Relationship of petrous temporal bone pneumatization to the eustachian tube lumen.

OBJECTIVES/HYPOTHESIS: Objectives were to determine the incidence of petrous apex pneumatization and to define the relationship between a pneumatized petrous temporal bone and the eustachian tube lumen. STUDY DESIGN: Retrospective study with institutional review board approval including only adult patients. METHODS: One hundred head computed tomography (ct) scans and 204 petrous temporal bone CT scans performed at a tertiary teaching hospital were reviewed. The two senior authors (s.h.s., p.c.s.) independently reviewed the petrous temporal bone CT scans for grade of pneumatization. Pneumatized CT scans were then reviewed for the presence of a direct communication with the eustachian tube lumen. Significance was determined using the chi test and Pearson correlation of ranks. RESULTS: The incidence of peritubal cells opening into the eustachian tube anterior to the tympanic orifice was 92%. CONCLUSION: The direct communication of peritubal cells with the bony eustachian tube may play a role in the development of persistent cerebrospinal fluid rhinorrhea after cerebellopontine angle surgery.

Mitomycin-C in the postsurgical ear canal.

OBJECTIVE: Our goal was to evaluate the use of topical mitomycin-C (MMC) in the prevention of scar tissue formation in the postsurgical external auditory canal (EAC). Study design and setting We conducted a prospective pilot study at a tertiary care institution. METHODS: Six patients with recurrent postoperative granulation tissue after canaloplasty, tympanomastoidectomy, or lateral temporal bone resection were included. MMC (0.5 mg/mL) was applied topically for 5 minutes to the EAC/mastoid cavity. RESULTS: Outcomes were measured at initial MMC application and 1 and 3 months thereafter using a visual analog scale score based on the degree of EAC occlusion by granulation tissue. Need for debridement of recurrent granulation tissue on follow-up was noted. Three (50%) patients had improved VAS 1 month after treatment. Two (33%) had improved visual analog scale score at 3 months. Five (83%) required at least one debridement procedure. Repeat MMC application was performed in 2 patients. CONCLUSION: Topical MMC was ineffective in preventing scar formation in the postsurgical EAC.

Sporadic Burkitt's lymphoma of the head and neck in the pediatric population.

Burkitt's lymphoma (BL) is one of the fastest growing malignancies in the pediatric population in the United States. BL is a high-grade B-cell Non-Hodgkin's lymphoma (NHL) which exists in endemic, sporadic, and human immunodeficiency-associated subtypes. The African, or endemic, variant usually involves the maxilla and other facial bones while head and neck manifestations in non-endemic BL are rare. We present three unusual present ations of sporadic BL stemming from Waldeyer's ring and the orbit. The clinical and pathologic features of BL are reviewed.

Significance of eosinophilia in chronic rhinosinusitis.

BACKGROUND: The purpose of this study was to investigate the impact of serum eosinophilia in the prognosis of chronic rhinosinusitis (CRS). Eosinophils are now considered to play a major role in the pathogenesis of CRS. To date, no study has evaluated the clinical course of patients with CRS and serum eosinophilia. METHODS: A retrospective chart review of 620 patients who underwent endoscopic sinus surgery, (ESS) for CRS was performed. Thirty-one patients (5%) had elevated serum eosinophil counts and served as the study group. Patient charts of the study group and 34 (5%) controls with normal serum eosinophil counts were reviewed for comorbid diseases including asthma, polyps, and allergic fungal sinusitis. The number of ESSs performed and the postoperative recurrence of multiple sinus infections and need for antibiotics, systemic steroids, and antifungal agents were compared. RESULTS: A higher proportion of patients with serum eosinophilia had a history of asthma, polyp disease, and allergic fungal sinusitis. Postoperatively, the study group had a statistically significant difference (p < 0.05) as compared with controls with respect to postoperative recurrent sinus infections (94% versus 32%) and polyp disease (35% versus 3%). Statistical difference between study and control groups was also found with respect to the postoperative need for antifungal agents (23% versus 3%), multiple courses of antibiotics (84% versus 32%), and revision ESS (84% versus 24%). Although not statistically significant, a higher proportion of the study group required systemic steroids. CONCLUSIONS: CRS patients with serum eosinophilia have a worse prognosis when compared with controls. Patients with eosinophilia should be counseled appropriately, and the physician should be aware of the chronicity of disease.