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1.
Medicine (Baltimore) ; 100(39): e27285, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34596124

RESUMO

RATIONALE: Ramsay Hunt syndrome is a type of herpes zoster infection involving geniculate ganglion and facial nerve. Unilateral facial palsy, otalgia, and painful vesicular rash on the auricle and external auditory canal are the typical symptoms. Although postherpetic neuralgia (PHN) is a devastating complication of herpes zoster infection, PHN following Ramsay Hunt syndrome has rarely been reported. PATIENT CONCERNS: A 55-year-old immunocompetent female patient visited our pain clinic, for left-sided refractory otalgia (PHN) that persisted for 3 months after she was diagnosed with Ramsay Hunt syndrome. Although facial palsy and tinnitus had recovered within 2 to 4 weeks after symptom onset, the patient had been experiencing a persistent and severe otalgia radiating to mandibular angle, temporal and upper cervical area of neuropathic nature. DIAGNOSES: The patient's pain persisted despite conservative medication and administration of ultrasound-guided stellate ganglion block, facial nerve block, and great auricular nerve block several times. INTERVENTIONS: The patient was treated with the application of ultrasound-guided pulsed radiofrequency (PRF) to the great auricular nerve. OUTCOMES: The patient experienced significant pain reduction more than 50% on a numeric rating scale after 2 weeks of PRF treatment. LESSONS: Chronic otalgia might be a type of PHN after Ramsay Hunt syndrome with cervical nerve involvement. PRF treatment to the great auricular nerve can be a therapeutic option for refractory otalgia following Ramsay Hunt syndrome.


Assuntos
Dor de Orelha/terapia , Herpes Zoster da Orelha Externa/terapia , Tratamento por Radiofrequência Pulsada , Orelha/inervação , Dor de Orelha/etiologia , Feminino , Herpes Zoster da Orelha Externa/complicações , Humanos , Pessoa de Meia-Idade , Indução de Remissão
2.
Continuum (Minneap Minn) ; 27(2): 491-525, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-34351116

RESUMO

PURPOSE OF REVIEW: This article reviews the causes of tinnitus, hyperacusis, and otalgia, as well as hearing loss relevant for clinicians in the field of neurology. RECENT FINDINGS: Important causes of unilateral and bilateral tinnitus are discussed, including those that are treatable or caused by serious structural or vascular causes. Concepts of hyperacusis and misophonia are covered, along with various types of neurologic disorders that can lead to pain in the ear. Hearing loss is common but not always purely otologic. SUMMARY: Tinnitus and hearing loss are common symptoms that are sometimes related to a primary neurologic disorder. This review, tailored to neurologists who care for patients who may be referred to or encountered in neurology practice, provides information on hearing disorders, how to recognize when a neurologic process may be involved, and when to refer to otolaryngology or other specialists.


Assuntos
Perda Auditiva , Zumbido , Dor de Orelha/diagnóstico , Dor de Orelha/etiologia , Perda Auditiva/diagnóstico , Humanos , Hiperacusia/diagnóstico , Zumbido/diagnóstico , Zumbido/etiologia , Zumbido/terapia
3.
Laryngorhinootologie ; 100(S 01): S1-S30, 2021 04.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-34352901

RESUMO

Otalgia, otorrhea and hearing loss are the most common ear-related symptoms that lead to the consultation of an otolaryngologist. Furthermore, balance disorders and affections of the cranial nerve function may play a role in the consultation. In large academic centres, but also in primary care, the identification of rare diseases of the middle ear and the lateral skull base is essential, as these diseases often require interdisciplinary approaches to establish the correct diagnosis and to initiate safe and adequate treatments. This review provides an overview of rare bone, neoplastic, haematological, autoimmunological and infectious disorders as well as malformations that may manifest in the middle ear and the lateral skull base. Knowledge of rare disorders is an essential factor ensuring the quality of patient care, in particular surgical procedures. Notably, in untypical, complicated, and prolonged disease courses, rare differential diagnoses need to be considered.


Assuntos
Perda Auditiva , Doenças Raras , Orelha Média , Dor de Orelha , Humanos , Doenças Raras/diagnóstico , Doenças Raras/terapia , Base do Crânio/cirurgia
4.
Med Clin North Am ; 105(5): 813-826, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34391535

RESUMO

Otalgia can be broadly categorized into primary otologic causes and secondary nonotologic causes. Isolated otalgia in the absence of hearing loss, otorrhea, or abnormal otoscopic findings is typically secondary to referred pain from nonotologic causes, as the sensory nerve supply to the ear arises from 4 cranial nerves and the cervical plexus. The most common causes of primary otalgia are acute otitis media and otitis externa, whereas the most common causes of secondary otalgia are temporomandibular joint disorders and dental pathology. Persistent unilateral ear pain and other alarm symptoms warrant further evaluation for possible neoplasm.


