Extraosseous Ewing's sarcoma is extremely rare in the soft tissues of the neck, especially in the sternocleidomastoid muscle. It usually manifests clinically as a rapidly growing mass that shows great potential for local spread. The aim of this paper is to present a rare case of еxtraosseous Ewing's sarcoma in the sternocleidomastoid muscle. To the best of our knowledge, this is the first case of extraskeletal Ewing's sarcoma at this location. The patient was admitted to our clinic because of a neck tumefaction. The computerized tomography finding showed a tumor mass, most of which was in the V region of the neck, measuring 40 × 27 × 35 mm. Pathohistological and immunohistochemical findings showed that it was Ewing's sarcoma. Unfortunately, the patient passed away nine months after the initial diagnosis. Extraosseous Ewing sarcoma is a rare, fast-growing malignant tumor manifesting histomorphological similarities to bone Ewing's sarcoma. Most reports state that extraosseous Ewing sarcoma has a worse prognosis than skeletal. Extraosseous Ewing sarcoma should be borne in mind in the differential diagnosis of soft tissue tumors of the neck.

Background: Frequent episodes of nasal symptoms are the usual clinical manifestations (CM) of allergic rhinitis (AR) and have a significant negative impact on health-related quality of life (HRQoL) in adolescents. The purpose of this cross-sectional study was to test the hypothesis that cytokines in nasal mucus may be associated with HRQoL in adolescents with AR. Methods: European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L), “The Adolescent Rhinoconjunctivitis Quality of Life Questionnaire” (AdolRQLQ) and the Total 4 Symptom Score (T4SS) scoring system were administered to 113 adolescents with AR, nonallergic rhinitis (NAR) and to healthy control subjects. Nasal secretions were sampled and tested for 13 cytokines using a multiplex flow cytometric bead assay. Results: The AR group had significantly lower EQ-5D-3L (0.661 ± 0.267 vs. 0.943 ± 0.088; p < 0.001) and higher AdolRQLQ total scores (2.76 ± 1.01 vs. 1.02 ± 0.10; p < 0.001) compared to the control group. The AR group had higher concentrations of IL-1β (p = 0.002), IL-6 (p = 0.031), IL-8 (p < 0.001), IL17-A (p = 0.013) and IL-18 (p = 0.014) compared to the control group, and IL-1β, IL-6, IL17-A and IL-18 were significantly (p < 0.050) increased with disease progression. Cytokines IL-1β, IL-6, as well as severe CM, were identified as significant predictors of lower HRQoL in adolescents with AR. Conclusions: This study identified IL-1β, IL-6, as well as severe CM, as predictors of lower HRQoL in adolescents with AR. However, these results should only serve as a starting point for additional confirmation research.

<p><strong>Introduction. </strong>The aim of this article was to present a case of a foreign body in the external auditory canal described as a pseudotumor of the middle ear, as well as to point out diagnostic and therapeutic aspects of this problem.</p> <p><strong>Case report. </strong>An 8-year-old girl was hospitalized several times in our department due to the surgery of left-sided chronic otitis media. Mastoidectomy and posterior atticotomy were performed during initial hospitalization. Six months later, she was admitted for the second act of the left-sided tympanoplasty. However, two months prior hospitalization, symptoms regarding the right ear appeared: sense of fullness, gradual hearing loss and occasional pain. An otoscopic finding on the right indicated the presence of &ldquo;tumefaction&rdquo; in the external auditory canal with a surface that was markedly hyperemic. This pseudotumor was finally interpreted as the foreign body in the external auditory canal.</p> <p><strong>Conclusion. </strong>Foreign bodies in the external auditory canal (EAC) are relatively common in pediatric population. The medical history sometimes is not reliable, and the clinical and radiological interpretation of pseudotumor in the external auditory canal or middle ear must include this possibility in the differential diagnosis as well. Surgical exploration and pathohistological diagnosis are necessary to make a definitive diagnosis and to avoid potential complications.</p>

