Primary Inverted Papilloma of the Middle Ear

Significance Statement: Primary middle ear inverted papilloma is an exceedingly rare finding posing a diagnostic challenge, as symptomatology often mimics common clinical entities like serous otitis media. Clinical and radiological findings are not specific, whilst high recurrence rates, local destruction, and potential malignant transformation constitute an overall demanding surgical challenge, requiring aggressive procedures. We report the case of a primary inverted papilloma of the middle ear, discussing diagnostic and therapeutic issues.

Revisiting pathogenesis of protracted forms of serous otitis media

The article is devoted to the role of the regional lymphatic system of the middle ear, from the point of view of the pathogenesis of the prolonged presence of fluid in the air cavities of the temporal bone with a prolonged course of serous otitis media. The study was carried out in an experiment on a model of exudative otitis media in laboratory animals (20 sexually mature male Wistar rats). Studied the state of regional (superficial, facial, and deep) lymph nodes collecting lymph from the mastoid process, tympanic cavity; external auditory canal, auditory tube. Comparative morphological and morphometric studies of lymph nodes were carried out on the 12th day of experimental otitis media and were assessed according to 19 criteria: total area of the node section, area of the capsule, marginal sinus, cortex, paracortex, medullary sinuses, medullary cords, number and area of primary and secondary lymphoid nodules, area of germinal centers, specific areas of cortical and medullary substance, sinus system, cortical/medullary ratio (C/M index), T- and B-dependent areas. Disorders of lymph outflow in the middle ear area, different nature, and degree of response of regional lymph nodes of different groups to the exudative process were revealed. It is assumed that the restructuring of the structural organization of the nodes, reflecting the inhibition of their protective and drainage functions, can prolong the phenomena of lymphostasis in the area of the primary focus and lead to the protracted course of exudative otitis media in clinical practice.

Prevalence of Gerlach tonsil: a mucosa associated lymphoid tissue aggregation in the nasopharynx

<p class="abstract"><strong>Background:</strong> The major aggregate of mucosa associated lymphoid tissue located in the nasopharynx is the adenoid. The minor aggregate located in the nasopharynx is the Gerlach tonsils or tubal tonsils. The Gerlach tonsils are well described in the text books. But unlike the adenoids they are rarely visualized during routine endoscopic examination. Several studies conducted in children for recurrence of adenoids or serous otitis media after surgery; have reported tubal tonsil hypertrophy widely. This study in adults aims to see the prevalence of Gerlach or tubal tonsils visible during nasal endoscopy.</p><p class="abstract"><strong>Methods:</strong> The case records of 155 adult patients, aged between 18-50 years, who underwent pre-operative diagnostic nasal endoscopy for the management of septal deviations, chronic Sinusitis, nasal polyposis or eustachian dysfunction between Jan. 2019 to March 2020 are retrospectively reviewed and the endoscopy findings analyzed and presented. </p><p class="abstract"><strong>Results:</strong> Gerlach tonsil hypertrophy is reported to be more prevalent in children than in adults. When hypertrophied, the Gerlach tonsils can cause symptoms in adults also and can be visualized during nasal endoscopy. In this adult study, we report a 0.6% incidence of Gerlach tonsil hypertrophy. </p><p class="abstract"><strong>Conclusions:</strong> The possibility of a Gerlach tonsil hypertrophy is to be remembered during nasal endoscopy in adult patients presenting with symptoms of eustachian dysfunction and past history of allergic rhinitis and adeno tonsillectomy. Comparing the size of the contra lateral torus tubaris and the eustachian tube opening during the act of swallowing is helpful in diagnosis.</p>

Should adults with isolated serous otitis media be undergoing routine biopsies of the post-nasal space?

BackgroundSerous otitis media is a recognised presentation of Eustachian tube dysfunction secondary to post-nasal space pathology. Post-nasal space biopsies are commonly taken in patients with isolated serous otitis media, despite normal nasendoscopy findings, without robust evidence for doing so. This study examined cases of unilateral serous otitis media with effusion in adults. It is the largest known retrospective study to investigate whether post-nasal space biopsies are indicated in non-endemic regions.MethodsA retrospective analysis was performed of 119 patients who underwent post-nasal space biopsy because of isolated serous otitis media, in a tertiary referral centre, from 2007 to 2017. Endoscopic examination and final histological report findings were reviewed.ResultsOf the 119 patients identified, 6 (5.0 per cent) were found to have abnormal histology. In all six cases, suspicious clinical findings had been noted on nasendoscopic examination prior to biopsy.ConclusionSuspicious findings pre-operatively predict sinister pathology. Biopsies are not recommended in cases of adult serous otitis media with normal nasendoscopy findings if no other risk factors exist. A UK-wide retrospective study or prospective study over the next 10 years will help provide the evidence necessary to support this guidance.

Intractable chronic otitis media, rhinosinusitis and facial palsy: a case of active granulomatosis with polyangiitis

Granulomatosis with polyangiitis (GPA) is a rare systemic disease of unknown aetiology, characterised by necrotising granuloma formation and diffuse vasculitis. It typically affects the upper and lower respiratory tract in addition to the kidneys. Without treatment, the 2-year mortality rate exceeds 90%. We describe a presentation of intractable serous otitis media, rhinosinusitis, fever and unilateral facial palsy in an 18-year-old man with learning difficulties, which highlights the need for a high index of suspicion in diagnosing and treating this enigmatic disease.

Relationship Between Serum Vitamin D Levels and Serous Otitis Media in Children with Adenoid Hypertrophy Based on Age

Background: Serous Otitis Media (SOM) is one of the most common diseases of children that can lead to hearing loss and imbalance. Recently, the role of vitamin D has been identified in strengthening and regulating the immune system. Moreover, vitamin D supplementation has been recognized to improve the immune response against upper respiratory infection and pathogen overgrowth. Methods: A cross-sectional study was performed on 89 children aged 1 - 15 years with adenoid hypertrophy who met the inclusion criteria. The serum vitamin D level was compared between the two groups of children with and without SOM. Results: The mean age of the target children was 69.57 ± 25.65 months. The mean serum vitamin D level was 23.86 ± 12.7 in all patients. The mean serum vitamin D level was 24.7 ± 13.1 and 22.9 ± 12.2 in patients with and without SOM (based on tympanometry), respectively, yet the difference was not statistically significant. However, the difference was significant between the two groups of children with the age of < 84 months and > 84 months (P = 0.05). Conclusions: The role of vitamin D was identified in increasing the incidence of SOM in children older than 84 months with adenoid hypertrophy. In older children, the timely diagnosis and treatment of vitamin D deficiency can prevent severe SOM complications, which can save a lot of costs for families and the health system.