Auditory outcomes after implantation and electrical stimulation of the lateral ampullar nerve in guinea pig.

OBJECTIVE: To determine in a guinea pig model the factors of invasiveness of a bipolar electrode implanted in the horizontal semicircular canal (HSC) and to evaluate the consequences on hearing of electrical stimulation of the ampullary nerve. DESIGN: Sixteen guinea pigs divided into four groups underwent surgical opening of the HSC of one ear as follows: control (group 1), cyanoacrylate glue application on the HSC opening (group 2), electrode implantation with cyanoacrylate glue on the HSC opening (group 3), and electrode implantation with electrical stimulation (1 hr/day) for 9 days (group 4). Auditory brainstem responses were recorded before and after surgery and after electrical stimulation. The effectiveness of electrical stimulation in producing a horizontal vestibulo-ocular reflex was evaluated by recording eye movement with video-oculography. RESULTS: Group 1 animals showed hearing loss, and in group 2, sealing the HSC opening with cyanoacrylate glue preserved the hearing thresholds. After electrode implantation, seven of the eight animals showed hearing loss compared with preoperative values. Electrical stimulation did not induce additional hearing loss. CONCLUSION: Electrode implantation at the canal level entailed a risk of hearing loss in an animal model, but electrical stimulation of the horizontal ampullary nerve did not further alter hearing function.

Biofilms on tracheoesophageal voice prostheses: a confocal laser scanning microscopy demonstration of mixed bacterial and yeast biofilms.

The aim of this study was to demonstrate the presence of yeast and bacterial biofilms on the surface of tracheoesophageal voice prostheses (TVPs) by a double-staining technique with confocal laser scanning microscopy (CLSM). Biofilms of 12 removed TVPs were visualized by scanning electron microscopy, then stained with ConA-FITC and propidium iodide for CLSM. Microbial identification was by partial 16S rRNA gene analysis and ITS-2 sequence analysis. Microbial biofilms on the TVPs consisted of bacteria and filamentous cells. Bacterial cells were attached to the filamentous and unicellular yeast cells, thus forming a network. Sequence analyses of six voice prostheses identified the presence of a variety of bacterial and yeast species. In vivo studies showed that Klebsiella oxytoca and Micrococcus luteus efficiently attached to Candida albicans. CLSM with double fluorescence staining can be used to demonstrate biofilm formations composed of a mixture of yeast and bacterial cells on the surface of TVPs.

Conservative management of 386 cases of unilateral vestibular schwannoma: tumor growth and consequences for treatment.

OBJECT: The object of this study was to evaluate the natural history, pattern, and occurrence of tumor growth and its consequences for treatment of small-sized vestibular schwannomas (VSs). METHODS: From 1990 to 2005, 386 patients underwent conservative management for VS because of the following: age > 60 years, poor health/medical risks, risk of deterioration of good hearing, small tumor size, minimal or no incapacitating symptoms, and/or patient preference. Tumor size was measured by MR imaging according to the guidelines of the Committee on Hearing and Equilibrium. The first MR imaging study was performed 1 year after diagnosis, and subsequent imaging was performed yearly or every 2 years depending on the appearance of new symptoms, tumor growth, or both. RESULTS: Sixty-one patients were lost to follow-up the first year after presentation. Of the 325 patients for whom 1-year follow-up data were available, 39 showed tumor growth > or = 3 mm. Conservative management was discontinued for these 39 patients. The patients who returned for follow-up were evaluated at 1- or 2-year intervals depending on tumor growth. The authors extrapolated to obtain data for 2-year intervals, yielding data for 160, 56, 21, and 8 patients at 3, 5, 7, and 9 years after initial presentation, respectively. The overall mean tumor growth rate (+/-standard deviation) was 1.15 +/- 2.4 mm/year. This rate was estimated by pooling all values of tumor growth that had been determined for all patients and dividing by the total number of "events," with each assessment constituting an event. In 58.6% of patients, the annual tumor growth rate was < 1 mm/year; in 29.2%, 1-3 mm/year; and in 12.2%, > or = 3 mm/ year. The growth rates of intrameatal (1.02 +/- 1.8 mm/year) and extrameatal (1.40 +/- 3.1 mm/year) tumors did not differ significantly. No significant association was found between tumor growth rate and sex, age, initial hearing status, or initial tumor grade. Delay in diagnosis was the only significant factor associated with tumor growth rate. During follow-up, conservative management was discontinued for 77 (23.7%) of the 325 patients for whom at least 12-month follow-up data were available; surgery was performed in 60 (77.9%) and radiation therapy in 17 (22.1%). CONCLUSIONS: The results of this study support the role of a conservative "wait-and-scan" policy of management for small-sized VSs because most have a slow growth rate. Long-term neuroimaging follow-up is needed even with non-growing tumors.

