Seromucinous Hamartoma of the Lateral Nasal Wall with Infiltration of the Orbit: A Rare Case Report and Review of the Literature.

Seromucinous hamartoma is a rare benign glandular proliferation arising from the respiratory epithelium of the sinonasal tract and nasopharynx. It was described for the first time in 1974 by Baillie and Batsakis. Since then, few cases have been reported in the literature with most of them occurring in the posterior nasal septum. We report the case of a 52-year-old woman that presented to our department with left periorbital edema, pain, and dacryorrhea due to seromucinous hamartoma arising from the left inferior turbinate and extending through the lateral nasal wall into the maxilla, the nasolacrimal duct, and the orbit. Endoscopic medial maxillectomy and endoscopic transnasal orbital tumor resection were performed. The patient remains symptom-free for 16 months, till her most recent follow-up. Seromucinous hamartoma of the nasal cavity is an exceedingly rare diagnosis, especially in the lateral nasal wall. It should be included in the differential diagnosis of nasal tumors. According to the literature review, this is the first case report of seromucinous hamartoma with orbit infiltration. Endonasal endoscopic resection is the treatment of choice.

Visual Analogue Scale for the Evaluation of Olfactory and Gustatory Dysfunction of COVID-19 Patients in Northwestern Greece.

Background The visual analogue scale (VAS) has been used as a diagnostic tool for the evaluation of the severity of olfactory and gustatory dysfunction (OGD) caused by SARS-CoV2 infection. The main objective of the present study was the evaluation of OGD with VAS in COVID-19-positive patients in Northwestern Greece and its possible association with the patients' self-reported symptoms of olfactory and gustatory dysfunction. Methods The presence of olfactory and gustatory symptoms and their severity were assessed by questionnaire along with the use of specific odorants and tastant ingredients, in three time periods: prior to COVID-19, during COVID-19 (initial diagnosis) and post-COVID-19 disease (at four weeks from disease onset). Three hundred COVID-19-positive patients (home-quarantined and hospitalized) tested with RT-PCR test in the University Hospital of Ioannina Greece were included in this study. Statistical analysis was performed on SPSS Statistics 26.0 (IBM Corp., Armonk, NY) Results Out of a total of 300 patients, 146 and 190 patients had mild hyposmia and hypogeusia respectively, followed by patients with severe hyposmia or hypogeusia (118 and 88 respectively), at the time of COVID-19 onset (initial diagnosis). An increase in the number of patients with recovery of symptoms was observed during the follow-up period, during which only eight patients had non-resolving severe symptoms (six patients with hyposmia and two with hypogeusia). On further analysis, a statistically significant association was found between the severity of symptoms (assessed by VAS score) and the self-reported symptoms of sensory dysfunction by the patients. There was a significant association between the groups of patients with mild hyposmia and patients that reported no loss of smell; between the patients with moderate hyposmia and the patients who reported "loss of smell"; and between the patients with severe hyposmia and the group of patients who reported a loss of smell, at the COVID-19 onset period. Similarly, patients with mild hyposmia were associated with those that reported a loss of smell at the same time. The severity of hyposmia was also associated with the reported symptom of "loss of taste" at the time of COVID-19 diagnosis. Similar findings were observed regarding the severity of hypogeusia and the reported symptom of "loss of taste" among the groups of patients. Finally, the severity of hypogeusia was associated with smell loss at the time of initial diagnosis of the infection. Conclusion Similar to the literature data, our findings indicate that hyposmia and hypogeusia are common symptoms of COVID-19 disease with varying severity. In our study, most of the patients exerted a complete recovery of these OGD symptoms. In addition, we found an association between olfactory dysfunction and self-reported sensory of taste as well as gustatory dysfunction and sensory of smell. Finally, we found that the VAS score was a reliable diagnostic tool in the estimation of OGD in this cohort of patients. However, our results need to be confirmed by larger-scale trials.

