Extensive Intratemporal Tumor-An Unusual Diagnosis.

A 21-year-old man presented with left-sided facial paralysis and sensorineural hearing loss; physical examination was otherwise normal. What is your diagnosis?

Sulodexide Monotherapy in Chronic Idiopathic Subjective Tinnitus: A Randomized Controlled Trial.

Objective To report the therapeutic value of sulodexide monotherapy in the management of patients with chronic subjective idiopathic tinnitus. Study Design Randomized double-blinded controlled trial. Setting Single tertiary care institution. Subjects and Methods Observations from 124 patients who received either sulodexide or placebo were collected from the patients' medical records. Computer-generated tables were used to allocate treatments. Patients took 1 tablet of the drug or placebo each morning and evening for 40 consecutive days. The response was assessed by the Tinnitus Handicap Inventory and the Mini-Tinnitus Questionnaire. Results Between 2014 and 2017, 124 patients were divided into 2 treatment arms. The sulodexide group encompassed 63 patients, whereas the placebo arm contained 61 patients. Tinnitus Handicap Inventory and Mini-Tinnitus Questionnaire scores were more decreased in the sulodexide arm compared to the placebo group ( P = .03 and P < .01, respectively). Conclusions Sulodexide monotherapy decreases chronic subjective idiopathic tinnitus.

Binaural stimulation through cochlear implants in postlingual deafness: a positron emission tomographic study of word recognition.

HYPOTHESIS: Bilateral stimulation through cochlear implants induces a brain activity pattern closer to the normal one than unilateral stimulation. BACKGROUND: Although it has been shown that speech comprehension through bilateral cochlear implants leads to better performances than after unilateral implantation, the existence of neural underpinnings of this improvement remains to be studied. METHODS: We performed an H2O positron emission tomographic study of word recognition in 5 patients with bilateral cochlear implants and 5 normal-hearing controls. Subjects had to distinguish words from nonwords in binaural and monaural conditions. RESULTS: There was no overactivation in patients for binaural stimulation, with a hypoactivation in the right temporal cortex. For monaural stimulation, patients demonstrated more activation contralaterally to the stimulation side in the posterior temporal cortex and in the cerebellum. CONCLUSION: Binaural stimulation through cochlear implants is advantageous compared with the monaural at the neurofunctional level because the pattern of brain activity is closer to the normal one.

Does diclofenac increase the risk of cervical necrotizing fasciitis in a rat model?

Non-steroidal anti-inflammatory drugs (NSAIDs) are known for aggravating in vitro infections and were reported in many cases of cervical necrotizing fasciitis (CNF). We developed a rat model of CNF, mimicking as closely as possible the human-CNF, to study the effect of a NSAIDs, diclofenac, as a promoting factor. Twenty rats were injected bilaterally in the neck with peptostreptococcus and with a fresh saliva specimen for another 20 rats. Half of each group was given an intramuscular injection of 4 mg/kg diclofenac at the time of inoculation and 24 h later, and the other half saline injections; rats were killed at day 7 and clinical, bacterial and histological studies were performed to assess the infectious process and the incidence of CNF. No statistically significant difference was found between groups treated with diclofenac vs. the saline injection groups. However a significant correlation was noted between clinical observation, bacterial density and histological signs of inflammation. CNF has a high mortality rate and the use of NSAIDs in conditions potentially leading to CNF is very common. However, our rat model does not support the hypothesis of a promoting role of diclofenac which was occasionally suggested in the medical literature. This study suggests that diclofenac does not seem to increase the risk of occurrence of CNF. Nonetheless, NSAIDs can mask inflammatory signs of an already spreading CNF.

Cochlear reimplantations: technical and surgical failures.

CONCLUSION: Cochlear implant surgeons should have a good knowledge of how to diagnose device failures and how to deal with medical complications related to cochlear implantation. Electrode array misplacement may be due to unidentified inner ear malformation. Use of peroperative telemetry and radiographic examination should help to avoid such complications. OBJECTIVES: To review our experience of cochlear implant revision surgery and to compare our series to the literature. To report two cases of electrode array misplacement into the vestibular system and to discuss how to prevent this complication. SUBJECTS AND METHODS: This was a retrospective review of cochlear implant revision surgery in a tertiary reference center. RESULTS: Of 487 cochlear implantations, 3.8% of adults and 4.5% of children underwent a revision surgery. The mean time to device failure was 7.6 years in children and 1.5 year in adults. Causes of revision were seven hard failures, four soft failures, and nine medical reasons. Among the medical reasons, four patients had skin flap infection associated with an extended endaural approach. Audiologic performances were stable or improved following reimplantation in 90% of cases. We had two cases of electrode array misplaced into the vestibular system.