Characterization of mucosal biofilms on human adenoid tissues.

OBJECTIVES: To demonstrate the presence of mucosal biofilm in adenoid tissue using double staining for visualization of both the bacterial matrix and the bacterial cells. To identify bacterial species present on the surface of the studied adenoids. STUDY DESIGN: Prospective study. METHODS: A total of 39 specimens of adenoidectomy were removed from children with chronic and/or recurrent otitis media. The specimens were prepared for light microscopy using Gram staining, scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM). Double staining was performed with CLSM to visualize both the bacteria and the glycocalyx matrix. Nine adenoids on which bacterial biofilms were visualized with CLSM were used for identification of bacterial species by 16S-DNA polymerase chain reaction (PCR) amplification and homology analysis. RESULTS: Of the 39 adenoids investigated, 22 (54%) showed evidence of mucosal biofilms. Gram staining, SEM and CLSM showed the presence of bacterial cells, organized in bacterial microcolonies. CLSM with double staining demonstrated mucosal biofilms by showing the presence of both bacteria and the glycocalyx. The use of 16S-DNA polymerase chain reaction (PCR) amplification and subsequent sequence analyses identified the presence of Corynebacterium argentoratense, Streptococcus salivarius, Micrococcus luteus, and Staphylococcus aureus. CONCLUSIONS: This study demonstrates that adenoid tissue in children with chronic or/and recurrent otitis media contains mucosal biofilms in 54% of the cases. The existence of living bacteria has been demonstrated. Further studies are required to describe the panel of bacteria that can be harbored in the biofilms present in adenoids and the mechanisms involved in the physiopathology of otitis prone children.

Middle ear gas loss in inflammatory conditions: the role of mucosa thickness and blood flow.

Several middle ear (ME) pathologies are associated with ME gas deficit. These include in particular the chronic otitis media diseases that are associated with inflammation (hence, increased ME mucosal blood flow) and/or reduced Eustachian tube (ET) function. The present study models the trans-mucosal gas exchange in normal and inflamed middle ears of rats. The model evaluates the role of the gas diffusion path in the ME mucosa using mucosa thickness as its index and the role of the mucosal blood flow rate on ME gas economy in order to compare between normal and inflamed MEs. An experimental method employing ME gas volume changes at constant pressure due to trans-mucosal gas exchange, and blood gas values from the literature, was used in anaesthetized rats to corroborate the model. Mucosa thickness was measured as an index of the gas diffusion path between the ME space and the ME circulation. ME inner surface area was estimated from its measured gas volume. Inflammation was inflicted by applying lipopolysaccharide (LPS) into one ear. The contralateral ear served as control. ME gas volume decreased significantly faster with time (p=0.02) in inflamed ears (-0.107 microL min(-1) +/- 0.034 S.D., n=10) versus control ears (-0.067 microL min(-1) +/- 0.036 S.D., n=10). Mucosa thickness was significantly thicker in inflamed ears (48.4 microm +/- 11.0 S.D.) versus controls (20.5 microm +/- 10.1 S.D.). The mathematical model, the experimental results, and the blood gas values were used to estimate the relative effective mucosal blood flow rate. The model predicts that in spite of almost doubling mucosa thickness in LPS treated ears, the increased gas loss in inflamed ears may be explained by increased mucosal blood flow rate. We suggest that the ability to estimate ME blood flow as obtained by applying the model to the measurements, is relevant to medical management of inflamed ME.

Demonstration of bacterial cells and glycocalyx in biofilms on human tonsils.

