Squamous cell cancer of the temporal bone: a review of the literature.

BACKGROUND AND AIMS: Squamous cell carcinoma (SCC) of the temporal bone is a rare malignancy accounting for only 0.2% of head and neck cancers. There is currently no clear consensus on staging or common approach to management. It is the aim of this work to provide the readers with a review of the current literature on this malignancy. METHODS: A literature review was performed identifying 16 case series with patient numbers ranging from 12 to 124. A total of 708 patients were included in this review, 67% presented with advanced disease. 578 cases were managed operatively with lateral temporal bone resection, some underwent local resection alone in early stage disease. In all studies radiation therapy was used as an adjunct to some degree. RESULTS: More than half of studies reported 100% either 2-, 3- or 5-year survival for T1 and T2 disease with no nodal involvement. Survival correlated with disease stage and in five studies SCC differentiation was found to be a significant prognostic factor. Post-operative radiotherapy was found to improve survival in only one study. CONCLUSIONS: Temporal bone SCC is a readily treatable malignancy in early stage disease, however late stage disease has a poor prognosis. Differentiation of the SCC and stage of disease at presentation appear to have the greatest influence on 5-year survival rates. Further work is required in both the identification of early stage disease and in the treatment of later T3 and T4 lesions.

Feasibility of a synthetic temporal bone for training in mastoidectomy: face, content, and concurrent validity.

OBJECTIVE: To investigate the face, content, and concurrent validity of the synthetic Pettigrew temporal bone (PTB) for mastoidectomy training as compared with cadaveric temporal bone (CTB). STUDY DESIGN: A prospective evaluation study. METHODS: Participants were invited to perform a step-by-step modified radical mastoidectomy using both bones and complete a 22-item, 5-point Likert scale questionnaire. The questionnaire is divided into 4 domains: face validity (FV), global content (GC), task-specific content (TSC), and curriculum recommendation (CR). RESULTS: Thirty-six experts and 89 trainees completed all tasks, 63 using CTB and 62 using PTB. The PTB median FV was 4 (IQR: 4-5), GC of 4 (IQR: 4-5), TSC of 4 (IQR: 3-4), and CR of 4 (IQR: 4-5). The CTB was rated significantly higher than PTB by both groups in all domains; CTB FV: 5 (IQR: 4-5), GC: 5 (IQR: 4-5), TSC: 5 (IQR: 4-5), and CR: 5 (IQR: 5-5), p < 0.001 for each. Trainees rated PTB significantly higher than experts in all domains. There was no statistically significant difference between experts and trainees in rating the CTB in all domains. PTB gives similar haptic feedback to CTB, allows the use of suction and irrigation, has the important landmarks painted for identification, and contains articulating ossicles. The facial nerve anatomy was found to be inaccurate around the region of the second genu. CONCLUSION: Participants found PTB to be valid for teaching some, yet not all, aspects of mastoid surgery, and experts agreed that it could improve global transferrable otologic skills. It is essential that the facial nerve anatomy is addressed before recommending this model.

Three-year ear, nose, and throat cross-sectional analysis of audiometric protocols for magnetic resonance imaging screening of acoustic tumors.

OBJECTIVES: (1) Evaluate audiometric protocols and recommend protocols with best sensitivity and specificity for magnetic resonance imaging (MRI) screening of acoustic tumors; (2) determine clinical risks (false negative) of missing acoustic tumors and potential wastes in screening (false positive) nonacoustic tumors or radiologically "normal" cases; and (3) identify the decibel difference and range of frequencies compared by the best-performing protocols. STUDY DESIGN: Cross-sectional study with chart review. SETTING: Ear, nose, and throat (ENT); audiology; and radiology departments in a tertiary-care hospital. SUBJECTS AND METHODS: Three-year cohort (2006-2009) of 1751 ENT patients underwent MRI screening and pure-tone audiometry indicating sensorineural hearing loss. Audiometric protocols were ranked by highest sensitivity to acoustic tumors, specificity A to nonacoustic tumors, and specificity B to "radiologically normal" cases. RESULTS: No audiometric protocols achieved 100% sensitivity or specificity rates. Only 2 protocols achieved ≥90% sensitivity: the AMCLASS-A-Urben protocol (93.16%) and the Mangham protocol (91.58%). Eleven of 15 protocols for specificity A and 12 of 15 protocols for specificity B achieved ≥50%. Clinical risks ranged from 6.84% to 18.95%, whereas potential wastes ranged from 33.56% to 68.37% for specificity A and 31.76% to 66.86% for specificity B. Interaural difference parameters indicating highest mean sensitivity were on the order of ≥10 dB, ≥15 dB, and ≥20 dB. For frequency comparison parameters, "2 or more adjacent frequency" and "single-frequency" comparison indicated higher mean sensitivity than the "averaged multifrequency" comparison. Mean specificity showed an opposite pattern. CONCLUSIONS: For optimum sensitivity, the Mangham protocol is preferred (sensitivity, 91.58%; specificity A, 44.23%; specificity B, 44.91%), which proposes a ≥10-dB interaural difference, averaging 1 to 8 kHz. For optimum specificity, the American Academy of Otolaryngology-Head and Neck Surgery protocol is preferred (sensitivity, 87.37%; specificity A, 65.38%; specificity B, 66.04%), which proposes ≥15 dB between ears, averaging 0.5 to 3 kHz.

Teflon-induced granuloma: a source of false positive positron emission tomography and computerized tomography interpretation.

Patients diagnosed with malignancy often undergo combined positron emission tomography (PET) and computerized tomography (CT) to investigate possible metastases. This report presents a case in which, in the investigation of suspected pulmonary malignancy, combined PET and CT images suggested a malignant lesion at the level of the vocal fold. Biopsy of the lesion, however, confirmed the clinical diagnosis of a Teflon granuloma. The case highlights the potential for a false positive report during scanning of patients who have had vocal fold injection.