Facial nerve neuromas occur throughout the course of the facial nerve and its branches, however lesions occurring on the chorda tympani branch are exceptionally rare. We present a case where the diagnosis was made intra-operatively; the patient was pre-operatively thought to have had a cholesteatoma. Total resection is the treatment of choice for these cases. Early diagnosis, aided by high resolution computed tomography (CT) scanning, will facilitate complete excision without damage to the facial nerve itself or the ossicular chain. The slow growing nature of the neuroma is likely to allow compensatory mechanisms to occur without the patient experiencing dysgeusia. As with any rarity the diagnosis can only be made with a high index of suspicion.
Cocaine is a commonly used illicit drug that is associated with cocaine-induced midline destructive lesions (CIMDLs). It is increasingly adulterated with levamisole, which has been shown to cause levamisole-induced vasculitis (LIV), a systemic vasculitis with ENT repercussions. Approximately 976 000 people aged 16-59 used powder cocaine in 2018/19 in the UK. 1 Levamisole, initially marketed in 1971 as an anti-helminthic drug, was removed from the US market in 2000 due to adverse effects, such as vasculitis. 2,3 It adds weight to cocaine and may potentiate its euphoric effect. 4 Approximately 70% of seized cocaine contained levamisole, and the proportion of cocaine "cut" with levamisole is increasing globally. 4 Whilst the prevalence of CIMDL and LIV is small compared with overall cocaine use, clinical repercussions can be severe.
Background There are significant drug–drug interactions between human immunodeficiency virus antiretroviral therapy and intranasal steroids, leading to high serum concentrations of iatrogenic steroids and subsequently Cushing's syndrome. Method All articles in the literature on cases of intranasal steroid and antiretroviral therapy interactions were reviewed. Full-length manuscripts were analysed and the relevant data were extracted. Results A literature search and further cross-referencing yielded a total of seven reports on drug–drug interactions of intranasal corticosteroids and human immunodeficiency virus protease inhibitors, published between 1999 and 2019. Conclusion The use of potent steroids metabolised via CYP3A4, such as fluticasone and budesonide, are not recommended for patients taking ritonavir or cobicistat. Mometasone should be used cautiously with ritonavir because of pharmacokinetic similarities to fluticasone. There was a delayed onset of symptoms in many cases, most likely due to the relatively lower systemic bioavailability of intranasal fluticasone.
The authors report the outcomes of a series of endonasal orbital decompression carried out by oculoplastic surgeons. Purpose: Orbital decompression is an established surgical treatment option for a range of orbital conditions. Traditionally, Ear, Nose and Throat surgeons have adopted the endoscopic route while ophthalmologists operate via an external approach. The authors report the outcomes of endonasal decompression performed by oculoplastic surgeons experienced in endonasal techniques. Methods: This was a retrospective case series of patients who underwent endoscopic orbital decompression for proptosis secondary to thyroid eye disease across 2 hospital sites between January 2011 and July 2018. Inclusion criteria were patients who had endoscopic decompression for proptosis in inactive thyroid eye disease or active disease without dysthyroid optic neuropathy. Information collected includes patient demographics, diagnosis, surgical details, preoperative and postoperative clinical findings (including, visual acuity, color vision, exophthalmometry readings, palpebral aperture, intraocular pressure, ocular motility, diplopia, and visual field), complications, and further treatment. Results: There were 70 cases of endoscopic decompression. The majority of patients had endoscopic medial and posterior medial wall/floor decompression (44.3%; 31/70 cases). Visual acuity remained stable in 98.6% (69/70). There was an average reduction in proptosis of 3.5 ± 1.2 mm (standard deviation [SD]) in the endoscopic medial wall only group, 3.9 ± 0.9 mm (SD) in endoscopic medial wall and posterior medial portion of the floor group, and 7.6 ± 2.1 mm (SD) in the 3-wall decompression group. Motility improved in 11.4% (8/70) and worsened in 2.9% (2/70). There were no significant intraoperative or postoperative complications associated with endoscopic surgery. Conclusions: Oculoplastic surgeons experienced in endonasal techniques can perform endoscopic orbital decompression with outcomes comparable to the literature.
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