Long-term follow-up results of facial nerve schwannoma with good facial nerve function: a multicenter study.

PURPOSE: Facial nerve schwannomas (FNSs) are rare intracranial tumors, and the optimal management of these tumors remains unclear. We investigated the long-term follow-up results of FNS with good facial nerve function. METHODS: At nine medical centers in the Korean Facial Nerve Study Group, 43 patients undergoing observation periods longer than 12 months for FNS with good facial nerve function (House-Brackmann grade ≤ II) were enrolled, and clinical and radiographic data were obtained for these cases. RESULTS: The mean follow-up period was 63 months. In the majority of cases, tumors involved multiple segments (81.4%) and only eight cases were confined to a single site. There were no cases where the tumor was confined to the extratemporal region. Tumor size increased slightly, with an average estimated change of 0.48 mm/year. Twenty (46.5%) of 43 patients showed no change in tumor size. Seven patients (16.3%) showed worsening House-Brackmann (H-B) grade, of which two patients deteriorated from H-B grade I to II, four worsened to grade III, and one deteriorated to grade IV. The remaining 36 patients (83.7%) showed no change in facial nerve function. There was no difference in H-B grade according to tumor size at the time of diagnosis or change in tumor size. CONCLUSION: We conducted a large-scale observational study of FNS with good facial nerve function. Our study showed that many patients maintained facial nerve function during long-term follow-up. Conservative management with regular examination and imaging can be an appropriate option for managing FNS with good facial nerve function.

Site-Specific Glycan Microheterogeneity Evaluation of Aflibercept Fusion Protein by Glycopeptide-Based LC-MSMS Mapping.

The evaluation of the protein glycosylation states of samples of aflibercept obtained from three different regions was conducted by site-specific N-linked glycan microheterogeneity profiling. Glycopeptide-based nano-LC MSMS mapping of tryptic-digested samples of each aflibercept lot provided site-specific information about glycan microheterogeneity on each of the five N-glycosylation sites (two sites in the VEGFR-1 region, two sites in the VEGFR-2 region, and one site in the human IgG Fc region). Next, the glycopeptide-mapping results obtained from the three different aflibercept lots were compared to evaluate the similarity between the samples. Three aflibercept lots showed a high degree of similarity in glycan composition, fucosylation level, sialylation level, and branching, when all five N-glycosylation sites were assessed together as a group. On the other hand, noticeable variations between lots in the glycan types and sialylation levels on the two sites of the VEGFR-2 domain were observed when each of the five N-glycosylation sites were assessed using the glycopeptide-based method. The presence of N-glycolylneuraminic acid (NeuGc) glycans, which may mediate adverse immune reactions in antibody therapeutics, were also detected on the sites of VEGFR1 and VEGFR2 domains, but not on the IgG Fc domain site. These results imply that analyses of the glycosylation profiles of fusion proteins containing multiple N-glycosylation sites, such as aflibercept, being done as a part of quality control for the therapeutics manufacturing process or for biosimilar development, can be done with a more applicable outcome by assessing each site separately.

Cochlear Implantation in Patients with Chronic Suppurative Otitis Media: Surgical Outcomes and a Management Algorithm.

BACKGROUND: Chronic suppurative otitis media (CSOM) was considered as a contraindication of cochlear implantation (CI) in the past. Recently, various surgical options have been adopted for CI in CSOM patients with showing a low complication rate. OBJECTIVES: To evaluate surgical outcomes of CI in patients with CSOM and to propose a management algorithm for those patients. METHODS: Thirty-six consecutive patients with CSOM who underwent single stage or staged CI were enrolled. Speech performance, including Categories of Auditory Performance (CAP) test and sentence score, and complications were retrospectively analyzed. RESULTS: The average follow-up was 3.1 years (range 0.5-9.2 years). Postoperative median CAP and sentence scores were 6 and 78%, respectively. Three (8.3%) of the 36 patients had postoperative complications. One experienced breakdown of the ear canal closure. Recurrence of the pars tensa retraction was observed in another patient with adhesive otitis media who underwent CI and cartilage tympanoplasty as a single stage operation. Electrode extrusion occurred in another patient who underwent staged CI with maintenance of a previous open cavity. Subtotal petrosectomy and cavity obliteration were used to manage the latter 2 complications. All implant patients with good mastoid pneumatization exhibited no complications. There were no significant differences in postoperative speech performance and complication rates between single stage CI and staged CI. Based on these current findings, a management algorithm was proposed according to type of CSOM, presence of open cavity, and mastoid pneumatization. CONCLUSIONS: Patients with CSOM show good postoperative speech performance after CI. Proper surgical options according to type of CSOM, presence of open cavity, and mastoid pneumatization may help in reducing complications.

