We report a case of vascular leiomyoma of the nasal cavity. A 90-year-old woman visited our hospital because of recurrent epistaxis, and she was found in fiberscopy and computed tomography to have a well-defined spherical submucosal mass in the left nasal vestibule. The lesion showed low intensity in T1- and intermediate intensity in T2-weighted magnetic resonance imaging, with homogeneous intense gadolinium enhancement. The tumor was excised in a transnasal approach using an ultrasonic scalpel. Histopathological and immunohistochemical findings yielded a definitive diagnosis of venous vascular leiomyoma. Vascular leiomyoma should be considered in the differential diagnosis of any well-circumscribed, hypervascular, soft-tissue mass arising in the submucosal tissue of the nasal cavity.
Hyperbaric oxygen (HBO) therapy combined with steroid administration is an effective treatment for idiopathic sudden sensorineural hearing loss (ISSNHL), but is sometimes unfeasible for patients with underlying diseases, particularly for those with steroid-intolerance. We conducted a controlled retrospective analysis of patients with ISSNHL who received HBO in combination with stellate ganglion block (SGB), prostaglandin (PG) E1, or steroid therapy in order to identify possible alternative regimens.Three hundred and six consecutive patients with ISSNHL (average hearing levels of 5 frequencies (250-4000Hz)≥40dB; time from the onset of hearing loss to the start of treatment ≤30 days) were enrolled. One hundred and ten, 95, and 101 patients underwent SGB+HBO (SGB group), PGE1+HBO (PG group), and steroid+HBO therapy (steroid group), respectively. Hearing recovery was evaluated by grade assessment, by hearing gain, and by hearing improvement rate compared to the unaffected contralateral ear.The overall hearing outcome did not differ among the three groups. In patients with initial hearing levels <80dB, the PG group tended to show a higher cure rate, recovery rate, hearing gain, and hearing improvement rate compared to those of the other groups. In contrast, in patients with initial hearing levels ≥80dB, the SGB group tended to show a higher recovery rate, hearing gain, and hearing improvement rate compared to those of the other groups, and the hearing improvement rate was significantly higher in the SGB group than in the PG group (53.0±5.0% vs. 35.3±6.8%; p<0.05).We concluded that both SGB+HBO and PGE1+HBO are promising alternative regimens for ISSNHL, and that SGB+HBO and PGE1+HBO are recommended for patients with initial hearing levels≥80dB and <80dB, respectively.
A case of papillary carcinoma arising from a thyroglossal duct cyst is reported. A 43-year-old man was referred to our clinic with an anterior cervical mass. CT scan and MRI imaging revealed a ring-enhanced cystic mass in his anterior neck, while ultrasonography showed an irregular echo in the mass. He was preoperatively diagnosed with thyroglossal duct cyst, and underwent resection of the mass by Sistrunk's procedure. Histopathological examination of the surgical specimen showed papillary carcinoma in the thyroglossal duct cyst. Because the histological findings indicated that the tumor had been completely resected, no additional treatment was given. His postoperative course was uneventful, and the patient is currently free from disease 3 years after surgery.It is known that carcinoma, mostly papillary carcinoma, occurs more frequently in thyroglossal duct cysts than in the ordinary thyroid gland. Ultrasonography is a sensitive and useful method for detecting calcified lesions for the diagnosis of this disease. The epidemiology and clinical characteristics of papillary carcinoma associated with thyroglossal duct cyst were reviewed in the literature.
Eikenella corrodens (E. corrodens) is a Gram-negative facultative anaerobic bacillus that originally was thought to be an attenuated and indigenous bacterium. In this study, we investigated the clinical and bacteriological characteristics of E. corrodens infections of the tonsil. Seventeen consecutive patients treated in our department for E. corrodens infections of the tonsils were retrospectively analyzed. Microbial specimens were subjected to light microscopic examination, aerobic culture using chocolate and sheep blood agar media, and anaerobic culture using Brucella HK agar medium. Cultured bacteria were subjected to antimicrobial susceptibility tests using the broth microdilution method. The patients were 11 males and 6 females, ranging in age from 4 to 53 years with an average of 22.8 years. One patient had liver cirrhosis, while the other patients had no particular risk factors or underlying diseases. E. corrodens was detected from the surface of the tonsil in 4 cases, from the resected tonsillar tissue in 11 cases, and from pus in the abscesses in 2 cases. Twelve patients demonstrated polymicrobial infections. Streptococcus was the most frequently detected pathogen coexisting with E. corrodens. Isolated E. corrodens was susceptible to third-generation cephems, carbapenems, and new quinolones; and moderately susceptible to benzylpenicillin, ampicillin, cefotiam, and minocycline; but resistant to first-generation cephems, oxacillin, erythromycin, and clindamycin. In conclusion, E. corrodens infections of the tonsils are not rare even in hosts with normal immunity. We should be aware of this bacteria in tonsillar infections.
Abstract Objective: We report a rare case of mitochondrial neurogastrointestinal encephalomyopathy with hearing loss. Case report: A 46-year-old woman presented with a three-year history of progressive, bilateral hearing loss and tinnitus. She had been suffering from unexplained abdominal pain and diarrhoea for 20 years. When first seen, her otoscopic findings were normal, and pure tone audiometry showed mild and moderate hearing loss in her right and left ears, respectively. She also had: bilateral ophthalmoparesis, neck and limb muscle weakness, and hypoactive deep tendon reflexes on neurological examination; diffuse leukoencephalopathy on magnetic resonance imaging of the brain; and markedly reduced leukocyte thymidine phosphorylase activity. On the basis of these findings, the patient was diagnosed with mitochondrial neurogastrointestinal encephalomyopathy. Conclusion: Mitochondrial neurogastrointestinal encephalomyopathy is an autosomal recessive disease caused by mutation of the thymidine phosphorylase gene, and is characterised by ophthalmoparesis, peripheral neuropathy, leukoencephalopathy, gastrointestinal symptoms and abnormal mitochondria in muscle cells. Current advances in genetic research may reveal a higher prevalence of mitochondrial disorders than had previously been thought. Otolaryngologists should be aware of mitochondrial neurogastrointestinal encephalomyopathy and other rare genetic disorders when managing patients with progressive hearing loss.
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