A Case of Solitary Fibrous Tumour Arising From the Anterior Skull Base.

Solitary fibrous tumours (SFTs) are rare tumours of mesenchymal origin, most commonly found in adults with a median age of 45-50 years. Cases in the head and neck are uncommon, and definitive diagnosis relies on histomorphological features supported by immunohistochemical staining. Here we present a case of a 26-year-old gentleman with a one-year history of right-sided nasal obstruction and bloody discharge on a longstanding background of recreational cocaine use. A computed tomography scan of the paranasal sinuses demonstrated a mass arising from the anterior skull base extending into the right middle turbinate. Immunohistochemistry testing for tumour characterisation showed hematopoietic progenitor cell antigen (CD34) and signal transducer and activator of transcription 6 (STAT6) positivity in keeping with an SFT. The patient underwent definitive surgery via endoscopic piecemeal resection with no further reoccurrence at follow-up.

The Outcomes of Cochlear Implantation in Elderly Patients: A Single United Kingdom Center Experience.

OBJECTIVES: The average life expectancy in the United Kingdom is currently nearly 80 years for a newborn baby with nearly 15% of the population, by 2040, being >75 years old. Hearing impairment is a common disability in the elderly individual, and there have been significant drives to support this population to lead longer and healthier working lives. We aimed to assess the long-term audiological and health-related quality-of-life benefits of cochlear implants (CI) in elderly individuals. METHODS: A retrospective and cross-sectional study of patients who received a CI at ≥70 years. Data extracted included speech perception scores, adverse events, telephone use, and patient-reported outcome measures using the Glasgow Benefit Inventory questionnaire with a minimum of 12 months follow-up. RESULTS: Sixty-four patients aged ≥70 years received a unilateral CI. A significant improvement in speech perception scores in all conditions was noted with no significant difference between differing age groups. Glasgow Benefit Inventory scores showed a significant positive impact on patients' lives and their health status, with no significant difference between the differing age groups. CONCLUSIONS: Cochlear implantation is a safe and well-tolerated procedure in the elderly patients with significant improvements observed in audiological performance, health status, and social interactions.

The management of periorbital cellulitis secondary to sinonasal infection: a multicenter prospective study in the United Kingdom.

BACKGROUND: Periorbital cellulitis is a potential sight-threatening complication of sinusitis. The majority of patients improve with medical management. Previous studies have suggested significant variations in practice and lack of evidence regarding the optimal management of this condition. METHODS: A prospective study was conducted over a 12-month period at 8 centers in the United Kingdom assessing the management of patients requiring inpatient treatment for periorbital cellulitis secondary to sinonasal infections. RESULTS: A total of 143 patients were recruited, of whom 40 were excluded. Of the remaining 103 patients, 5 (4.9%) were diagnosed with neurosurgical complications. This resulted in 98 patients admitted with periorbital cellulitis secondary to an upper respiratory tract infection/sinusitis. A total of 72 were children, of whom 12 (16.7%) required surgical intervention; and of 26 adults, 5 (19.2%) required surgery: the most common antimicrobial regimes administered were intravenous ceftriaxone (with or without metronidazole), and co-amoxiclav. The use of both ceftriaxone and metronidazole from admission was associated with the shortest duration of inpatient stay (3.8 days) in comparison to ceftriaxone alone (5.8 days) or co-amoxiclav (4.5 days) and a reduction in number of patients requiring surgical intervention. There was also an association between the early use of intranasal decongestants and steroids and reduction in requirement for surgical intervention. CONCLUSION: For a condition where swab and blood cultures are often negative, this study supports the use of ceftriaxone in combination with metronidazole. The administration of intranasal decongestants and corticosteroids correlated with a smaller percentage of those progressing to surgery in those with and without periorbital abscesses.

Case Report: Case report: A rare case of middle-ear Rhabdomyosarcoma in a 4-year-old boy.

We present a rare case of a four-year-old boy with a botyroid embryonal rhabdomyosarcoma of the right middle ear. Rhabdomyosarcoma is a soft tissue malignancy which is thought to originate from embryonic mesenchymal cells of striated skeletal muscle.  It is a disease primarily of children and is exceptionally rare in parameningeal regions.  The diagnosis is often delayed and easily misdiagnosed as aural polyp. Therefore, advanced disease is common at the time of diagnosis.  A four-year-old boy presented with a four-month history of recurrent left ear blood and pus discharge, otalgia and fevers. He attended his GP three times and paediatric A&E 13 times where he received antibiotics for presumed otitis media and externa. He was eventually referred to the otolaryngology department and underwent an examination under anaesthesia of ear and excisional biopsy of a suspicious aural polyp.  Staging chest CT and PET scan showed no loco-regional spread or distal metastasis. Magnetic resonance imaging demonstrated absence of invasion into adjacent organs.  Histology confirmed embryonal rhabdomyosarcoma, botryoid subtype.  Subsequent to the initial excision of the polyp, he was started on an ifosfamine, vincristine and actinomycin (IVA) chemotherapy regime in three weekly cycles for nine cycles with concomitant radiotherapy. Two weeks subsequent to his first chemotherapy dose he presented with a House-Brackmann II-III facial nerve palsy but no other middle ear complications. He was started on intravenous antibiotics and dexamethasone. The facial nerve palsy incompletely resolved with treatment.

