Cochlear implants (CIs) are an established treatment for the rehabilitation of profound sensorineural hearing loss. Although overall complication rates are low, postoperative infections and wound complications may require revision surgery or device explantation. A 27-year-old Black male with profound bilateral hearing loss since infancy underwent right cochlear implantation in 2013. Following head trauma in 2022, the patient developed magnet-related issues and subsequently experienced recurrent inflammation and purulent discharge at the implant site. He remained a non-user of the device for approximately two years. Due to persistent local infection and absence of auditory benefit, partial removal of the internal implant was performed. Delayed bone overgrowth around and over a CI receiver is a rare but important late complication that can lead to infection, skin breakdown, and device dysfunction. This case underscores the need for long-term follow-up and early surgical intervention when unexplained symptoms or implant failure occur.
Dermoid cysts, found in the lateral neck are uncommon and it is evident that fewer cases have been documented in the parotid gland and tonsillar fossa area. We would like to report a case of a 20-year-old male patient who has presented with a swelling measuring 7 × 8 cms, on the left side of the upper neck, extending inferiorly from below the pinna and angle of the mandible up to the upper third of the sternocleidomastoid along its anterior border. The patient was provisionally diagnosed with a second branchial cysts and was advised to go for surgical excision. The MRI findings revealed a T1 hyperintense lesion, and a tract that extended to the pharyngeal wall, both of which were missed during the initial evaluation. A lateral presentation in the neck involving the parotid gland is very uncommon, with PubMed and Google searches revealing very few cases.
Pott’s puffy tumor (PPT), defined by frontal bone osteomyelitis with a subperiosteal abscess, is a known sequela of bacterial rhinosinusitis. This case report highlights Mycobacterium tuberculosis as a cause for PPT, which had resulted in delayed diagnosis and treatment. Although previously described, extrapulmonary tuberculosis (TB) of the sinonasal cavity is an exceedingly rare cause for atypical PPT. A 76-year-old immunocompromised female with several days of isolated, progressive facial swelling, consistent with PPT, underwent urgent frontal sinus trephination and endoscopic sinus surgery. Intraoperative cultures and histopathology demonstrated Mycobacterium tuberculosis infection. The patient recovered without any complications after surgery and antitubercular therapy. TB is a rare but important differential in atypical PPT, particularly in immunocompromised patients or those with risk factors for TB. Given the nonspecific clinical and radiographic features, diagnosis often relies on a high index of suspicion. Delayed recognition carries significant public health implications, including further transmission and intracranial progression.
The objective is to describe contralesional horizontal video head impulse test (vHIT) hypergain in chronic unilateral M & eacute;ni & egrave;re disease and relate it to low-frequency rotational asymmetry. A 72-year-old man with definite left-sided M & eacute;ni & egrave;re disease, onset February-March 2020, underwent follow-up audiometry, horizontal and vertical HIMP/SHIMP, VVOR/VORS, and rotational chair testing. Horizontal HIMP gain was 1.04 left and 1.50 right; SHIMP gain was 1.26 left and 1.42 right. Vertical gains were broadly preserved. Symptoms remained left-sided, with no right aural fullness or tinnitus. The patient showed no frank ipsilesional high-acceleration canal deficit, but clear rightward horizontal hypergain. Rotational testing showed reduced low-frequency gain, mild rightward directional preponderance, and asymmetric post-rotatory time constants. Contralesional vHIT hypergain may represent the high-acceleration expression of residual slow-domain imbalance within an incompletely recalibrated horizontal vestibular network.
Node-first Kawasaki disease (NFKD) is a phenotype in which cervical lymphadenopathy precedes other diagnostic criteria, frequently mimicking deep neck infection, and it remains under- recognised among otolaryngologists, who tend to diagnose it later than paediatricians. We present two children (a 7-month-old boy and a 2.5-year-old girl) admitted to the Department of Otolaryngology with suspected suppurative lymphadenitis. In both cases, ultrasonography excluded abscess formation, antibiotic therapy proved ineffective, and a notable CRP-procalcitonin (C-reactive protein-procalcitonin) dissociation (CRP >240 mg/L with PCT <0.5 ng/mL) was observed. Incomplete Kawasaki disease (KD) was diagnosed after paediatric consultation, and both patients responded promptly to intravenous immunoglobulin (IVIG). Follow-up over approximately 2 years showed no coronary abnormalities. Raising awareness of NFKD in otolaryngology training and applying a stepwise management algorithm may prevent unnecessary surgery and reduce coronary complications.
