Secondary non-Hodgkin lymphoma of the ethmoid sinus after temozolomide.

The paranasal sinuses are rarely the site of malignancy, especially non-Hodgkin lymphoma. In such cases, the ethmoid sinus is the second most frequently involved paranasal sinus. Diagnosis of these malignancies is difficult because the early symptoms often mimic benign sinus pathology. Thus, most cases are diagnosed at an advanced stage, and their prognosis is poor. Here we describe the case of a 58-year-old man with a secondary high-grade B-cell non-Hodgkin lymphoma of the ethmoid sinus. This malignancy was diagnosed two years after the patient had received treatment with temozolomide for a glioblastoma multiforme. This case highlights that malignant tumours of the paranasal sinuses should always be included in the differential diagnosis of sinus disease. Additionally, patients treated with temozolomide should receive regular follow-up care including vigilant evaluation for secondary tumours, such as non-Hodgkin lymphoma.

Fixation of cochlear implants: an evidence-based review of literature.

HYPOTHESIS: There are numerous cochlear implant fixation techniques to prevent soft tissue complications related to device migration. The literature does not provide sufficient evidence to determine the most suitable fixation method. BACKGROUND: Cochlear implants (CI) are becoming a routine treatment for patients with severe to profound deafness. Steadily growing numbers of implant centres and surgeons worldwide are inevitably leading to higher rates of complications, including device migration. It is currently unknown whether this can be prevented by proper implant fixation during surgery. The low prevalence of this complication makes it challenging to interpret publications regarding CI fixation techniques. METHODS: An exhaustive literature review reveals a variety of different fixation techniques. Most authors advocate the creation of a bony well for the CI receiver/stimulator (R/S); however, an increasing number of surgeons no longer secure implants at all. Here we give an overview of all published fixation methods, with special attention to the evidence-based quality and descriptions of the advantages and drawbacks of each. CONCLUSIONS: Literature review reveals an absence of level I evidence-based publications addressing device migration. Existing publications report on too few cases to draw a conclusion on whether surgical fixation prevents implant migration. To have statistical power, studies of alternative or new fixation methods should include high numbers of implantations in each study arm and the studies should be longitudinal and prospective. In default of other evidence, it seems fair to define good practice as the creation of at least a bony well and/or (bony) sutures.

Epidemiology of hearing impairment at three Flemish Institutes for Deaf and Speech Defective Children.

A retrospective analysis of 190 records of hearing impaired children up to the age of 14, all educated at one of three Flemish Institutes for Deaf and Speech Defective Children in Belgium, was performed. Until 1999, the well-known behavioral test (Ewing test) was used in the Flemish national screening program for hearing losses. Because it presented a lot of disadvantages, it has been replaced by Automated Auditory Brainstem Responses (AABR), enabling the Flemish national neonatal screening program to commence. This study is an extension of the preliminary results of a recently performed retrospective analysis in one Flemish institute of the hearing loss of patients that were diagnosed in the pre-AABR era. The authors analyzed the following data: etiology, risk factors of congenital hearing impairment, the patient's history from the moment of the first suspicion to diagnosis and treatment. The median age of the children was 8.5 years (2-14 year). In 66.5% the parents and/or grandparents were the first to raise suspicion, this was at a median age of approximately 9 months. The diagnosis was often made late, at a median age of 15 months (0-88 months). The etiology was unknown in 32.6% of the cases. The only cast-iron certain diagnoses were pre- and perinatal infections, syndromal and genetic hearing loss, and acquired infections (meningitis and measles). No risk factors of hearing loss, as they are stated by the Joint Committee on Infant Hearing, were found in more than 50% of the cases. Audiometry was performed in all cases, often supplemented with Auditory Brainstem Responses and/or click-evoked otoacoustic emissions, while other diagnostic investigations (imaging, genetics, etc.) were only variably performed. Finally, the authors confirm the need for universal neonatal screening, which only recently started in Belgium, and suggest that a detailed protocol should be established to pursue a coherent diagnostic policy.