Do salivary bypass tubes lower the incidence of pharyngocutaneous fistula following total laryngectomy? A retrospective analysis of predictive factors using multivariate analysis.

Salivary bypass tubes (SBT) are increasingly used to prevent pharyngocutaneous fistula (PCF) following laryngectomy and pharyngolaryngectomy. There is minimal evidence as to their efficacy and literature is limited. The aim of the study was to determine if SBT prevent PCF. The study was a multicentre retrospective case control series (level of evidence 3b). Patients who underwent laryngectomy or pharyngolaryngectomy for cancer or following cancer treatment between 2011 and 2014 were included in the study. The primary outcome was development of a PCF. Other variables recorded were age, sex, prior radiotherapy or chemoradiotherapy, prior tracheostomy, type of procedure, concurrent neck dissection, use of flap reconstruction, use of prophylactic antibiotics, the suture material used for the anastomosis, tumour T stage, histological margins, day one post-operative haemoglobin and whether a salivary bypass tube was used. Univariate and multivariate analysis were performed. A total of 199 patients were included and 24 received salivary bypass tubes. Fistula rates were 8.3% in the SBT group (2/24) and 24.6% in the control group (43/175). This was not statistically significant on univariate (p value 0.115) or multivariate analysis (p value 0.076). In addition, no other co-variables were found to be significant. No group has proven a benefit of salivary bypass tubes on multivariate analysis. The study was limited by a small case group, variations in tube duration and subjects given a tube may have been identified as high risk of fistula. Further prospective studies are warranted prior to recommendation of salivary bypass tubes following laryngectomy.

Granular Cell Tumour of the Larynx.

A 55-year-old lady with a 6 month history of hoarse voice presented to our ENT department. Endoscopic examination displayed a white left arytenoid lesion. Biopsy of this lesion displayed a nodule covered with non-keratinizing stratified squamous epithelium, with a central core of polygonal cells, positive for S-100 staining. This confirmed a granular cell tumour. CO2 laser was utilised to excise this benign tumour. Granular cell tumours of the head and neck are common, but are infrequently found in the larynx. This case report highlights the importance for the otolaryngologist to be aware of this differential diagnosis, particularly as histologically they may be confused with squamous cell carcinoma.

A unique complication of radiofrequency therapy to the tongue base.

INTRODUCTION: Radiofrequency ablation treatment of the tongue base can be used either alone or as part of a multilevel approach in the treatment of snoring. This involves the generation of thermal energy around the circumvallate papillae of the tongue. Potential complications include ulceration, dysphagia, haematoma and abscess formation. PRESENTATION OF CASE: We present the case of a 50-year-old patient who developed an anterior neck swelling following a second application of radiofrequency ablation therapy to the tongue base for snoring. This was secondary to an infection of a previously undiagnosed thyroglossal cyst. The patient made a full recovery following intravenous antibiotic therapy and ultrasound-guided needle aspiration. DISCUSSION: Thyroglossal tract remnants are thought to be present in seven percent of the adult population. An infection in a thyroglossal tract cyst has not previously been reported following radiofrequency ablation of the tongue base. Given the relatively high complication rate of tongue base radiofrequency ablation in some series, this complication may be under-recognised. CONCLUSION: An infected thyroglossal tract cyst should be suspected in patients with anterior neck swellings following radiofrequency ablation therapy to the tongue base. We advise caution when performing this procedure on patients with known thyroglossal tract remnants though there is insufficient evidence to suggest that this procedure is contraindicated.

Paecilomyces lilacinus causing debilitating sinusitis in an immunocompetent patient: a case report.

INTRODUCTION: Since the discovery of the first documented case of Paecilomyces in 1963, only five cases of Paecilomyces sinusitis have been described to date and all of them have predisposing factors such as immunocompromised status or prior nasal surgery. We present the first case of Paecilomyces lilacinus sinusitis in a fit young woman with no identified predisposing factors. To the best of our knowledge, this is the first known case in the UK and in Europe. CASE PRESENTATION: A 20-year-old Iraqi woman who has lived in the UK for the past five years presented with rhinorrhea, hyposmia, and nasal obstruction. She was previously fit and well and had no significant medical history. Imaging revealed a fungal infection that was eventually revealed on cytological examination to be P. lilacinus. CONCLUSIONS: P. lilacinus is both a difficult and important organism to identify because it has intrinsic anti-fungal resistance. In our case, the infection was severe and recurrent, and the organism demonstrated resistance to common oral anti-fungal agents. There was a delay in its diagnosis, owing to its similarity in appearance to Penicillium and a difficulty in distinguishing between the two without specialized knowledge of fungal taxonomy. In the field of otolaryngology, Paecilomyces is relatively unknown. Our intention is to raise awareness of this organism as well as to describe the challenges in its management.