Out of all benign tumors of the ceruminous glands, syringocystadenoma papilliferum is the rarest and represents only 2% of cases. It is an extremely rare benign tumor that originates from modified apocrine sweat glands. The aim of this paper was to present, according to our findings, the 18th case of syringocystadenoma papilliferum in the external auditory canal, with a detailed review of its clinical, radiological and histomorphological characteristics. A 59-year-old man reported to our clinic due to a 5×5 mm papillomatous growth at the entrance to the right external auditory canal. Histopathology indicated, after an excisional biopsy, that it was a syringocystadenoma papilliferum. The resection lines were free of tumor tissue, and the patient has no signs of tumor recurrence. Although rare, it should be considered as a differential diagnosis of lesions in this region. Complete excision is mandatory in order to avoid recurrence and potential malignant alteration.

Objective Using a short-form specific questionnaire, we sought to quantify specific and generic benefits of surgery for chronic otitis media (COM) while adjusting for expectancy (placebo) bias. Study Design A prospective observational pretreatment/posttreatment study. Setting A national tertiary referral center. Patients Consecutive adult COM patients were enrolled for 1 year. Of 246 patients, 205 were recommended for surgery, and 167 were operated on the (more) affected ear. Intervention(s) All patients filled out two questionnaires, one specific (Chronic Otitis Media Questionaire-12) and one generic (Short Form-36) at baseline, and then again 6 and 12 months after surgery. Main Outcome Measures Factor-based scores of questionnaires, standardized response means (SRMs) for treatment effects, with multiple linear regression for implementing bias adjustment. Results All but one (generic Short Form-36 “mental” scale) of the seven considered measures gave very highly significant (p < 0.001) improvements. Unadjusted SRMs were large (1.0–2.0 standard deviation units) for audiometry, symptoms of ear discharge, reported hearing, and aggregate specific quality of life, but only moderate for the less specific activity/healthcare. The proposed bias adjustment reduced SRM magnitudes for most measures by about a third, for activity/healthcare and ear discharge by only a tenth to a fifth, and for audiometry not at all. Conclusion Most scores of the specific questionnaire displayed definite placebo-like biases; this demands caution in interpreting improvement after COM surgery. With bias adjustments, credible and worthwhile magnitudes of improvements remained for Chronic Otitis Media Questionnaire-12 total and subscores (0.5–1.09 standard deviation SRM), but not for generic quality of life.

Introduction. Tinnitus is a perception of a sound in the ears in the absence of acoustic stimulation whose pathophysiological mechanisms have not been evaluated yet. Approximately, 1-2% of people report distress which can negatively affect their daily performance. Our study aimed to assess the incidence of anxiety in patients with tinnitus. Methods. The study was designed as a cross-sectional study. The participants were divided into two groups: a group of 73 patients with tinnitus (with two subgroups in relation to the duration of tinnitus-less than one year and more than one year) and a control group of 43 patients without tinnitus. We examined the presence of anxiety in all patients using the Burns Anxiety Inventory (BAI). The quality of life of all patients was estimated by Tinnitus Handicap Inventory (THI). Results. In the group of patients with tinnitus, 56.2% of them had mild and 24.7% moderate hearing loss, while 27.7% of respondents from control group had mild and 8.5% moderate levels of hearing impairment. THI results showed that patients with tinnitus less than 1 year had a significantly (p= 0.002) higher level of disorders in daily life, compared with the group who had tinnitus for more than 1 year. The 30.8% of respondents had minimal anxiety, 26.7% borderline anxiety, 17.5% mild anxiety, the same percentage of respondents moderate, 5% severe, while 2.5% had extreme anxiety based on BAI. Conclusion. Anxiety can be considered as potentially significant modulators of changes in brain structures observed in people with tinnitus.

