6 research outputs found

    An Exceptional Case of Intraparotid Plexiform Neurofibroma Originating from Autonomic Fibers of the Auriculotemporal Nerve

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    Plexiform neurofibromas are benign tumors that tend to occur in patients suffering from neurofibromatosis type 1 (NF-1). This report addresses a rare case where the tumor affected the parotid gland, deriving almost exclusively from the peripheral portion of the facial nerve. A 6-year-old male was referred to us complaining about a gradually enlarging swelling over the right parotid area. Imaging localized the lesion to the superficial lobe of the parotid gland, suggesting a neurofibroma. Cosmetic disfigurement and a functional deficit led us to perform complete surgical resection. Meticulous surgical dissection as well as auriculotemporal nerve origin made complete extirpation possible with almost zero morbidity and ensured alleviation of both aesthetic impairment and pain. This is the first case of an intraparotid PN in a pediatric NF-1 patient, which originated from branches of the auriculotemporal nerve and particularly from fibers of the autonomic nervous system. Radical surgical excision was decided according to established decision-making algorithms

    Study on the effect of noise on hearing, in relation to the function of the olivocochlear bundle and the use of otoacoustic emissions

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    Aim: The aim of the present study was to investigate the hearing damagecaused by firearms, as well as to evaluate the effectiveness of existing hearingprotection devices. Furthermore, our main aim was to explore the possible utilityof otoacoustic emissions (OAEs) and efferent system strength in order todetermine vulnerability to noise exposure in a clinical setting and foresee animpending hearing handicap.Material/Method: The study group of our cohort comprised of 344 volunteerswho had just begun mandatory basic training as Hellenic Corps Officers MilitaryAcademy cadets. Pure-tone audiograms were obtained at frequencies 0.25,0.5, 1, 2, 3, 4, 6 and 8 kHz on both ears. Furthermore participants weresubjected to diagnostic transient evoked otoacoustic emissions (TEOAEs)using ILO 292 DP Echoport instrument. Finally, they were all tested for efferentfunction through suppression of TEOAE’s with contralateral noise. Followingbaseline evaluation, all cadets fired ten rounds using a 7.62mm Heckler & KochG3A3 assault rifle while lying down in prone position. Immediately afterexposure to gunfire noise and no later than 10 hours, all participants completedan identical protocol for a second time, which was then repeated a third time,30 days later.Results: The data showed that after the firing drill 280 participants suffered atemporary threshold shift (TTS) (468 ears), while in the third evaluationconducted 30 days after exposure 142 of these ears still presented a thresholdshift compared to the base line evaluation (Permanent threshold shift - PTSears). In 454 of the ears, showing a temporary threshold shift (TTS), partial ortotal recovery of the threshold occurred (ie either did not show a (PTS) (326ears), or exhibited a PTS, but this was quantitatively less than the (TTS) (128ears)). It was also found that as the range of TTS increased, the possibility ofPTS also increased. However, especially as far as PTS was concerned, thefinal hearing threshold exceeded 20 dB HL (normal hearing threshold), in asmuch as four ears (1.7%). Concerning the frequency range of the hearingdamage, no TTS or PTS occurred at 250, 500 and 1000 Hz frequencies. Threshold shifts mostly occurred at 3 kHz (343 ears with TTS (49.9%) and 62ears with PTS (9.1%).There was no statistical correlation between loss of OAEs amplitudebetween first and second evaluation and TTS (p = 0.092), while a statisticalcorrelation was found between loss of OAEs amplitude between the first andthe third evaluation and PTS (p 20 dB HL), τουλάχιστον με μία μόνο έκθεση σε θόρυβο. Το εύρος της προσωρινής πτώσης της ακοής (TTS) βρέθηκε να συσχετίζεται με το αν θα δημιουργηθεί και μόνιμη μεταβολή του ουδού (PTS).Η συχνότητα των 3 kHz πρέπει, τέλος, να συμπεριληφθεί με πάγιο τρόπο, στη ρουτίνα του ακοομετρικού ελέγχου πληθυσμών, που εκτίθενται σε θόρυβο,καθώς η παράλειψή της, είναι πολύ πιθανό να οδηγεί σε υποτίμηση των βλαβών που προκαλούνται.Επιπλέον, επιβεβαιώθηκε η άποψη, ότι η δημιουργία ενός «εικονικού»ακοογράμματος, μέσω των ωτοακουστικών εκπομπών, δεν είναι δυνατή,καθώς υπάρχει ασθενής και ασταθής συσχέτιση μεταξύ της πτώσης των ωτοακουστικών εκπομπών και της ανόδου των τονικών ουδών. Ανεξάρτητα αυτού, καταδεικνύεται η σημασία και χρησιμότητα των ωτοακουστικών εκπομπών στη μελέτη πληθυσμών που εκτίθενται σε θόρυβο,συμπληρωματικά στην τονική ακοομετρία.Το κομβικό συμπέρασμα της μελέτης στάθηκε η ανάδειξη μίας σαφούς συσχέτισης, ανάμεσα στην ένταση των ωτοακουστικών εκπομπών και στην πιθανότητα διαταραχής του τονικού ουδού, μετά από έκθεση σε θόρυβο.Μάλιστα, καταδείχθηκε ότι είναι δυνατή η καθιέρωση των ωτοακουστικών εκπομπών, ως μία προγνωστική διαγνωστική δοκιμασία, η οποία θα είναι σημαντικά ευαίσθητη και ειδική, ώστε να υιοθετηθεί από προγράμματα μελέτης και προστασίας της ακοής (hearing conservation programs).Η ισχύς της δράσης του ελαιοκοχλιακού δεματίου δε φάνηκε να προστατεύει από τις θορυβογενείς βλάβες με τρόπο που να φτάνει τη στατιστική σημαντικότητα και δε φάνηκε να προβλέπει, με αξιόπιστο τρόπο, τα αυτιά που θα υποστούν βλάβη. Ωστόσο, υπήρξε στατιστικά μια τάση προς αυτήν την κατεύθυνση, που δημιουργεί την ανάγκη περαιτέρω μελετών

