Introduction Foreign bodies retained within the cervical soft tissues represent an uncommon clinical entity in otorhinolaryngology and head and neck surgery. In most cases, the diagnosis is established immediately because of an obvious history of trauma and acute clinical manifestations. Long-standing retained foreign bodies that remain undetected for several months are exceptional and may subsequently present with delayed infectious complications. Case presentation We report the case of a 23-year-old man with a history of a penetrating neck injury sustained during a knife assault one year earlier, who presented with a cervical cutaneous sinus. Radiological investigations revealed a knife blade deeply embedded within the cervical soft tissues. Elective surgical removal was successfully performed. Conclusion This case highlights the importance of appropriate clinical and radiological assessment of penetrating neck injuries, particularly when a deep retained foreign body is suspected. Delayed removal requires accurate anatomic localization and meticulous surgical planning.
Introduction. Resonant voice therapy is common in clinical practice to treat patients with a range of voice disorders. Lessac-Madsen Resonant Voice Therapy (LMRVT) is an established approach for training resonant voice and has demonstrated positive effects on voice quality. However, evidence regarding its effects on voice function parameters, particularly those derived from voice range profile (VRP) assessments, remains limited. This case study aimed to investigate the effects of LMRVT on voice quality, voice function, and self-perceived evaluations, in a patient with postoperative Reinke's edema. Case Presentation. A female patient with postoperative Reinke's edema received a total of eight LMRVT sessions, each lasting 60 minutes, conducted twice weekly. Evaluations were conducted immediately before therapy (E1), four days after the final therapy session (E2) and at follow-up 5.5 months later (E3). Outcome measures included acoustic, auditory-perceptual, and self-evaluation measures. VRP analysis demonstrated clinically significant improvements in minimum and maximum intensity, maximum fundamental frequency (F0), intensity range and semitone range at E2 and E3 compared to baseline. Although intensity values decreased at E3 relative to E2, they remained elevated when compared to baseline. Auditory-perceptual ratings and self-evaluation measures indicated clinically significant improvements in perceived voice quality at E2 and E3 compared to baseline. At E2, vocal function enhancements predominated due to improved VRP, whereas in E3 enhancements in voice quality were more pronounced. Conclusion. LMRVT was associated with various improvements on voice parameters. Further research is needed to assess LMRVT effects in larger participant pools with postoperative Reinke’s edema.
Temporal bone encephaloceles associated with tegmen tympani defects represent a rare but increasingly recognized cause of spontaneous cerebrospinal fluid (CSF) leakage and lateral skull base pathology, frequently associated with idiopathic intracranial hypertension (IIH). Chronic elevation of intracranial pressure may lead to progressive osseous erosion of the tegmen tympani and tegmen mastoideum, resulting in herniation of meningeal and temporal lobe tissue into the middle ear and mastoid cavity. We report the case of a 65-year-old morbidly obese woman presenting with unilateral conductive hearing loss, pulsatile tinnitus, middle ear effusion, CSF rhinorrhea, headaches, and visual disturbances. Imaging investigations demonstrated multiple temporal bone encephaloceles associated with tegmen tympani defects, mastoid CSF accumulation, and transverse–sigmoid venous sinus stenosis, consistent with underlying IIH. The patient underwent successful surgical repair through a middle cranial fossa approach with multilayer reconstruction using collagen matrix, temporalis fascia, muscle grafts, pericranium, and hydroxyapatite bone cement. Owing to persistent intracranial hypertension, endovascular venous sinus stenting was subsequently performed, resulting in normalization of intracranial pressure and marked clinical improvement. This case highlights the pivotal role of multimodal imaging in accurately characterizing tegmen defects and temporal encephaloceles, identifying associated radiological stigmata of intracranial hypertension, guiding surgical planning, and optimizing multidisciplinary therapeutic management to reduce recurrence risk and improve long-term outcomes.