Immune-Mediated Inner Ear Disease Associated with Type 1 Autoimmune Hepatitis: A Challenging Coexistence.

Autoimmune hepatitis (AIH) is characterized by elevated serum transaminase, increased immunoglobulin G levels, presence of autoantibodies, and hepatocellular damage. Coexistence with other autoimmune diseases has been reported in almost half of patients with AIH. Here, we report a 60-year-old man who developed rapidly progressive, bilateral, asymmetrical, and asynchronous sensorineural hearing loss that was consistent with immune-mediated inner ear disease (IMIED). This devastating presentation evolved as a late manifestation in the context of a six-month systemic illness that had previously resulted in type 1 AIH. A biochemical remission with normalization of aminotransferases achieved within two months after the initiation of corticosteroids with azathioprine. Further, an acceptable response has also been achieved at the patient regarding the right ear-hearing impairment; though, treatment could not reverse the substantial decrement in hearing capability of the left ear. To our knowledge, this is the first case report of the concurrent development of type 1 AIH and IMIED.

A Study of Airborne Pollen Grains and Fungal Spores in the Region of Epirus (Northwestern Greece).

INTRODUCTION: In the region of Epirus (Northwestern Greece) there are characteristic climatic and geographical conditions that facilitate the growth of typical vegetation with the production of allergic pollen. Aerobiological research into airborne pollen diversity and seasonal variation in pollen counts and fungi spores has become essential due to the growing incidence of allergic rhinitis, allergic asthma, and other pollen-related and spore-related allergic conditions. Furthermore, weather conditions and other factors like air pollution may affect the intensity, the onset, and the duration of the pollen season, and the impact on the patient's symptomatology. METHODS: The diversity of airborne pollen grains (grains/m3) and fungal spores (spores/m3) in the region of Epirus were measured volumetrically using Burgard trap for 13 months, from May 1, 2017 to May 31, 2018. RESULTS: Totally, 10 pollen families and two fungi were recognized. The six most common taxa were Cupressaceae, Pinaceae, Urticaceae, Poaceae, Betulaceae, and Compositeae. The fungi taxa were Cladosporium and Alternaria. Peak pollen centralization was recorded from May to September. Urticaceae had the longest pollen season while Oleaceae and Pinaceae had the shorter. Fungal spores were recorded during all the months of the year. Also, there was a correlation between meteorological parameters and most pollen taxa. CONCLUSION: The pollen and spore calendar shows the concentration of pollen grains and fungal spores in the region of Epirus. This knowledge is important for physicians and allergic patients as it could improve the management of the allergic respiratory disease.

Fibrous Dysplasia of the Temporal Bone: a Demanding Entity for Radiologists and ENT Surgeons.

Fibrous dysplasia (FD) is a rare, benign, chronic, slowly progressive bone disorder characterized by the replacement of normal bone and bone marrow by fibrous tissue, leading to deformity, pain and functional impairment. It was considered a disease of unknown etiology, uncertain pathogenesis and diverse histopathology. It was later discovered that was caused by a non-heritable activating mutation in the á-subunit gene of the stimulatory G-protein coding gene. Temporal bone involvement is the least frequently reported type, especially in children. The purpose of the current manuscript was to report a rare case of fibrous dysplasia of the left temporal bone of a 17-year-old child who came to the emergency room of our hospital with otalgia and progressive hearing loss on the left ear.

Clinical Symptoms in Hospitalized and Self-Quarantined Patients with SARS-CoV-2 Infection in Northwestern Greece - Association with Olfactory and Gustatory Dysfunction.

