This case aims to report an unusual clinical situation with uncommon and severe side effects, which can even be life threatening for the patient. The ENT and Hematology specialist should be aware of diagnosing and treating adequately.

Benign paroxysmal positional vertigo (BPPV) is one of the most common disorders that causes dizziness. The incidence of horizontal semicircular canal (HSC) BPPV ranges from 5% to 40.5% of the total number of BPPV cases diagnosed. Several studies have focused on establishing methods to treat BPPV caused by the apogeotropic variant of the HSC, namely, the Appiani maneuver (App). In 2016, a new maneuver was proposed: the Zuma e Maia maneuver (ZeM), based on inertia and gravity. The aim of this study is to analyze the efficacy of App versus ZeM in the resolution of episodes of BPPV produced by an affectation of the horizontal semicircular canal with apogeotropic nystagmus (Apo-HSC). A retrospective, quasi-experimental study was conducted. Patients attended in office (November 2014-February 2019) at a third-level hospital and underwent a vestibular otoneurology assessment. Those who were diagnosed with Apo-HSC, treated with App or ZeM, were included. To consider the efficacy of the maneuvers, the presence of symptoms and/or nystagmus at the first follow up was studied. Patients classified as A were those with no symptoms, no nystagmus; A/N+: no symptoms, nystagmus present during supine roll test; S: symptoms present. Previous history of BPPV and/or otic pathology and calcium levels were also compiled. From the 54 patients included, 74% were women. The average age was 69. Mean follow-up: 52.51 days. In those patients without previous history of BPPV (n = 35), the probability of being group A was 63% and 56% (p = 0.687) when treated with App and ZeM, respectively, while being A/N+ was 79% and 87% for App and ZeM (p = 0.508). Of the 19 patients who had previous history of BPPV, 13% and 64% were group A when treated with App and ZeM (p = 0.043), and 25% and 82% were A/N+ after App and ZeM, respectively (p = 0.021). In conclusion, for HSC cupulolithiasis, ZeM is more effective than App in those cases in which there is a history of previous episodes of BPPV (A: 64% (p = 0.043); A/N+: 82% (p = 0.021)).

Objectives The method of drug delivery directly into the cochlea with an implantable pump connected to a CI electrode array ensures long-term delivery and effective dose control, and also provides the possibility to use different drugs. The objective is to develop a model of inner ear pharmacokinetics of an implanted cochlea, with the delivery of FITC-Dextran, in the non-human primate model. Design A preclinical cochlear electrode array (CI Electrode Array HL14DD, manufactured by Cochlear Ltd.) attached to an implantable peristaltic pump filled with FITC-Dextran was implanted unilaterally in a total of 15 Macaca fascicularis (Mf). Three groups were created (5 Mf in each group), according to three different drug delivery times: 2 hours, 24 hours and 7 days. Perilymph (10 samples, 1¿L each) was sampled from the apex of the cochlea and measured immediately after extraction with a spectrofluorometer. After scarifying the specimens, x-Rays and histological analysis were performed. Results Surgery, sampling and histological analysis were performed successfully in all specimens. FITC-Dextran quantification showed different patterns, depending on the delivery group. In the 2 hours injection experiment, an increase in FITC-Dextran concentrations over the sample collection time was seen, reaching maximum concentration peaks (420-964µM) between samples 5 and 7, decreasing in successive samples, without returning to baseline...

Objectives: The aim of this study was to determine whether the dexamethasone-eluting electrode (DEXEL) has a protective anti-inflammatory effect in a normal hearing implanted cochlea, as well as its performance and safety. Design: Ten healthy and normal hearing cynomolgus macaques (Mf) were divided into two cohorts: DEXEL group (DG) (CONCERTO CI device containing a DEXEL) and conventional CI group (CG) (unmodified CONCERTO CI device). The electrode was inserted into the scala tympani via the round window with an angle of insertion of 270 degrees. Auditory, impedance, electrically evoked compound action potential (eCAP), and recovery of function measurements were recorded monthly until sacrifice at 6 months post-implantation. A histologic analysis was also performed. Results: At 6 months, measurement of auditory brainstem responses revealed a mean threshold shift, as well as a mean impedance value, lower in the DEXEL group. The minimum eCAP for the remaining active contacts in the DEXEL group was 68% of that in the conventional CI group. Also at 6 months, the eCAP amplitude produced by a stimulating current of 800 cu (eCAP800) was almost 2.5-fold higher in the DEXEL group than in the conventional CI group (1338.86 +/- 637.87 mu V versus 545.00 +/- 137.37 mu V; p = 0.049). Tissue reactions, in particular fibrosis and ossification, were more common in the conventional CI group. Conclusions: The CI electrode array equipped with a dexamethasone-eluting component tested in ...

