Clinical manifestations of cholesterol granulomas depend on their anatomic location and the involvement of the adjacent structures. Aggressive lesions in patients with residual hearing can be drained via an infralabyrinthine or an infracochlear approach with minimal morbidity. Follow-up must be preferred for patients with nonaggressive lesions. Although magnetic resonance imaging provides a specific diagnosis tool for cholesterol granulomas, computed tomography is essential for an accurate evaluation of the location of the cyst and choice of the surgical procedure.

We report 3 patients who complained of positional vertigo shortly after head trauma. Positional maneuvers performed in the plane of the posterior canal (PC; Dix-Hallpike maneuver) and the horizontal canal (HC; patients were rolled to either side in a supine position with the head raised 30 degrees) revealed a complex positional nystagmus that could only be interpreted as the result of combined PC and HC benign paroxysmal positional vertigo (BPPV). Two patients had a right PC BPPV and an ageotropic HC BPPV, and 1 patient had a bilateral PC BPPV and a left geotropic HC BPPV. All 3 patients were rapidly free of vertigo after the PC BPPV was cured by the Epley maneuver and the geotropic HC BPPV was cured by the Vannucchi method. The ageotropic HC BPPV resolved spontaneously. Neuroimaging (brain computed tomography and/or magnetic resonance imaging scans) findings were normal in all 3 patients. From a physiopathological viewpoint, it is easy to conceive that head trauma could throw otoconial debris into different canals of each labyrinth and be responsible for these combined forms of BPPV. Consequently, in trauma patients with vertigo, it is mandatory to perform the Dix-Hallpike maneuver, as well as supine lateral head turns, in order to diagnose PC BPPV, HC BPPV, or the association of both. Early diagnosis and treatment of BPPV may help to reduce the postconcussion syndrome.

The purpose of this study was to assess histopathological findings after a bilateral near-total thyroidectomy (residual thyroid tissue about 4 to 5 g) for multinodular goiter (MNG). The 270 patients included 238 women and 32 men with a mean age of 52 years (range: 19-82 years) who had MNG involving the entire gland and had undergone a primary bilateral surgical procedure between 1993-1998. There was no intra-or postoperative mortality. Indications for the MNG surgery were suspected malignancy (7.7%), thyrotoxicosis (27.7)%, pressure on cervical structures with tracheal deviation (38%), significant cosmetic deformity in young female patients (6.6%) and intrathoracic extension of the MNG (19.6%). Grave's disease was not included in our study. The surgical specimen weight ranged from 60 to 560 g (average 120 g). Final pathological findings were benign in 237 patients (87.8%) and malignant in 33 patients (12.2%). Nineteen patients were diagnosed with macroscopic (ten patients) or microscopic (nine patients) types of papillary carcinoma: there were two patients with the follicular variant of papillary carcinoma, three with lymphoma and Hashimoto's thyroiditis, three with medullar carcinoma, three with anaplastic carcinoma, two with follicular carcinoma and one with Hürthle cell carcinoma. A true total completion thyroidectomy was performed only for the medullary carcinoma patients and for four of the "high-risk" papillary carcinoma patients. Permanent (>12 months) unilateral recurrent paralysis occurred in four patients (1.4%), permanent (>12 months) hypoparathyroidism in ten patients (3.7%) and hypertrophic or keloid scar in 14 patients (5.1%). Our results suggest that near total thyroidectomy with minimal residual tissue is a versatile surgical procedure for various histopathological features in MNG patients. Low rates of postoperative complications were observed.

Using round window membrane delivery, the perilymphatic entry of mannitol and inulin depended on their molecular weight. Intratympanic delivery induced a high inter-individual heterogeneity of the drug concentration within the inner ear, with subsequent variability of the therapeutic effects.

A description of the lateral infratemporal approach of the jugular foramen (JF) was performed according to bone data, anatomico-radiologic relationships and microsurgical and endoscopic dissection: the jugular foramen is an anteromedial fissure of the petro-occipital fissure. The location of the exocranial facial nerve and the skeletonization of the third portion of the facial canal represents the main obstacle. A retro-facial dissection, then a medio-facial sub-labyrinthine dissection, while displacing the sigmoid sinus, should avoid a systematic diversion of the nerve, which is the cause of severe paralysis. The broad approach of the "pars nervosa" of the jugular foramen demands the control of the vertical part of the carotid canal. The lateral infratemporal approach of the jugular foramen is necessary for the treatment of specific lesions of the area (chemodectoma, neurinoma), which is invaded contiguously (carcinoma).

Hearing preservation after surgical removal of a vestibular schwannoma by a modified translabyrinthine approach was initially reported by McElveen et al in 1991. We report the case of a 46-year-old man from whom a vestibular schwannoma (grade I) was removed by this approach. The patient's hearing was preserved and was stable after 21 months. To the best of our knowledge, this is the first case with satisfactory and long-standing hearing preservation. However, further experimental studies are needed to determine the mechanisms of hearing preservation in order to develop a reliable technique for this approach before using it as an alternative in the management of vestibular schwannoma.