Backround: We aimed to assess the relation of chemosensory dysfunction with the reported symptoms in two subgroups of patients in Northwestern Greece: the first one included patients with moderate to severe symptomatology who needed hospitalization and the second one, patients with mild symptoms who recovered at home. Methods:We used a questionnaire to select information about patient demographics, medical history and reported symptoms during infection. Three hundred COVID-19 positive patients who were identified via RT-PCR test in the University Hospital of Ioannina, Greece, were included in the present study, of which 150 recovered at home and the remaining 150 needed hospitalization. Statistical analysis was based on IBM-SPSS Statistics 26.0. Results:The majority of patients had fever during infection, while o minor percentage of those who needed hospitalization (12.67%) suffered from sore throat. There was a statistically significant difference between the loss of smell and clinical symptoms including fatigue, nose congestion, body aches and headache, and loss of taste and reported symptoms including fatigue, body aches, runny nose, headache and sore throat. Conclusion: Fever was the symptom with the highest percentage rate, while sore throat was the symptom with the lowest percentage rate. There are reported clinical symptoms related with olfactory and gustatory dysfunction during COVID-19 infection.

The Impact of Age and Gender and Their Association with Chemosensory Dysfunction, in Hospitalized and Self-Quarantine Patients with Covid-19 Infection, in Epirus, Greece.

Objective:Olfactory and gustatory dysfunction that relates with the infection from severe acute respiratory syndrome-related coronavirus (SARS-CoV-2) has already improved. The relation between chemosensory dysfunction and age and gender in covid-19 positive patients is the main objective of the present study. Methods:We used a questionnaire to select information about medical history, patient demographics and reported symptoms during infection. Three hundred covid-19 positive patients, who underwent a RT-PCR test in the University Hospital of Ioannina, Grecce, were included in this study; 150 of them recovered at home and the remaining 150 were admitted to hospital. Statistical analysis based on ÉBM-SPSS Statistics 26.0 was done. Results:The total sample included 300 patients, of which 106 females and 194 males. There was a statistically significant difference between the subgroup of patients aged 21-25, 61-65 and 71-75 with loss of smell, that of hospitalized patients aged 41-45 with loss of smell and the subgroup of those aged 31-35 and 71-75 with loss of taste. Conclusion:There is a significant association between chemosensory dysfunction and younger age groups. Olfactory and gustatory dysfunction appears more frequently in women than men. Male gender relates with disease severity.

Nasal Valve Management in Rhinoseptoplasty.

Objectives: To provide a detailed description and evaluation of therapeutic techniques for the management of nasal valve in rhinoseptoplasty. Method:An extensive review of the international bibliography has been conducted to highlight published articles on nasal valve pathology and therapeutic measures to address it. Results:To date, many techniques have been described for increasing the cross-sectional area of the nasal valve. Selection of the appropriate technique poses a significant challenge to the nasal valve surgeon. Long-term correction of NVD requires surgical intervention. Correction typically involves the use of various grafts or suture techniques to enlarge and/or support the nasal valve. Selection of the appropriate technique depends on the location and type of dysfunction (dynamic/static). Conclusion:The nasal valve plays an important role in nasal airflow. It is important for the otolaryngologist not only consider, but also fully evaluate the nasal valve when seeing a patient with nasal obstruction. If it is not the primary cause of obstruction, it is often a contributing factor. If NVD is discovered, it should be addressed during surgical intervention (functional rhinoplasty) to avoid a suboptimal outcome.

Parenchymal Brain Abscess as an Intracranial Complication After Sinusitis.

Brain abscesses caused by sinusitis are rare in the antibiotic era. The purpose of the current manuscript was to report a rare case of a brain abscess located mainly in the frontal lobe after sinusitis, which was initially thought to be meningitis or encephalitis. A 39-year-old man was transferred to our hospital from another neighbouring hospital with tonic-clonic seizures, severe headache, and purulent nasal secretions. For one week, he was taking antibiotics for sinusitis. The computed tomography indicated lesions in the right sinuses but not in the parenchymal brain and thus antibiotics along with antiepileptic drugs were given. However, due to the deterioration of symptoms, magnetic resonance imaging was executed, which revealed an abscess in the frontal lobe. Afterward, an anterior ethmoidectomy and middle maxillary antrostomy were performed in order to drain the purulent content from the right sinuses. Ten days later, the patient presented disorientation and thus an open craniotomy for successful removal of the parenchymal abscess was performed. One month later, the patient was discharged with mild irritability, which was eliminated gradually over the next two months. Conclusively, brain abscesses can be caused by local spread from an infection of the paranasal sinus. The contribution of imaging modality is very significant not only for the early diagnosis but also for the therapeutic management of such cases. Frequently antibiotic treatment is insufficient and surgery may be required.