Potential benefits of salvage intratympanic dexamethasone injection in profound idiopathic sudden sensorineural hearing loss.

PURPOSES: To compare hearing recovery levels after initial treatment or salvage intratympanic dexamethasone injection (ITDI), and to find the prognostic factor on salvage ITDI therapy in profound ISSNHL. METHODS: We retrospectively reviewed 115 patients with profound ISSNHL. All patients were treated with combination or systemic steroid therapy as the initial treatment. Next, we used salvage ITDI therapy on patients who showed slight or no improvement according to Siegel's criteria. To find the prognostic factors for the effectiveness of salvage ITDI therapy, we analyzed clinical data, such as, age, sex, vertigo, symptom duration, diabetes, hypertension, initial PTA, pre-salvage PTA, and treatment methods, using multiple regression analyses. RESULTS: The rate of serviceable hearing recovery were 10.4% (12/115) in the initial-treatment group and 20.4% (21/103) in the salvage group. The difference was statistically significant (p = 0.041). Pre-salvage PTA, diabetes mellitus, and symptom duration were affective factors for the effectiveness of salvage ITDI therapy in profound ISSNHL refractory to initial treatment, with odds ratios of 1.169 (95% confidence interval, 1.088-1.256), 0.069 (95% confidence interval, 0.005-0.889), and 9.242 (95% confidence interval, 1.079-79.146). CONCLUSIONS: Salvage therapy should be considered for profound ISSNHL, which is expected to result in poor prognosis or hearing recovery: ITSI therapy might be an effective treatment as salvage therapy.

Radiological parameters related to success of the round window approach in cochlear implantation: A retrospective study.

OBJECTIVES: To evaluate the radiologic parameters related to success of round window (RW) approach for cochlear implantation (CI). DESIGN: A retrospective cohort study. SETTING: Academic-tertiary centre. PARTICIPANTS: Eighty-four consecutive patients without inner ear anomaly who underwent CI with the intent of the RW approach were included. The RW approach was performed through the facial recess after posterior tympanotomy (RW group). When the RW approach was not possible despite maximum effort to expose the RW, promontory cochleostomy (PC) was performed (PC group). MAIN OUTCOME MEASURES: The following radiologic parameters were compared between the two groups: (a) Width of the facial recess, (b) oblique distance between the cochlear basal turn (CBT) and facial nerve (FN), (c) anteroposterior distance between the posterior margin of the RW and FN and (d) angle between the EAC and CBT. RESULTS: Seventy patients (83.3%) were implanted using the RW approach, and 14 patients (16.7%) underwent the PC approach for CI. The anteroposterior distance between the posterior margin of the RW and FN and the angle between the EAC and CBT in the RW group were significantly longer and wider than those in the PC group (P < 0.001 and P = 0.001, respectively). Multivariate analysis revealed that these two parameters were independent parameters for success of the RW approach. CONCLUSIONS: The distance between the posterior margin of the RW and FN and the angle between the EAC and CBT are associated with success of RW approach. Therefore, preoperative radiologic analysis of the two parameters might help CI surgeons to select RW approach.

Compensation of Vestibular Function and Plasticity of Vestibular Nucleus after Unilateral Cochleostomy.

