Tumours of the oral cavity and pharynx
Anju Sahdev, Sarah J. Vinnicombe in Husband & Reznek's Imaging in Oncology, 2020
The most common nasopharyngeal malignancy, nasopharyngeal carcinoma (NPC), is classified by the World Health Organization (WHO) into three types: keratinizing squamous cell carcinoma (type I), non-keratinizing squamous cell carcinoma (type II), and undifferentiated carcinoma (type III). Type III is the most common and is endemic in regions of the world such as China, Southeast Asia, and North Africa. NPC is more common in males, arises at any age but is predominantly a disease of middle age, and is linked to the Epstein–Barr virus (EBV) and genetic and dietary factors. There is a four-fold increase in subjects with a first-degree family history of NPC (38). Common presenting symptoms include epistaxis, nasal blockage, and hearing loss secondary to dysfunction of the eustachian tube. However, early-stage disease can be clinically silent, and commonly NPC presents only in the more advanced stages when it has invaded deep structures, such as the brain and cranial nerves, or spread to lymph nodes in the neck.
The Special Sense Organs and Their Disorders
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss in Understanding Medical Terms, 2020
Problems with any of the structures involved in sound transmission from the body surface to the brain may impair hearing. External otitis is an inflammation of the outer ear and may block the progress of sound waves. Impacted cerumen is an accumulation of cerumen or earwax that blocks the ear canal and prevents sound waves from reaching the tympanic membrane. Inflammation of the tympanic membrane is known as myringitis or tympanitis and may prevent the tympanic membrane from vibrating appropriately. Eustachian tube dysfunction is a general term used to describe any condition in which the ability of the eustachian tube to equilibrate ambient and middle ear pressure is impeded.
Physiology of Hearing
John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed in Paediatrics, The Ear, Skull Base, 2018
The middle ear in the human acts as an efficient passive and linear transformer to conduct acoustic energy from the tympanic membrane to the stapes footplate at the oval window and to the cochlea. The middle ear apparatus consists of the tympanic membrane, the ossicular chain of the malleus–incus–stapes complex along with the middle ear muscles. Its fundamental function is to provide critical modifications to the sound energy by providing mechanical advantages to overcome the impedance encountered by the acoustic signal when it is conducted from an air-filled medium (the middle ear cavity) to a fluid-filled medium (the perilymphatic and the endolymphatic fluid in the cochlea). Essentially, therefore, acoustic energy is transferred from a low-impedance, high-velocity medium to a high-impedance, low-velocity medium through this ossicular coupling (Figure 48.13). The impedance difference is mainly matched by the ratio of the surface area of the tympanic membrane to the stapes footplate and by the lever action of the ossicles and the membrane. The Eustachian tube links the nasal cavity to the middle ear. This tube supplies air to the middle ear for the air particles to vibrate and also equalize pressure across the tympanic membrane between the EAC and the middle ear.
Teprotumumab for the treatment of thyroid eye disease
Published in Expert Opinion on Biological Therapy, 2023
Poupak Fallahi, Francesca Ragusa, Sabrina Rosaria Paparo, Giusy Elia, Eugenia Balestri, Valeria Mazzi, Armando Patrizio, Chiara Botrini, Salvatore Benvenga, Silvia Martina Ferrari, Alessandro Antonelli
All events of alopecia were mild in severity, except for one event of moderate severity. 23% of menstruating women experienced menstrual disorders (amenorrhea, metrorrhagia, dysmenorrhea). Teprotumumab may increase blood sugar (10%), so it is necessary to evaluate glycemia before the start of the treatment, and glycemic levels should be tracked during the treatment. However, hyperglycemia might be transient and can recover after the end of the treatment, or with a specific therapy. Another possible side effect is related to hearing problems, that are present in about 10% of patients and in some cases can persist after the end of the treatment. Hearing impairment includes deafness, eustachian tube dysfunction, hyperacusis, hypoacusis, and autophony. A case of a woman with chronic teprotumumab-associated sensorineural hearing loss has been recently reported [67]. The patient had chronic TED with proptosis and diplopia. After three doses of teprotumumab she developed tinnitus, followed by hearing loss after five doses. The audiogram showed bilateral mild to moderate-severe hearing loss, significantly worse with respect the baseline audiogram. Teprotumumab was immediately interrupted, however 6 weeks later the audiogram showed no amelioration. Due to the potentially irreversible sensorineural hearing loss, close monitoring with regular audiometric tests before, during and after treatment with teprotumumab is recommended, and it may be important to consider potential treatment to recover from any hearing problems [67].
Delayed postoperative complications in 624 consecutive cochlear implantation cases
Published in Acta Oto-Laryngologica, 2021
Lusen Shi, Guangjie Zhu, Dengbin Ma, Chengwen Zhu, Jie Chen, Xiaoyun Qian, Xia Gao
One patient was diagnosed with chronic suppurative otitis media (CSOM) and had no history of CSOM prior to implantation. After being implanted with a Nucleus Freedom Contour Advance at 18 months old, the boy came to our hospital 4 months later with ear pain, ear discharge, and fever. The patient was diagnosed with acute suppurative otitis media (ASOM) after tympanostomy exploration of the affected ear, and purulent secretions and granulated tissues were found surrounding the receiver-stimulator as shown in Figure 4. Bacteria cultured from the purulent effusion were Streptococcus pneumoniae, and inflammation was detected on histological analysis. After 25 months the patient was diagnosed with CSOM after reporting ear discharge on four separate occasions. Since the first diagnosis, the patient was treated with ceftizoxime sodium to treat the infection and a corticosteroid nasal spray to improve the function of the Eustachian tube. During his four hospitalizations, two further tympanostomy explorations were performed, but the electrode array did not shift. Symptoms of ear discharge have not been reported from the patient for the past 2 years and 8 months.
Clinical characteristics of otogenic lateral sinus thrombosis in patients under 18 years old compared with that in adult patients
Published in Acta Oto-Laryngologica, 2021
Yi-Bo Huang, Li Li, Yucheng Pan, Qing-Zhong Li, Huawei Li
Posterior tympanotomy could improve ventilation between the mastoid cells and the middle cavity. On the one hand, granulation or/and swollen mucosa in the tympanic antrum, attic cavity, and the tympanic isthmus blocked the natural drainage pathway between the mastoid cells and tympanic cavity. However, posterior tympanotomy could establish a new way from mastoid cells and tympanic cavity. On the other hand, in some patients, the eustachian tube was blocked by granulation or/and swollen mucosa, while the tympanic membrane was intact. In this condition, the blocked eustachian tube could not provide ventilation and drainage to the tympanic cavity and mastoid cells, but the tympanostomy tube could help. Besides, canal wall up mastoidectomy preserved the physiological anatomy but with the same effect as canal down mastoidectomy, hence the conservative way was recommended as other studies [4,5,8].
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