Validation and reliability analysis of the Questionnaire on the Emotional Impact of Vertigo-CIEV version translated to the Brazilian Portuguese language

PURPOSE

To determine the internal consistency and reliability of the "Questionário de Impacto Emocional da Vertigem (CIEV)" and to validate the instrument with respect to the Dizziness Handicap Inventory (DHI) in a sample of individuals with balance disorders.

METHODS

38 subjects participated in the study, males and females, aged from 23 to 85 years, who presented dizziness, vertigo, and/or falls complaints and attended to the Vestibular Disorders clinic at the University Hospital. Individuals with hearing complaints and/or tinnitus unrelated to dizziness, previous psychiatric comorbidities, and/or cognitive impairments were excluded. We performed an anamnesis and collected complementary data from the medical records. After that, the self-perception questionnaires, DHI, and CIEV, were applied. Statistical analysis was performed in which the Cronbach's alpha verified the internal consistency of the CIEV. Reliability and validity of the CIEV related to the DHI were calculated using Intraclass Correlation Index (ICC) and Pearson's correlation test, respectively.

RESULTS

There was a statistically significant correlation between the scores obtained, for both reliability and validation analysis (p<0.001). The mean ICC showed a moderate correlation between the total scores (0.695) and a strong correlation with the physical, emotional, and functional DHI domains (0.706 to 0.869), being the emotional aspect the highest degree (0.869). Pearson's correlation showed strong correlation between the total scores (r=0.820) and varied from moderate to strong, with strongest correlations to the DHI emotional domain (r=0.788).

CONCLUSION

The outcomes illustrate important contribution to validation parameters to consider clinical use of the CIEV in the Brazilian population, aiming to identify emotional aspects in patients with balance disorders.

Dissociation between video head impulse test and caloric test: a marker of menière's disease? - A systematic review and meta-analysis

OBJECTIVE

To analyze, by means of a systematic review and meta-analysis, the proportion of patients with Meniere's disease who have altered caloric test and vHIT, as well as to determine the prevalence of altered caloric test and normal vHIT dissociation in the diagnosis of Meniere's disease.

METHODS

The literature search had no restriction regarding the period of publication on the following indexed data platforms: PubMed, PubMed PMC, BVS-Bireme, Web of Science, Embase and Cochrane Library. Articles that evaluated patients with Meniere's disease who underwent caloric test and vHIT were included. Two researchers independently conducted the analysis of the articles, promoting the selection and capture of data, following the recommendations of the PRISMA method, and complying with the criteria for articles inclusion and exclusion defined in the research protocol. In case of disagreement during the selection process, a third researcher was included for analysis.

RESULTS

From a total of 427 initial studies, the researchers selected 12 articles, published between 2014 and 2021, with a total of 708 patients evaluated, with a mean age of 52.72 years old. The prevalence of patients with Meniere's disease with altered caloric reflex test was 64% (95% CI 57%‒71%), while the prevalence of altered vHIT was only 28% (95% CI 16%-40%). The prevalence of the altered caloric test + normal vHIT dissociation was 47% (95% CI 37%-57%).

CONCLUSION

The video head impulse test and the caloric test are valuable tools for vestibular assessment. The dissociation of findings between these two tests in patients with Meniere's disease was more prevalent in this meta-analysis and may be a result of the tonotopy of specialized hair cells in the ampullary crest. The prevalence of altered caloric test was 64% and anormal vHIT was 28%. The dissociation caloric asymmetry and normal vHIT was observed in 47% of the patients.

LEVEL OF EVIDENCE: 1

Vestibular recruitment: new application for an old concept

INTRODUCTION

Vestibular recruitment is a sign of hyperexcitability of central vestibular neurons and may be characteristic of peripheral vestibular damage.

OBJECTIVE

To define the post-caloric recruitment index and its ability to predict the stage of vestibular compensation and peripheral lesion.

METHODS

First of all, we demonstrated that larger values in the cold post-caloric stimulation compared to warm stimulation were equivalent to vestibular recruitment observed during the sinusoidal harmonic acceleration test. In the next step, patients with vestibular complaints and asymptomatic controls were submitted to the caloric test. We calculated post-caloric recruitment index for the control group. Among the study group, we analyzed the relation between post-caloric recruitment and unilateral weakness as well as the types of vestibular diagnoses.

