Case Report: Inflamed Jacobson nerve: an uncommon cause of persisting otalgia after an acute otitis media

Introduction

Otalgia can have multiple causes. Mostly otalgia is caused by a tubal dysfunction or an acute middle ear infection. This case describes a patient with an inflammation of the Jacobson's nerve causing severe persistent otalgia after an acute otitis media. The patients complaints completely disappeared after neurolysis of the Jacobson's nerve.

Case presentation

We describe a case of a 21-year-old female caucasian patient with acute otitis media and persistent intractable otalgia. Infection was first successfully controlled by antibiotics. But the patient reported a persistent otalgia not responding to analgetics. We performed a CT scan, which exhibited a regular aerated middle ear finding, and a diagnostic tympanoscopy to examine the middle ear structures particularly the tympanic Jacobson's nerve as a possible cause for persistent pain. The following neurolysis of Jacobson's nerve under general anaesthesia led to a resolution of otalgia.

Conclusion

An inflamed tympanic Jacobson's nerve is a rare observation and a persisting otalgia after an acute otitis media not responding to conservative treatment can be treated by a neurolysis.

A new device for the removal of cochlear schwannoma: A temporal bone study

Background

Intralabyrinthine schwannoma (ILS) is a rare, mostly unilateral disease that causes deafness. Different intralabyrinthine sites of ILS can occur and can be removed by different surgical approaches. Cochlear ILSs are frequently partially hidden by the modiolus and therefore difficult to extirpate. Surgical techniques can be traumatic, offer limited surgical control during removal, and are time-consuming. The aim of this present study was to demonstrate the performance and handling of a newly developed device for the removal of cochlear intralabyrinthine schwannoma in the temporal bone.

Methods

In a temporal bone study with a prepared posterior tympanotomy, an enlarged round window approach, and additional second turn access, a stiffened device with silicone rings was inserted and extracted gradually from the second turn access until the rings were visible in the second turn access.

Results

Insertion and extraction of the second cochlear access were easily performed. Pulling and pushing the silicone rings through the modiolus and hidden parts of the basal turn was possible and worked like a pipe cleaner.

Conclusion

This newly developed tissue removal device in combination with the proposed surgical handling offers a new and less traumatic way to remove cochlear ILS.

Primary head and neck cancer cell cultures are susceptible to proliferation of Epstein-Barr virus infected lymphocytes

BACKGROUND

New concepts for a more effective anti-cancer therapy are urgently needed. Experimental flaws represent a major counter player of this development and lead to inaccurate and unreproducible data as well as unsuccessful translation of research approaches into clinics. In a previous study we have created epithelial cell cultures from head and neck squamous cell carcinoma (HNSCC) tissue.

METHODS

We characterize primary cell populations isolated from human papillomavirus positive HNSCC tissue for their marker expression by RT-qPCR, flow cytometry, and immunofluorescence staining. Their sensitivity to MDM2-inhibition was measured using cell viability assays.

RESULTS

Primary HNSCC cell cultures showed the delayed formation of spheroids at higher passages. These spheroids mimicked the morphology and growth characteristics of other established HNSCC spheroid models. However, expression of epithelial and mesenchymal markers could not be detected in these cells despite the presence of the HNSCC stem cell marker aldehyde dehydrogenase 1 family member A1. Instead, strong expression of B- and T-lymphocytes markers was observed. Flow cytometry analysis revealed a heterogeneous mixture of CD3 + /CD25 + T-lymphocytes and CD19 + B-lymphocytes at a ratio of 4:1 at passage 5 and transformed lymphocytes at late passages (≥ passage 12) with CD45 + CD19 + CD20 + , of which around 10 to 20% were CD3 + CD25 + CD56 + . Interestingly, the whole population was FOXP3-positive indicative of regulatory B-cells (B_regs). Expression of transcripts specific for the Epstein-Barr-virus (EBV) was detected to increase in these spheroid cells along late passages, and this population was vulnerable to MDM2 inhibition. HPV + HNSCC cells but not EBV + lymphocytes were detected to engraft into immunodeficient mice.

CONCLUSIONS

In this study we present a primary cell culture of EBV-infected tumor-infiltrating B-lymphocytes, which could be used to study the role of these cells in tumor biology in future research projects. Moreover, by describing the detailed characteristics of these cells, we aim to caution other researchers in the HNSCC field to test for EBV-infected lymphocyte contaminations in primary cell cultures ahead of further experiments. Especially researchers who are interested in TIL-based adopted immunotherapy should exclude these cells in their primary tumor models, e.g. by MDM2-inhibitor treatment. BI-12-derived xenograft tumors represent a suitable model for in vivo targeting studies.

