Treatment of bilateral vocal cord paralysis following permanent recurrent laryngeal nerve injury

Bilateral vocal cord paralysis is a serious illness requiring emergency intervention to resolve the potentially life-threatening respiratory distress. Several surgical procedures were proposed to help improve the airway and to eliminate the tracheostoma in those patients with permanent paralysis. All the procedures have their own advantages and disadvantages. We conducted a retrospective study of 30 patients affected by bilateral vocal cord paralysis following total thyroidectomy. All the patients underwent total thyroidectomy for benign thyroid pathology. In 26 patients (86.6%), cord paralysis occurred during the perioperative stage; and in the remaining 4 cases (13.3%), it occurred within the following 6 months. We treated all these bilateral recurrent laryngeal nerve paralysis patients with arytenoidectomy alone in 5 patients and arytenoidectomy with concomitant true and false posterior cordectomy in the remaining 25 patients. Twenty-four of the 25 patients who underwent the combined procedures (96%) reported subjective respiratory improvement and were decannulated within 60 days, being able to return to their normal daily activities. This study demonstrates that arytenoidectomy associated with posterior cordectomy is a satisfactory surgical treatment of bilateral vocal cord paralysis because it leads to a considerable and stable enlargement of the breathing space

Sjogren syndrome and parotid marginal zone lymphoma: Report of a case and review of literature

Five percent of the cancers in the parotid region are non-hodgkin lymphomas. This lymphoma, involving the mucosa-associated lymphoid tissue (MALT), is called MALToma. A chronic autoimmune inflammatory process of the parotid gland, such as Sjogren's syndrome, results in an increased incidence of parotid MALToma. Biopsy of the parotid is essential for appropriate diagnosis; this can then be completed by radiotherapy, chemotherapy or therapy with monoclonal antibodies according to the stage of the disease. This study shows a clinical case of a 50-year-old patient with Sjogren's syndrome who developed a parotid MALToma

MICRORNA-21 EXPRESSION IN VESTIBULAR SCHWANNOMA: POTENTIAL EFFECT ON GROWTH AND POSSIBLE PROGNOSTIC FACTOR

Background: Vestibular schwannomas are benign slow growing tumors arising from VIII cranial nerve. They are potential life threatening benign tumor because of intracranial located. The management could be surgical or conservative, but, left untreated, the tumor preserve the possibility to further growth and complication may arise. The natural history is however not predictable and prognostic factor to select patients manageable conservatively should be studied. The molecular pathways that lead to tumorigenesis and growth are not completely defined and a role could be played by microRNA. Elevated levels of microRNA-21 may contribute to tumor growth by deregulating the tumor suppressor phosphatase (PTEN) and consequent activation of protein kinase B (AKT). Aims: evaluation of microRNA-21 expression and measurement of PTEN levels in vestibular schwannoma specimens, compared with expression in normal nerve tissue, to assess a possible overexpression. A correlation of micorRNA-21 expression with tumor size and growth rate of the tumor, when available, was hypothesized to make a prognostic factor. Methods: collection of vestibular schwannomas and great auricular nerve specimens was done sterilely during surgery and immediately stored at -80°C, until its use. Quantitative real-time PCR was used to assess levels of expression of micro-RNA 21 and mRNA for PTEN. Levels of PTEN protein were assessed with immunohistochemical analysis. A retrospective correlation was done between data obtained and clinical notes of patients: tumor size and growth rate. Results: 31 patients with vestibular schwannoma were studied. MicroRNA-21 was founded overexpressed in all cases when compared with normal nerve tissue. Levels of microRNA-21 were not statistically related with tumor size at time of surgery, but a positive correlation with growth rate was noted in 10 cases in which this data was available. PTEN mRNA was founded in all cases. The PTEN protein levels were low in 10 specimens of 13 in which the data was available, and an inverse correlation with levels of microRNA-21 was noted. Conclusions: The microRNA-21 plays a role in tumor development and in growth regulation also in vestibular schwannoma. MicroRNA- 21 may be a proper molecular target for therapies act to reduce the tumor growth and could represent a prognostic factor in selecting patients manageable with observation or early hearing preservation surgery