RESULTS

Mean post-caloric recruitment was 17.06% and 33.37% among the control and study group, respectively. The ratio between post-caloric recruitment and unilateral weakness was 1.3 in the study group. Among recruiting subjects, no significant difference of unilateral weakness from the lesioned or healthy side was observed. We found no differences in vestibular diagnoses between recruiting and non-recruiting subjects.

CONCLUSION

Post-caloric recruitment index identified asymmetric vestibular tonus and central compensation. The normal value was established at 17.06%.

Does the video head impulse test replace caloric testing in the assessment of patients with chronic dizziness? A systematic review and meta-analysis

Introduction

Caloric testing is the most frequently used test to assess peripheral vestibular function since the beginning of the 20th century. However, the video head impulse test, vHIT, has gained prominence in the field of neurotology, as it is a faster examination, easier to perform and less uncomfortable for the patient.

Objective

To compare, through systematic review and meta-analysis, the proportion of altered cases between vHIT tests and caloric testing in patients with chronic dizziness, in addition to assessing the sensitivity and specificity of vHIT, with caloric testing as the gold standard.

Methods

The literature search was carried out in the PubMed, Scopus, BVS-Bireme, Web of Science, Embase, Cochrane and ProQuest indexed databases, with no restrictions regarding the publication period. All articles that contained the results of the two tests were included in the evaluation of patients with dizziness. Two researchers independently conducted data selection and extraction from the studies, strictly following the inclusion and exclusion criteria defined in the research protocol. In case of disagreement during the selection, a discussion was carried out with a third evaluator.

Results

Eleven of the 1293 initial articles met the eligibility criteria and were analyzed. 2670 patients were evaluated, of which 1112 (41.6%) were males and 1558 (58.4%) females, with a mean age of 51.6 years. The proportion of altered results in the vHIT was 21% (95%CI 9% –33%), and 55% in the caloric testing (95%CI 43% –67%).

Conclusion

The vHIT does not substitute for caloric testing. The tests are complementary in assessing the patient with dizziness, as they describe the tonotopy of the ampullary crest at different frequency ranges of stimulation. In chronic cases, the vHIT has a low sensitivity and high diagnostic specificity in comparison to caloric testing.

Proposal of standardization of Horus® computerized posturography in adults

PURPOSE

To propose a normalization model of a posturography platform in adults without changes in body balance, through descriptive analysis by age group and sex.

METHODS

Cross-sectional observational study. Adults, with no changes in body balance and no vestibular complaints were submitted to 6 sensory conditions on the Horus® posturography platform. The following variables were analyzed: stability limit area and confidence ellipse area, trajectory length and average velocity for each condition tested. The variables were analyzed by age group and sex. The equilibrium score, the sensory integration test and the equilibrium index were calculated on the conditions.

RESULTS

Sixty-one subjects (38.3%) and 23 (37.7%) were male, 40 (65.57%) between the ages of 20 and 40 and 21 (34.43). %) between 41 and 59 years. The area of the stability limit and pressure center variables for 6 sensory conditions tested - confidence ellipse area, trajectory length, total mean velocity and confidence ellipse ratio by the area of the stability limit were described. There was a statistically significant difference in the comparison between the area of the stability limit between sexes and between age groups, being a higher value in males and in younger patients. Regarding the analysis of the variables by each condition, there was no difference of results between the sexes and age groups.

CONCLUSION

Subjects of different sexes and age groups should be considered separately only in the analysis of the stability limit.

Neurotology: definitions and evidence-based therapies - Results of the I Brazilian Forum of Neurotology

Introduction

Neurotology is a rapidly expanding field of knowledge. The study of the vestibular system has advanced so much that even basic definitions, such as the meaning of vestibular symptoms, have only recently been standardized.

Objective

To present a review of the main subjects of neurotology, including concepts, diagnosis and treatment of Neurotology, defining current scientific evidence to facilitate decision-making and to point out the most evidence-lacking areas to stimulate further new research.

