Rhinoscleroma is a chronic, infectious and granulomatous disease of the respiratory tract. There is often a delay in diagnosis due to unfamiliarity with the disease and also because culture is not always positive. We report a case in a 26-year-old woman with granular mass obstructing bilateral nasal cavities and causing breathing diffi culty. Histopathological examination showed characteristic Mikulicz histiocytes containing numerous Gram-negative intracellular rod-shaped bacilli consistent with the diagnosis of rhinoscleroma. The patient was treated with gemifl oxacin and tetracycline and remains asymptomatic over a year follow-up period. It is important to consider rhinoscleroma in cases of chronic nasal obstruction. As culture is not always positive, histopathological examination may be crucial to the diagnosis.

Summary Introduction: Eagle's syndrome is characterized by cervicopharyngeal signs and symptoms associated with elongation of the styloid apophysis. This elongation may occur through ossification of the stylohyoid ligament, or through growth of the apophysis due to osteogenesis triggered by a factor such as trauma. Elongation of the styloid apophysis may give rise to intense facial pain, headache, dysphagia, otalgia, buzzing sensations, and trismus. Precise diagnosis of the syndrome is difficult, and it is generally confounded by other manifestations of cervicopharyngeal pain. Objective: To describe a case of Eagle's syndrome. Case Report: A 53-year-old man reported lateral pain in his neck that had been present for 30 years. Computed tomography (CT) of the neck showed elongation and ossification of the styloid processes of the temporal bone, which was compatible with Eagle's syndrome. Surgery was performed for bilateral resection of the stylohyoid ligament by using a transoral and endoscopic access route. The patient continued to present pain laterally in the neck, predominantly on his left side. CT was performed again, which showed elongation of the styloid processes. The patient then underwent lateral cervicotomy with resection of the stylohyoid process, which partially resolved his painful condition. Final Comments: Patients with Eagle's syndrome generally have a history of chronic pain. Appropriate knowledge of this disease is necessary for adequate treatment to be provided. The importance of diagnosing this uncommon and often unsuspected disease should be emphasized, given that correct clinical-surgical treatment is frequently delayed. The diagnosis of Eagle's syndrome is clinical and radiographic, and the definitive treatment in cases of difficult-to-control pain is surgical.

Folliculosebaceous cystic hamartoma (FSCH) is a cutaneous hamartoma of pilosebaceous origin that usually occurs on the face. We present what we believe is only the second reported case of FSCH of the external auditory canal, and the first in an adult. The patient was a 59-year-old woman who presented with a 4-year history of a firm nodule on the left external auditory canal that had caused hearing loss, pruritus, and pain. The lesion was excised, and histopathologic examination identified infundibular cysts, hyperplasia of the sebaceous lobules, and a large amount of mucin, features that are consistent with FSCH. One year postoperatively, the patient was asymptomatic, and no evidence of recurrence was noted.

Summary Introduction: Rhinoscleroma is a chronic granulomatous infectious disease caused by the bacterium Klebsiella rhinoscleromatis. It affects the respiratory tract mucosa, most frequently in the nose. It is considered endemic to certain countries of Africa and Central America, but is rare in Brazil. Nasal involvement occurs in 3 phases: catarrhal, granulomatous, and sclerotic. Throughout its course, the disease presents nonspecific symptoms, making it difficult to diagnose. Diagnosis is established by culture or by anatomopathological observation of Mikulicz cells or Russell corpuscles. Treatment consists of long-term antibiotic therapy and, occasionally, surgery. Objective: We report a case of rhinoscleroma in a young woman who complained of obstruction in both nostrils and persistent headache. Our intent is to enable otorhinolaryngologists to diagnose this rare disease, which presents with nonspecific symptoms that resemble numerous pathologies of the nasal region.

Treat ment in sudden sensorineural hearing loss is a contentious issue, today, oral steroids are the most common choice and considered the best treatment option, but the use of intratympanic steroids has become an attractive alternative, especially in cases when systemic therapy fails, or to avoid the side effects of the systemic use of steroids. Aim:To describe the results of intratympanic methylprednisolone in idiopathic sudden sensorineural hearing loss after failure of oral prednisolone.Methods: In a prospective study fourteen patients with idiopathic sudden sensorineural hearing loss were treated with intratympanic methylprednisolone after failing in the treatment with systemic steroids. Pretreatment and post-treatment audiometric evaluations including pure tone average (PTA) and speech reception thresholds (SRT) were analyzed. Results:Ten from 14 patients treated with intra-tympanic methylprednisolone presented with hearing recovery > 20 dB in PTA or 20% in SRT. Conclusion:Three intratympanic injections of methylprednisolone improved pure-tone average or speech discrimination scores for a subset of sudden hearing loss subjects that failed to benefit from oral steroids. Braz J Otorhinolaryngol. 2010;76(4):499-509. ORIGINAL ARTICLE BJORL

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