Dizziness and vertigo frequently occur after cochlear implantation (CI) surgery, particularly during the early stages. It could recover over time but some of the patients suffered from delayed or sustained vestibular symptoms after CI. This study used rat animal models to investigate the effect of unilateral cochleostomy on the vestibular organs over time. Twenty-seven Sprague Dawley rats underwent cochleostomy to evaluate the postoperative changes in hearing threshold, gain and symmetry of the vestibular ocular response, overall balance function, number of hair cells in the crista, and the c-Fos activity in the brainstem vestibular nucleus. Loss of vestibular function was observed during the early stages, but function recovered partially over time. Histopathological findings demonstrated a mild decrease in vestibular hair cells numbers. Increased c-Fos immunoreactivity in the vestibular nucleus, observed in the early stages after cochleostomy, decreased over time. Cochleostomy is a risk factor for peripheral vestibular organ damage that can cause functional impairment in the peripheral vestibular organs. Altered vestibular nucleus activity may be associated with vestibular compensation and plasticity after unilateral cochleostomy.

Clinical implication of ocular torsion in peripheral vestibulopathy.

Acute unilateral vestibular loss presents as ocular torsion (OT) and caloric unilateral weakness (UW). However, the amount of OT is frequently dissociated from UW depending on when the examination was performed and the extent and cause of the vestibular lesion. This study evaluated the relationship between OT and UW in peripheral vestibular diseases, including Ménière's disease (MD) and vestibular neuritis (VN), and determined whether it contributed to OT as a means of differentiating between the two diseases. A retrospective chart review was performed in 64 patients with VN and 67 patients with MD. We divided the patients into three groups according to the interval from symptom onset to when the tests were performed: within 7 (group A), from 8 to 30 (group B) and over 30 (group C) days. UW, OT and the chronological correlation/dissociation between the two parameters were analyzed. For the 64 patients with VN, the degree of OT and severity of UW were positively correlated in group A (r = 0.749, P < 0.001). OT and UW were significantly dissociated with time (P < 0.001). For the 67 patients with MD, no correlation between the degree of OT and severity of UW was seen in MD group A. No significant dissociation change was revealed among the groups (P = 0.114). The OT abnormality is remarkable during the acute phase of VN, whereas it might not be remarkable immediately after a vertigo attack in MD. This finding can be used to differentiate MD and VN, especially when no definite hearing loss is seen or VN recurs.

Endoscopic malleostapedotomy versus incudostapedotomy for stapes fixation with or without lateral chain fixation: A comparative outcomes study.

Objectives: This study aims to evaluate and compare the surgical outcomes of endoscopic malleostapedotomy (EMS) and endoscopic incudostapedotomy (EIS). Methods: A retrospective analysis was conducted on 36 consecutive ears in 33 patients who underwent stapes surgery using either EMS (EMS group) or EIS (EIS group). Operational practicability across surgical steps, postoperative hearing, operation time, switch of approach, and complications were compared between the two groups. Results: The EMS and EIS groups comprised seven (19.4%) and 29 ears (80.6%), respectively. The EMS group exhibited a greater proportion of moderate practicability in anchoring site exposure (42.9%, three of seven) and in securing the prosthesis (100%, seven of seven) in comparison to the EIS group, which had 0% (0 out of 29) and 41.4% (12 out of 29), respectively. Postoperative hearing improvements were equivalent between the groups, with EMS achieving a mean air-bone gap improvement of 28.8 dB and EIS of 23.2 dB. The ABG closure rates within 10 dB and 20 dB for the EMS group were 28.6% and 100%, respectively, and not significantly different from the EIS group (p = .103). However, the average surgical duration for EMS was extended by 77.4 min. The rate of complications was comparable between the groups (EMS 14.3%, EIS 10.3%, p = 1.000). Conclusion: The findings indicate that while EMS requires a longer operation time because of decreased practicability in specific surgical steps, it provides comparable outcomes to EIS, underscoring the potential of endoscopic techniques to establish malleostapedotomy as a surgical option as it is with traditional incudostapedotomy. Level of Evidence: 4.