Introduction. Late metastases of malignant tumors in the temporal bone are very rare lesions. They can be asymptomatic for a long time, and usually manifest themselves in the form of hearing loss, dizziness, tinnitus, and paralysis of the facial nerve. Modern radiological diagnostics and explorative surgery with biopsy are essential for diagnosis. Case report. We present a rare and unusual case of a 66-year-old female patient with a facial nerve paralysis that appeared as the first sign of metastatic breast cancer in the temporal bone 10 years after treatment. A sudden hearing loss and dizziness occurred six months later and value of CA 15-3 was elevated. Scintigraphy pointed to susceptible metastatic deposits of the axial skeleton, without lesions in the temporal bone. Finally, repeated computerized tomography revealed osteolytic changes of the temporal bone six months after that. Immunohistochemical analysis of mastoid tissue samples confirmed that it was a breast cancer metastasis. One year after palliative radiotherapy and oral hormone therapy, a patient has a good general condition with better function of the facial nerve. Conclusion. A high degree of clinical suspicion sometimes requires repeated radiological diagnostics in order to detect osteolytic metastatic changes in the temporal bone, but also in other bone structures within the hematogenous dissemination of the malignant disease.

Background: Cochlear dysfunction can arise not only from various factors such as ear diseases but also from systemic disorders of the body. The occurrence of otologic symptoms such as hearing loss, dizziness, and tinnitus can be due to cardiovascular disorders. Therefore, current understandings in the field of the diagnosis and therapy of cardiovascular diseases (CVDs) should include, among others, evidence of otologic disorders. Objective: The aim of this study is to determine the association between risk factors for CVD and cochlear dysfunction. Methods: The cross-sectional study included 128 participants with major CVD risk factors who underwent auditory function examination (pure tone audiometry). Results: There were 52 women (40.6%) and 76 men (59.4%) in total. The mean age of the participants was 58 years (a range of 28–83 years). The mean age among participants with hearing loss was 60 (±10.88), whereas the mean age among participants that had normal hearing thresholds was 54 (±12.18). Sensorineural hearing loss (SNHL) was measured in 59% of participants, of most frequent mild degree hearing loss. The prevalence of SNHL was higher in participants with arterial hypertension (P < 0.001, OR = 5.881, 95% CI 2.694–12.837) and the most common among them was moderate degree hearing impairment (38%). There is also a statistically significant association of SNHL with dyslipidemia and elevated body mass index (P < 0.001, [OR]: 4.118, 95% [CI]: 1.873–9.053 and P< 0.001, [OR]: 1.517, 95% [CI]: 1.237–1.859 ) with moderate and profound hearing loss. Conclusion: Based on the data obtained, it seems that the presence of major cardiovascular risk factors was a significant predictor for cochlear dysfunction.

OBJECTIVES Malignant (necrotizing) otitis externa (MOE) is an aggressive form of skin inflammation of the external ear with a tendency to spread infection to the temporal bone. The study aimed to evaluate a causal relationship between treatment responses and clinical features in patients with MOE. MATERIALS and METHODS In a retrospective, descriptive section study, the database was analyzed between January 2008 and December 2018 in our department, all patients with diagnosed MOE were identified. RESULTS A total of 30 patients were evaluated, of which 27 men and 3 women. The youngest patient was 52 years old while he was eldest 88 years, (mean-71 years old). As the most common comorbidity, diabetes mellitus was found in 23 (76%) subjects. Median duration of symptoms was about 3 months. The most common isolated pathogen was Pseudomonas aeruginosa (47%). Patients with facial nerve palsy and erosion of temporal bone find on computerized tomography affect prolonged stationary treatment (Mean, SD 29.2±8.5 and 26,7±11.6 days), while 80% of patients with facial nerve palsy had recurrence of disease (p=0.005) with mean duration of clinical remission of 60±17.3 days. Overall length of treatment is also increased in the presence of comorbidities as well as in patients with cranial nerve involvement. CONCLUSION Patients with cranial nerve involvement, erosion of temporal bone and presence of comorbidities affect prolonged treatment and adverse prognosis. Early diagnosis and initiation of aggressive therapy are essential for stopping the further spread of the disease and prevention of serious complications.