Background Although severe primary arterial hemorrhage during intracapsular tonsillectomy is rare, these cases illustrate that it may still occur. The role of endovascular embolization in this setting has been only sparsely described. Case presentation We report two otherwise healthy pediatric patients who underwent Coblation intracapsular tonsillectomy and developed disproportionately brisk hemorrhage arising from the inferior tonsillar pole. In the first case, left inferior pole bleeding was refractory to pressure, topical hemostatic packing, bipolar cautery, suction cautery, and vascular clipping, prompting immediate transfer from the operating room to interventional neuroradiology. Angiography demonstrated hemorrhage from branches of the external carotid circulation, and embolization achieved definitive hemostasis. In the second case, right inferior pole bleeding was initially controlled intraoperatively with pressure, hemostatic packing, bipolar cautery, intravenous tranexamic acid, and intubation for airway protection, but recurred several hours later after coughing; urgent lingual artery embolization was required. Both patients remained intubated overnight for airway protection and were extubated the following day without neurologic or local complications. Conclusion Although Coblation intracapsular tonsillectomy is generally associated with a low hemorrhage burden, life-threatening primary or early recurrent bleeding can still occur, particularly from inferior pole branches of the external carotid system. These cases highlight the need for early recognition of unusually brisk inferior pole hemorrhage, prompt escalation beyond repeated transoral maneuvers when standard hemostasis fails, and early involvement of interventional neuroradiology.
Petrified ear is a rare condition characterized by calcification or ossification of the auricular cartilage. It has been associated with trauma and systemic endocrinopathies such as diabetes mellitus, hypothyroidism, and adrenal insufficiency. Here, we present a case of a 59 year-old male with adrenal insufficiency for over 25 years who developed symptomatic bilateral petrified ears. The patient presented with a seven year history of progressive bilateral otalgia, auricular stiffening, and subjective hearing loss. He had significant discomfort when contacting his ears, preventing him from wearing hats, headphones, or lying on his side. Physical examination demonstrated bilateral, symmetric, rigid and tender auricles without overlying skin changes. The otoscopic exam was unremarkable. Audiometry showed a mild bilateral sensorineural hearing loss. Computed tomography showed bilateral auricular cartilage calcifications without other abnormalities. Serum calcium levels were normal. A diagnosis of petrified ears was made and attributed to his adrenal insufficiency. The patient was counseled on protective measures to reduce trauma and discomfort and referred to endocrinology to address the underlying adrenal pathology. Although petrified ears are frequently asymptomatic, symptomatic cases can have serious consequences for patient quality of life. Endocrine pathologies are often associated with this condition. The pathophysiology is poorly understood, and there is limited evidence on the reversibility of petrified ears, even with adequate management of an underlying endocrine disorder. This case highlights the importance of recognizing symptomatic petrified ear and considering systemic causes, particularly adrenal insufficiency, in affected individuals.
Eosinophilic otitis media (EOM) is a rare and difficult-to-treat inflammatory middle ear disease frequently associated with type 2 inflammatory comorbidities, particularly asthma and chronic rhinosinusitis with nasal polyposis. We report the long-term clinical, radiological, audiological, immunological, and histopathological follow-up of a patient with refractory EOM who received dupilumab for severe chronic rhinosinusitis with nasal polyposis and subsequently underwent staged otologic surgery. A 57-year-old man presented with persistent bilateral otorrhea and progressive hearing loss in the setting of longstanding asthma and chronic rhinosinusitis with nasal polyposis. Previous treatment, including left mastoidectomy and bilateral tympanostomy with ventilation tubes, had failed to achieve sustained symptom control. Baseline assessment showed moderate bilateral mixed hearing loss, elevated total IgE, peripheral eosinophilia, obstructive spirometry, and bilateral inflammatory soft tissue involvement of the middle ear and mastoid cavities on computed tomography. Dupilumab was initiated primarily for chronic rhinosinusitis with nasal polyposis and type 2 inflammation, rather than as a direct indication for EOM. During follow-up, the patient showed progressive reduction in otorrhea and middle ear inflammation, improvement in otoendoscopic findings, closure of the air-bone gap, improved puretone average thresholds, reduced inflammatory soft tissue density on imaging, and improvement in sinonasal endoscopic findings. Histopathological evaluation supported eosinophil-predominant inflammation. No adverse events related to dupilumab were observed. This case suggests that dupilumab may provide additional middle ear benefit when used for approved type 2 inflammatory indications in selected patients with refractory EOM and associated type 2 inflammatory disease. Further studies are needed to define indications, timing, and long-term effectiveness.