OBJECTIVES: To demonstrate mucosal biofilms in human tissue by direct visualization of bacteria and glycocalyx using confocal laser scanning microscopy with double fluorescent staining on tonsils and to compare the findings with the results of scanning electron microscopy analysis. DESIGN: Prospective study. SETTING: Tertiary university-based referral center. PATIENTS: Twenty-four tonsils were obtained from children with chronic or recurrent tonsillitis. INTERVENTIONS: Tonsils were prepared for analysis by scanning electronic microscopy and by confocal laser scanning microscopy. MAIN OUTCOME MEASURES: Double fluorescent staining for confocal laser scanning microscopy consisted of propidium iodide staining to detect bacterial cells and fluorescein isothiocyanate concanavalin A staining to detect the glycocalyx matrix. Images were analyzed for characteristic biofilm morphologic features by 3 investigators who evaluated the images independently in a blinded retrospective manner. Consensus of all observers was required to demonstrate the presence of a biofilm in a specimen. RESULTS: Findings from analyses using scanning electronic microscopy suggested the presence of biofilm formations on tonsils by showing bacterial cells in microcolonies. Double-staining technique using confocal laser scanning microscopy showed bacterial cells and the glycocalyx matrix, providing visual evidence for the presence of biofilms on tonsils. CONCLUSION: Using a novel visualization approach in single sections of human mucosal tissue, the presence of biofilms was demonstrated on tonsils in most (17/24 [70.8%]) patients with tonsillitis.

Role of nitrogen in transmucosal gas exchange rate in the rat middle ear.

This study investigates the role of nitrogen (N2) in transmucosal gas exchange of the middle ear (ME). We used an experimental rat model to measure gas volume variations in the ME cavity at constant pressure. We disturbed the steady-state gas composition with either air or N2 to measure resulting changes in volume at ambient pressure. Changes in gas volume over time could be characterized by three phases: a primary transient increase with time (phase I), followed by a linear decrease (phase II), and then a gradual decrease (phase III). The mean slope of phase II was -0.128 microl/min (SD 0.023) in the air group (n = 10) and -0.105 microl/min (SD 0.032) in the N2 group (n = 10), but the difference was not significant (P = 0.13), which suggests that the rate of gas loss can be attributed mainly to the same steady-state partial pressure gradient of N2 reached in this phase. Furthermore, a mathematical model was developed analyzing the transmucosal N2 exchange in phase II. The model takes gas diffusion into account, predicting that, in the absence of change in mucosal blood flow rate, gas volume in the ME should show a linear decrease with time after steady-state conditions and gas composition are established. In accordance with the experimental results, the mathematical model also suggested that transmucosal gas absorption of the rat ME during steady-state conditions is governed mainly by diffusive N2 exchange between the ME gas and its mucosal blood circulation.

Fundamental frequency histograms measured by electroglottography during speech: a pilot study for standardization.

This study was designed to develop a database for the electroglottographic measurement of fundamental frequency (Fo) in normal subjects in running speech, for reference in the diagnosis and follow-up of dysphonic patients. A prospective pilot study included 20 healthy male volunteers without laryngeal disorder. Electroglottographic recordings of speaking Fo during connected speech (French) were obtained from two texts with different prosodic content. Fo histograms were sensitive to the variation of speaking Fo between both texts. Graphic representation of the range and distribution of the Fo of the speaker were designed as normalized Fo histograms with plot lines at 5th and 95th percentiles. Less than 5% variability of Fo histograms was recorded when recording more than 15 subjects. This pilot study designed a graphic display of standardized electroglottographic Fo measurements during the physiological condition of connected speech. As the degree of Fo variability depends on the phonetic contents of the text and on the language spoken, a separate histogram for normal subjects needs to be developed in each country or at least for each voice laboratory, with a standard, previously chosen text.

Transmucosal gas-loss rates in middle ears initially filled with O2 or CO2.

This study investigates the role of different gases in clearance of gas in the middle ear cavity (ME) by its mucosal blood flow. A rat model was used to measure gas volume changes in the ME cavity at constant pressure without ventilation. We disturbed the normal gas composition of the ME by filling it with O2 or CO2, measured the consequent changes in gas volume over time and compared these results with previously obtained ones for air and N2. The first 5 min of the primary transient phase (phase I) for O2 or CO2 was characterized by a volume loss decrease of -0.49 ± 0.34 µL and -46.28 ± 8.49 µL, respectively, with volume loss increase for air and N2 differing greatly, at +0.17 ± 0.17 and +2.31 ± 0.81, respectively. The CO2 value of -46.28 µL showed that a volume of gas equivalent to that of the ME cleft volume was eliminated within the first 5 min. In the second phase (phase II), all gases showed a linear decrease in volume, which presumably represents a steady-state gas loss rate. However, the gas loss rate of -0.307 ± 0.170 µL min-1 for O2-filled MEs was significantly higher than the mean of -0.124 µL min-1 for all other gases. We used a previously established mathematical model to calculate the effective ME mucosal blood flow rate under steady-state (phase II) conditions. The blood flow results for O2-filled MEs differed greatly from those of the other gases (89.0 ± 49.28 vs. 26.5 µL min-1, on average), which suggest that the model used to calculate blood flow should be modified if used with O2-filled MEs. Further work should involve a comparison of our method with different methods to verify ME blood flow rate.