INTRODUCTION Chondromas are rare mesenchymal benign tumors that are most often encountered in pelvis and ribs, and rarely in head and neck region. They account for about 10% of all benign chondroid proliferations and the rarest occurrence of soft tissue chondromas is within oral cavity. CASE A 10-year-old female patient was referred to our Clinic because of moderate speech impairment, swallowing disturbances and foreign body sensation in tongue. On clinical examination and MRI scans, hard, painless, clearly demarcated submucosal mass was observed on the left side of the tongue. Surgery was perfomed using intraoral incision approach, and the tumor was completly removed. Histopathological examination of the specimen was positive for chondroma. CONCLUSION Chondromas benign tumors of mature hyaline cartillage localized in soft tissues of head and neck region. Growing slowly, and painlessly, they remain silent for some period, until reaching certain dimensions, and becoming symptomatous. Magnetic resonance imaging scan provides complete information about localization, size, growth of the tissue, and contributes significantly to the decision of appropriate surgical approach.

Introduction. Acute otitis media is a very common disease in the early childhood age, with typical symptoms such as otalgia and fever. Otogenic complications are divided into extracranial and intracranial. Although the introduction of antibiotics has significantly reduced the incidence of intracranial complications, they are still present. Clinical picture usually develops fast, with the predominance of neurologic symptoms. Case outline. An 11-year-old boy was admitted to a tertiary health care children?s hospital because of fever, agitation, altered behavior and disorder of consciousness. Based on the anamnesis, clinical examination, CT, MRI, and lumbar puncture, it has been established that it is a case of meningoencephalitis as complications of acute otitis media. Besides intense antibiotic and symptomatic therapy, surgical treatment too was conducted as well. Firstly, mastoidectomy with the implantation of ventilation tube was done, followed by radical tympanomastoidectomy, because there was no improvement. The treatment was followed by numerous complications, such as toxic hepatitis, mycoplasma pneumoniae infection, and hemolytic anemia. The treatment lasted for 71 days, and the patient was discharged from the hospital in a good general condition, without the focal motor failure. Conclusion. Meningoencephalitis is unusual and rare complication of acute otitis media that requires urgent diagnostic procedure and multidisciplinary approach to the treatment. Surgical treatment of the ear that caused complications should not be postponed, and the choice of surgical method must be adapted to each patient individually. Hospital treatment of these patients is often prolonged and auditory and neurological sequelae are substantial and require long-term treatment.

OBJECTIVE This study aimed to compare two sampling methods for nasal nitric oxide in healthy individuals and allergic rhinitis patients, and to examine the within-subject reliability of nasal nitric oxide measurement. METHODS The study included 23 allergic rhinitis patients without concomitant asthma and 10 healthy individuals. For all participants, nitric oxide levels were measured non-invasively from the lungs through the mouth (i.e. the oral fractional exhaled nitric oxide) and the nose. Nasal nitric oxide was measured by two different methods: (1) nasal aspiration via one nostril during breath holding and (2) single-breath quiet exhalation against resistance through a tight facemask (i.e. the nasal fractional exhaled nitric oxide). RESULTS Compared with healthy participants, allergic rhinitis patients had significantly higher average oral and nasal nitric oxide levels. All methods of nitric oxide measurement had excellent reliability. CONCLUSION Nasal nitric oxide measurement is a useful and reliable clinical tool for diagnosing allergic rhinitis in patients without asthma in an out-patient setting.

INTRODUCTION Turner syndrome is a chromosomal abnormality where all or a part of one of the X chromosomes is absent or it has other abnormalities. Besides characteristic abnormalities of short stature and infertility, women with Turner syndrome have increased risks for tumors of the central nervous system, especially meningioma and an otologic disease. Meningioma involving the middle ear is extremely rare, and this condition has never been published in association with Turner syndrome. CASE REPORT We present an otologic manifestation associated with other abnormalities in a patient with Turner syndrome and discuss diagnosis and possible treatment options. CONCLUSION Multidisciplinary team approach is essential in these patients in order to evaluate their vulnerability and define therapeutic priorities.