Hyperbaric oxygen as an adjuvant treatment for malignant otitis externa.

BACKGROUND: Malignant, or necrotising, otitis externa is a potentially fatal infection of the external ear canal and surrounding soft tissue and bone. It may be complicated by involvement of cranial nerves, principally the facial nerves and the contents of the jugular foramen. It is an uncommon condition mainly found in the elderly or in diabetics. OBJECTIVES: To assess the effectiveness of adjunctive hyperbaric oxygen treatment for malignant otitis externa. SEARCH METHODS: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 4 April 2013. SELECTION CRITERIA: Randomised controlled trials, involving adults, undergoing hyperbaric oxygen therapy in malignant otitis externa. DATA COLLECTION AND ANALYSIS: No identified articles described randomised controlled trials of hyperbaric oxygen therapy in the treatment of malignant otitis externa. MAIN RESULTS: Due to the lack of data we could present no results. AUTHORS' CONCLUSIONS: No clear evidence exists to demonstrate the efficacy of hyperbaric oxygen therapy when compared to treatment with antibiotics and/or surgery. We found no data to compare rates of complication between the different treatment modalities. Further research is required.

Is familial adenomatous polyposis associated with sensorineural hearing loss?

Abstract The mutation causing familial adenomatous polyposis (FAP) affects the adenomatous polyposis coli (Apc) gene, which has a role in the cytoskeleton and has been shown to be important in the structure of supporting cells in the cochlea. One previous study suggested that FAP sufferers may have sensorineural hearing loss. In order to demonstrate whether this is the case we invited patients known to suffer from familial adenomatous polyposis to take part in our study. Audiograms were performed and compared to normal values for that patient's age and gender calculated using ISO standard data. Thirteen patients were included in the study analysis. No conductive hearing losses were identified. A statistically significant greater hearing loss was identified at 500 Hz (2.8 dBHL, P = 0.03) and 1000 Hz (2.5 dBHL, P = 0.05). No audiometric difference could be identified between the patients with FAP and attenuated FAP. A power calculation demonstrated that the study was of adequate size. This study did not demonstrate a clinically significant difference in hearing loss between the FAP group and the calculated normal values.

Are facial nerve outcomes worse following surgery for cystic vestibular schwannoma?

OBJECTIVES: This study sought to determine explicitly whether postsurgical facial nerve outcomes for patients with a cystic component to a vestibular schwannoma were significantly different from those with a solid tumor. DESIGN: Seventy patients who underwent translabyrinthine surgery for a cystic vestibular schwannoma between May 1981 and the present, and who had complete records in our database, were identified. These were compared with a group of patients with solid tumors matched to the study group on the following parameters: House-Brackmann grade at presentation, tumor size, surgical approach, age. SETTING: Regional tertiary referral center. PARTICIPANTS: Adult patients with vestibular schwannomas. MAIN OUTCOME MEASURES: House-Brackmann score 2 years following surgery. RESULTS: No significant difference was found between the two groups. CONCLUSIONS: The perceived difference in outcomes between cystic and solid vestibular schwannomas cannot be demonstrated when confounding factors such as tumor size are taken into account.

A facial nerve schwannoma masquerading as a vestibular schwannoma.

Schwannoma of the facial nerve is an extremely rare condition with an incidence far lower than that of vestibular schwannoma. We discuss the case of a woman who had been diagnosed as having vestibular schwannoma and referred to our hospital. Initially, we concurred with the diagnosis, but on reassessment of magnetic resonance imaging scans before surgery, we revised the diagnosis to facial nerve schwannoma. This allowed us to counsel the patient appropriately preoperatively regarding the expected outcome. We discuss the importance of this case and the lessons to be learned from it.