Methods

This text is the result of the I Brazilian Forum of Neurotology, which brought together the foremost Brazilian researchers in this area for a literature review. In all, there will be three review papers to be published. This first review will address definitions and therapies, the second one will address diagnostic tools, and the third will define the main diseases diagnoses. Each author performed a bibliographic search in the LILACS, SciELO, PubMed and MEDLINE databases on a given subject. The text was then submitted to the other Forum participants for a period of 30 days for analysis. A special chapter, on the definition of vestibular symptoms, was translated by an official translation service, and equally submitted to the other stages of the process. There was then a in-person meeting in which all the texts were orally presented, and there was a discussion among the participants to define a consensual text for each chapter. The consensual texts were then submitted to a final review by four professors of neurotology disciplines from three Brazilian universities and finally concluded. Based on the full text, available on the website of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery, this summary version was written as a review article.

Result

The text presents the official translation into Portuguese of the definition of vestibular symptoms proposed by the Bárány Society and brings together the main scientific evidence for each of the main existing therapies for neurotological diseases.

Conclusion

This text rationally grouped the main topics of knowledge regarding the definitions and therapies of Neurotology, allowing the reader a broad view of the approach of neurotological patients based on scientific evidence and national experience, which should assist them in clinical decision-making, and show the most evidence-lacking topics to stimulate further study.

Caloric test and video head impulse test sensitivity as vestibular impairment predictors before cochlear implant surgery

OBJECTIVES

Currently, cochlear implant procedures are becoming increasingly broad and have greatly expanded. Bilateral cochlear implants and cochlear implants are more frequently applied in children. Our hypothesis is that the video head impulse test may be more sensitive than the caloric test in detecting abnormal vestibular function before cochlear implant surgery. The objective of this study was to compare the video head impulse test and caloric test results of patients selected for cochlear implant procedures before surgery.

METHODS

The patients selected for cochlear implant surgery were submitted to a bithermal caloric test and video head impulse test.

RESULTS

By comparing angular slow phase velocity values below 5° in the bithermal caloric test (hypofunction) and video head impulse test with a gain lower than 0.8, we identified 37 (64.9%) patients with vestibular hypofunction or canal paresis and 21 (36.8%) patients with abnormal video head impulse test gain before the cochlear implant procedure. Of the 37 patients with caloric test vestibular hypofunction, 20 (54%) patients exhibited an abnormal gain in the video head impulse test.

CONCLUSION

The caloric test is more sensitive than the video head impulse test (Fisher's exact test, p=0.0002) in detecting the impaired ear before cochlear implant delivery. The proportion of caloric test/video head impulse test positive identification of abnormal vestibular function or caloric test/video head impulse test sensitivity was 1.8:1.

Video head impulse test relevance in the early postoperative period after cochlear implantation

BACKGROUND

Cochlear implantation (CI) is the gold standard therapy for profound or severe sensorineural hearing loss. It is a safe surgical procedure but, because of the proximity of the cochlea and vestibule, postoperative vestibular disorder may occur. Our hypothesis is that the video head impulse test (vHIT) may be a good tool to achieve a topographic diagnosis of dizziness in the early postoperative period after CI.

AIMS/OBJECTIVES

To evaluate patients with instability, imbalance and vertigo between 7 and 14 days after CI procedure.

MATERIAL AND METHODS

A total of 31patients scheduled for unilateral CI were included in this study. vHIT for horizontal semicircular canal was performed before CI and between days 7 to 14 after the surgery.

RESULTS

Six subjects had dizziness complaints after CI: instability (N = 2), imbalance (N = 2) and vertigo (N = 2). The postoperative vHIT test turned abnormal only in subjects with vertigo as compared to the preoperative vHIT test results.

CONCLUSION AND SIGNIFICANCE

vHIT is a good vestibular function test during the first 2 weeks after CI surgery when vertigo is the main complaint.

Sensitivity of caloric test and video head impulse as screening test for chronic vestibular complaints

OBJECTIVE:

This study compared the results of the caloric test with those of the video head impulse test obtained during the same session and evaluated whether the former can be used to screen for non-acute vestibular dysfunction.

METHODS:

A total of 157 participants complaining of dizziness with vestibular characteristics of varying durations and clinical courses completed the caloric test and video head impulse test.

RESULTS:

Significantly more caloric test results than video head impulse test results were abnormal.

CONCLUSIONS:

The results of the caloric test and video head impulse test are distinct but complement each other. Within our sample, the caloric test was more sensitive for vestibular dysfunction. Therefore, the video head impulse test is not a suitable screening tool of the vestibular system in patients with chronic complaints.

Stapedial reflex and recruitment: what is the relationship with tinnitus?