Early postoperative CT scanning for juvenile nasopharyngeal angiofibroma: detection of residual disease.

BACKGROUND AND PURPOSE: High recurrence rates and early recurrence have been reported for juvenile nasopharyngeal angiofibroma (JNA) involving the skull base. The purpose of this study was to evaluate the diagnostic accuracy of contrast-enhanced CT scanning for the detection of residual disease (RD) in the early postoperative course after surgical excision of JNA. METHODS: We retrospectively reviewed data in 20 male patients (mean age +/- SD, 15.4 +/- 5 years; range, 10-32 years) who underwent enhanced helical CT in the days after apparent complete surgical excision of JNA with initial expansion in the skull base. Four independent, blinded readers evaluated the occurrence of RD. Final diagnoses were rendered on the basis of histologic examination of excised specimens of RD or clinical and radiologic follow-up. The Cohen kappa test was performed to examine interreader agreement. RESULTS: Postoperative contrast-enhanced CT had a sensitivity of 75%, a specificity of 83%, a positive predictive value of 75% and a negative predictive value of 83% for the detection of RD. The prevalence of RD was 40%. The base of pterygoids was the most frequent location of RD. Interreader agreement was high for the detection of putative RD (kappa=0.83). Variabilities in readers' interpretations were encountered for false-positive results and for disease in the foramen lacerum. False-negative results involved the base of pterygoids. Early postoperative CT scanning was well tolerated by all patients. CONCLUSION: Contrast-enhanced helical CT is an accurate tool to evaluate excision of JNA in the days after surgery.

Technical pitfalls in middle ear gas studies: errors introduced by the gas permeability of tubing and additional dead space.

CONCLUSIONS: We demonstrated errors introduced by the gas permeability of the tubing and additional dead space. Materials with practically no permeability, such as glass, must be used to overcome the loss or gain of gas through the walls of tubes used for studying ME gas variations. Experiments conducted at a constant volume (variable pressure) require the smallest possible tubing volume in order to obtain good sensitivity and improve the accuracy of the results. OBJECTIVES: Experimental studies that investigate middle ear (ME) gas exchanges, using either pressure measurements or volume changes, are conducted using various tubing connections between the ME and a measuring device. The aims of this study were to highlight experimental problems due to the errors introduced by (i) the gas permeability of the tubing used and (ii) additional dead space in experiments conducted at constant volume. MATERIAL AND METHODS: The problem of the gas permeability of the tubing was addressed by comparing three types of tube (silicone, polyethylene, PVC) with a glass tube. Horizontally placed tubes were connected to a syringe filled with pure CO2 via a gas-tight valve. The end of each tube tested was plunged into colored water (5% Coomassie Brilliant Blue R-250). The tube was washed out with CO2 until gas bubbles were seen leaving it. The valve was then closed and the movement of water in the tube was observed. The same experiments were repeated for pure O2. The problem of the error introduced by the additional dead space volume was addressed at a theoretical level using the well-known gas laws. Two conditions were studied: condition A, in which the experiment was conducted at constant pressure and the volume was measured; and condition B, in which the experiment was conducted at constant volume and the pressure was measured. The main outcome measure of each condition was the calculated variation in the final number of moles of gas involved. RESULTS: No water movement was observed in glass tubes. In contrast, plastic tubes exhibited significant gas permeability effects for both CO2 and O2. The colored solution advanced at a faster rate with CO2 than O2 but differently for each type of tubing. For condition A, gas transfer was independent of the volume of the external tubing and was accurately measured by the displacement of the droplet in the lumen. In contrast, for condition B, the pressure variations were influenced by the volume of the tubing.

Variability of electroglottographic glottal closed quotients: necessity of standardization to obtain normative values.