    Utility of otoacoustic emissions and olivocochlear reflex in predicting vulnerability to noise-induced inner ear damage

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    Aim: The aim of the present study was to explore the possible utility of otoacoustic emissions (OAEs) and efferent system strength to determine vulnerability to noise exposure in a clinical setting. Materials and Methods: The study group comprised 344 volunteers who had just begun mandatory basic training as Hellenic Corps Officers Military Academy cadets. Pure-tone audiograms were obtained on both ears. Participants were also subjected to diagnostic transient-evoked otoacoustic emissions (TEOAEs). Finally, they were all tested for efferent function through the suppression of TEOAEs with contralateral noise. Following baseline evaluation, all cadets fired 10 rounds using a 7.62 mm Heckler & Koch G3A3 assault rifle while lying down in prone position. Immediately after exposure to gunfire noise and no later than 10 h, all participants completed an identical protocol for a second time, which was then repeated a third time, 30 days later. Results: The data showed that after the firing drill, 280 participants suffered a temporary threshold shift (TTS) (468 ears), while in the third evaluation conducted 30 days after exposure, 142 of these ears still presented a threshold shift compared to the baseline evaluation [permanent threshold shift (PTS) ears]. A receiver operating characteristics curve analysis showed that OAEs amplitude is predictive of future TTS and PTS. The results were slightly different for the suppression of OAEs showing only a slight trend toward significance. The curves were used to determine cut points to evaluate the likelihood of TTS/PTS for OAEs amplitude in the baseline evaluation. Decision limits yielding 71.6% sensitivity were 12.45 dB SPL with 63.8% specificity for PTS, and 50% sensitivity were 12.35 dB SPL with 68.2% specificity for TTS. Conclusions: Interestingly, the above data yielded tentative evidence to suggest that OAEs amplitude is both sensitive and specific enough to efficiently identify participants who are particularly susceptible to hearing loss caused by impulse noise generated by firearms. Hearing conservation programs may therefore want to consider including such tests in their routine. As far as efferent strength is concerned, we feel that further research is due, before implementing the suppression of OAEs in hearing conservations programs in a similar manner

    Duplication of the External Auditory Canal: Two Cases and a Review of the Literature

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    The objective of the present paper is to describe the clinical presentation, diagnostic process, surgical treatment, and outcome of 2 patients with first branchial cleft anomaly. The first case was an 8-year-old girl presented with an elastic lesion located in the left infra-auricular area, in close relation with the lobule, duplicating the external auditory canal. The magnetic resonance imaging revealed a lesion, appearing as a rather well-circumscribed mass within the left parotid gland and duplicating the ear canal. A superficial parotidectomy was subsequently performed, with total excision of the cyst. The second patient was a 15-year-old girl presented with a congenital fistula of the right lateral neck. At superficial parotidectomy, a total excision of the fistula was performed. During the operation the tract was recorded to lay between the branches of the facial nerve, extending with a blind ending canal parallel to the external acoustic meatus. Conclusively, first branchial cleft anomalies are rare malformations with cervical, parotid, or auricular clinical manifestations. Diagnosis of first branchial cleft lesions is achieved mainly through careful physical examination. Complete surgical excision with wide exposure of the lesion is essential in order to achieve permanent cure and avoid recurrence
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