Investigating ischemia and reperfusion-induced organ damage in severe cardiac arrest: A comprehensive proteomics perspective.

Image 1.

A Giant Congenital Mastoid Cholesteatoma With Extension to the Occipital Condyle.

A congenital mastoid cholesteatoma (CMC) is a keratinizing epithelium originating from embryological epithelial tissue of the mastoid. It is often not diagnosed until it becomes large because of its rarity and indolent nature. Although there are a few reports on giant CMC, its exact extensions have not been well described, and detailed information regarding surgical methods is lacking, especially in giant CMC involving the occipital condyle and the middle and posterior cranial fossae. In this article, we report a case involving a 70-year-old woman with a giant CMC that extended inferiorly to the occipital condyle. The CMC eroded the middle and posterior cranial fossae, sigmoid sinus plate, and fallopian canal of the facial nerve. For complete removal, we used a subtotal petrosectomy in conjunction with an exposure of the cranial cervical junction and a wide decompression of the suboccipit. The boundaries of exposure were similar to those of a petro-occipital transsigmoid approach which is usually used for management of tumor involving the jugular foramen. The wide exposure allowed for complete removal of the lesion without any complications. Thus, we recommend this surgical approach for management of the giant CMC involving the occipital condyle and the middle and posterior cranial fossae.

Transcanal Endoscopic Stapedial and Tensor Tympani Tenotomy for Middle Ear Myoclonus: A Retrospective Case Series of Surgical Outcomes.

OBJECTIVE: To describe and analyze the surgical outcomes of transcanal endoscopic resection of the stapedial tendon (ST) and tensor tympani tendon (TT) in the management of middle ear myoclonus (MEM). STUDY DESIGN: A retrospective case series. SETTING: Tertiary academic center. PATIENTS: Seven consecutive patients (seven ears) with tinnitus were diagnosed with MEM. INTERVENTION: Transcanal endoscopic resection of both the ST and TT using either microinstruments or a laser. MAIN OUTCOME MEASURES: The symptom of tinnitus, based on visual analog scale and Tinnitus Handicap Inventory scores, was analyzed preoperatively and postoperatively for each patient. The intraoperative findings and postoperative complications were also evaluated. RESULTS: Amelioration of objective tinnitus with significant improvement in visual analog scale and Tinnitus Handicap Inventory scores was noted in all seven patients. The ST and TT were easily identified in the same endoscopic field, with minimal or no removal of the scutum. There was no need to perform an anterior tympanotomy to expose the TT. Resection of both the ST and TT and creating a gap between the cut edges were achieved by using either microinstruments or a laser under an endoscopic field. Conversion to or conjunction with the microscopic approach was unnecessary for any of the seven patients. No hearing loss or hyperacusis occurred postoperatively. CONCLUSIONS: Transcanal endoscopic resection of the ST and TT successfully ameliorated the symptom of tinnitus in patients with MEM. A transcanal endoscopic approach provides an alternative method to manage MEM, providing excellent visualization and minimal invasiveness.

Bilateral Congenital Ossicular Anomalies: Are the Anomalies Symmetric for Both Ears?

OBJECTIVE: To evaluate whether bilateral congenital ossicular anomalies (COAs) differ regarding ossicular anomalies and hearing loss severities between the ears of the individual. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral academic center. METHODS: Between March 2012 and December 2022, 7 consecutive patients (14 ears) with surgically confirmed bilateral COAs were included in the study. Preoperative pure-tone thresholds, COA classification according to the Teunissen and Cremers system, surgical procedures, and postoperative audiometric results were compared between the 2 ears of each patient. RESULTS: The median age of the patients was 11.5 (range: 6-25) years. Both ears of each patient were categorized based on the same classification. Three patients possessed class III COAs and the other 4 had class I COAs. The interaural differences in preoperative bone and air conduction thresholds were within 15 dB for all patients. Differences in postoperative air-bone gaps between ears were not statistically significant. The surgical procedures required for ossicular reconstruction were almost identical for both ears. CONCLUSION: The severity of ossicular abnormalities and hearing loss in patients with bilateral COAs were symmetrical between ears, thereby enabling prediction of the characteristics of the contralateral ear based on the findings observed in 1 ear. These symmetric clinical features can aid surgeons when operating on the contralateral ear.