Primary Non-Hodgkin’s lymphoma of the parotid gland

Primary malignant lymphomas in the salivary glands are relatively rare. Clinical presentation is not characteristic and the disease is often overlooked resulting in diagnosis and treatment delays. Aim To stress the importance of the diagnostic process and combined management, we present a series of eight patients with malignant lymphoma of the parotid who were diagnosed only after surgery and managed with radiation and chemotherapy. Methods Retrospective series of patients with primary malignant lymphoma of the parotid gland managed with radiotherapy and diagnostic surgical partial resection. Results After treatment completion we achieved a loco-regional control rate of 87.5%. Toxicity was charted according to the Common Toxicity Criteria and it was seen in six patients (75%). Six patients are still alive without evidence of recurrent disease in their last follow-up. Conclusion Our study confirms that primary early stage Non-Hodgkin Lymphoma of the parotid gland is a disease with an excellent prognosis and a good local control rate, with minimal morbidity

Surgical Management of Retraction Pockets: Does Mastoidectomy have a Role?

Abstract Introduction Retraction pocket is a condition in which the eardrum lies deeper within the middle ear. Its management has no consensus in literature. Objective To assess the role of mastoidectomy in the management of retraction pockets added to a tympanoplasty. Methods Prospective study of patients with retraction pocket and referred to surgery. The patients were randomly assigned to two groups: one managed with tympanoplasty and mastoidectomy and the other group with tympanoplasty only. The minimum follow-up considered was 12 months. The outcomes were: integrity of eardrum, recurrence, and hearing status. Results This study included 43 patients. In 24 cases retraction occurred in the posterior half of the eardrum, and in 19 patients there was clinical evidence of ossicular interruption. The two groups of treatment were composed by: 21 patients that underwent tympanoplasty with mastoidectomy and 22 patients had only tympanoplasty. One case of the first group had a recurrence. In 32 cases patients follow up was longer than 48 months. The average air-bone gap changed from 22.1 dB to 5 dB. The percentage of air-bone gap improvement was assessed at 60% in those patients treated with mastoidectomy, and 64.3% in those without it (p > 0.5). Conclusion Tympanoplasty and ossiculoplasty should be considered to treat atelectatic middle ear and ossicular chain interruption. Mastoidectomy as a way to increase air volume in the ear seems to be a paradox; it does not add favorable prognostic factor to management of retraction pockets

The discovery of stapes

Giovanni Filippo Ingrassia revisited and redefined some of Galeno's reports, and was recognized as one of the leading Italian Physicians of the 16(th) century. Ingrassia principally studied the skull, and gave very important contributions to otorhinolaryngology, including the discovery of the stapes. He also isolated the inferior nasal concha from the maxillary bone, described the frontal sinus, the pterygopalatine fossa and several foramina of the skull. Ingrassia firstly attributed a sensorial function to the middle ear bones, which he called fifth particular function. He also added some details to the description of the VIII cranial nerve, which introduces the concept of bone conducting sound. The most important discovery in Ingrassia's study about the hearing organ was the first description of the third bone of the ossicular chain that he called "stapes". Ingrassia should thus be reconsidered under a new light for his important discovery and for his intuitions about the stapes and its role in hearing. It is appropriate for a Sicilian physician to be placed at his rightful place side-by-side with Eustachio and Valsalva in the history of otology

Sudden Sensorineural Hearing Loss as Prodromal Symptom of Anterior Inferior Cerebellar Artery Infarction

Sudden sensorineural hearing loss is a clinical condition characterized by a sudden onset of unilateral or bilateral hearing loss. In recent years sudden deafness has been frequently described in association with anterior inferior cerebellar artery (AICA) infarction generally presenting along with other brainstem and cerebellar signs such as ataxia, dysmetria and peripheral facial palsy. The authors report a rare clinical case of a 53-year-old man who suddenly developed hearing loss and tinnitus without any brainstem or cerebellar signs. Computed tomography of his brain was normal, and the audiological results localized the lesion causing deafness to the inner ear. Surprisingly, magnetic resonance imaging showed an ischemic infarct in the right AICA territory. This case represents the fifth in the literature to date but it confirms that AICA occlusion can cause sudden deafness even without brainstem or cerebellar signs. Therefore, we recommend submitting the patient for neuroimaging, as an emergency, in order to exclude infarction of the AICA territory. By doing this, it may be possible to limit the extent of the lesion by commencing early therapy