Maxillary Ameloblastoma: A Review With Clinical, Histological and Prognostic Data of a Rare Tumor.

Diagnosis of odontogenic tumors can be challenging due to their rarity and diverse morphology, but when arising near the tooth, the diagnosis could be suspected. When their location is not typical, like inside the paranasal sinuses, the diagnosis is less easy. Maxillary ameloblastomas are exceedingly rare with only sparse information on their epidemiological, histological and genetic characteristics. The aim of this report is to thoroughly review the available literature in order to present the characteristics of this tumor. According to available data, maxillary ameloblastomas can occur in all ages but later than mandible ones, and everywhere within the maxillary region without necessarily having direct contact with the teeth. No sex preference has been shown. The most common histological patterns seen in this location are the follicular and plexiform ones. Maxillary ameloblastomas are locally aggressive neoplasms, thus therapy aims for excision including normal bone beyond the lesion. In contrast to mandible ameloblastomas, maxillary ones most commonly show mutations of the SMO gene. Furthermore, differential tumor diagnosis is thoroughly discussed in the present review.

Outcome factors in surgically treated patients for cervical spondylotic myelopathy.

Context/Objective: To investigate prospectively preoperative parameters that might be related to the outcome of surgically treated patients for cervical spondylotic myelopathy (CSM).Design: Prospective study.Setting: Single Center in Ioannina, Greece.Participants: Thirty-six patients were included in the study. There were 21 males and 15 females, mean age 50.8 years, range 39-70 years. The mean BMI was 27.3.Outcome measures: From each patient, we recorded age, sex, BMI, symptoms, duration of symptoms, comorbidities, lifestyle, myelopathy grade based on MRI and levels of compression. All patients completed the modified JOA (mJOA) and NPE questionnaires preoperatively and at 1, 3, 12 months and 5-years postoperatively.Results: The mean mJOA score significant improved from 10.8 ± 1.9 points preoperatively to 16.6 ± 2.2 points at 12 months postoperatively. The mean mJOA score at 5-years postoperatively was 15.5 ± 3 points. The difference was still highly significant. The mean NPE score significant improved from 59.8 ± 12.2 points preoperatively to 28.2 ± 8.5 points at 1 month, to 35.8 ± 8.1 points at 3 month and to 28.2 ± 8.8 points at 12 months postoperatively. Younger patients had significant higher baseline mJOA scores and significant higher mJOA scores 5-year postoperatively. No correlation was found between sex, BMI, symptom duration, baseline mJOA or myelopathy grade and outcome at 12 months or 5-year postoperatively.Conclusion: Age was highly predictive factor of outcome for patients undergoing surgical treatment of CSM.

Intraoperative flow cytometry for head and neck lesions. Assessment of malignancy and tumour-free resection margins.

Head and neck cancer poses a significant health problem worldwide. We set out to investigate the value of rapid intraoperative cell cycle analysis by flow cytometry for the intraoperative characterization of head and neck lesions and surgical margins. Seventy patients with head and neck lesions suspicious of malignancy were included in the study. There were 31 neoplastic and 39 benign lesions. Flow cytometry permitted the intraoperative detection of neoplastic lesions within 6 min with high sensitivity and specificity based on cell cycle fractions. In the cases in which surgical margins were assessed, intraoperative flow cytometry had complete concordance with pathology. Intreoperative flow cytometry is a novel promising technique for rapid intraoperative characterization of malignancy and tumour free resection margins in head and neck lesions.