Introduction and importance: Pneumolabyrinth is a rare condition defined by the presence of air within the inner ear most often identified on imaging and considered pathognomonic for a perilymphatic fistula. Beyond its radiological features, it represents a clinically significant entity associated with acute audiovestibular symptoms. PNL secondary to penetrating trauma is exceedingly uncommon, with only a limited number of cases reported in the literature. Given its rarity, the clinical presentation, diagnostic approach, and optimal management remain subjects of debate, with no established therapeutic consensus. Case presentation: We report the case of a 50-year-old male patient, who consulted our ENT department for otorrhagia following penetrating trauma to the left ear caused by a metallic wire, associated with severe vertigo and hearing loss. Otoscopic examination revealed active bleeding and a large central perforation of the left tympanic membrane. Pure-tone audiometry demonstrated a moderate mixed hearing loss. CT scan showed a subluxation of the ossicular chain associated with pneumovestibule, and a bone fragment incarcerated within the vestibule. The patient was managed conservatively with close clinical follow-up. Clinical discussion: Pneumolabyrinth is a rare radiological finding, particularly following penetrating trauma. Management remains non-standardized due to the limited number of reported cases; however, conservative treatment is commonly adopted and includes bed rest with head elevation, avoidance of Valsalva maneuvers, systemic corticosteroids, antibiotic prophylaxis, and close clinical and radiological follow-up. This approach is often effective, with vestibular symptoms generally showing better recovery than hearing outcomes, especially when intralabyrinthine air involves the cochlea. Conclusion: Post-traumatic pneumolabyrinth is a rare entity that may present with severe audiovestibular symptoms. Nevertheless, conservative management can be effective in selected cases, provided that careful clinical evaluation, appropriate imaging, and close follow-up are ensured to avoid unnecessary surgical intervention.
Sinonasal paraganglioma (SNP) is an exceptionally rare neuroendocrine tumor characterized by nonspecific symptoms and significant hypervascularity, posing considerable diagnostic and therapeutic challenges. This report presents the case of a 32-year-old female with a 5-month history of progressive unilateral nasal obstruction, purulent discharge, and recurrent epistaxis. Nasal endoscopy revealed a hyperemic, friable mass occupying the left common and middle meatus. Preoperative imaging, including computed tomography (CT) and magnetic resonance imaging (MRI), identified a well-defined, intensely enhancing lesion with characteristic gyriform pattern involving the left middle and superior meatus, extending into adjacent sinuses and causing focal erosion of the anterior skull base. The patient underwent complete endoscopic resection without preoperative embolization, with an estimated blood loss of 300 mL. Histopathological examination confirmed the diagnosis, demonstrating the classic nested (Zellballen) architecture. Immunohistochemistry was positive for synaptophysin, chromogranin A, and CD56 in chief cells, with S-100 protein highlighting sustentacular cells. SDHB expression was retained, and the Ki-67 proliferation index was approximately 15%. The postoperative course was uneventful, with no evidence of recurrence at the 6-month follow-up. This case highlights the importance of considering SNP in the differential diagnosis of unilateral hypervascular nasal masses. Definitive diagnosis relies on histopathology and immunohistochemistry. Endoscopic resection is the treatment of choice, with preoperative embolization recommended for large or highly vascularized tumors to mitigate intraoperative hemorrhage. Given the potential for hereditary syndromes and late recurrence, genetic counseling and long-term surveillance are essential components of comprehensive management.
