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  • ISSN: 2379-948X
    Volume 3, Issue 5
    Short Communication
    Kurren S. Gill*, Mindy Rabinowitz, James Evans, Marc Rosen, David Hsu, Christopher Farrell and Gurston Nyquist
    Introduction: As dedicated endoscopy suites for skull base surgery are becoming more prevalent, it is important to consider the optimal operative room setup. Multiple techniques have been presented for surgeon positioning for two-team endoscopic skull base surgery. Classically, the neurosurgeon and otolaryngologist stand adjacent to each other on the same side of the patient bed while operating. We describe an alternative approach utilizing dynamic endoscopy where the two surgeons stand across from each other. We discuss the merits of this approach from both a neurosurgical and otolaryngological perspective.
    Methods and results: We describe our technique of surgeon positioning, monitor positioning, operating room setup, and their implications on ergonomics and surgeon fatigability.
    Conclusion: We believe our approach of surgeon positioning, where surgeons stand on opposite sides of the patient bed while operating, to be a viable and more ergonomic alternative to the classical approach.
    O Judd* and R Persaud
    In the current litigious society, separating malingerers from true hearing loss patients is ever more important, especially when compensation for industrial hearing loss is claimed. We present a novel test for feigned hearing loss which is very quick and precise, and utilises equipment readily available in the Otolaryngology office.
    The test is based on the well established physiological phenomenon of bone conduction and exploits the fact that there is very little (0-12dB) attenuation of sound across the skull.
    Step 1: A 256Hz or 512Hz tuning fork is placed on the Mastoid process of the "Good Ear" (Left).
    Result – The patient reports hearing the sound.
    Step 2: The same 256Hz or 512Hz fork is placed on the Mastoid bone of the "Bad Ear" (Right).
    Result – The patient reports inability to hear the sound.
    Step 3: The test can be repeated as above as desired to confirm the results.
    The Judd-Persaud test is a simple, easy to perform, quick and accurate test for unilateral feigned hearing loss in the malingerer.
    Sébastien Lazzarotto, Karine Baumstarck* and Pascal Auquier
    Objectives: The aim of this study was to provide an overview of instruments available to assess the impact of age-related hearing loss (ARHL) on quality of life (QoL), and recommendations and guidance for clinicians that including their respective strengths and shortcomings.
    Methods: The search of the literature was performed from 1983 to 2013. The following papers were selected: related to the development or validation process for disease-specific questionnaires, related to the use of generic questionnaires on ARHL populations. A standardized data collection form was generated referring to different aspects of validation: general characteristics (name and acronym, year of publication, original language, number of items, response scale, domains, scoring, and completion time…), population, psychometric properties.
    Results: One hundred and twenty papers were analysed. Two questionnaires explored specifically the impact of hearing impairment on QoL; only one had been specifically developed to explore QoL among individuals with ARHL: the Hearing Handicap Inventory for Elderly. Two instruments explored the impact on the QoL and daily life of conditions/symptoms that can be linked to a hearing loss (dizziness and tinnitus). Among the studies assessing the QoL using generic questionnaires, two questionnaires were identified: SF-36 and WHO-QOL BREF.
    Conclusion: This literature review identified two ARHL-specific instruments supporting the possibility of developing a new instrument using more recent standard methods of development. Recommendations could be based on: item generation based exclusively on the patient's point of view, a validation process performed on a large and representative population of patients with ARHL.
    Case Report
    Erica Cristina Campos e Santos*, Natalia Maria Couto Bem Mendonca, Milton Pamponet da Cunha Moura, Washington Luiz de Cerqueira Almeida and Paulo Sergio Lins Perazzo
    Introduction: Paragangliomas (PGL) are uncommon tumors originated from the neural crest. They represent only 0.012% of all tumors and 0.6% of tumors in head and neck topography. The goal is to report a rare disease of atypical presentation.
    Case Report: A 40- year- old male presented to our service complaining of neck pain for six months with worsening in the last month, foreign body sensation in throat and hoarseness. Direct laryngoscopy was performed and mass of nodular aspect, rich in vascularization was detected in the left aryepiglottic fold. The patient underwent laryngeal microsurgery to remove the lesion with a suspected diagnosis of cyst or granuloma. Twelve hours after the surgical procedure reproach was needed, because the patient had heavy bleeding at the site. The hemorrhage was contained with cauterization of the bleeding site. Histopathology showed the presence of neuroectodermal lineage cells, which required immune histochemistry examination to establish final diagnosis, which revealed PGL. In postoperative follow-up the patient presented with improved clinical picture without neck pain.
    Conclusion: PGL are rare tumors, usually benign, rich in vascularization and slow growing. Surgical excision is the treatment of choice.
    Thomas B. V Nguyen*, Ronald Y Chin and Firoz Iqbal
    Background: Malignant peripheral nerve sheath tumors (MPNST) are rare soft tissue sarcomas. They can arise from pre-existing benign nerve tumors, from normal nerves or as secondary neoplasm's 10 to 20 years after radiation therapy. They are most commonly found on the extremities and trunk and less often in the head and neck. These tumors are characteristically aggressive, resulting in considerable patient morbidity and generally a poor prognosis. MPNST of the accessory nerve have not yet been described. We highlight a case that occurred at the right base of skull that presented as hypoglossal nerve palsy. Case Description: A 47 year old male presented with intermittent, multiple cranial nerve palsies and wasting and fasciculation's of the right tongue. He had a previous Hodgkin's Lymphoma which was treated with radiotherapy 24 years prior. A CT scan showed a heterogeneous soft tissue density mass within the right superior carotid space. This was avidly enhancing on MRI with extension to the right jugular foramen with local mass effect. Multiple FNA biopsies were non-diagnostic and an excision of the lesion diagnosed a MPNST of the accessory nerve. He was then treated with further radiation therapy after discussion at a multidisciplinary head and neck cancer meeting.
    Conclusion: MPNSTs are rare tumors that seldom occur in the head and neck. MPNSTs are staged and treated as malignant soft tissue sarcomas. Because they are rare, there are currently no definitive efficacy trials. In various studies, five-year survival rates range from 34 to 64 percent. We present a case occurring at the jugular foramen which presented with palsies in the relevant cranial nerves.
    Deena Pourang*, Richard Green, Javed Sheikh and Shefali Samant
    An 84 year-old man presented with chronic cough and subsequent dysphagia. He was noted to have hoarse speech, right tongue atrophy and weakness, and a palpable right cervical lymph node. Nasolaryngoscopy confirmed right-sided vocal cord paralysis, and magnetic resonance imaging showed ill-defined tissues and lymphadenopathy in the right tonsillar region, and he was diagnosed with Tapia's syndrome secondary to metastatic primary CNS lymphoma. He subsequently underwent laryngoplasty with hyaluronic acid gel injection, but deferred chemotherapy or radiation, and passed away shortly thereafter. This is the first reported case of adult-onset Tapia's syndrome secondary to metastatic primary CNS lymphoma.
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