OBJECTIVE: To demonstrate the variability of electroglottographic measurements of the glottal closed quotient (GCQ) in normal subjects by the calculation method used, fundamental frequency, and intensity. DESIGN: Prospective study. SETTING: Tertiary university-based referral center. SUBJECTS: Twenty healthy male volunteers without laryngeal disorder. Three successive sustained productions of the vowel /a/ were performed by each subject. Electroglottographic recordings of GCQ were obtained using the criterion level method, which defines an approximate duration of glottal closure and opening. Glottal closed quotient values were calculated based on criterion levels ranging from 10% to 40%. MAIN OUTCOME MEASURES: The extent of correlation between GCQ variation and the mean fundamental frequency and intensity. RESULTS: As the criterion level increased, a decrease in the mean GCQ was recorded, which was significant with a 10% criterion level increase, up to a critical level of 25%. A significant positive correlation was found between GCQ and the variables of fundamental frequency and intensity. CONCLUSIONS: This study demonstrated significant effects of the criterion level used, fundamental frequency, and intensity in the determination of normative values of GCQ. Normative values can only be assessed through the standardization of one criterion level reached by consensus.

Radiofrequency soft palate procedure in snoring: influence of energy delivered.

OBJECTIVE: We conducted a retrospective study to evaluate the influence of amount of energy delivered during radiofrequency procedure for soft palate reduction in snoring, to improve the cure rate. METHODS: Consecutive patients with chronic disruptive snoring presenting to our department were successively treated in an outpatient procedure. A visual analog scale was used to assess the severity of snoring by the bed partner and the pain by the patient, before treatment and after each treatment session. The soft palate was divided into 3 treatment sites: middle, lateral right, and lateral left. Any mucosal injury of the soft palate was classified as a complication. RESULTS: Forty-3 patients were classified into 2 groups according to energy assignment. The total amount of energy delivered was 1250 J in group 1 (n = 15) and 1500 J in group 2 (n = 28). Energy was predominantly distributed in the middle of the soft palate in group 1 (550 J) and group 2 (800 J). After each treatment session, the 1500-J delivery of radiofrequency energy (total per session) led to a better snoring grading reduction in comparison with the 1250-J delivery with a significant difference after 2 treatment sessions (P < 0.05). The mean pain score and the incidence rate of complications per treatment were not statistically different in comparing both groups. CONCLUSION: Better snoring scores can be expected by increasing radiofrequency energy applied to the soft palate. Further randomized long-term investigations are required to confirm that the cure rate can be improved when increasing energy with a suitable distribution and good clinical tolerance.

Vestibular-like facial nerve schwannoma.

OBJECTIVE: To evaluate the prevalence as well as the management of primary facial nerve schwannoma (PFNS) presenting as vestibular schwannoma. METHODS: A retrospective review was carried out on 146 patients referred to and operated upon in our institution over a 5-year period for tumors of the internal auditory canal extending or not into the cerebello-pontine angle (TICA). A review of the literature included an extensive MEDLINE search of the literature since 1966 and careful inspection of the bibliography of each article. Articles pertaining to facial nerve schwannomas were reviewed to identify cases of vestibular-like facial (V-LF) nerve schwannoma. RESULTS: Two cases of tumors were finally diagnosed as PFNS. Clinical and radiological evaluations were typical of a vestibular schwannoma. Facial function was normal in each case. Unsuspected facial nerve schwannomas were found during surgery. Tumor removal was not performed. Postoperatively House and Brackmann (HB) facial function was normal in one case and grade II in the other case. These two cases represented a 1.4% prevalence, which is within the limits reported in the literature. Among V-LF nerve schwannomas reported in the literature, the postoperative functional facial outcome usually worsened when the tumor was resected. CONCLUSION: The prevalence of V-LF nerve schwannoma has been reported in the two last decades owing to the development of modern imaging. The conservative management of early staged tumors presenting as vestibular schwannoma is recommended in order to counsel the patient regarding the possibility of V-LF nerve schwannoma and to prolong normal facial function.

Ipsilateral beating nystagmus after acoustic schwannoma resection.

OBJECTIVE: To highlight the alert value of an ipsilateral beating nystagmus to detect any potential vascular complication in the early postoperative course of acoustic schwannoma (AS) surgery. METHODS: In a series of 432 cases of AS operated by the same surgeons between January 1991 and December 2000, two cases of vascular complications were detected by an ipsilateral beating nystagmus toward the operated side. RESULTS: One case of arterial infarction giving rise to a partial AICA syndrome and one case of hematoma of the cerebello-pontine angle (CPA) were revealed by an ipsilateral beating nystagmus. It was the first or the only objective neurologic sign encountered in the early postoperative course of AS surgery. CONCLUSIONS: An ipsilateral beating nystagmus after AS resection, even appearing as the only abnormal objective neurologic finding, should always raise suspicion of a brain stem event. Early extubation is recommended for systematic neurologic assessment in order to detect as quickly as possible any potential vascular complication in the early postoperative course of AS.