Assuntos
Dor de Orelha/patologia , Dor de Orelha/terapia , Dor de Orelha/diagnóstico , Dor de Orelha/etiologia , Humanos , Otite Média com Derrame/patologia , Atenção Primária à Saúde , Transtornos da Articulação Temporomandibular/patologia
5.
J Pak Med Assoc ; 71(7): 1893-1896, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34410269

RESUMO

External auditory canal, like other epithelialized surfaces is predisposed to malignancies such as Squamous cell carcinomas (SCC), melanomas and adenocarcinomas. In this background, malignancies like adenoid cystic carcinoma (ACC) are a rare occurrence and need to be thoroughly evaluated both locally and for distant extension. The malignancy needs to be addressed with an aggressive approach surgically with adequate marginal clearance. The role of radiation is debatable considering the outcomes in the limited data. Here we present the case of a 35-year-old female who came in with otalgia and otorrhea associated with a mass in the external auditory canal. After biopsy and imaging, a diagnosis of adenoid cystic carcinoma was made and the patient was managed accordingly.


Assuntos
Carcinoma Adenoide Cístico , Neoplasias da Orelha , Adulto , Carcinoma Adenoide Cístico/diagnóstico por imagem , Carcinoma Adenoide Cístico/cirurgia , Meato Acústico Externo/diagnóstico por imagem , Neoplasias da Orelha/diagnóstico por imagem , Neoplasias da Orelha/cirurgia , Dor de Orelha , Feminino , Humanos , Doenças Raras
7.
BMJ Case Rep ; 14(4)2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33811095

RESUMO

Chronic otorrhoea from a tympanic membrane perforation is common. We present the case of a patient who had already received seemingly adequate treatment for his condition in the past. Yet, he presented to our outpatient clinic with worsening otalgia and otorrhoea, progressive hearing loss and a new tympanic membrane perforation. After a thorough otological evaluation, the patient's medical history and the histological specimen from a previous operation were reviewed. The findings met the diagnostic criteria of eosinophilic otitis media. After treatment with topic triamcinolone through the perforated tympanic membrane, the patient's otalgia subsided, hearing levels were improved and the size of the tympanic membrane perforation decreased.


Assuntos
Perda Auditiva , Otite Média Supurativa , Otite Média , Perfuração da Membrana Timpânica , Timpanoplastia , Antibacterianos/uso terapêutico , Doença Crônica , Dor de Orelha/etiologia , Perda Auditiva/tratamento farmacológico , Perda Auditiva/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Otite Média/tratamento farmacológico , Otite Média Supurativa/complicações , Otite Média Supurativa/tratamento farmacológico , Otite Média Supurativa/cirurgia , Resultado do Tratamento , Perfuração da Membrana Timpânica/tratamento farmacológico , Perfuração da Membrana Timpânica/cirurgia
8.
J Int Med Res ; 49(2): 300060521996517, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33641518

RESUMO

OBJECTIVE: To determine the prevalence, sociodemographic features, and clinical presentation of temporomandibular joint disorder in otorhinolaryngological practice. METHODS: This prospective hospital-based study involved patients diagnosed with temporomandibular joint disorder in our institution's ear, nose, and throat department. Data for this study were obtained from the patients using pretested interviewer-assisted questionnaires. RESULTS: The prevalence of temporomandibular joint disorder in this study was 1.3%. The study population included 17 (26.2%) male patients with a male:female ratio of 1.0:2.8. Joint disorder accounted for 75.4% of all disorders, while both mastication muscle and joint disorder accounted for 21.5%. A majority of the patients (47.7%) presented between weeks 1 and 13 of the illness. Unilateral temporomandibular joint disorder accounted for 98.5% of all disorders. The main otologic clinical features were earache and a dull tympanic membrane in 100% and 35.4% of patients, respectively. Middle ear assessment revealed type A in 73.8% of patients and type B in 20.0% according to Jerger's classification system of tympanometry. Most patients (81.5%) were referred by their family physician. All patients had undergone prehospital treatment prior to presentation. CONCLUSION: Temporomandibular joint disorder is a common presentation in medical practice. Common clinical features include ear, joint, and mastication muscle disorders.