Otosclerosis is a primary disease of the temporal bone that typically presents with conductive hearing loss. Stapes surgery, the treatment of choice, is a safe but technically demanding procedure that can be associated with some ‘anomalies’, namely floating footplate which can lead to sensorineural hearing loss and vestibular symptoms. This requires the surgeon to carefully adopt an approach in order to achieve good results and prevent possible sequelae. A 40-year-old female patient was referred to the ENT specialist for unilateral progressive hearing loss. After evaluation, the patient was scheduled for exploratory tympanotomy, which confirmed the presence of stapes fixation, and stapedotomy was performed. During this procedure, a floating footplate was observed. The Teflon prosthesis was placed over the footplate, with good functional results. However, given the instability of the support site, one year after the surgery the prosthesis was displaced, requiring revision surgery, which was performed with adequate audiometric success.
Liposarcoma of the hypopharynx is extremely rare. We report a 66-year-old male who presented with a six-month history of throat foreign body sensation and progressive dysphagia. Laryngoscopy revealed a smooth, mucosa-covered mass on the posterior hypopharyngeal wall. MRI demonstrated a 3.3 cm cystic mass with heterogeneous enhancement. Transoral endoscopic laser resection was performed. Histopathology and FISH confirmed well-differentiated liposarcoma with MDM2 amplification. No adjuvant therapy was given. The patient resumed oral feeding within one week. At two-year follow-up, he remained free of dysphagia, respiratory, or speech impairment, and endoscopy showed no recurrence. This case highlights diagnostic challenges, the necessity of MDM2 FISH testing, and the importance of long-term surveillance.
Otosclerosis is an osteodystrophy of the temporal bone. Its pathophysiology consists of osseous remodeling of the otic capsule, primarily causing conductive hearing loss. Treatment usually includes stapes surgery and, in some cases, the fitting of conventional hearing aids. This case report describes the coexistence of otosclerosis with anterior semicircular canal dehiscence (ASCD). A 45-year-old female patient was referred to the ENT specialist for bilateral hearing loss with a 5-year history. The combined findings from the pure tone audiometry, acoustic impedance, and high-resolution computed tomography scan established the simultaneous diagnosis of otosclerosis and ASCD in both ears. Due to the potential complications associated with stapes surgery when otosclerosis coexists with an ASCD, the patient was fitted with a hearing aid which provided no functional gain. For this reason, a bone conduction implant, the OSIA (R) system, was subsequently placed in the left ear uneventfully, resulting in hearing improvement.
Schwannomas are benign, slow-growing tumors arising from Schwann cells. Extracranial head and neck lesions are uncommon, and sinonasal schwannomas are rare. We report two cases managed at tertiary centers. A 51-year-old man presented with progressive left nasal obstruction and proptosis due to a frontoethmoidal mass abutting the orbit. Endoscopic excision revealed ancient schwannoma, and he remained recurrence-free at three years. A 39-year-old woman with diabetes had right nasal obstruction and mild epistaxis from a posterior septal mass. Coblator-assisted endoscopic excision was performed, and histopathology confirmed schwannoma. Both patients recovered uneventfully. Radiologically, these tumors appear as homogeneous soft-tissue lesions with bony remodeling on CT and contrast enhancement on MRI. Histology demonstrates biphasic Antoni A and B areas with S-100 positivity. These cases emphasize diagnostic pitfalls and surgical considerations in sinonasal schwannomas, especially when mimicking mucoceles or arising near the skull base.
We report a 58-year-old female with recurrent right-sided cholesteatoma who underwent tympanomastoidectomy. Imaging revealed extensive cholesteatoma with ossicular erosion. Postoperatively, she developed persistent unilateral linguistic auditory hallucinations in her previously deaf right ear. She described hearing accusatory and distressing voices. In contrast to typical non-linguistic postoperative auditory disturbances like tinnitus or musical hallucinosis, these hallucinations were highly structured. This progressed to delusions, including one of a tube implanted in her ear during surgery. Notably, she lacked internal emotional attribution typical of psychiatric illness; her hallucinations were closely linked to her surgery, suggesting a peripheral or neuro-otological etiology secondary to surgical stress on a chronically sensory-deprived auditory system. This case illustrates unilateral auditory hallucinations following tympanomastoidectomy, likely due to peripheral auditory disruption and microangiopathic brain changes. Symptoms improved with antipsychotics and anxiolytics. Early recognition of non-psychiatric causes and interdisciplinary management are crucial to prevent misdiagnosis and ensure appropriate treatment.