Treatment Efficacy of Various Maneuvers for Lateral Canal Benign Paroxysmal Positional Vertigo With Apogeotropic Nystagmus: A Randomized Controlled Trial.

OBJECTIVES: The aim of this study was to determine the most effective treatment approach by comparing the impacts of various otolith reduction techniques in patients with apogeotropic lateral semicircular canal benign paroxysmal positional vertigo (LC-BPPV). METHODS: We performed a multicenter randomized prospective study from January to December 2015, involving 72 consecutive patients with apogeotropic LC-BPPV. The patients were divided into three treatment groups: therapeutic head-shaking (group A), the Gufoni-Appiani maneuver (group B), and the cupulolith repositioning maneuver (CuRM; group C). Each group underwent evaluation and treatment up to the fourth week. Treatment success was defined as the disappearance of positional vertigo and nystagmus. RESULTS: This study included 72 patients (49 male and 23 female), with a mean (±standard deviation) age of 55.4±13.5 years. The mean duration of vertigo experienced prior to treatment was 3.9±4.4 days. The mean latency and duration of nystagmus were 2.7±3.0 seconds and 47.9±15.8 seconds, respectively. The overall treatment frequency was 2.0±0.9. The number of treatments differed significantly among the three groups (P<0.05). After 4 weeks, the success rates for groups A, B, and C were 90.5%, 92.3%, and 100%, respectively. No significant difference was observed in the success rate across treatment. METHODS: and periods (P>0.05). However, CuRM was the only method with a 100% treatment success rate. CONCLUSION: While no clear difference was observed among the three treatments for LC-BPPV, CuRM was found to be superior to the other approaches in the long term.

Clinical and histologic features of inverted papilloma-associated malignancy.

The objectives of the study were to analyze the clinical features of inverted papillomas (IP) associated with malignancy and to evaluate the correlation of tumor stage, survival and histolologic features. We conducted a retrospective review of 18 IP associated with malignancy patients. In addition, we compared histopathologic characteristics (tumor differentiation and malignant cell proportion) with clinical outcomes. Eleven of the tumors were present on the nasal cavity and 7 on the maxillary sinus. The rates of synchronous and metachronous malignancy were 10.1 and 1.1%, respectively. The disease-free survival rate was 83.3%. The tumors were staged as T1 (5/18), T2 (2/18), T3 (8/18), and T4 (3/18). According to the percentage of the malignant cell in the entire tumor tissue, 4 patients (22%) were in grade I, 4 patients (22%) were in grade II, 3 patients (17%) were in grade III, and 7 patients (39%) were in grade IV. There was no relationship between recurrence- and/or disease-free survival and histologic findings including tumor differentiation and malignant proportion. IP-associated malignancy tends to occur synchronously and have more favorable prognosis compared to other sinonasal malignancy. Furthermore, the proportion of malignant cell to IP and tumor stage seems not to affect the clinical outcome of IP-associated malignancy.

Pneumolabyrinth as an Early Computed Tomographic Finding After Cochlear Implantation and its Clinical Significance.