Assuntos
Dor de Orelha , Transtornos da Articulação Temporomandibular , África ao Sul do Saara , Feminino , Humanos , Masculino , Mastigação , Estudos Prospectivos , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/epidemiologia
9.
Eur Arch Otorhinolaryngol ; 278(12): 4707-4713, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33502545

RESUMO

PURPOSE: High-resolution temporal bone computer tomography (HRTBCT) is the most common initial radiological modality used for the assessment of necrotizing otitis externa (NOE). OBJECTIVES: (1) To compare the extension of disease, as seen on HRTBCT, in patients with NOE caused by different pathogens and (2) assess whether radiological findings may suggest the offending pathogen in cases of sterile-NOE. METHODS: All NOE patients were hospitalized between 1990 and 2018. All patients underwent HRTBCT at admission. Three groups (fungus-NOE, PA-NOE and sterile-NOE) comprising of ten patients each were randomly selected. HRTBCT was reevaluated by a senior radiologist. Thirteen radiological subsites were selected for reevaluation. RESULTS: All patients in the fungal-NOE group complained of otalgia, compared to nine in the sterile-NOE and six in the PA-NOE groups (p value = 0.044). External ear canal edema and granulation tissue were the most common findings in all groups. Surgery was performed in five patients in the fungal-NOE and PA-NOE and three in the sterile-NOE group (p value = > 0.05). Radiological findings indicating severe bone erosion within the EEC was seen in all patients but 3 (p value = > 0.05). Severe TMJ erosion was seen in one patient within the fungal-NOE and PA-NOE group (p value = > 0.05). When mild and severe involvement were combined, TMJ bone erosion was seen in four patients in the fungal-NOE and only in one patient in the PA-NOE (p = 0.04). CONCLUSIONS: TMJ involvement may be more common in fungal disease, suggesting a different spreading pathway, as opposed to PA-NOE. Accordingly, TMJ involvement on HRTBCT may justify antifungal treatment in sterile culture-NOE.


Assuntos
Otite Externa , Computadores , Meato Acústico Externo , Dor de Orelha , Humanos , Otite Externa/diagnóstico por imagem , Tomografia Computadorizada por Raios X
10.
Laryngoscope ; 131(5): E1640-E1646, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33141477

RESUMO

OBJECTIVES/HYPOTHESIS: To compare the efficacy and adverse effects of triamcinolone acetonide econazole cream and nystatin suspension in the treatment of otomycosis, and to determine the clinical features, predisposing factors, and etiology of otomycosis. STUDY DESIGN: A prospective study. METHODS: A prospective clinical trial was conducted on 786 patients diagnosed with otomycosis. The study population was randomly divided into two treatment groups of triamcinolone acetonide econazole cream (TAEC) and nystatin suspension in a 1:1 ratio. After clearing all fungal deposits in the external auditory canal, the antimycotic drugs were locally applied for at least 2 weeks. The efficacy and adverse effects were compared between the two antifungal reagents by statistical analysis. Meanwhile, patient clinical data were collected to find out the clinical features, predisposing factors, and etiology. RESULTS: Pruritis was the most common symptom and Aspergillus niger was the leading fungal pathogen. There was high association (44.5%) of otomycosis with a history of unclean ear picking. The cure rate was 97.6% in the TAEC group and 73.5% in the nystatin group (P < .01). Treatment with TAEC resulted in 2.4% of patients complaining of discomforts (irritant dermatitis, otalgia, or headache) versus 59.8% of patients complaining discomforts treated with nystatin (P < .01). The residue rate of antifungals was 1.9% in the TAEC group and 89.9% in the nystatin group (P < .01) at the end of treatment. CONCLUSIONS: Thoroughly cleaning of the external auditory canal followed by local use of TAEC under endotoscope is an effective, convenient, and well-tolerated treatment for otomycosis. LEVEL OF EVIDENCE: 1 Laryngoscope, 131:E1640-E1646, 2021.


