Parotid Gland Tumors: A Multicenter Analysis of 1020 Cases. Increasing Incidence of Warthin's Tumor.

We assessed the frequency of the parotid gland tumor entities and correlated sex and age in different tumor types. Retrospective data were obtained from three major otorhinolaryngology clinics in Karlsruhe and Pforzheim, Germany within a 10-year period. In total, 1020 cases of parotidectomy for benign and malignant lesions were identified. We found 864 (84.7%) and 156 (15.3%) patients with benign and malignant tumors of the parotid gland, respectively. The most common benign parotid tumor was Warthin's tumor, followed by pleomorphic adenoma. The most common primary malignant tumor types were acinic cell carcinoma and mucoepidermoid carcinoma. Secondary malignant tumors of the parotid gland included lymphoma and metastatic, cutaneous squamous cell carcinoma. The frequency of Warthin's tumors was higher than that of pleomorphic adenomas. A large proportion of the malignant parotid tumors represent metastases from squamous cell carcinoma of the skin of the head and neck.

Effects of the COVID-19 Pandemic on Head and Neck Cancer Stage and Treatment Duration.

Objective To assess the efficacy of oncologic healthcare during the COVID-19 pandemic on patients with head and neck squamous cell carcinoma (SCC) in a tertiary university hospital in Germany. Methods This retrospective, cross-sectional, observational study included 94 patients with newly diagnosed head and neck squamous cell carcinoma during a two-year period. Patients were assigned to two date-dependent groups; referrals before (group A) and during (group B) the COVID-19 pandemic. Time intervals from the symptom(s) onset to diagnosis, diagnosis to treatment, and treatment initiation to completion were recorded. Furthermore, TNM stages and the application of reconstructive surgery with free tissue transfer were determined. Patients' outcomes and characteristics were compared between the two groups. Finally, a comprehensive literature review was carried out to identify similar epidemiological studies. Results The symptom-to-diagnosis interval was longer during the COVID-19 pandemic [median 9.5 (A) versus 15 (B) weeks, p = 0.054]. The intervals from diagnosis to treatment and treatment initiation to end of treatment were approximately the same in both groups [median 3 (A) versus 3.2 (B) weeks, p = 0.264; and 6.9 (A) versus 6.3 (B) weeks, p = 0.136]. The T-and N-stages were not higher during the pandemic [early T-stage (T1+T2) versus advanced T-stage (T3+T4), p = 0.668; and N-negative (N0) versus N-positive status (N1,2,3), p = 0.301]. Patients who presented with distant metastatic disease and those who underwent reconstructive surgery with free tissue transfer were observed more frequently in the lockdown phase [M1 versus M0, p= 0.022; and flap versus no flap, p=0.007]. Conclusion This study suggests the consistent diagnostic and therapeutical performance of the tertiary oncologic healthcare in Berlin, Germany, despite the challenges that patient care units faced during the COVID-19 pandemic.

Diagnostic value of computed tomography in Eustachian tube dysfunction.

OBJECTIVE: Investigate radiological findings on temporal bone computed tomography, which are associated with obstructive Eustachian tube dysfunction and determine its diagnostic validity. METHODS: The present study was conducted as a prospective, cross-sectional case series study in a tertiary referral center. Forty patients with clinically diagnosed unilateral Eustachian tube dysfunction and older than 16 years old underwent pre interventional radiological assessment by temporal bone computed tomography while performing a Valsalva-maneuvre to enhance visualization of Eustachian tube lumen. The Eustachian tubes were assessed for intersite morphological differences, presence of mucus in the lumen or middle ear cleft and secretion retention or mucosal swelling in the adjacent sinuses. Image analyses and radiological statements about the side of pathology were delivered blinded to the clinical diagnoses. RESULTS: The radiologic detection of mucus/mucosal edema in Eustachian tube or adjacent middle ear cleft structures was associated with the pathological side (t (1, N = 40) = 3.60, p = 0.001 < 0.05). On the contrary, there is no association between radiological findings of sinonasal disease and side of Eustachian tube dysfunction (x2 (1, N = 40) = .00, p = 1.00 > 0.05). The diagnostic value of radiologic assessment in Eustachian tube dysfunction has a sensitivity and specificity of 52,5 and 97,5% respectively. CONCLUSION: The sensitivity of radiologic assessment is rather low, and hence it is inappropriate as a screening tool for Eustachian tube dysfunction in routine clinical practice. In the case of present CT-scans of the temporal bone, the focus should be laid on the detection of mucus in the Eustachian tube or adjacent structures, as a predictor of disease.