Ear Involvement in Inflammatory Bowel Disease: A Review of the Literature.

Inflammatory bowel disease (IBD) is a multisystemic disease. The ear is a rare but recognized site of extraintestinal manifestations of IBD. In external ear, the more common manifestations of IBD are pyoderma gangrenosum, metastatic Crohn's disease and relapsing polychondritis and the treatment includes corticosteroids and anti-TNF agents. Sensorineural hearing loss (SNHL) is the most common ear disease in IBD and especially in patients with ulcerative colitis. In most cases of IBD patients with SNHL, the hearing loss is attributable to autoimmune inner ear disease (AIED). Diagnosis of AIED is based on clinical presentation, the demonstration of a progressive sensorineural hearing loss in periodic audiological tests, a response to immunosuppressive drugs and exclusion of other causes of SNHL. The only diagnostic test that is available for clinical use is the Otoblot test (Western blot for antibodies against 68 kD protein-inner ear antigens). Initial therapy is usually steroids, with a step up to anti-TNF-a therapy and cochlear implantations with failure of treatment. Furthermore, Cogan's syndrome, a chronic disease characterized by deafness, vertigo keratitis and aortitis, has been associated with IBD and mainly with Crohn's disease.

Molecular aspects in HPV-dependent laryngeal and oropharyngeal carcinoma.

Human papillomavirus (HPV)-mediated cervical carcinogenesis represents a well analyzed model of viral implication in epithelial malignant transformation. Mechanisms of high risk (HR) HPV-related infection seem to demonstrate a similar action regarding its implication in head and neck (HN) carcinomas, predominantly in squamous cell carcinoma (SCC) histological type. The prevalence of HR HPV subtypes - mainly HPV16 - is characterized by a broad geographic heterogeneity. Furthermore, HPV-associated HNSCCs demonstrate differences regarding sexual, molecular, epidemiological, and prognostic features compared to alcohol and tobacco dependent ones. Based on these differences, HPV-derived HNSCC appear to be a specific well-defined entity mostly affecting young to middle-aged - male mainly - non-smokers. This is a strong reason of detecting an increased HR-HPV DNA levels -due to viral transmission - in oropharyngeal and laryngeal anatomic regions. Additionally, different response rates to chemoradiation and targeted therapeutic regimens are another significant field for handling these SCC malignancies in the corresponding patients. In the current special article we explored the role of HPV-related carcinogenesis in oropharyngeal and laryngeal SCC focused on the latest molecular aspects.

Subcutaneous Emphysema as a Complication of Tonsillectomy: A Systematic Literature Review and Case Report.

INTRODUCTION: Subcutaneous and mediastinal emphysema is a rare complication after tonsillectomy. This case presentation and literature review summarizes the existing literature on this unusual complication. MATERIALS AND METHODS: This study presents a case of a 21-year-old man who developed a cervical subcutaneous emphysema 6 days after tonsillectomy, whereby conservative treatment produced spontaneous resolution. A proper analysis of this case also required undertaking a systematic search in MEDLINE/PubMed and SCOPUS electronic databases concerning this rare complication, without language restrictions. RESULTS: Based on our criteria, we identified 41 reports including 43 individual cases, in which patients were mostly young and equally distributed between the genders (18 males and 23 females, two unknown). The treatment was mainly conservative and consisted of observation and/or antibiotic therapy. CONCLUSION: Subcutaneous or mediastinal emphysema is an uncommon complication after tonsillectomy. It is important that clinicians become aware of this rare complication, which requires a close monitoring of the patient.

Anterior Cervical Disc Fusion Does not Affect the Presence of Cervical Vestibular-Evoked Myogenic Potential.