Assuntos
Antifúngicos/administração & dosagem , Aspergilose/tratamento farmacológico , Econazol/administração & dosagem , Nistatina/administração & dosagem , Otomicose/tratamento farmacológico , Triancinolona Acetonida/administração & dosagem , Administração Tópica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/efeitos adversos , Aspergilose/diagnóstico , Aspergilose/microbiologia , Aspergillus niger/isolamento & purificação , Criança , Pré-Escolar , Dermatite Irritante/epidemiologia , Dermatite Irritante/etiologia , Combinação de Medicamentos , Meato Acústico Externo/efeitos dos fármacos , Meato Acústico Externo/microbiologia , Dor de Orelha/induzido quimicamente , Dor de Orelha/epidemiologia , Econazol/efeitos adversos , Feminino , Cefaleia/induzido quimicamente , Cefaleia/epidemiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Nistatina/efeitos adversos , Otomicose/microbiologia , Estudos Prospectivos , Suspensões , Resultado do Tratamento , Triancinolona Acetonida/efeitos adversos , Adulto Jovem
11.
Ann Otol Rhinol Laryngol ; 130(3): 273-279, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32772544

RESUMO

BACKGROUND: Refractory otomycosis is a common condition that is difficult to treat. OBJECTIVES: This study aimed to evaluate the effectiveness of 1% topical voriconazole drops in the treatment of otomycosis. METHODS: This retrospective analysis was conducted from November 2017 to November 2019. Patients who had refractory otomycosis without tympanic membrane perforation confirmed by microbial culture and fluorescent staining were included in the study. All patients were treated with 1% topical voriconazole drops hourly at daytime for 2 weeks. Evaluation of effectiveness was conducted 1 month after the completion of topical voriconazole treatment. Before and after topical voriconazole treatment, hearing tests were performed in all patients. RESULTS: Fifty-five patients were included in this study. The reasons for refractoriness were resistant recurrence to imidazole drugs (50 cases, 90.9%) and difficulty in cleaning the external auditory canal (5 cases, 9.1%). The most common strain was Aspergillus terreus (50.9%), followed by Aspergillus flavus (29.1%), Aspergillus niger (10.9%), and Aspergillus fumigatus (9.1%). After 2 weeks of treatment with 1% topical voriconazole drops, otomycosis in all patients was resolved. There was no significant change in bone conduction before and after topical voriconazole treatment (paired t-test, P = 0.5023; linear correlation analysis, R2 = 0.98; equation, y = 1.003x-0.284). Adverse effects, such as blurred vision and phototoxicity, were not observed in any patient. CONCLUSIONS: Administration of 1% topical voriconazole drops was effective and safe in the treatment of refractory otomycosis without tympanic membrane perforation within 2 weeks.


Assuntos
Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Otomicose/tratamento farmacológico , Voriconazol/uso terapêutico , Administração Tópica , Adulto , Aspergillus , Aspergillus flavus , Aspergillus fumigatus , Aspergillus niger , Audiometria de Tons Puros , Técnicas de Cultura , Dor de Orelha/fisiopatologia , Feminino , Perda Auditiva/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Otomicose/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
12.
Ann Otol Rhinol Laryngol ; 130(3): 314-318, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32772562

RESUMO

BACKGROUND: Petrous apicitis (PA) is a serious infection involving the apical portion of the petrous temporal bone. The classic triad of purulent otorrhea, ipsilateral abducens nerve palsy and retroorbital pain is rarely seen due to early detection and widespread use of antibiotics. Medical management is the primary treatment modality with surgery reserved for cases of recalcitrant petrous apex abscess. METHODS AND RESULTS: We presented a case of PA with previously untreated otitis media. After multidisciplinary evaluation, the patient was initially treated with intravenous antibiotics followed by drainage of the abscess using a combined transmastoid and middle cranial fossa (MCF) approach. The patient recovered well with no recurrence of the infection based on imaging and symptoms. DISCUSSION: While a variety of different surgical approaches can be used in treatment of PA, we recommend the MCF approach in cases where access to the anterior petrous apex may be challenging via transcanal or transmastoid approach.


Assuntos
Abscesso/terapia , Antibacterianos/uso terapêutico , Ventriculite Cerebral/terapia , Drenagem/métodos , Mastoidectomia/métodos , Mastoidite/terapia , Meningite/terapia , Otite Média Supurativa/terapia , Petrosite/terapia , Abscesso/diagnóstico por imagem , Ventriculite Cerebral/diagnóstico , Ventriculite Cerebral/etiologia , Confusão/etiologia , Fossa Craniana Média , Dor de Orelha , Humanos , Masculino , Mastoidite/diagnóstico por imagem , Meningite/diagnóstico , Meningite/etiologia , Pessoa de Meia-Idade , Otite Média Supurativa/diagnóstico por imagem , Petrosite/diagnóstico por imagem , Fotofobia/etiologia , Streptococcus pneumoniae , Tomografia Computadorizada por Raios X
13.
Laryngoscope ; 131(5): 1101-1109, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-32940937

