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Metabolic Bone Disease and Systemic Disorders of the Temporal Bone
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Victoria Alexander, Parag Patel
Otological symptoms include chronic otitis media, vertigo, polyneuritis causing multiple cranial neuropathies (including facial nerve palsy) and SNHL. These symptoms (serous otitis media/HL) can be the first presentation of the disease.
Tumors of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Adverse effects depend on the total dose of radiation administered, the extent of the treated area, and the time elapsed from treatment. There is greater risk of acute and chronic adverse effects with WBRT and larger total dose and fraction size. Acute effects include: Fatigue: very common, sometimes delayed until after radiation therapy has finished (somnolence syndrome), but self-limited.Signs of elevated ICP (headache, vomiting) and focal neurologic deficits may develop or worsen due to edema from acute tumor necrosis – usually best managed with corticosteroids.Reduced taste and dry mouth, from effects on salivary glands and glossal papillae.Reduced hearing – usually from serous otitis media from swelling of the eustachian tube. It is best treated with decongestants and steam inhalation.
The Special Sense Organs and Their Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Otitis media is an inflammation of the mucous membranes of the middle ear and tympanic membrane that involves eustachian tube dysfunction and viral or bacterial infection. Types of the disorder are classified according to duration and complications: acute/chronic suppurative otitis media; acute bacterial otitis media; purulent otitis media; and secretory, nonsuppurative, serous otitis media.
Clinical and economic evaluation of minimally invasive cartilaginous palisade myringoplasty
Published in Acta Oto-Laryngologica, 2018
Guillaume Michel, Florent Espitalier, Julie Boyer, Olivier Malard, Phillipe Bordure
At 6 months and 2 years postoperative, the rate of tympanic membrane closure was 93.4% (Figure 3). No new perforation had appeared between 2 months and 2 years after surgery. None of the patients complained of otalgia, otorrhea, otorrhagia, or dizziness. At the microscopic examination, none of the patients presented medialization of the cartilaginous layers. In two cases (6.6%), a tympanic retraction zone was found. Three patients presented serous otitis media (10%). None presented signs suggesting cholesteatoma or external auditory canal stenosis.
Chemoradiation-induced hearing loss remains a major concern for head and neck cancer patients
Published in International Journal of Audiology, 2018
Nicole C. Schmitt, Brandi R. Page
Most patients with HNSCC seen in our multidisciplinary practice receive the low-dose, weekly regimen of cisplatin (40 mg/m2) with concurrent IMRT. Administration of chemotherapy in this fashion allows for the ability to receive a majority of the cumulative dose of chemotherapy in case one is missed due to toxicity. It is not unusual for us to see patients who complain of tinnitus, often after the first dose. We also continue to see a few patients with clinically relevant, permanent hearing loss affecting their quality of life. Some patients also experience serous otitis media from radiotherapy, which may require intervention or drainage. We hypothesise that the newer cisplatin regimen and IMRT are largely responsible for a decreased incidence in SNHL in our patients, but this deserves further study with late-responding tissue reaction. With regard to radiotherapy-related dose volume constraints, for patients with base of skull or nasopharynx tumours we follow QUANTEC recommendations (Marks et al, 2010) for <30% cochlea volume getting less than 45 Gy. For tumours that do not require more than prophylactic dose close to the base of skull, we use a 30 Gy limit, or even a 10 Gy limit where possible, taking into account the patient’s age, baseline hearing function, need for cisplatin, and availability of hearing rehabilitation options (Pan et al, 2005; Bhandare et al, 2007; Hua et al, 2008). We do query our patients about pre-existing hearing loss and counsel them regarding the risks of hearing loss with cisplatin. Our ability to counsel patients would be improved if there were more data in the literature on the incidence and severity of hearing loss with these new treatment paradigms. We routinely arrange for pre-treatment and post-treatment audiograms in the majority of patients, so that patients with hearing loss can be offered follow up and hearing aid evaluation. To study this in more rigorous fashion, we have recently opened a prospective clinical to track hearing before and after low-dose cisplatin chemoradiation in head and neck cancer patients at Johns Hopkins University and the National Institutes of Health.
A two-year-old with a duplicated external auditory canal; a first branchial cleft anomaly
Published in Acta Oto-Laryngologica Case Reports, 2019
Christianne C.A.F.M. Veugen, Henk M. Blom
A 2-year-old girl reported to the hospital with recurrent infections of an extra orifice in the left external auditory meatus. On clinical examination, a sinus of the cartilaginous external auditory canal was seen (Figure 1). There were no other anatomical deformities of the external ear. Otoscopic examination showed that the tympanic membrane was intact and had a normal anatomy. A preoperative computed tomography (CT) scan confirmed a sinus originating from the cartilaginous external auditory canal (Figure 2). The sinus tract ended superficially, travelling adjacent to the external acoustic canal and not extending deeply in the parotid gland or facial nerve. The sinus had a blind ending (cul-de-sac) laterally to the tympanic membrane. The tympanic membrane and the auditory ossicles of the first pharyngeal arch (i.e. malleus and incus) were present. There was no malformation of the Eustachian tube or other middle ear structures. A concurrent bilateral serous otitis media was seen. Audiometry was performed and showed a conductive hearing loss fitting with a bilateral otitis media. Surgery was planned; because of the aforementioned clinical findings an uncommon surgical approach was chosen. A less invasive marsupialization technique was performed as opposed to the commonly performed excision, primarily because of the favorable position of the anomaly next to the external auditory canal, not extending deeply in the parotid gland or facial nerve. Prior to marsupialization the end of the sinus was verified using a sinus probe. The sinus seemed to consist of both skin and cartilage. The sinus was marsupialized making a lengthwise incision of the cartilaginous external auditory canal. Bilateral ventilation tubes were inserted. The surgery was performed using NIM® nerve monitoring of the facial nerve. On follow-up three months after surgery, the external auditory canal was healed and there was no sign of recurrence of the sinus (Figure 3). The patient did not have complaints of recurrent infections, there were no complications and the patient made an uneventful recovery. Audiometry (otoacoustic emission) was performed and showed bilateral normal hearing.