Tinnitus is characterized by an auditory perception of sound, with no stimuli from the external environment. Tinnitus is an increasingly significant complaint, affecting 10-17% of the world population. As a symptom, it should always be considered with pathology in the auditory system. Our study aims to assess the relationship of this symptom with the presence of a stapedial reflex and the phenomenon of recruitment. Medical records of patients complaining of subjective tinnitus during their first consultation in the Outpatient Clinic of the Unicamp Teaching Hospital, in Brazil, between 2011 and 2012 were analyzed. We carried out a study with 65 non-randomized tinnitus individuals using questionnaires, clinical and audiological evaluations. The visual analogue scale was used to characterize the degree of disturbance caused by tinnitus. Statistical tests were performed using the IBM SPSS Statistics 19. No association was found between tinnitus and the presence of acoustic reflex or phenomenon of recruitment. We concluded that there is no relationship between tinnitus, the phenomenon of recruitment or the presence of an acoustic reflex.

Dizziness Profile and Clinical Features: A Population-Based Survey in São Paulo City, Brazil

Objectives:

In clinical practice, knowing the epidemiology of dizziness is essential. The aim of the study was to estimate the prevalence of dizziness among the adult population of the city of São Paulo, Brazil and describe the clinical features and level of discomfort.

Methods:

A cross-sectional epidemiological survey was conducted in São Paulo, Brazil between April and October 2012. In this field study, 1960 household interviews were completed. The following variables were assessed: sex, age, clinical characteristics of dizziness, and dizziness disability index. Chi-square test, Student t test, Tukey test, and logistic regression were used for statistical analysis (95% confidence interval).

Results:

The dizziness prevalence was 42%. Among 2 age groups, peaks of dizziness were observed: 49% among the 46 to 55 years old and 44% among the elderly subjects (>65 years old). Vestibular vertigo was estimated in 8.3% with a strong female preponderance ( P < .001). Symptoms caused disability in 27% of the affected respondents and were more frequent among women ( P < .001), who sought medical care more frequently ( P < .001). The dizziness disability index was significantly higher ( P = .0165) among subjects with lower educational level. There was no correlation between dizziness discomfort and the type of job.

Conclusions:

The prevalence of dizziness in São Paulo, Brazil, was established in 42%. Among the symptomatic subjects, 67% reported interruption of daily activities, but only 46% of them sought medical attention.

Study of the relationship between the degree of tinnitus annoyance the presence of hyperacusis✩✩Please cite this article as: Guimarães AC, Carvalho GM, Voltolini MM, Zappelini CE, Mezzalira R, Stoler G, et al. Study of the relationship between the degree of tinnitus annoyance and the presence of hyperacusis. Braz J Otorhinolaryngol. 2014;80:24-8

Introdução

A hiperacusia pode ser definida como uma manifestação de ganho central aumentado das vias auditivas, compreendida como um estado pré-zumbido. Em alguns casos, o zumbido pode ser secundário a esse ganho aumentado.

Objetivo

Avaliar a prevalência da hiperacusia em pacientes com zumbido e sua associação com o incômodo do zumbido.

Materiais e métodos: Estudo retrospectivo envolvendo pacientes do ambulatório de otoneuro-logia com queixa principal de zumbido que foram submetidos a avaliação clínica, audiológica e a questionário de avaliação da hiperacusia e do zumbido. O grau de incômodo da hiperacusia e do zumbido foi classificado utilizando a Escala Visual Analógica.

Resultados

Foram analisados prontuários de 309 pacientes, 169 (54,7%) do sexo feminino e 140 (45,3%) do sexo masculino, com idade média de 53 anos. O grau de incômodo do zumbido apresentou mediana de sete. A hiperacusia esteve presente em 57 (18,4%) pacientes, com mediana de grau de incômodo de cinco. O grau de incômodo pelo zumbido nos pacientes com hiperacusia foi semelhante ao dos pacientes sem hiperacusia.

Conclusão

A hiperacusia esteve presente em 18,4% dos pacientes com zumbido. O grau de incômodo do zumbido não teve correlação com a presença da hiperacusia.

© 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Publicado por Elsevier Editora Ltda. Todos os direitos reservados.

Evaluation of factors related to the tinnitus disturbance

INTRODUCTION

The perception of tinnitus varies among individuals. The limitations caused by tinnitus are related to psychological factors, mood changes and psychiatric conditions, while other factors related to discomfort caused by tinnitus are being studied. Hearing loss is an important factor for the onset of tinnitus.