OBJECTIVE: To determine the incidence and volume of pneumolabyrinth using early temporal bone computed tomography (TBCT) findings and evaluate the correlation between pneumolabyrinth and various clinical variables. STUDY DESIGN: Retrospective case review. SETTING: Tertiary academic center. PATIENTS: Fifty-three consecutive adult cochlear implantation (CI) recipients (53 ears) with normal inner ears who underwent high-resolution TBCT within 3 days after CI were included. INTERVENTION: Axial TBCT images were used for detection and measurement of pneumolabyrinth. MAIN OUTCOME MEASURES: Incidence and volume of pneumolabyrinth were evaluated. In addition, the following clinical variables were analyzed to evaluate the correlation with pneumolabyrinth volume: demographics, implant type, surgical approach, postoperative dizziness, and preservation of functional residual hearing. RESULTS: Pneumolabyrinth was present in all patients, and the average volume was 8.496 mm3. Pneumolabyrinth was confined to the cochlea (pneumocochlea) in all patients except for one who also had pneumovestibule. The pneumolabyrinth volume in patients with postoperative dizziness was significantly larger than that in patients without postoperative dizziness (10.435 mm3 vs. 8.016 mm3; p = 0.029). Multivariate analysis showed that a larger volume of pneumolabyrinth was significantly associated with postoperative dizziness (odds ratio, 1.420; 95% confidence interval, 1.114-1.808; p = 0.005). CONCLUSION: A certain volume of pneumolabyrinth was always present in the early stage after CI, and the volume of pneumolabyrinth measured using early TBCT findings was significantly associated with the occurrence of postoperative dizziness.

Susceptibility to Postoperative Changes in Music Appreciation in Elderly Cochlear Implant Recipients.

With the rise in life expectancy and the consequent increase in the elderly population, the use of cochlear implants (CI) in elderly patients with hearing loss is also increasing. The aim of this study was to investigate whether music appreciation in elderly CI users differs from that of non-elderly users. Forty-nine adult CI recipients participated in the study, and the Korean version of the Music Background Questionnaire was utilized preoperatively and postoperatively to evaluate music appreciation. The changes between the preoperative and postoperative values were compared after categorizing the participants into a non-elderly group (<65 years; n = 31) and an elderly group (≥65 years; n = 18). When compared to the non-elderly group, the elderly individuals exhibited a significant decrease in music listening times, without a significant change in the genre of music listened to following CI surgery. Moreover, the elderly group demonstrated significant decreases in music appreciation scores in terms of music quality and music elements, perceiving music as less natural, less clear, and more complex. They also exhibited significant changes in scores with respect to perception of rhythm, melody, timbre, and lyrics. This susceptibility to postoperative changes in music appreciation among elderly CI users should be considered in surgical counseling and music training programs.

Chorda tympani nerve course and feasibility of its preservation during atresiaplasty for congenital aural atresia.

Objectives: The association between the chorda tympani nerve (CTN) and atresiaplasty has not been investigated. This study aimed to describe the course of the CTN observed during atresiaplasty for congenital aural atresia (CAA) and explore the feasibility of CTN preservation. Methods: In this retrospective study, six consecutive patients who underwent atresiaplasty in a tertiary academic center were included. The course of the tympanic segment of the CTN and its preservation feasibility were evaluated. Atresiaplasty was performed using an anterior approach. The average Jahrsdoerfer score was 8.7 points (range, 8-9 points). Results: The CTN was located in the atretic plate in all patients. It emerged from an average of 5.6 mm (range, 5.2-6.1) inferior to the incus buttress and crossed the middle ear in an anterior-superior direction. The distance between the neck of the malleus and the CTN varied in the absence of the malleus handle. However, when the malleus handle developed, the CTN passed between the incus and the malleus handle. The CTN was preserved in two of the six patients. They had a Jahrsdoerfer score of 9 and grade I microtia. Conclusion: The CTN was located in the atretic plate, emerging from an average distance of 5.6 mm inferior to the incus buttress. The incus buttress might serve as a good anatomical landmark to identify and preserve the CTN. CTN preservation is feasible in atresiaplasty candidates with a Jahrsdoerfer score of 9 and auricular deformity of grade I. Level of Evidence: 4.

Results of Active Middle Ear Implantation in Patients With Mixed Hearing Loss After Middle Ear Surgery: A Prospective Multicenter Study (the ROMEO Study).

