No abstract

Tumors originating from ceruminous glands are rare lesions of the external auditory canal. The lack of specific clinical and radiological signs makes their diagnosis challenging. We report the case of an exceptionally rare benign tumor, a syringocystadenoma papilliferum (SCAP), in an atypical location in the bony segment of the external auditory canal with uncommon clinical signs. The special traits of the case included the following: the most lateral component of the tumor was macroscopically cystic and a granular myringitis with an obstructing keratin mass plug was observed behind the mass. The clinical, audiological, radiological, and histological characteristics of the neoplasm are consequently presented. Intraoperative diagnosis of the epidermal cyst was proposed. The final diagnosis of SCAP was determined only by histological analysis after the surgical excision. The educational aspects of the case are critically discussed.

Temporal bone osteomyelitis is a serious life-threatening condition—a quick and proper diagnosis is needed to start treatment and reduce morbidity and mortality. Changing trends of the disease make a differential diagnosis difficult. To emphasize the importance of a clinical suspicion of this dangerous condition, our experience with three difficult cases is presented. The diagnosis was based on clinical symptoms, otoscopic findings, and findings on computed tomography or magnetic resonance imaging. Neoplasm and granulomatous inflammation were excluded by multiple biopsies. The disease can develop in nondiabetic patients. The disorder might be related to the initial inflammatory process in the middle ear with further direct spreading of infection through defects in the bony walls to deep temporal bone structures. Imaging should be performed early to detect osteolytic lesions of the skull base. Surgery was used for the presence of bone sequestra and infratemporal abscess.

A 40-year-old man presented to our tertiary care facility less than 24 hours after acute violent blunt head trauma. He was hit with brass knuckles in the right preauricular region. He did not lose consciousness after the trauma. At arrival, the patient complained of moderate headache, dizziness, hearing loss, and high-pitched tinnitus on the right side as well as mild bleeding from the mouth and painful swallowing. He also reported problems with occlusion on the right side. He denied shortness of breath, trismus, and dysphagia. On physical examination, the patient had a Glasgow Coma score of 15, a right lower lid subcutaneous hematoma and subconjunctival hemorrhage. Microscopically, there were several small tympanic membrane hematomas along the handle of the malleus with a reduced range of eardrum movements on pneumotoscopy of the right side. A skin laceration was detected on the anterior wall of the bony part of the external auditory canal on that side. The Weber lateralized to the left ear and the Rinne was positive bilaterally. Audiometry revealed moderate-to-severe mixed hearing loss with an air-bone gap of 15 dB on the right side. The hearing in the left ear was normal. A type B tympanogram was found on the right side. Nasopharyngoscopy with a 30-degree 4 mm-diameter rigid endoscope revealed multiple mucosal membrane lacerations on the posterior and lateral walls of the nasopharynx.High-resolution spiral nonenhanced computed tomographic (CT) scans of the temporal bones revealed air above the left mastoid tegmen and bilateral fractures of styloid processes (SP) with caudal dislocation of the inferior fragments (Figs.

Meningoencephalocele is a rare condition that usually occurs in children and is treated by neurosurgeons with occasional help from ENT doctors. The symptoms of meningoencephalocele might not develop until adulthood, but usually they are apparent immediately after birth. The case of small anterior basal transethmoidal meningoencephalocele in a 24-year-old patient who had headaches and runny nose since childhood is presented. Endonasal endoscopic approach for meningoencephalocele removal and skull base defect reconstruction was used. It was concluded that endoscopic endonasal approach is less invasive and provides an acceptable operative outcome with short recovery time and less postoperative complications in comparison with other external microsurgical approaches.