhinolaryngological ones prompted us to search their etymology. The term "otorhinolaryngology" (combined form from the ancient Greek words :ous, rhina, larynx, and logos) and the term indicating the specialized doctor who practices "0torhinolaryngology," widely known as ENT in a brief version, are being examined. The investigation leads us to see which of these terms is the appropriate and etymologically correct one, and to support clearly the term "otorhinolaryngology" instead of "otolaryngology" and "otorhinolaryngologist" instead of "ENT."

Therapeutic methods used for otolaryngological problems during the Byzantine period.

Evidence of herbal, animal, and chemical substances from the natural world used in medicines for otolaryngological problems, including opium, hyoscyamus, barley, honey, dried beans and peas, olives, fruits, Agaricus, castoreum, cassia, and afronitron, was traced in the Byzantine medical treatises, mainly from the 4th century AD to the 15th century AD. The texts of Antyllus, Orivasios of Pergamos, Aetios of Amida, Alexander of Tralles, Paul Aeginitis, Leon Iatrosophistis, Theophanis Nonnos, Nickolaos Myrepsos, Michael Psellos, and others strongly suggest the influence of ancient Greek and Roman medicine, but at the same time stress original medical thought. The main otolaryngological problems encountered in that period were loss of hearing, purulent otitis, rupture of the tympanic membrane, pharyngitis, laryngitis, rhinitis, acute tonsillitis, seasickness, vertigo, fracture of the nose, and cancers of the ear, larynx, nose, and oral cavity. The tradition stating that remedies were the final products of substance combinations, started in the classical period (5th and 4th centuries BC), is presented clearly and in detail in Byzantine prescriptions related to otolaryngology.