RESUMO

OBJECTIVES: To identify the frequency and primary site of metastatic pathologies to the temporal bone and characterize the associated symptomatology. METHODS: The MEDLINE, Embase, and Web of Science databases were systematically reviewed according to the PRISMA guidelines to identify all cases of pathologically confirmed distant temporal bone metastases published with English translation until October 2019. Descriptive statistics were performed. RESULTS: Out of 576 full-length articles included for review, 109 met final criteria for data extraction providing 255 individual cases of distant temporal bone metastases. There was a male predominance (54.9%) with median age of 59.0 years (range 2-90). The most common locations of primary malignancy included the breasts (19.6%), lungs (16.1%), and prostate (8.6%). Most tumors were carcinomas of epithelial origin (75.3%) and predominantly adenocarcinoma (49.4%). The commonest metastatic sites encountered within the temporal bone were the petrous (72.0%) and mastoid (49.0%) portions. Bilateral temporal bone metastases occurred in 39.8% of patients. Patients were asymptomatic in 32.0% of cases. Symptomatic patients primarily reported hearing loss (44.3%), facial palsy (31.2%), and otalgia (16.6%) for a median duration of 1 month. Petrous lesions were associated with asymptomatic cases (P = .001) while mastoid lesions more often exhibited facial palsy (P = .026), otalgia (P < .001), and otorrhea (P < .001). Non-carcinomatous tumors were associated with petrosal metastasis (P = .025) and asymptomatic cases (P = .109). Carcinomatous metastases more often presented with otalgia (P = .003). CONCLUSIONS: Temporal bone metastasis is uncommon but should be considered in patients with subacute otologic symptoms or facial palsy and history of distant malignancy. Laryngoscope, 131:1101-1109, 2021.


Assuntos
Adenocarcinoma/epidemiologia , Neoplasias Ósseas/epidemiologia , Neoplasias da Mama/patologia , Neoplasias Pulmonares/patologia , Neoplasias da Próstata/patologia , Osso Temporal/patologia , Adenocarcinoma/complicações , Adenocarcinoma/secundário , Neoplasias Ósseas/complicações , Neoplasias Ósseas/secundário , Dor de Orelha/epidemiologia , Dor de Orelha/etiologia , Paralisia Facial/epidemiologia , Paralisia Facial/etiologia , Feminino , Perda Auditiva/epidemiologia , Perda Auditiva/etiologia , Humanos , Masculino
15.
Clin Anat ; 34(1): 24-29, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32279338

RESUMO

BACKGROUND: The nociceptive receptive field of the vagus nerves in animals includes virtually the entire thoracic, abdominal and laryngopharyngeal regions. However, the role of the vagus nerves in the transmission of visceral pain in humans, with the exception of pain from coronary artery diseases, is believed to be insignificant. AIM: The purpose of this report is to map out the clinical visceral pain receptive field of the vagus nerves relative to its nociceptive counterpart in animals. MATERIALS AND METHODS: The PubMed database and PMC were searched for case reports of patients with orofacial pain believed by the author(s) of the article to be referred from underlying non-cardiac thoracic, laryngopharyngeal or abdominal diseases. Reports of diseases for which non-neural explanations for the orofacial spread of pain were suggested were excluded. RESULTS: A total of 52 case reports of jaw pain and/or otalgia referred from laryngopharyngeal and noncardiac thoracic sources were discovered. In addition, a multicenter prospective study found that 25.8% of more than 3,000 patients with thoracic aortic dissection experienced pain in the head and neck region. In stark contrast, no case reports of orofacially referred pain from abdominal diseases were found. DISCUSSION: The results indicate that the laryngopharyngeal and thoracic portions of the vagal receptive field are capable of referring pain orofacially while the abdominal portion is not. The roles of the somatotopic organization of the trigeminal sub nucleus caudalis and neuromodulation in this referral of pain were discussed. CONCLUSION: Referred orofacial pain can lead to delayed diagnosis and poorer outcome in visceral diseases.