OBJECTIVES

To evaluate the correlation between the degree of discomfort caused by tinnitus and the hearing loss level.

MATERIALS AND METHODS

A retrospective study of the patients treated at the Otolaryngology Service of the State University from Campinas for 15 months, using the Visual-Analogue Scale to classify the degree of discomfort by tinnitus.

RESULTS

107 patients were studied and there was no correlation between the degree of annoyance of tinnitus with hearing loss, age, gender, presence of dizziness, of neck pain, headache, changes of the temporomandibular joint, the use of caffeine or excessive intake of carbohydrates. The discomfort was slightly higher in patients without hearing loss and in women.

CONCLUSION

Dizziness, neck pain, headache and caffeine abuse are prevalent complaints in patients with tinnitus.

Self-medication profile of ENT patients

Aim

To describe self-medication habits of patients with otorhinolaryngological disorders to characterize problematic aspects in order to manage and correct them.

Study Design

Descriptive.

Materials and Methods

A multiple-choice questionnaire was used to obtain the data, consisting of 17 questions about self-medication habits. It was distributed to the patients assisted in our ENT clinic, in July/2003.

Results

Approximately 83% of the admitted patients have practiced self-medication (without medical prescription). However, 73% of them stated that it wasn’t mandatory to present a prescription in order to obtain the medicine. The most utilized drugs were: analgesics/antipyretics (90%), cold and flu drugs (78%), and NSAIDs (69%); antibiotics were the 8th (11%). Among the reasons or diseases patients believed to suffer from that justified the self-medication practice, we observed: headaches (76%), cold/flu (74%) and nonspecific febrile illnesses (56%); otitis, in general, was the last (12%).

Conclusions

This study demonstrates the need for continuous educational programs about the risks of self-medication, besides appropriate governmental regulation and inspection.

Can oculomotricity be altered in patients with tinnitus only? A preliminary study

The study of oculomotricity is performed by evaluating three systems: saccadic ocular movements (SOMs), optokinetic nystagmus (OKN), and smooth pursuit eye movements (SPEMs). Our aim was to study oculomotricity in patients with a complaint of only tinnitus and to compare it with the value of our control group. We studied the SOMs, OKN, and SPEMs in 25 patients complaining only about tinnitus and in 35 normal adults and compared the results. The data analysis showed a significant difference in the value of the SOMs and SPEMs between the two groups. Sensorineural tinnitus can originate in the organ of Corti, in the cochlear nerve, or in the auditory pathways of the central nervous system. The auditory cortex connects with visual areas and with the superior colliculus. The latter structure is involved in the origin of SOMs and OKN. In our study, we found an increased delay in saccadic tests. In the SPEMs, we observed an increase in the degree of distortion, and a reduction in the gain. This outcome is in accordance with the literature. However, we detected a few alterations in the OKN, and this finding is in partial agreement with the studies analyzed. Alterations in oculomotricity can indicate involvement of the central nervous system in patients with a complaint of only tinnitus.

Can cochlear implants decrease tinnitus?

Suppression of tinnitus by electrical stimulation via a cochlear implant has been studied in recent years. Some individuals who undergo cochlear implant surgery report total or partial relief of the symptoms even in the contralateral ear. The mechanisms involved in this suppression are not clear. The results obtained in our study demonstrated an improvement of 71% in 29 implant cases, confirming data found in the literature. Our aim was to study tinnitus in individuals before surgery and after cochlear implant activation and to observe improvement in the perception of tinnitus, comparing these results with data in the literature. We conducted a retrospective study of 29 postlingual adults who had profound sensorineural hearing loss and underwent cochlear implant surgery at the cochlear implant sector of the Otorhinolaryngology, Head and Neck Surgery Department, University of Campinas, São Paulo, Brazil, between May 2003 and June 2005. The device employed in this procedure was the Nucleus 24K multichannel device (Cochlear Ltd, Lane Cove, Australia). After the internal component was activated, patients completed a questionnaire. Before surgery, 21 of the 29 patients (72%) who later underwent cochlear implant surgery presented with tinnitus, which was bilateral in 14 cases (67%). After the cochlear implant was activated, seven patients (33%) presented with total suppression, and eight patients (39%) reported partial relief. In the 14 cases with bilateral symptoms, tinnitus was totally suppressed or decreased in both ears in 12 cases (86%). Individuals who underwent multichannel cochlear implant surgery presented with reduced tinnitus even in the contralateral ear.