Corrigendum: A new device for the removal of cochlear schwannoma: A temporal bone study

[This corrects the article DOI: 10.3389/fsurg.2023.1077407.].

3T MRI-based estimation of scalar cochlear implant electrode position

Common techniques to evaluate intracochlear electrode position include ionised radiation by multi-slice computer tomography, digital volume tomography (MSCT, DVT) and flat panel tomography (FPT). Recent advances in the knowledge about handling MRI artefacts and the pain-free performance of MRI scans in cochlear implantees showed that estimation of the intracochlear electrode position is possible at 1.5 T with perimodiolar or midmodiolar arrays. The aim of the present study is to evaluate the assessment of the ipsilateral scalar position of a cochlear implant lateral wall electrode by MRI sequences at 3T. In a prospective study we evaluated 10 patients implanted with a diametrically bipolar implant magnet system with a lateral wall electrode in the intrascalar electrode position in an axial and coronal position and a T2 weighted sequence at 3T and a resolution of 0.8 mm. We compared the intracochlear position with routine postoperative DVT scan. In all cases, the MRT-estimated scalar position corresponded with that estimated by DVT scan. In all cases, a scala tympani position was present. While the position in the basal turn is reliably localisable, the first-turn visual assessment is difficult. Estimation of the intracochlear position of lateral wall cochlear implant electrodes by 3T MRI is possible for the basal turn. Electrode design plays a major role in visual assessment.

[Intralabyrinthine schwannomas]

Schwannomas are benign neurogenic tumors arising from Schwann cells that usually form the myelin sheath of peripheral nerves. The typical localization of vestibular schwannomas is the internal auditory canal or the cerebellopontine angle. Intralabyrinthine lesions are extremely rare. Here we describe a series of four consecutive cases of intralabyrinthine schwannomas that were treated in the Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Bielefeld in Bielefeld, Germany. Therapeutic options are discussed and the literature is reviewed.

Epstein-Barr Virus Infection associated with Acute Recurrent Laryngeal Nerve Palsy

Introduction

Epstein-Barr virus (EBV) belongs to the group of human herpes viruses and can cause the clinical syndrome of infectious mononucleosis. EBV infection has been reported to cause several neurological complications. However, cranial nerve deficits are rare and have been infrequently reported. To our knowledge, recurrent laryngeal nerve palsy in EBV acutely infected patients has been reported only once with a case of bilateral laryngeal nerve palsy.

Case presentation

A case of a 41-year-old female Caucasian patient with a positive serology of active EBV infection developing acute recurrent laryngeal nerve palsy is presented. Fiberoptic rhinolaryngoscopy with stroboscopy showed complete paralysis of the left vocal cord in abduction with abundant secretions, consistent with unilateral recurrent laryngeal nerve paralysis. Full recovery over a 6-month follow-up period has been achieved by starting immediate speech therapy.

Conclusion

Our case report confirms the possible involvement of EBV infection in recurrent laryngeal nerve palsy. This rarely described association should be taken into account as an extremely rare differential diagnosis in patients suffering from recurrent laryngeal nerve paralysis and fatigue symptoms with muscle pain. To minimize the risk of permanent palsy, immediate speech therapy is recommended.

Juvenile nasopharyngeal angiofibroma: management and therapy

OBJECTIVE

To conduct a review of contemporary approaches on the diagnostic-preoperative, operative, and postoperative methods in the management of juvenile nasopharyngeal angiofibroma (JNA).

STUDY DESIGN

Retrospective study of 14 cases of JNA resection at the Department of Otorhinolaryngology, University of Innsbruck (Innsbruck, Austria) between 1987 and 1998.

METHODS

Data was obtained for each patient regarding age, presenting symptoms, duration of symptoms, biopsy findings, tumor location, administration of preoperative angiography and embolization, and surgical approach. The follow-up period ranged from 1 to 13 years.

RESULTS

Based on the histological evaluation by the preoperative biopsy and the tumor location, several surgical approaches were applied. A transnasal endoscopic procedure was employed in seven cases. The preoperative embolization and the intranasal approach with the potassium titanyl phosphate laser minimized blood loss. The recurrence rate was at a low of 15%.

CONCLUSION

The surgical approach should be determined by tumor location, tumor size, and effectiveness of tumor embolization. For patients with JNA with tumor extension involving the nasopharynx, the nasal cavity, the paranasal sinuses, and the pterygopalatine fossa, the transnasal endoscopic technique offers a minimally invasive resection of the entire tumor mass with minimal morphological disturbance.