Inflammatory Pseudotumor in the Parapharyngeal Space: Is It Possible to Diagnose by Exclusion?

Inflammatory pseudotumor (IP) is a rare pathologic condition that easily can be confounded with malignancy. The clinical presentation depends on the site of occurrence and the radiological or laboratory findings are not specific. Diagnosis can be established only with histology. We report a case of a 64-year-old woman with IP in an uncommon localization, the parapharyngeal space extending to skull base. Although the diagnosis was not certain after histopathological examination, broad diagnostic workup helped to exclude malignancy or bacterial infection and led to diagnosis of an IP by exclusion. We observed a good clinical and radiological regression of symptoms after administration of oral immunosuppressants, confirming the immunological mechanism of the disease.

Morphologic measurements of 3D Eustachian tube model and their diagnostic value regarding Eustachian tube dysfunction - A cross-sectional observational study.

PURPOSE: To investigate the diagnostic value of three-dimensional morphologic measurements of the Eustachian tube on computed tomography in Eustachian tube dysfunction. METHOD: This prospective cross-sectional observational study includes forty patients with unilateral Eustachian tube dysfunction. The clinical diagnosis is verified using the Eustachian tube score - 7 and the Eustachian tube dysfunction questionnaire - 7. Computed tomography scans of the temporal bone are acquired while performing a Valsalva manoeuvre to improve the visualization of the air-filled Eustachian tube lumen. The Eustachian tubes are delineated on curved planar reconstructions, and three-dimensional models are constructed. Seven morphological parameters are measured for each Eustachian tube: the cross-sectional size of the tympanic and pharyngeal orifice; the visualization length; the inclination angles, and the curvature angles. Morphological measurements and Eustachian tube scores are correlated. RESULTS: The mean value of the visualization length of the complete Eustachian tube and in its bony segment is significantly higher in healthy sides than in pathological sides (p = 0.034 and p = 0.029, respectively). There is a significant correlation between the Eustachian tube score - 7 and the cross-sectional size of the tympanic orifice (rP = 0.361; p = 0.022). The Eustachian tube score - 7 correlates significantly with the visualization length of complete Eustachian tube (rP = 0.436; p = 0.005) and its bony segment (rS = 0.598; p < 0.0001), respectively. CONCLUSIONS: The cross-sectional size of the tympanic orifice may be a specific imaging feature indicating the obstructive Eustachian tube. However, 3D morphologic measurements of the Eustachian tube are insufficient to yield useful data about its function.

Balloon Eustachian Tuboplasty (BET) in Children: A Retrospective Multicenter Analysis.

OBJECTIVE: Generation of pilot data for planning of prospective BET-studies for treatment of dilatory Eustachian tube (ET) dysfunction in children. STUDY DESIGN: Retrospective multicenter analysis. SETTING: Nine ENT departments at tertiary care teaching hospitals. PATIENTS: 4-12-year-old children with chronic otitis media with effusion (COME) for more than 3 months or more than 3 episodes of acute otitis media during the last year, having failed standard surgical therapy at least once. INTERVENTION: BET with or without paracentesis, ventilation tube insertion, or tympanoplasty. MAIN OUTCOME MEASURES: Tympanic membrane appearance, tympanometry, and hearing threshold. RESULTS: Two hundred ninety-nine ETs of 167 children were treated. Mean age was 9.1 years (95% confidence interval [95% CI]: 8.7-9.4 yr). In 249 ears (83.3%), COME and/or retraction of the tympanic membrane were the indication for BET. Median hearing threshold was 20 dB HL (95% CI: 0-46 dB). One hundred fifty-five ears (51.8%, 95% CI: 46.1-57.4%) showed a tympanogram type B. Treatment consisted of BET without other interventions ("BET-only") in 70 children, 128 ears. Median length of follow-up for 158 (94.6%) children was 2.6 months (95% CI: 0.3-16.1 mo). After treatment, the tympanic membrane appeared normal in 196 ears (65.6%, 95% CI: 60.0-70.8%, p < 0.001). Median hearing threshold improved to 10 dB HL (95% CI: 0-45 dB, p < 0.001). Tympanograms shifted toward type A and C (type A: 39.1%, 95% CI: 33.7-44.7, p < 0.001). These improvements were also observed in subgroup analyses of "BET-only" treatment and the indication of "COME" respectively. CONCLUSION: BET is improving a variety of dilatory ET dysfunction-related ear diseases in children. This study provides detailed data for design and planning of prospective studies on BET in children.