Purpose To compare the surgical and audiological outcomes with two perimodiolar electrode arrays (Nucleus 512-Contour Advance (R) y Nucleus 532-Slim Perimodiolar (R)) and a straight electrode array (Nucleus 422/522). Methods Patients were retrospectively selected from our cochlear implant program database. Only patients with a history of bilateral, sensorineural postlingually profound hearing loss who underwent cochlear implant surgery with either a N512, a N532 or a N422 were included. Throughout a year of follow-up, pure tone audiometry (PTA), speech perception, Impedances and T-C Thresholds levels were analyzed. Surgical data were also analyzed. Results 66 patients were included (19-CI532, 20-CI512 and 27-CI422). The most common type of cochlea access with the N532, N512 and N422 was through an extended round window, a promontorial cochleostomy and a pure round window, respectively. No significant differences were observed after 12 months in Mean PTA and Speech recognition. No significant differences were seen in the levels of hearing preservation at frequencies of 250 and 500. The average values of the impedances were significantly higher in the CI group N532 and N422 than in the N512. The mean values of the T and C levels were significantly lower in the CI groups N532 and N422 compared with the N512. Conclusions No significant differences were observed after 12 months in Mean PTA and Speech recognition; however, a faster acquisition of auditory results were observed in the group of patients treated with the CI N532. The type of electrode array influences in the type of cochleostomy.

We present a case report of a 25-year-old male patient who was complaining about a sensation and noise described as a ''sponge crunching'' in the right preauricular region and right ear that was more noticeable when inflating the cheeks. Under the clinical suspicion of a pneumoparotid case, a CT scan was performed. The study revealed the presence of air in the ductal system and within the gland. The patient was diagnosed with pneumoparotid and was treated conservatively. Herein, we review the literature and discussion the management of this uncommon condition. © 2020

Introduction Chronic rhinosinusitis (CRS) is a highly prevalent pathology in our society. Due to the prevalence of this condition and to the persisting symptoms despite an appropriate medical treatment, surgical techniques are often required. Lately, minimal invasive techniques have been described, such as lacrimal diversion devices (LDDs). This technique offers a fast and convenient choice for delivery of sinus irrigation and topical medication. Objective We aimed to describe our experience with LDDs and evaluate the safety and effectiveness of the procedure in patients with moderate to severe CRS without nasal polyposis (CRSsNP) and persistent symptomatology despite medical therapy. Methods A total of 7 patients underwent bilateral lacrimal stents placement in the operating room. A retrospective observational study was conducted. The Sino-Nasal Outcome Test-20 (SNOT-20) survey was performed and the score obtained was compared before and 1month after the procedure. Results The LDDs were used for an average of 80 days. During the follow-up, only three patients had a mild complication with the device (granuloma in the punctum, obstruction, and early extrusion). The mean baseline SNOT-20 score dropped significantly ( p =0.015) from 25.85 to 11.57 (mean: - 14.29) 1month after the procedure. Conclusion According to our experience and results, the use of LDD is a novel, feasible, and less invasive technique to treat refractory CRS. It reduces the risk of mucosal stripping, provides short-term outcomes, and the surgical procedure does not require advanced training in endoscopic sinus surgery. Moreover, it can be performed in-office under local anesthesia or sedation.

The placement of a Hypoglossal Nerve Stimulation Implant (HNSI) is a surgical technique, which requires specialized training by the surgeon. As it is already known, in medicine all treatments must be individualized and specifically in this case, treatment and care of every patient with OSA should be carried out in an interdisciplinary and an integral way. The existence of preset guidelines for patient selection pursue to get the same results and guarantee the best outcome. The aim of this chapter is to discuss special situations that may be encountered when choosing the right candidate for surgery, diverse conditions that may need to be changed during surgery, and follow-up that may need to be individualized to obtain the best benefits.

Atrophic rhinitis (or rhinosinusitis) (AR) is a complex syndrome associated with progressive atrophy of the nasal mucosa and underlying bone [1]. It is a disease of debatable and often unproven etiology [2]. Some consensus exists [3] around the general theory that it can originate either as a primary form (as discussed in previous chapters) that is mostly related to bacterial colonization [4] or as a secondary consequence of traumatic and inflammatory stimuli to the nasal mucosa. Both situations lead to a significant impairment in the quality of life of the patient [5]. The purpose of this chapter is to conduct an in-depth exploration of the form of atrophic rhinitis that occurs after sinonasal surgical intervention. This type of atrophic rhinitis will be referred to as ¿empty nose syndrome¿ (ENS). Specific etiologies and epidemiology and proposed theories for pathophysiology will be discussed. Typical clinical manifestations, as well as features that are distinct from the primary form, will be reviewed. Finally, we seek to provide a guide for the diagnosis and management of this chronic pathology according to existing evidence in the literature.