Online script concordance test for clinical reasoning assessment in otorhinolaryngology: the association between performance and clinical experience.

OBJECTIVE: To report on the creation and administration of an online Script Concordance Test (SCT) for ear, nose, and throat (ENT), the ENT-SCT. DESIGN: Prospective study. SETTING: Two tertiary care university centers. PARTICIPANTS: In total, 132 individuals were asked to test an ENT-SCT of 20 cases and 94 questions based on the major educational objectives of the ENT residency program. MAIN OUTCOME MEASURES: Three levels of experience were tested: medical students, ENT residents, and board-certified otorhinolaryngologists as the expert panel. The test's construct validity-whether scores were related to clinical experience-was statistically analyzed. Reliability was estimated by the Cronbach α internal consistency coefficient. Participants' perception of the test was assessed with the use of a questionnaire. RESULTS: The 65 respondents with usable data were medical students (n = 21), ENT residents (n = 22), and experts (n = 22). Total mean (SD) test scores differed significantly: 76.81 (3.31) for the expert panel, 69.05 (4.35) for residents, and 58.29 (5.86) for students. The Cronbach α coefficient was 0.95. More than two-thirds of the participants found the test to be realistic and relevant for assessing clinical reasoning. The test was also considered fun, interesting, and intuitive. CONCLUSIONS: The Web-based ENT-SCT is feasible, reliable, and useful for assessing clinical reasoning. This online assessment tool may have applications for residency programs and continuing medical education.

Detection of bacterial biofilm on cochlear implants removed because of device failure, without evidence of infection.

OBJECTIVE: To investigate the formation of bacterial biofilms on the surface of the electrode array of cochlear implants (CI) explanted because of device failure, without evidence of infection, by use of scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM). STUDY DESIGN: Prospective study. SETTING: Patients from 2 tertiary-care referral centers. PATIENTS AND METHODS: CIs were explanted from 9 patients because of device failure. Specimens were immediately snap-frozen in cold isopenthane, stored at -80°C and examined with SEM and CLSM by 3 investigators. MAIN OUTCOME MEASURE: Presence of bacterial biofilm ascertained by SEM and CSLM. RESULTS: One specimen showed the formation of a bacterial biofilm on the middle ear part of the electrode array. No biofilm formation was found in the inner-ear part of electrode arrays. In the middle-ear part of the electrode array, a cylindrical cover of human muscular tissue was seen plugging the cochleostomy. CONCLUSION: This is the first study demonstrating that bacterial biofilms may exist on the surface of the electrode array of CIs explanted because of device failure but not infection. We found 1 case of biofilm formation in 9 explanted CIs. Further studies with larger series of CIs are required to investigate biofilm formation on the surface of CI electrode arrays to address both the pathophysiology of bacterial biofilms and prevention of device-related infections in CI patients.

Primary mucosa-associated lymphoid tissue (MALT) lymphoma of the larynx.

BACKGROUND: Mucosa-associated lymphoid tissue (MALT) lymphoma is usually associated with a chronic inflammatory disease from which lymphoid tissue of MALT type arises as a prerequisite for lymphoma proliferation. No well-characterized chronic inflammatory process has been identified in the larynx. METHODS: We report a case of primary MALT lymphoma of the larynx associated with extraesophageal reflux, chronic laryngitis, and gastric Helicobacter pylori infection, raising the issue of its physiopathology and treatment. RESULTS: Treatment of this MALT lymphoma of the larynx consisted of complete surgical excision associated with omeprazole, amoxicillin, and clarithromycin. No evidence of disease was observed after 24 months of follow-up. CONCLUSIONS: We may assume that chronic laryngitis could be a precursor to MALT lymphoma. This case is the first one to our knowledge of a primary MALT lymphoma of the larynx treated with conservative management combining surgical excision, reflux therapy, and eradication of gastric H. pylori infection.

Fibromatosis of the cervical fascia.

Fibromatosis is a rare benign soft-tissue tumor of fibroblastic origin arising from the aponeurotic structures. Preoperative diagnosis of fibromatosis of the deep cervical fascia is difficult from clinical presentation alone. We report a case of a tumor of the cervical fascia space for which the radiologic appearance did not exhibit specific characteristics. Critical analysis of the radiologic images combined with fine-needle aspiration findings were helpful in suggesting preoperatively the diagnosis of fibromatosis, which was confirmed histologically after surgical resection.