Cervical lymphadenitis is the most common presentation of atypical mycobacterium infections in immunocompetent pediatric patients. Regional or extensive spread, such as intrathoracic NTM infections or systemic disease, is more commonly encountered in immunocompromised patients. A previously healthy 21-month-old female presented with a one-month history of cough, wheezing, and increased work of breathing. Her upper respiratory symptoms persisted, and imaging revealed an endotracheal mass. Bronchoscopy confirmed a mass obstructing approximately 90% of the tracheal lumen. Biopsy of the mass confirmed Mycobacterium avium complex infection. The patient was managed with prolonged antibiotic therapy and surgical debulking, resulting in clinical resolution of her respiratory symptoms. Due to the rarity of this patient's disease presentation, no treatment guidelines currently exist for this particular clinical manifestation. This case report highlights the successful use of combined surgical and medical therapies leading to symptom improvement and disease remission.
Cervical schwannomas are rare benign tumors that can mimic thyroid tumors, especially when located adjacent to the thyroid gland. The preoperative diagnosis is often difficult to establish due to nonspecific and inconclusive findings on imaging and fine-needle aspiration cytology. This case report describes an older woman who presented with a gradually enlarging cervical mass associated with hoarseness. This was initially diagnosed as an adenomatous thyroid nodule during routine follow-up. However, the patient developed progressive neck swelling accompanied by hoarseness and dyspnea, and marked tumor enlargement was noted. Computed tomography revealed a large heterogeneous mass compressing the trachea and esophagus. Laryngoscopy demonstrated left vocal cord paralysis, suggesting recurrent laryngeal nerve involvement. The tumor was surgically resected, and left thyroid lobectomy was performed. Histopathological examination revealed proliferation of spindle-shaped cells with S-100 positivity, consistent with schwannoma. Accordingly, cervical schwannoma should be considered in the differential diagnosis of thyroid-adjacent neck masses.
We present a case of glossopharyngeal and vagal nerve palsy induced by varicella-zoster virus (VZV), which subsequently progressed to acute retinal necrosis (ARN). A man in his 70s presented with severe dysphagia, hoarseness, and a unilateral ulcer on the left soft palate. Serological testing revealed elevated VZV IgM and IgG titers, confirming VZV reactivation, despite the absence of typical vesicular eruptions. The patient received intravenous acyclovir and corticosteroids for lower cranial polyneuropathy; however, dysphagia persisted, necessitating gastrostomy for nutritional support. On day 38 of hospitalization, approximately five weeks following the onset of cranial neuropathy, he developed blurred vision in the left eye, leading to a diagnosis of ARN, confirmed by the detection of VZV DNA in the aqueous humor. Intensified antiviral therapy improved his visual acuity, though the cranial neuropathy required long-term rehabilitation. This case highlights an important diagnostic pitfall: VZV-related lower cranial neuropathy may appear clinically stable yet precede delayed, sight-threatening ocular complications despite standard antiviral therapy. Otolaryngologists should therefore remain vigilant for new visual symptoms during follow-up to prevent irreversible visual loss.
Introduction: Chondroid lesions of the parotid gland are exceptionally rare. The differential diagnosis includes pleomorphic adenoma with extensive chondroid differentiation and extraskeletal chondromas. Clinically, they present as slow-growing, painless, well-circumscribed masses. Case presentation: A 70-year-old asymptomatic male was referred after incidental detection of a parapharyngeal mass on brain MRI. Clinical and endoscopic evaluation revealed left oropharyngeal and nasopharyngeal bulging. Neck MRI showed a well-defined, predominantly cystic lesion in the deep lobe of the left parotid gland, with peripheral nodularity, high T2 signal, high apparent diffusion coefficient (ADC) values, and minimal enhancement. Following ultrasound guided fine needle aspiration (FNA) pleomorphic adenoma was considered. The patient underwent partial parotidectomy and histopathology showed a chondroid lesion with degenerative changes. RNA sequencing revealed a HMGA2WIF1 fusion. The tumor was completely excised with close margins. Postoperative recovery was uneventful. Discussion: The presence of an HMGA2WIF1 fusion favors a diagnosis of chondroid pleomorphic adenoma rather than a true extraskeletal chondroma, although a true chondroma cannot be fully excluded. Complete surgical excision with preservation of the facial nerve is the standard treatment. Recurrence remains a consideration; therefore annual imaging follow-up can be considered, taking into account tumor characteristics and surgical factors. Conclusion: Chondroid lesions of the parotid gland are rare and diagnostically challenging. The identification of an HMGA2WIF1 fusion, characteristic of pleomorphic adenoma but not reported in chondromas, supports classification as a chondroid pleomorphic adenoma. These findings question whether salivary gland chondromas constitute a distinct entity and highlight the value of molecular analysis in this differential diagnosis.
