The diagnosis of Ménière disease (MD) is based primarily on clinical symptoms and there is no single feature or subset of features from the history, clinical examination or instrumental tests that are able to establish a certain diagnosis. Identification of diagnostic markers that can discriminate MD more accurately, and also that are reliable, reproducible and easy-to-obtain, could be useful. The pathophysiology of MD is complex and debated. Starting from the pathophysiological hypotheses of the disease, different approaches have been used in order to find useful biomarker candidates for diagnosis. We will present the main results in the literature and our personal experience in the field of molecular diagnostics applied to MD, and specifically of proteomics studies.

article: Universal screening of preoperative cases for COVID-19. Is this the way forward post-pandemic? A surgeon’s perspective - Otorinolaringologia 2020 December;70(4):159-60 - Minerva Medica - Journals

Mandibular angle fractures are frequently observed. Not only the angle is a weak transition region, but the presence of impacted third molar tooth also plays an important role in the development of mandibular angle fractures. Fractures of the mandibular angle are usually isolated, whereas bifocal mandibular fractures usually involve a different region, such as symphysis or condyle. In fact, mandibular fractures involving both mandibular angles are rare. The aim of the present article was to present a case report of a Biangular Mandibular Fracture, along with its characteristics and surgical management.

BACKGROUND: Ménière’s disease (MD) is a complex illness characterized by the typical association of acute onset of vertigo lasting less than 12-24 hours and low-frequency sensorineural fluctuating hearing loss. In our cohort of patients, MD manifested immediately as its definite form in about 35% of cases whereas in the remaining 75% of cases the pathology started as a monosymptomatic form.METHODS: In order to determine the temporal relationship among these two forms, we evaluated the clinical history on 283 patients affected by definite MD.RESULTS: The very first symptom of MD resulted more frequently the hearing loss. The average time delay between the onset of the first and the second symptom resulted within one year. The risk of onset of the definite form after the first symptom was about 80% within 5 years. The transition from the monosymptomatic form the definite form was quicker in case of vertigo happened as the first symptom.CONCLUSIONS: In conclusion the most frequent layout of onset of MD is a unilateral low-frequency sensorineural fluctuating hearing loss followed by the appearance of vertigo within 5 years. According to the MD guidelines proposed in 1995, all patients referring such kind of hearing loss should be treated as MD, in order to prevent the subsequent occurrence of vertigo.

Cholesterol granuloma is a granulomatous tissue reaction consisting of cholesterol cleft surrounded by foreign body giant cells, foam cells and macrophages filled with hemosiderin pigments. It commonly occurs within the middle ear cavity and temporal bone. We report a case of right antrochoanal polyp which turned out to be a sinonasal cholesterol granuloma in an elderly female patient who presented with a one-month history of unilateral blood-stained nasal discharge. Patient underwent surgical excision of the nasal mass successfully with no complications or recurrence. Albeit rare, cholesterol granuloma should be considered as a differential diagnosis of sinonasal mass.

There is currently a great interest in the study of Ménière’s disease using imaging. Magnetic resonance imaging (MRI) with delayed acquisition provides a powerful means to characterize endolymphatic hydrops noninvasively by using the properties of contrast media on inner ear perilymph. Despite their popularity and widespread use, there are a number of practical considerations that must be considered in order to increase the robustness of endolymphatic hydrops evaluation in Ménière’s disease patients. Besides endolymphatic hydrops, other imaging biomarkers have more recently proven to be useful in Ménière’s disease patients characterization and follow-up, such as blood-labyrinthine barrier impairment or an absence of visible saccule. The progressive ossification of the vestibular aqueduct in both temporal bones of Ménière’s disease patients have also been described, including using nonenhanced CT/cone beam CT scans to rule out the presence of endolymphatic hydrops. This article describes what we consider as major findings of imaging Ménière’s disease patients using MRI scan (first part) and CT/CBCT scan (second part), with particular emphasis on technical considerations that can have an important impact in the results. The recommendations here are intended to inform healthcare providers on potential important shortcomings of their current imaging protocols, as well as to guide future physicians on some of the key issues and decisions that must be faced when doing the imaging report. Finally, we will provide perspectives on what could be expected for Ménière’s disease imaging in the next few years, based on machine learning new developments (last part).

Mandibular fractures are frequent, and it is common to observe multiple mandibular fractures. Bifocal bilateral fractures are usually diagnosed because of the trauma dynamics and mandibular anatomy. Instead, bifocal unilateral fractures are a rare entity, thus presenting a free mandibular segment without anterior and posterior support. The aim of this article is to present and discuss the characteristics and surgical management of a bifocal unilateral mandibular fracture.

Oncocytic lipoadenoma is an extremely rare benign tumor of the salivary glands; less than 20 cases have been reported in literature, since the first report in 1998. We are presenting a case of a 73-year-old man with a slowly growing painless parotid mass; ultrasound and magnetic resonance imaging enhanced with gadolinium showed a lesion with benign features and heterogeneous content. Fine needle aspiration biopsy was suggestive for a Warthin’s tumor. Surgical approach was a classic lateral parotidectomy with facial nerve identification and preservation. Histology revealed a well-capsulated mass with mixed components, including oncocytes (70%) and mature adipocytes (30%), consistent with oncocytic lipoadenoma. The results of immunohistochemical staining supported this diagnosis. Main characteristics of this neoplasm are reviewed and briefly discussed, along with the differential diagnostic elements of more common lesions. The knowledge and the awareness of this entity could be helpful when evaluating a patient with a salivary gland tumor.

BACKGROUND: Hearing loss in the unilateral form of Ménière disease (MD) is described as a low-frequency sensorineural deficit that has to be greater than 30 dB at least at two contiguous frequencies below 2000 Hz. The aim of the present study was to determine whether the audiometric pattern of the hearing loss in a large series of definite MD patients correlates with parameters proposed by the Barany Society consensus paper.METHODS: The study group was composed by 275 patients suffering from episodes of typical MD vertigo and unilateral low-frequency fluctuating hearing loss.RESULTS: According to the Barany Society criteria, 133 (48%) patients presented a hearing threshold difference greater than 30 dB between the two ears at least at two contiguous frequencies. In particular, the hearing threshold difference between was greater than 30 dB in 50% of cases at 250 Hz, in 53% of cases at 500 Hz and in 41% of cases at 1 kHz. According to the updated 2015 Barany Society criteria, only 48% of diseases which were previously claimed “definite MD” on the basis of the 1995 AAO guidelines can be really considered definite MD.CONCLUSIONS: Our study suggests that the limit of 30 dB of differential hearing threshold between the two ears seems too large, possibly leading to high rates of misdiagnosis.