We report a missed case of otosyphilis presenting as otic capsule lucencies on temporal bone computed tomography.

A 58-year-old woman presented with a 15-year history of bilateral, mixed hearing loss together with otic capsule lucencies, subsequently confirmed as otosyphilis. A literature review of otosyphilis was undertaken based on a PubMed search of studies published between 1988 and 2012, using the key words ‘otosyphilis’, ‘otodystrophy’, ‘otic capsule lucencies’ and ‘luetic osteitis’.

Although rare, otosyphilis is important to recognise as it is one of the few treatable causes of deafness when diagnosed early. The differentiating computed tomography features of luetic osteitis (otosyphilis) of the temporal bone have only rarely been described. We emphasise how these imaging features can be used to distinguish the rare but treatable condition of luetic osteitis from other, more common conditions with similar imaging findings.

This paper reports on two patients with posterior inferior cerebellar artery infarction whose only presenting complaint was acute unilateral hearing loss.

In the two cases reported, sudden hearing loss was an initial symptom, with no other neurological signs. Infarction in the territory of the posterior inferior cerebellar artery was diagnosed using brain magnetic resolution imaging. The patients had some degree of hearing improvement 3 or 4 days after initial treatment.

In this article, new cases of posterior inferior cerebellar artery infarction presenting as sudden deafness, without prominent neurological signs, are described. Otologists should be aware that hearing loss can sometimes appear as a warning sign of impending posterior inferior cerebellar artery infarction.

We aimed to determine the prevalence of symptomatic subglottic laryngotracheal stenosis in patients with granulomatosis with polyangiitis (Wegener's granulomatosis); we also wanted to characterise the clinical outcomes and surgical interventions required, and the relapse rate in our cohort.

We undertook a retrospective clinical review of all granulomatosis with polyangiitis patients with symptomatic subglottic laryngotracheal stenosis attending St Thomas' Hospital, London, United Kingdom.

Symptomatic subglottic laryngotracheal stenosis developed in 16 per cent of granulomatosis with polyangiitis patients attending our clinic. The median age of patients at diagnosis was 44 years (range: 34–81 years); 78 per cent of those presenting with subglottic laryngotracheal stenosis were women and 22 per cent were men. All patients were white; 67 per cent of patients were proteinase 3-antineutrophil cytoplasmic antibody-positive and 67 per cent developed relapsing disease requiring repeated surgical intervention. Subglottic laryngotracheal stenosis relapse was not associated with active systemic vasculitis elsewhere.

Subglottic laryngotracheal stenosis is an uncommon but significant complication of granulomatosis with polyangiitis. Management of subglottic laryngotracheal stenosis requires a multi-disciplinary approach, with both rheumatological and otolaryngological expertise involved, given the relapsing nature of the disease.

Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissue that most commonly affects the feet and lower limbs. It is rare for this infection to occur on the face, and it is exceptionally rare for it to involve the nose and sinuses. This paper reports a rare case of nasal chromoblastomycosis in a 50-year-old Malaysian male.

The patient, who was a rubber plantation worker in the southern state of Johor, presented to the ENT clinic with a history of epistaxis. He did not recall any history of injury to the nose. Nasal endoscopy showed a pale yellowish lesion at the inferior edge of the left middle turbinate. Histology revealed that this was a case of chromoblastomycosis.

Chromoblastomycosis of the nasal cavity is very rare and can be mistaken for other granulomatous conditions in the nose. It progresses very slowly over many years. Our patient was managed conservatively, as he was not keen on undergoing surgical intervention. Lesion size remained the same at five months' follow up, with no recurrence of epistaxis.

Complementary and alternative medicine usage, though rising, remains largely devoid of a sound scientific basis; however, there is increasing evidence to support its use in cancer therapy.

To present the case of a patient with laryngeal carcinoma who made a full recovery following mistletoe therapy, despite failing to respond to chemoradiotherapy and salvage laryngectomy.

Case report with relevant literature review.

The patient developed extensive, unresectable stomal recurrence, and it was deemed appropriate to supply palliative care only. Following treatment with mistletoe extract injections after palliative radiotherapy, he recovered fully and was eventually discharged from care.