Assuntos
Dor de Orelha/fisiopatologia , Dor Facial/fisiopatologia , Dor Referida/fisiopatologia , Nervo Vago/fisiopatologia , Dor Visceral/fisiopatologia , Humanos
16.
Clin Interv Aging ; 15: 2313-2320, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33335390

RESUMO

Background: Multiple cranial dural arteriovenous fistulas (dAVFs) are considered to be an uncommon vascular condition. dAVFs usually manifest with vague symptoms, which are related to the site of occurrence of the lesion and present with complex angio-architectural features, which in turn can render treatment procedures difficult. Appropriate treatment that aims to reduce the risk of intracranial bleeding and manage the patient's symptoms requires a multidisciplinary approach. Case Presentation: The patient was a 62-year-old man who developed symptoms of progressive right-sided otalgia and tinnitus. Cross-sectional imaging revealed long-standing venous congestion with intracranial hemorrhage in the right parieto-occipital region. Moreover, cerebral angiography demonstrated multiple complex dAVFs at the right transverse sinus-sigmoid sinus (TS-SS) junction, right posterior condylar confluence (PCC), and torcula. Treatment consisted of one session of endovascular treatment, in which transarterial Onyx embolization was used to treat the dVAF at the right TS-SS junction, transvenous coil embolization for the dVAF at the right PCC, and particle embolization for both occipital arteries feeding the torcular dAVF. Postoperative improvement with favorable clinical outcomes was observed at the patient's last follow-up visit. Conclusion: Multiple cranial dAVFs are an uncommon vascular lesion, which can present with unusual symptoms such as otalgia. Moreover, a single session of endovascular therapy can treat this lesion, ie, it can improve the patient's symptoms and provide a beneficial long-term outcome.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/patologia , Dor de Orelha/etiologia , Zumbido/etiologia , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Embolização Terapêutica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
19.
Pan Afr Med J ; 36: 276, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33088405

RESUMO

Undifferentiated nasopharyngeal cancer of the cavum (UCNT) is the most frequent neoplasm of the nasopharynx, having a close relationship with exposure to Epstein-Barr virus. It has a high potential for locoregional or distant invasion which are the cause of some treatment failures. The extension to the maxillary sinus is rarely described. We report here the case of a 38-year-old patient with headaches associated with epistaxis, left otalgia and facial pain. Examination by anterior rhinoscopy objectively revealed a polylobed ulcerating mass. Otoscopic examination revealed a left seromucous otitis media. Computed tomography showed a voluminous tumour process in the infra temporal fossa and nasopharynx with significant locoregional extension particularly in the maxillary sinus. Pathological examination revealed an UCNT of the cavum and the patient was classified as T4N2M0. The patient received chemoradiotherapy, with wide irradiation of the cervical lymph node areas. The deep localization of the cancer of the cavum, which is difficult to examine, requires a diagnostic and extension work-up, both endoscopic and radiological, which is an important step in the diagnostic and therapeutic management.


Assuntos
Neoplasias do Seio Maxilar/diagnóstico , Neoplasias Nasofaríngeas/diagnóstico , Adulto , Quimiorradioterapia , Dor de Orelha/etiologia , Endoscopia , Epistaxe/etiologia , Dor Facial/etiologia , Humanos , Neoplasias do Seio Maxilar/patologia , Neoplasias do Seio Maxilar/terapia , Neoplasias Nasofaríngeas/patologia , Neoplasias Nasofaríngeas/terapia , Tomografia Computadorizada por Raios X
20.
AJNR Am J Neuroradiol ; 41(12): 2188-2198, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33093134

RESUMO

Otalgia is very common, and when the cause of ear pain is not identified on otoscopy and physical examination, cross-sectional imaging is routinely used to evaluate for potential sources of referred ear pain (secondary otalgia). Innervation of the ear structures is complex, involving multiple upper cervical, lower cranial, and peripheral nerves, which transit and innervate a large anatomic territory involving the brain, spine, skull base, aerodigestive tract, salivary glands, paranasal sinuses, face, orbits, deep spaces of the neck, skin, and viscera. Interpreting radiologists must be familiar with these neural pathways and potential sources of secondary otalgia. The purposes of this review are to detail the currently proposed mechanisms of referred ear pain, review the salient neuroanatomy of the complex pathways responsible for secondary otalgia, highlight important benign and malignant etiologies of referred ear pain, and provide a structured search pattern for approaching these challenging cases on cross-sectional imaging.


Assuntos
Dor de Orelha/diagnóstico por imagem , Dor de Orelha/patologia , Dor Referida/diagnóstico por imagem , Dor Referida/patologia , Dor de Orelha/etiologia , Humanos , Neuroimagem/métodos , Dor Referida/etiologia
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