Auricular avulsion injuries represent a significant reconstructive challenge. Although microsurgical replantation is considered the gold standard, it is not always feasible because of vessel damage or patient-related factors. The Baudet technique, described in the 1970s, offers a simple nonmicrosurgical alternative that remains underreported despite its clinical relevance, particularly in frail elderly patients.An 81-year-old man sustained a near-total right auricular amputation following high-energy traffic trauma. As no suitable vessels for microvascular repair were identified and the patient had significant cardiovascular comorbidities, reconstruction was performed under local anesthesia using the Baudet technique. Early postoperative venous congestion was successfully managed with leech therapy. One month postoperatively, partial-thickness anterior skin necrosis, including loss of the earlobe, occurred and was treated with debridement and conservative wound care, resulting in complete healing within two months. As the Baudet technique is inherently a two-stage procedure, the patient declined the second stage because he was satisfied with the functional and aesthetic outcome.This case illustrates that, in carefully selected frail elderly patients, the Baudet technique remains a pragmatic salvage option when microsurgical repair is not feasible, offering acceptable functional outcomes with limited operative burden.
Horizontal canal benign paroxysmal positional vertigo (HC-BPPV) is usually self-limiting or responsive to repositioning maneuvers, and surgical treatment is rarely indicated. We report a 63-year-old woman with long-term recurrent and intractable HC-BPPV who underwent horizontal semicircular canal occlusion. The patient experienced repeated bilateral HC-BPPV over more than 10 years, with left-dominant involvement and an episode of left acute vestibular dysfunction. Preoperative vestibular testing demonstrated left-sided canal paresis and reduced cervical and ocular vestibular evoked myogenic potential responses. Given the persistent left-sided vestibular vulnerability, left horizontal semicircular canal occlusion was performed. Postoperatively, positional vertigo resolved completely without hearing deterioration, and video head impulse testing confirmed functional occlusion of the targeted canal. This case highlights the importance of careful patient selection and objective vestibular evaluation when considering surgical treatment for intractable HC-BPPV.
Pediatric Eosinophilic Granulomatosis with polyangiitis (EGPA), also known as Churg-Strauss syndrome, is one of the rarest systemic vasculitides documented.1 More limited are the cases of pediatric EGPA patients presenting with isolated stridor and severe subglottic stenosis, with only one reported case published to our knowledge to date.2 We present the case of an 18-year-old female who initially developed expiratory stridor two years ago, with no other significant medical history. CT imaging revealed non-fixed pulmonary infiltrates, and endoscopic evaluation revealed grade 3 subglottic stenosis. Biopsy results of the stenotic segment showed reactive epithelium with eosinophils present. Lower airway bronchoscopy with bronchoalveolar lavage demonstrated eosinophils, neutrophils, and macrophages, and serology tests resulted positive for ANCA antibodies. These findings, together with the patient's symptoms, are most consistent with EGPA disease. Initially deemed as severe asthma exacerbation, this case highlights the importance of considering autoimmune conditions in patients with expiratory stridor and/or idiopathic subglottic stenosis.