The benefit of mistletoe in laryngeal cancer treatment requires further investigation, and might be considered in selected patients, as an adjunct or when other conventional therapies have failed.

This paper reports a rare case of a human immunodeficiency virus infected man with gummatous syphilis of the face.

A 39-year-old man presented with an ulcer of the face which had been slowly progressive over the previous 6 years. Examination showed an ulcerative lesion of the midface involving the cheeks, and completely destroying the nose, the upper lip and part of the lower lip. The teeth and gums were exposed. The ulcer had a moist, purulent base with rolled edges. The patient had human immunodeficiency virus, with a cluster of differentiation 4 count of 641 cells per µl. The rapid plasma reagin test titre was 1:1024 and the Treponema pallidum haemagglutination assay result was positive. Biopsy showed non-necrotising granulomata with a negative Warthin–Starry silver stain. There was a dramatic response to treatment with penicillin.

This case study is a reminder that syphilis needs to be considered in the differential diagnosis of unusual presentations involving skin and bone.

We aimed to examine the clinical usefulness of a new World Health Organization classification scheme for salivary gland mucoepidermoid carcinoma, and to identify the factors most strongly associated with prognosis and outcome.

The clinicopathological features of 45 patients who received treatment for mucoepidermoid carcinoma between 1986 and 2010 were retrospectively investigated.

The overall disease-specific 5-year survival rate was 81.8 per cent. The rate for patients with low-grade tumours (92.5 per cent) was significantly higher than that for patients with intermediate or high-grade tumours (52.2 per cent). Univariate analysis revealed that five factors were significantly associated with five-year survival: age, tumour stage classification, lymph node status, histological grade and treatment method. Four factors were significant in multivariate analysis: age, sex, tumour stage classification and lymph node status.

The new World Health Organization classification was useful in predicting disease progression in patients with mucoepidermoid carcinoma. Patients with high-grade tumours or other prognostic factors positively associated with disease progression should be carefully evaluated and monitored.

Cochlear implant surgery is increasingly being performed through a small incision because of the benefits associated with this technique, such as fewer wound complications. Efforts have been made to maximise surgical exposure in order to improve this evolving technique; this includes the development and use of new retractors. For instance, elasticated stay hooks can retract skin in a radial fashion and they are less bulky than traditional retractors. These hooks are usually attached directly to surgical drapes or to a disposable retractor ring; there are disadvantages to both of these methods.

This paper describes a technique using a laryngeal suspension bar in which the bar acts as a fixed structure to which these elasticated stay hooks can be attached.

This technique was found to be safer, cheaper and more effective for obtaining optimal surgical exposure compared with a technique whereby the stay hooks are attached directly to the drapes or to a disposable retractor ring.

This paper describes the first reported case of progressive sensorineural hearing loss caused by azathioprine, which was reversed on stoppage of the drug.

A female patient with previously normal hearing presented with progressive sensorineural hearing loss after being started on azathioprine. Otological and neurological examination findings were unremarkable. After stopping the drug, the patient reported an improvement in hearing, which was confirmed on pure tone audiometry.

This previously unreported side effect of azathioprine is highlighted in order to increase clinical awareness. Early recognition of this adverse effect is important to minimise the possibility of permanent sensorineural hearing loss.

Maxillary sinus atelectasis is a form of chronic rhinosinusitis of uncertain aetiology. Previously, the conventional treatment for this condition has been standard endoscopic surgery. There are no reports in the literature of successful treatment using balloon sinuplasty.

A case of a patient with right maxillary sinus atelectasis is presented, who was treated using the balloon sinuplasty technique.

The patient's right maxillary sinus atelectasis was successfully treated using balloon sinuplasty. Three-month follow-up evaluation documented retention of the remodelled form of the uncinate process, and of maxillary sinus os patency.

This is the first report of successful use of the balloon sinuplasty technique for the treatment of maxillary sinus atelectasis. Follow up demonstrated resolution of the underlying pathophysiology. Further study of the balloon sinuplasty technique for the treatment of maxillary sinus atelectasis is required to determine whether it has widespread applicability, given the current standard treatment.