Although paranasal sinus foreign bodies were historically considered uncommon, iatrogenic cases related to dental procedures have increased with the widespread use of implants. Migrated implants may remain asymptomatic but can eventually cause sinonasal inflammation or serious complications. We report two cases of long-standing dental implant foreign bodies in the paranasal sinuses. In Case 1, an early-70s woman developed maxillary discomfort 13 years after implant placement. In Case 2, an early-80s man was incidentally diagnosed with a migrated implant 11 years after peri-implant fixture loss. In both cases, computed tomography demonstrated implants associated with sinusitis. Endoscopic sinus surgery enabled complete removal of the foreign bodies. Postoperatively, symptoms resolved and normal mucosa was restored. Even long-standing and asymptomatic dental implant foreign bodies can be successfully treated with endoscopic sinus surgery. Early removal should be considered regardless of symptoms, and close medical-dental collaboration is essential to prevent delayed complications.
Tracheo-esophageal puncture (TEP) with a voice prosthesis (VP) is the most widely used modality for vocal rehabilitation after total laryngectomy (TL). The most common associated complications are less serious peri- and intra-prosthetic leakages, inflammation, and strictures. Serious complications are rare and can be associated with significant morbidity and even mortality. In this article, we aim to shed light on a rare complication in 2 cases with delayed erosion of the VP through the posterior pharyngeal wall, leading to osteomyelitis with irreversible neurological morbidity. One case was treated surgically with spinal decompression, whereas the second case had a rapid clinical deterioration that led to abstention of treatment and mortality. Both cases had irreversible tetraplegia. Such rare, serious complications require a prompt diagnosis followed by a multi-disciplinary management due to the fact that they carry significant neurological morbidity.
Nasal obstruction is a prevalent ENT complaint that is frequently caused by inferior turbinate hypertrophy and/or septum deviation. Septoplasty with turbinate reduction is a safe and highly effective surgical procedure that is commonly performed worldwide to relieve nasal obstruction. We recently encountered a case of unilateral intractable otitis media following septoplasty with turbinate reduction surgery due to post-operative complete fibrosis of the left eustachian tube. In addition, the patient had ventilation tube obstruction on multiple occasions due to extremely viscous ear discharge. Despite the rarity of this complication, as no such cases have previously been published, we communicate our experience for sharing the lesson gained from this case and take this complication into consideration postoperatively. Additionally, we propose a simple technique to provide protection for the eustachian tube during nasal surgery.
Poorly differentiated chordoma is a rare, aggressive chordoma subtype occurring predominantly in paediatric population. We report a paediatric clival poorly differentiated chordoma that posed diagnostic challenges due to atypical clinical, radiological and histological findings. A 1-year-old male child presented with neck stiffness and snoring which later progressed into upper airway obstruction. Initial imaging suggested a retropharyngeal abscess with clival erosion and intraoperatively were reported as undifferentiated sarcoma. Despite chemotherapy the disease progressed. Repeated biopsy with adequate viable tissue revealed sheets of neoplastic cells with absence of physaliphorous cells. The tumor cells were positive for brachyury, CK and EMA and showed loss of INI1 expression, clinching the diagnosis of poorly differentiated chordoma. Unfortunately, due to the aggressiveness of the tumor patient succumbed within months after the diagnosis. This case highlights the importance of adequate tissue sampling, targeted immunohistochemistry, and clinicopathological correlation in diagnosing paediatric poorly differentiated chordoma.
We present a case of pediatric spontaneous tonsillar hemorrhage treated by emergency tonsillotomy. The article describes the diagnostic challenges of this rare and unclear occurrence, as well as the need for an individually decided treatment plan based on the etiology of the hemorrhage. Tonsillotomy, to our knowledge previously unreported in the literature for this indication, proved effective both in achieving hemostasis and in relieving long-term symptoms caused by tonsillar hypertrophy.