OBJECTIVES: This study was conducted to evaluate the user satisfaction, efficacy, and safety of round window (RW) vibroplasty using the Vibrant Soundbridge (VSB) in patients with persistent mixed hearing loss after mastoidectomy. METHODS: The study included 27 patients (mean age, 58.7 years; age range, 28-76 years; 11 men and 16 women) with mixed hearing loss after mastoidectomy from 15 tertiary referral centers in Korea. The VSB was implanted at the RW. The Korean translation of the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire and the Korean version of the International Outcome Inventory for Hearing Aids (K-IOI-HA) questionnaire were used to evaluate user satisfaction as the primary outcome. The secondary outcome measures were audiological test results and complication rates. RESULTS: The mean scores for ease of communication (61.3% to 29.7% to 30.2%), reverberation (62.1% to 43.1% to 37.4%), and background noise (63.3% to 37.7% to 34.3%) subscales of the APHAB questionnaire significantly decreased after VSB surgery. The mean K-IOI-HA scores at 3 and 6 months after surgery were significantly higher than the mean preoperative score (18.6 to 27.2 to 28.1). The postoperative VSB-aided thresholds were significantly lower than the preoperative unaided and hearing aid (HA)-aided thresholds. There was no significant difference between preoperative unaided, preoperative HA-aided, and postoperative VSB-aided maximum phonetically balanced word-recognition scores. None of the 27 patients experienced a change in postoperative bone conduction pure tone average. One patient developed temporary facial palsy and two developed surgical wound infections. CONCLUSION: RW vibroplasty resulted in improved satisfaction and audiological test results in patients with mixed hearing loss after mastoidectomy, and the complication rate was tolerable.

Characteristics of primary papillary thyroid carcinoma with false-negative findings on initial (18)F-FDG PET/CT.

BACKGROUND: We often observe that uptake of tracer is not detected in the primary cancer focus in patients with histologically proven papillary thyroid carcinoma (PTC) on preoperative (18)F-fluorodeoxyglucose positron emission tomography-computed tomography ((18)F-FDG PET/CT). Therefore, we analyzed the clinical and pathologic variables affecting false-negative findings in primary tumors on preoperative (18)F-FDG PET/CT. METHODS: We retrospectively reviewed the medical records of 115 consecutive patients who underwent (18)F-FDG PET/CT for initial evaluation and were diagnosed with PTC by postoperative permanent biopsy. The clinical and pathologic characteristics that influence the (18)F-FDG PET/CT findings in these patients were analyzed with respect to the following variables: age, gender, tumor size, multifocality of the primary tumor, perithyroidal invasion, lymphovascular or capsular invasion, and central lymph node metastasis-based final pathology. RESULTS: Twenty-six (22.6%) patients had false-negative (18)F-FDG PET/CT findings. In patients with negative (18)F-FDG PET/CT findings, tumor size, and perithyroidal and lymphovascular invasion were significantly less than in patients with positive (18)F-FDG PET/CT findings. Tumors >1 cm in size were correlated with (18)F-FDG PET/CT positivity. On multivariate analysis, perithyroidal invasion (P = 0.026, odds ratio = 7.714) and lymphovascular invasion (P = 0.036, odds ratio = 3.500) were independent factors for (18)F-FDG PET/CT positivity. However, there were no significant differences between (18)F-FDG PET/CT positivity and age, gender, capsular invasion, and central lymph node metastasis based on final pathology. CONCLUSIONS: Tumor size and perithyroidal and lymphovascular invasion of papillary carcinoma can influence (18)F-FDG PET/CT findings. Absence of perithyroidal and lymphovascular invasion were independent variables for false-negative findings on initial (18)F-FDG PET/CT in patients with PTC.

Management of an Inappropriately Treated Case of Auricular Hematoma.

Othematoma is a condition in which blood collects beneath the perichondral layer of the pinna. Recurrent auricular hematoma can be a challenging medical problem, with complications resulting in ear deformity, therefore, appropriate management is important. Improper treatment can result in a deformity known as 'cauliflower ear' or 'wrestler's ear.' We report a case of othematoma that was inappropriately treated and present a review of current treatment options.