Oculomotricity in childhood: is the normal range the same as in adults?

The study of oculomotricity is done by the evaluation of three systems: saccade eye movements (MOS), optokinetic nystagmus (NO) and smooth pursuit eye movement (MORL). The joint action of these three systems allows the visual field's establishment in different movement situations.

AIM

To compare the value of oculomotricity in normal adults and children to confirm, or not if it is viable to use the same parameters of adults normality to children's exams interpretation.

STUDY DESIGN

Clinical with transversal cohort.

MATERIAL AND METHOD

We studied MOS, NO and MORL in 50 normal children and in 35 adults and the results were compared by the t Student test.

RESULTS

The data analysis showed significant difference between children and adults (significance at level +/- = 0.05)

DISCUSSION

In the literature we have found evidence that myelinization of the vestibular pathways happen at about 16 weeks and the pyramidal tracts, at 24 months. Oculomotricity is finished at this time. Other papers describe the importance of these tests in the diagnostic of neurological diseases, visual alterations and as predictors of the risk of schizophrenia development but they do not report the normal range in children. In our study we found increased latency of MOS, increase in gain of NO, reduction in gain and increase in the distortion of MORL in children if compared to adults, which is in accordance with the literature. These alterations can be explained by the low attention during the tests and the immaturity of ocular movements' control in children.

CONCLUSION

Therefore, the establishment of a parameter of normality to the oculomotricity in childhood is necessary for the correct analysis of the oculography to avoid misinterpretation of the exam.

Seasonality in vestibular disorders

Our objective in this study was to evaluate a causal relationship between vestibular pathological findings and climatic variations during the year (summer, autumn, winter, and spring). The study was conducted in a Brazilian clinic located in a tropical climate and having well-defined warm and cold weather. For this retrospective study, our outpatients were the subjects, and the diagnosis was made on the basis of clinical (ear, nose, and throat) and electronystagmographic evaluation. Data were collected, matched with the year's seasons, and analyzed for significance statistics. We found no significant differences among the illnesses in relation to the climatic seasons. We concluded that a correlation did not exist between annual seasons and vestibular disorders in our environment.

The contribution of otoneurological evaluation to tinnitus diagnosis

Tinnitus has been reported for nearly 80% of patients referred to the otolaryngology services. Usually, its evaluation is based on tonal and vocal audiometry, tympanometry, brainstem-evoked potentials, electrocochleography, and otoacoustic emissions. However, as the cochleovestibular system works as a unit, the use of vestibular tests has been proposed to evaluate tinnitus. Many patients with tinnitus have altered vestibular test results even in the absence of vestibular symptoms. This finding accounts for the indication of complete vestibular and audiological evaluation of tinnitus. The aim of this study is to analyze the contribution of otoneurological evaluation in the diagnosis of tinnitus. Patients were selected and divided into two groups. Group 1 was composed of patients complaining about tinnitus only, whereas group 2 was composed of patients with tinnitus associated with dizziness, hearing loss, and fullness. All submitted to otoneurological evaluation based on directed clinical history, physical examination, tonal and vocal audiometry, tympanometry, and vestibular examination. A total of 195 patients were analyzed. The otoneurological evaluation was conclusive in the diagnosis in 48 cases (75%) in group 1 and in 94 cases (72%) in group 2. The present study showed that otoneurological evaluation contributes to the etiological diagnosis of tinnitus.

Ewing's sarcoma of the head and neck

CONTEXT

Ewing's sarcoma is a rare neoplasm, which usually arises in long bones of the limbs and in flat bones of the pelvis, with the involvement of head and neck bones being very unusual.

CASE REPORT

a case of Ewing's sarcoma occurring in the mandible of a 35-year-old female. Pain and swelling of the tumor were the main complaints. The early hypothesis was an undifferentiated malignant neoplasm, possibly a sarcoma. The CT scan depicted an expansive lesion, encapsulated, with septa and characteristics of soft tissue, involving the left side of the mandible and extending to the surrounding tissues. The patient underwent surgical excision of the lesion, the definitive diagnosis of Ewing's sarcoma was established, and the patient commenced on radiotherapy.