A giant paraesophageal hiatal hernia causing vocal fold paralysis

We report the case of a patient who presented with severe dysphonia as a consequence of a giant hiatal hernia that was paralysing the patient’s vocal folds

Spindle cell carcinoma: Two instances mistaken for vocal polyps

Spindle cell carcinoma is a variant of squamous carcinoma, with behavior that is apparently more aggressive than that of squamous carcinoma and that can produce distant lymphatic metastasis. It was first described by Virchow in 1864 [1], but the origin of the tumor is still not clear. The tumor is biphasic, with an epidermal component and a sarcomatous component involving spindle cells; transition zones between these components can be found [2–5]. In part due to this peculiar and complex nature, the tumor has accumulated various names since it was first described: sarcomatoid tumor, carci- nosarcoma, pleomorphic carcinoma, collision tumor, etc. [2,5,6]

Histopathological reaction in the vestibule after cochlear implantation in Macaca fascicularis.

Cochlear implantation surgery (CI) is considered a safe procedure and is the standard treatment for the auditory rehabilitation in patients with severe-to-profound sensorineural hearing loss. Although the development of minimally traumatic surgical concepts (MTSC) have enabled the preservation of residual hearing after the implantation, there is scarce literature regarding the vestibular affection following MTCS. The aim of the study is to analyze histopathologic changes in the vestibule after CI in an animal model (Macaca fascicularis). Cochlear implantation was performed successfully in 14 ears following MTCS. They were classified in two groups upon type of electrode array used. Group A (n = 6) with a FLEX 28 electrode array and Group B (n = 8) with HL14 array. A 6-month follow-up was carried out with periodic objective auditory testing. After their sacrifice, histological processing and subsequent analysis was carried out. Intracochlear findings, vestibular presence of fibrosis, obliteration or collapse is analyzed. Saccule and utricle dimensions and neuroepithelium width is measured. Cochlear implantation was performed successfully in all 14 ears through a round window approach. Mean angle of insertion was >270◦ for group A and 180–270◦ for group B. In group A auditory deterioration was observed in Mf 1A, Mf2A and Mf5A with histopathological signs of scala tympani ossification, saccule collapse (Mf1A and Mf2A) and cochlear aqueduct obliteration (Mf5A). Besides, signs of endolymphatic sinus dilatation was seen for Mf2B and Mf5A. Regarding group B, no auditory deterioration was observed. Histopathological signs of endolymphatic sinus dilatation were seen in Mf 2B and Mf 8B. In conclusion, the risk of histological damage of the vestibular organs following minimally traumatic surgical concepts and the soft surgery principles is very low. CI surgery is a safe procedure and it can be done preserving the vestibular structures

Lacrimal Diversion Devices (Sinopsys Lacrimal Stent): Sharing our Experience with Patients with Chronic Rhinosinusitis without Polyposis

Introduction: Chronic rhinosinusitis (CRS) is a highly prevalent pathology in our society. Due to the prevalence of this condition and to the persisting symptoms despite an appropriate medical treatment, surgical techniques are often required. Lately, minimal invasive techniques have been described, such as lacrimal diversion devices (LDDs). This technique offers a fast and convenient choice for delivery of sinus irrigation and topical medication. Objective: We aimed to describe our experience with LDDs and evaluate the safety and effectiveness of the procedure in patients with moderate to severe CRS without nasal polyposis (CRSsNP) and persistent symptomatology despite medical therapy. Methods: A total of 7 patients underwent bilateral lacrimal stents placement in the operating room. A retrospective observational study was conducted. The Sino-Nasal Outcome Test-20 (SNOT-20) survey was performed and the score obtained was compared before and 1 month after the procedure. Results: The LDDs were used for an average of 80 days. During the follow-up, only three patients had a mild complication with the device (granuloma in the punctum, obstruction, and early extrusion). The mean baseline SNOT-20 score dropped significantly (p ¼ 0.015) from 25.85 to 11.57 (mean: - 14.29) 1 month after the procedure. Conclusion: According to our experience and results, the use of LDD is a novel, feasible, and less invasive technique to treat refractory CRS. It reduces the risk of mucosal stripping, provides short-term outcomes, and the surgical procedure does not require advanced training in endoscopic sinus surgery. Moreover, it can be performed in-office under local anesthesia or sedation

Correlation between high-resolution computed tomography scan findings and histological findings in human vestibular end organs and surgical implications

Background: Histological study of vestibular end organs has been challenging due to the difficulty in preserving their structures for histological analysis and due to their complex geometry. Recently, radiology advances have allowed to deepen the study of the membranous labyrinth. Summary: A review and analysis of surgical implications related to the anatomy of the vestibular end organ is performed. Radiological advances are key in the advancement of the knowledge of the anatomy and pathology of the vestibule. Thus, application of such knowledge in the development or improvement of surgical procedures may facilitate the development of novel techniques. Key Messages: During the last few decades, the knowledge of the anatomy of the auditory system through histology and radiology had improved. Technological advances in this field may lead to a better diagnosis and therapeutic approach of most common and important diseases affecting the inner ear

Intra-operative radiological diagnosis of a tip roll-over electrode array displacement using fluoroscopy, when electrophysiological testing is normal: the importance of both techniques in cochlear implant surgery.