OBJECTIVE: Cervical spondylosis and cervical disk herniation are the most frequent forms of degenerative disease in the cervical spine. Surgical treatment mainly includes anterior cervical disk fusion. However, information concerning vestibular-evoked myogenic potential (VEMP) recording in patients undergoing cervical spine surgery is limited. The present prospective study aimed to investigate the effect of anterior disk fusion surgery on cervical VEMP (cVEMP) parameters. MATERIALS AND METHODS: Twenty-five patients were enrolled in this study, and 20 patients (10 men and 10 women) completed cVEMP testing. Patient ages ranged from 29 to 76 y (mean, 52 y). Patients with conductive hearing loss or vestibular dysfunction were excluded. The cVEMP test was recorded preoperatively and 1 and 4 months postoperatively. Air-conducted tone-bursts of 500 Hz were used. RESULTS: We found no statistically significant difference between the preoperative and postoperative cVEMP values. CONCLUSION: Cervical spine surgery (anterior cervical disk fusion) for treating cervical spondylosis does not appear to affect the presence of cVEMP or the parameters of cVEMP, when using air-conducted tone-bursts of 500 Hz. Moreover, cVEMP testing can be used in the postoperative phase for evaluating vertigo in patients who have undergone anterior cervical disk fusion.

DNA mismatch repair deficiency in lung and oral cavity carcinomas: the role of histogenetic origin.

DNA mismatch repair system (DNA MMR) is a crucial genetic mechanism for DNA homeostasis in prokaryotic and eukaryotic cells. During DNA replication and also recombination, point intra-nucleotide errors including base deletion, insertion, and mis-incorporation happen. These raised abnormalities in the newly synthesized DNA strand could affect negatively the stability of the molecule and the function of the corresponding genes. DNA MMR proteins prevent these errors by recognizing and repairing them, securing directly the normal anatomy of the DNA double strand and indirectly the expression of the genes. Specific genomic alterations - mutations, loss of heterozygosity (LOH), or promoter hypermethylation - regarding the MMR genes (human homologues) hMLH1, hMSH2, hMSH3, hMSH6, hPMS1 and hPMS2 modify negatively their expression leading to loss of their function in repairing the corresponding base to base errors. The result known as microsatellite instability (MSI) was initially recognized in colonic carcinoma, especially in its inherited aspect - the Lynch syndrome -, the most common form of hereditary colon carcinoma. Since then, acquired deficiencies in specific DNA MMR genes have been detected in a broad spectrum of malignancies including different anatomic regions and histologies such as stomach, prostate, esophageal, endometrial, lung and head & neck. In the current special review we explored the role of DNA MMR deficiency in lung and oral cavity carcinomas in order to identify similarities and differences regarding the corresponding genes alterations.

mTOR deregulation in oral cavity squamous cell carcinoma.

Signal transduction pathways consist of a variety of inter- and intra-cellular molecules. They act as supporting mechanisms for cell survival and homeostasis. Among them, the phosphatidylinositol 3-kinase (PI3K)/tumor suppressor phosphatase and tensin homologue deleted on chromosome ten (PTEN)/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) pathway plays a crucial role in regulating normal cell growth based on growth factor receptors (GFRs) interaction, including epidermal GFR (type II-HER2) and insulin GFR (IGF). mTOR protein acts as a serine-threonine kinase that belongs to the PI3K-related kinase family. It mediates protein and lipid synthesis, mitochondrial metabolism, biogenesis, proliferation and also negatively regulates autophagy. Two distinct multiprotein complexes have been mainly identified and cloned: mTOR complex 1 (mTORC1) and mTOR complex 2 (mTORC2). mTOR is deregulated predominantly due to mutations, deletions, loss of heterozygosity (LOH) or abnormal phosphorylation of the upstream molecules inside the current pathway. Pure mTOR mutations are very rare. Development of specific inhibitors at the basis of targeted therapeutic strategies such as rapamycin (rapalogs) is an evolution in handling patients with mTOR abnormal overactivity. In the current special article we explored the role of the gene deregulation leading to abnormal protein expression in oral cavity squamous cell carcinoma (SCC).