Benign positional paroxysmal vertigo (BPPV) is a common vestibular disorder that is usually straightforward to diagnose and treat. However, management can be challenging in patients with significant physical limitations. We present a case of BPPV in a 70-year-old male with severe cervical spine rigidity. Fixation of the neck prevented the use of the standard Dix-Hallpike manoeuvre. The Thomas Richard Vitton (TRV) mechanical repositioning chair was employed to perform whole-body positional testing. This approach enabled a definitive diagnosis and successful treatment. The TRV chair can improve outcomes in patients who cannot undergo conventional manoeuvres.
Orbital cavernous hemangiomas are benign vascular tumors commonly found in adults but are rarely managed by otolaryngologists. Advances in endoscopic technology have expanded the use of endonasal endoscopic surgery for intraorbital lesions, providing minimal invasiveness and excellent cosmetic outcomes. We report the case of a 47-year-old woman with decreased vision in the left eye due to a cavernous hemangioma in the posteroinferior orbit. The tumor was completely resected via a bilateral transnasal endoscopic approach using the endoscopic modified medial maxillectomy technique and the transseptal access with crossing multiple incisions techniques, with minimal bleeding and preservation of visual function. Postoperative recovery was favorable, with improved vision and no recurrence at 6 months. The endonasal approach is particularly effective for lesions situated medial to the optic nerve, at the orbital apex, or in the inferomedial region and is considered the preferred method depending on tumor localization at preoperative diagnosis.
We present a case of coexistence of papillary thyroid carcinoma (PTC) and metastatic fallopian tube carcinoma within cervical lymph nodes. A 63-year-old female with a history of fallopian tube cancer presented with rising CA-125 levels and hypermetabolic cervical nodes. While fine-needle aspiration of the thyroid gland suggested PTC, a total thyroidectomy with central neck dissection revealed incidental bilateral PTC (pT1a) alongside unexpected central nodal metastasis from high-grade serous carcinoma. This diagnosis was confirmed via immunohistochemistry (WT-1+/p53+/TTF-1-). Following subsequent lateral neck dissection for recurrence and salvage chemotherapy, the patient achieved complete remission. This case underscores that cervical lymphadenopathy in patients with prior extra-thyroidal malignancy should not be presumed to be of thyroid origin. It highlights the critical diagnostic role of lymph node sampling and immunohistochemical differentiation in guiding definitive oncological management.
Plexiform neurofibromas (PNF) in neurofibromatosis type 1 (NF1) can mimic infantile hemangiomas on MRI, leading to misdiagnosis and inappropriate interventions. We highlight this diagnostic challenge and the role of genetic testing. A 14-year-old male with a retroauricular mass, initially misdiagnosed as a hemangioma, received an unsuccessful intralesional bleomycin injection before surgical resection. Histopathology confirmed a PNF. Trio-based whole-exome sequencing identified a pathogenic NF1mutation (c.6446_6447delinsAA) in the proband. Segregation analysis confirmed the same variant in his mother and sibling, establishing familial NF1. The patient recovered well postoperatively. This case underscores the risk of misdiagnosing PNF as hemangioma and emphasizes the necessity of a high suspicion for NF1, detailed family history, and application of diagnostic criteria. Genetic testing, particularly trio WES, is crucial for clarifying ambiguous diagnoses and identifying familial cases.
Benign paroxysmal positional vertigo (BPPV) involving the horizontal semicircular canal (HSC) typically presents with unidirectional nystagmus during positional testing. However, biphasic nystagmus, characterized by a spontaneous reversal of direction without head movement, can be observed. We report two cases of HSC BPPV (canalithiasis) in which biphasic positional nystagmus was observed during diagnostic positional testing. In both cases, the initial nystagmus spontaneously reversed after a brief latency, without any additional head movement. Notably, one case exhibited reversal on the ear-down side with weaker nystagmus—a pattern not previously described. We hypothesize that free-floating otoconia distributed in both anterior and posterior segments of the HSC may produce sequential excitatory and inhibitory responses, resulting in biphasic nystagmus. These cases may represent an atypical presentation of HSC BPPV and highlight the need for further investigation into otoconial dynamics and their influence on nystagmus patterns.