Presently cochlear implantation (CI) is a worldwide well-known procedure for the treatment of severe to profound hearing loss.1 New surgical techniques and technological upgrades in the past years have helped to decrease complications of this procedure, but they still exist, defying experienced surgeons and device manufacturers. Major complications are defined as events that need surgical intervention with reimplantation, such as wound infections, device extrusions, device failure and electrode misplacement.2 The incidence of electrode misplacement fluctuates between 0.2% and 5.8%, including both extracochlear and labyrinthine misplacements.3 Despite the many described ways to ensure proper electrode array positioning, there is no universally accepted protocol for intraoperative monitoring during cochlear implantation. We present a case of an intracochlear array misplacement (tip rollover) that was diagnosed intraoperatively with a fluoroscope after normal electrophysiological tests

Intra-operative radiological diagnosis of a tip roll-over electrode array displacement using fluoroscopy, when electrophysiological testing is normal: the importance of both techniques in cochlear implant surgery.

Presently cochlear implantation (CI) is a worldwide well-known procedure for the treatment of severe to profound hearing loss.1 New surgical techniques and technological upgrades in the past years have helped to decrease complications of this procedure, but they still exist, defying experienced surgeons and device manufacturers. Major complications are defined as events that need surgical intervention with reimplantation, such as wound infections, device extrusions, device failure and electrode misplacement.2 The incidence of electrode misplacement fluctuates between 0.2% and 5.8%, including both extracochlear and labyrinthine misplacements.3 Despite the many described ways to ensure proper electrode array positioning, there is no universally accepted protocol for intraoperative monitoring during cochlear implantation. We present a case of an intracochlear array misplacement (tip rollover) that was diagnosed intraoperatively with a fluoroscope after normal electrophysiological tests

Caracterización endoscópica y funcional de la disfonía por tensión muscular

El origen y los cimientos de los distintos trabajos y teorías que terminarían por definir lo que actualmente se conoce como Disfonía por Tensión Muscular (DTM) se inicia durante los primeros años de la década de los ochenta. En 1982 Koufman y Blalock (Koufman & Blalock, 1982), en un intento por definir y organizar mejor los desórdenes funcionales de la voz (Disfonías funcionales), propusieron una forma de clasificarlos que los dividía en cinco grandes grupos: Reacción de conversión (conversión reaction), ronquera crónica postviral (postviral chronic hoarseness), falseto inapropiado (inappropriate falsetto), disfonía postoperatoria (postoperative dysphonia) y los síndromes de mal uso/abuso vocal (vocal misuse/abuse syndromes)

Caracterización endoscópica y funcional de la disfonía por tensión muscular

El origen y los cimientos de los distintos trabajos y teorías que terminarían por definir lo que actualmente se conoce como Disfonía por Tensión Muscular (DTM) se inicia durante los primeros años de la década de los ochenta. En 1982 Koufman y Blalock (Koufman & Blalock, 1982), en un intento por definir y organizar mejor los desórdenes funcionales de la voz (Disfonías funcionales), propusieron una forma de clasificarlos que los dividía en cinco grandes grupos: Reacción de conversión (conversión reaction), ronquera crónica postviral (postviral chronic hoarseness), falseto inapropiado (inappropriate falsetto), disfonía postoperatoria (postoperative dysphonia) y los síndromes de mal uso/abuso vocal (vocal misuse/abuse syndromes)

A novel maneuver for diagnosis and treatment of torsional-vertical down beating positioning nystagmus: anterior canal and apogeotropic posterior canal BPPV

Introduction: In patients with benign paroxysmal positional vertigo, BPPV; a torsional-vertical down beating positioning nystagmus can be elicited in the supine straight head-hanging position test or in the Dix-Hallpike test to either side. This type of nystagmus can be explained by either an anterior canal BPPV or by an apogeotropic variant of the contralateral posterior canal BPPV Until now all the therapeutic maneuvers that have been proposed address only one possibility, and without first performing a clear differential diagnosis between them. Objective: To propose a new maneuver for torsional-vertical down beating positioning nystagmus with a clear lateralization that takes into account both possible diagnoses (anterior canal-BPPV and posterior canal-BPPV). Methods: A prospective cohort study was conducted on 157 consecutive patients with BPPV. The new maneuver was performed only in those with torsional-vertical down beating positioning nystagmus with clear lateralization. Results: Twenty patients (12.7%) were diagnosed with a torsional-vertical down beating positioning nystagmus. The maneuver was performed in 10 (6.35%) patients, in whom the affected side was clearly determined. Seven (4.45%) patients were diagnosed with an anterior canal-BPPV and successfully treated. Two (1.25%) patients were diagnosed with a posterior canal-BPPV and successfully treated with an Epley maneuver after its conversion into a geotropic posterior BPPV. Conclusion: This new maneuver was found to be effective in resolving all the cases of torsional-vertical down beating positioning nystagmus-BPPV caused by an anterior canal-BPPV, and in shifting in a controlled way the posterior canal-BPPV cases of the contralateral side into a geotropic-posterior-BPPV successfully treated during the followup visit. Moreover, this new maneuver helped in the differential diagnosis between anterior canal-BPPV and a contralateral posterior canal-BPPV