RESUMO
The uncommon occurrence of primary squamous carcinoma of the submandibular gland makes it a challenge to diagnose and treat. Clinical as well as histopathological assessments are key elements for the diagnosis. Although no clear treatment guidelines exist, surgical excision with a neck dissection is the cornerstone of the treatment with or without adjuvant therapy. In this paper, we report a rare case of a primary squamous carcinoma in an 82-year-old lady with no history of smoking or alcohol use, who presented with a right sided cervical swelling of 3-month duration. An ultrasound guided fine needle aspiration cytology was negative, as well as a panendoscopy with systemic biopsy of the base of tongue and the homolateral palatine tonsil. In addition, a blind fine needle aspiration cytology from the mass during the panendoscopy was performed and was positive for squamous cell carcinoma. A PET scan showed hypermetabolism of the right submandibular gland with no distant lesions. Therefore, a submandibular gland excision was performed with a frozen section histopathological examination in favor of squamous cell carcinoma, therefore the intervention was completed by a selective neck dissection. High clinical suspicion should be present while dealing with this rare entity, as well as not underestimating the poor outcomes associated with it.
RESUMO
There is a discrepancy between the hearing test results in patients with single-sided deafness (SSD) and their reported outcome measures. This is probably due to the presence of two elements in everyday situations: noise and head movements. We developed a stereo-audiometric test in noise with free head movements to evaluate movements and auditory performance in monaural and binaural conditions in normal hearing volunteers with one occluded ear. Tests were performed in the binaural condition (BIN), with the left ear (LEO) or the right ear occluded (REO). The signal was emitted by one of the seven speakers, placed every 30° in a semicircle, and the noise (cocktail party) by all speakers. Subjects turned their head freely to obtain the most comfortable listening position, then repeated 10 sentences in this position. In monaural conditions, the sums of rotations (head rotations for an optimal hearing position in degrees, random signal azimuth, 1 to 15 signal ad lib signal presentations) were higher (LEO 255 ± 212°, REO 308 ± 208° versus BIN 74 ± 76, p < 0.001, ANOVA) than those in the BIN condition and the discrimination score (out of 10) was lower than that in the BIN condition (LEO 5 ± 1, REO 7 ± 1 versus BIN 8 ± 1, respectively p < 0.001 and p < 0.05 ANOVA). In the monaural condition, total rotation and discrimination in noise were negatively correlated with difficulty (Pearson r = -0.68, p < 0.01 and -0.51, p < 0.05, respectively). Subjects' behaviors were different in optimizing their hearing in noise via head rotation. The evaluation of head movements seems to be a significant parameter in predicting the difficulty of monaural hearing in noisy environments.
RESUMO
In this study, a training simulator for the examination of dizzy patients based on a virtual-reality-enhanced mannequin (VREM) was developed to evaluate the detection of catch-up saccades during head impulse test (HIT) and the effect of training in VREM. For novices (n = 35), 2 trials were conducted before and after a training session. Experts (n = 7) were submitted to an evaluation session. In each trial, a left or a right horizontal canal deficit with an overt catch-up saccade (delay between 110 and 320 ms) was randomly presented. Participants scored the difficulty in performing the maneuver, in recognizing the saccades, and the self-confidence in the diagnosis using a visual analogue scale (VAS). Saccade delay significantly influenced the performance. Training significantly improved the sensitivity in the residents (69.1% before to 97.9% after the training, p < 0.001, Fisher's exact test, n = 560 tests), surpassing experts' performances (p < 0.001, versus 87% in experts, Fisher's exact test). The specificity also increased to the expert level (78% before to 95% after the training, and 95% in experts, p < 0.001, Fisher's exact test). The VAS showed a decrease difficulty to execute the HIT, with an increase in the confidence after training. VREM improved the HIT execution performance and the confidence in novice practitioners.