Nasal bone fractures are the most common type of facial bone fracture, and accurate reduction is essential for restoring the nasal form and function. Ultrasound-guided closed reduction allows real-time visualization of the fracture site without radiation exposure; however, adequate visualization can be technically challenging because the nasal bone protrudes from the surface of the body. Additionally, acoustic coupler gel pads for nasal bone fractures are expensive.We report the case of a 23-year-old man with a depressed nasal bone fracture who underwent successful closed reduction under ultrasound guidance using a commercially available ice gel pack containing a superabsorbent polymer as an acoustic interface. The ice gel pack, warmed to room temperature, provided clear visualization of the fracture site with minimal ultrasound gel and allowed precise intraoperative assessment and reduction. Postoperatively, the patient showed marked improvement in external nasal deviation and nasal obstruction, with satisfactory fracture healing as confirmed by computed tomography.This simple, inexpensive, and readily available technique may serve as a practical alternative to conventional acoustic coupler gel pads and facilitate the wider adoption of ultrasound-guided reduction of nasal bone fractures in routine clinical practice.
Introduction Capillary hemangioma is a benign vascular tumor commonly encountered in the head and neck region; however, involvement of the external auditory canal (EAC) is exceedingly rare, particularly in the pediatric population. Due to its vascular nature and nonspecific clinical appearance, this entity may pose diagnostic and therapeutic challenges and can mimic inflammatory or neoplastic lesions of the ear canal. Case Presentation We report the case of a 5-year-old boy who presented with a progressively enlarging left external auditory canal mass associated with intermittent bleeding on minimal contact over a three-month period. Otoendoscopic examination revealed a hyperemic, friable mass occupying the external auditory canal. Audiological assessment demonstrated normal hearing. High-resolution computed tomography and contrast-enhanced magnetic resonance imaging confirmed a well-defined vascular lesion confined to the external auditory canal without bony erosion, middle ear, or mastoid involvement. Histopathological examination following biopsy established the diagnosis of capillary hemangioma. Definitive management consisted of complete surgical excision via a transcanal approach, with preservation of surrounding structures. The postoperative course was uneventful, and no recurrence was observed during 12 months of follow-up. Review of the Literature A comprehensive review of the literature was performed, identifying 26 previously reported cases of hemangioma involving the external auditory canal. Comparison with published cases highlights the rarity of pediatric presentation and supports complete surgical excision as the treatment of choice for lesions confined to the canal. Conclusion This case emphasizes the importance of including capillary hemangioma in the differential diagnosis of bleeding external auditory canal masses in children and demonstrates that transcanal excision provides excellent outcomes when complete removal is achieved.
Background: Metastatic involvement of the thyroid gland is uncommon, and metastasis from gynecologic malignancies is exceedingly rare. To our knowledge, thyroid metastasis originating from primary fallopian tube carcinoma has not previously been reported. Case presentation: A 75-year-old woman underwent surgery for high-grade serous carcinoma of the left fallopian tube 5 years earlier. Seventeen months postoperatively, recurrence in the para-aortic lymph nodes was detected. She subsequently received systemic chemotherapy with paclitaxel, carboplatin, and bevacizumab, followed by niraparib for approximately 19 months. Treatment was discontinued due to recurrent adverse events, including bone marrow suppression, and best supportive care (BSC) was initiated. Approximately 2 years after transitioning to BSC, she developed progressive anterior neck swelling. Imaging revealed enlargement of the para-aortic and bilateral common iliac lymph nodes, along with newly identified cervical lymphadenopathy and diffuse enlargement of the thyroid gland. Fine-needle aspiration cytology demonstrated malignant cells lacking nuclear features of papillary thyroid carcinoma. Core-needle biopsy confirmed adenocarcinoma histologically concordant with the previously resected fallopian tube carcinoma. Immunohistochemistry revealed positivity for Wilms tumor 1 and estrogen receptor and negativity for thyroglobulin and thyroid transcription factor-1, confirming metastatic Müllerian carcinoma. Palliative management included opioid analgesics for abdominal pain and compression therapy for lower limb lymphedema. The patient remained clinically stable for 14 months following diagnosis. Conclusion: Thyroid metastasis from fallopian tube carcinoma can occur years after initial treatment. In patients with a history of gynecologic malignancy presenting with neck swelling, metastatic disease should be considered. Histopathological confirmation with immunohistochemistry is critical for accurate diagnosis.
