Abstract. Meningioma is a common intracranial tumor involving the meninges. The localization of this type of tumor is rarely extracranial due to its typically low invasive properties. Furthermore, invasion of the middle ear is exceptional. The present study reported a case of meningioma extending into the middle ear from the middle cranial fossa through the tegmen tympani. The clinical and pathological characteristics, as well as the outcome of the patient, were described. IntroductionMeningioma is a common intracranial tumour, accounting for 13-19% of all primary brain tumors (1). This tumor is generally encapsulated and benign (2). The symptoms of meningioma depend on the pressure of the tumor on the brain or spinal cord and the intracranial location of the tumor (3). Symptoms, such as seizures, single or multiple muscle twitches, spasms, loss of control of body functions, change in sensation and partial or total loss of consciousness, are associated with the different locations of the mass (1,4). Meningiomas accounted for ~33.8% of all the primary brain and central nervous system tumors reported in the United States between 2002 and 2006 (2). Furthermore, in recent decades, increased exposure to risk factors has determined an increase in the incidence of primary brain tumors, inclusive of meningioma, in several countries (5). The predominant risk factor identified is the exposure to ionizing radiation; however, other risk factors may be associated with the risk of meningioma, including elevated estrogen and/or progesterone hormone levels (2,6,7), head trauma (2), cell phone use (2,8), breast cancer (2), occupation (2), diet (2). Notably, a significant inverse correlation has been identified between meningioma and allergies (2,9); Linos et al (10) revealed that individuals with a history of allergy exhibited a lower risk of developing brain tumours than individuals with no history of allergy. Meningiomas have a higher incidence rate among female individuals, with a female to male ratio of ~2:1 (5). In addition, age-specific incidence rates indicate that risk increases with age. Prevalence rates for non-Hispanic individuals of African descent are marginally higher (6.67 per 100,000 persons) compared with Caucasian non-Hispanic and Hispanic individuals (5.90 and 5.94 per 100,000 persons, respectively) (2,4). The primary treatment strategy for meningiomas is total resection surgery if the tumor is benign and in an area of the brain where it can be safely and completely removed. Subsequently, radiation therapy is applied for the most malignant cases of meningioma or when surgery is not feasible due to the meningioma location.Extracranial meningiomas are uncommon (accounting for <2% of meningiomas) (11), particularly those extending into the middle ear. The present study described a rare case of meningioma extending into the middle ear from the middle cranial fossa through the tegmen tympani. Written informed consent was obtained from the patient. Case reportIn May 2004, a 56-year-old woman presented to the Ear Nos...
Sudden sensorineural hearing loss is defined as an acute hearing reduction of 30 dB or more, in at least three consecutive frequencies, occurring within 3 days of symptom onset. There is no consensus on the best treatment option. The aims of this paper were to evaluate the effectiveness of a treatment protocol based on medical therapy combined with hyperbaric oxygen therapy and to examine the factors that influence the recovery of hearing (age, gender, the amount of time between the onset of symptoms and the initiation of treatment -time since onset -, audiometric curve type and objective vertigo). Audiometric results were evaluated according to Siegel's criteria. In patients treated also with hyperbaric oxygen therapy we observed complete resolution in 44.1% of the patients, partial resolution in 37.2%, slight improvement in 10.5% and no improvement in 8.2% of the patients. This resolution pattern was significantly different from that observed in the patients treated only with medical therapy. The factors associated with a better prognosis were young age, rapid intervention, upward sloping or pantonal audiometric patterns and the absence of objective vertigo. Gender appeared to be an insignificant factor. Medical treatment associated with hyperbaric oxygen therapy gives better results in terms of hearing gain compared to exclusive medical treatment.
Malignant external otitis is a severe infection of the external auditoy canal, characterized by high gravity and mortality. It can arrive to skull base and originate intracranial complications. The most frequent pathogenic agent is Pseudomonas aeruginosa. Authors described two cases of external malignant otitis caused by Staphylococcus aureus, explaining clinical features, progression, diagnostic and therapeutic approach, prognosis of this disease. A comparison between Pseudomonas aeruginosa and Staphylococcus aureus malignant otitis was described, associated with a literature analysis.
Solitary intraparotid facial nerve plexiform neurofibromas are extremely rare. These tumors arise from Schwann cells. The plexiform variant is recognized by tortuous and multinodular gross and microscopic lesions. It has a high risk of malignant transformation. We report a case of a solitary plexiform neurofibroma in a 5-year-old Italian male, who initially presented a right parotid mass of four-month duration. He had not pain, trismus, facial weakness or previous trauma. There was not familiar history of Von Recklinghausen's disease. TC and MRI scans revealed a mass in the superficial lobe of the parotid gland. A partial parotidectomy was performed. Histopatological examination indicated plexiform neurofibroma. The incidence, presentation, diagnosis and surgical treatment of this lesion are discussed. In our case, the tumor could be readily separated from the main trunk, and facial movement was completely preserved owing to the rich neural network around the mass.
Respiratory infections are the most frequent nosocomial infections after those urinaries and surgicals. We analysed respiratory infection incidences in patients treated with different kinds of respiratory assistance (non-invasive ventilation and invasive mechanical ventilation trough tracheostomy), studying 640 patients recovering in the intensive area of respiratory disease from 2010 to 2013. We had 113 cases of respiratory infections: 42.5% in patients of non-invasive ventilation group and 57.5% of patients treated with invasive ventilation with a statistically significant difference between the two groups. The patients treated with non-invasive ventilation showed a lower incidence of nosocomial respiratory infections. Prevention guidelines are important to reduce nosocomial infections frequency.
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