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Otological symptoms (otalgia, subjective hearing loss, blocked ear sensation, tinnitus and vertigo) associated with temporomandibular disorders are documented features of Costen's syndrome. However, the origin of these symptoms and the causes of hearing loss are unknown. This study aimed to characterise hearing loss in a large number of patients with temporomandibular disorders. The causes of these symptoms were explored in patients with otological symptoms and normal audiometric findings.
A prospective case study and literature review were performed. The audiometric features of 104 temporomandibular disorder patients were compared with those of 110 control participants.
A large proportion of temporomandibular disorder patients had several otological symptoms. Twenty-five per cent of unilateral or bilateral temporomandibular disorder patients had either unilateral (ipsilateral) or bilateral hearing loss; respectively, which was usually mild (p = 0.001). Hearing loss was predominantly sensorineural.
The main cause of otological symptoms (apart from otalgia) and of audiometric findings in temporomandibular disorder patients is postulated to be an altered middle-ear to inner-ear pressure equilibrium.
A large proportion of patients with vocal fold polyps are cigarette smokers. However, prior to this report no comparative study of polyp histopathology in smokers versus non-smokers had been performed.
A prospective histopathological study of vocal fold polyps excised from 29 patients was undertaken. This comprised a comparative analysis of polyp histopathology in smokers versus non-smokers and a review of the pertinent literature.
Vocal fold polyps were larger in smokers than in non-smokers. Histopathological features significantly associated with the polyps of smokers versus those of non-smokers were increased keratinisation, dysplasia, a basement membrane thinning and hyaline degeneration.
Cigarette smoke has an injurious effect on vocal fold polyp epithelium and leads to increased hyaline degeneration in polyps.
Established middle-ear cleft cholesteatoma is associated with keratinous debris, which is likely to be an ideal medium for saprophytic fungal colonisation. This prospective case study aimed to explore the incidence and nature of fungal elements in cholesteatoma keratin samples obtained during primary mastoid surgery.
All cases of middle-ear cleft cholesteatoma treated with primary mastoid surgery at the El-Sahel Teaching Hospital over a seven-month period were included. Keratinous debris obtained from the mastoid antrum was subjected to mycological analysis at the Department of Medical Microbiology and Immunology, Faculty of Medicine, Cairo University. A literature search was performed to determine the clinical and pathological relevance of fungal colonisation in cholesteatoma.
Eighteen patients underwent primary mastoid surgery for cholesteatoma (nineteen ears in total) in a seven-month period starting 30 March 2013. Patients included 13 males and 5 females, with an age range of 9 to 45 years (mean 23 years). Fungal cultures were obtained from 17 keratin samples (89 per cent). Of these, five fungal isolates belonged to the dermatophyte group (21 per cent).
Fungal colonisation in middle-ear cleft cholesteatoma probably plays a significant role in disease progression. Moreover, saprophytic fungal colonisation in cholesteatoma keratin may be responsible for the fetor commonly associated with the ear discharge.
A plunging ranula is an uncommon cause of neck swelling which typically presents in a gradually progressive fashion. This report describes a rare case of acute presentation of a plunging ranula. The condition progressed rapidly to respiratory distress, requiring urgent surgery.
A 14-year-old male student presented with a rapidly enlarging neck swelling associated with a sublingual swelling. Computed tomography suggested the diagnosis of plunging ranula. Several hours after admission, the neck swelling became very tense and the sublingual swelling enlarged dramatically. The tongue was pushed upwards and backwards by the sublingual swelling, causing respiratory embarrassment and requiring urgent surgery. Four months after surgery, there was no evidence of recurrence.
To the best of the author's knowledge, this is the first case report of a plunging ranula progressing acutely and rapidly to cause respiratory compromise. The literature is reviewed and pertinent features concerning the diagnosis and management of plunging ranula are presented.
Fungal rhinosinusitis has gained much attention in recent years. To our knowledge, no previous studies have addressed the role of fungus in primary atrophic rhinitis.
Prospective case study.
Patients and methods:
All cases of primary atrophic rhinitis presenting to the out-patient department at El-Sahel Teaching Hospital over a five-month period were included in the study. Crusts and purulent secretions removed from patients' nasal cavities underwent microbiological analysis at the Medical Microbiology and Immunology department of the Cairo University Faculty of Medicine. Special emphasis was placed on fungal isolation.
Fourteen consecutive cases of primary atrophic rhinitis were studied in the five-month period starting 26 November 2007. Patients comprised eight females and six males, with an age range of 12 to 65 years (mean 37 years). Microscopy of the crusts and purulent secretions showed pus cells in most of the samples. Klebsiella species were isolated from nine patients (65 per cent), and other bacterial species were isolated in most of the remainder. Fungal elements, most commonly aspergillus species, were isolated in 13 patients (93 per cent).
It is proposed that the initial trigger for primary atrophic rhinitis is a virulent bacterial infection of the nasal lining, which leads to damage of the ciliated epithelium. This initiates the cascade of events leading to inflammation of the mucosa and submucosa, with secondary pyogenic osteomyelitis of the turbinate bone. The persistence of purulent secretion, within the setting of impaired mucociliary clearance, leads to saprophytic fungal colonisation which contributes greatly to the clinical picture.
Angiolymphoid hyperplasia with eosinophilia is a rare condition that demonstrates dermal or subcutaneous proliferation of endothelial cells associated with an inflammatory cell infiltrate. A case is reported, with emphasis on the histopathological features on repeated biopsies. The report serves to stress the importance of considering this condition in the differential diagnosis of lesions in and around the ear.
A case of Pott’s puffy tumour in a diabetic patient with renal failure is reported. The patient did not respond to intravenous antibiotics and further investigation revealed that the patient had mucormycosis. As far as we are aware, this is the first case of Pott’s puffy tumour due
to mucormycosis to be reported in the literature.
Leukaemic relapse in the ear is very rare. We report a case of relapse of acute lymphoblastic leukaemia in the left ear. The patient presented with an aural polyp and ipsilateral facial palsy. The temporal bone showed simultaneous leukaemic infiltrate and cholesteatoma. To our knowledge, this is the first case reported with such pathology.
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