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Malignant tumors of the temporal bone are rare neoplasms. Adenoid cystic carcinoma (ACC) is the most common malignant tumor of minor salivary glands, while a quite rare tumor of the major. It is considered a slow-growing tumor with a course that is characterized by local recurrences and late distant metastases to lungs (80-90%), bone and liver. When metastases occur in bone especially the spine, the course of disease is usually fulminant. Intracranial involvement can occur by direct extension, hematogenous or perineural spread and represents an advanced stage of the disease. In this paper, we present a rare case of temporal bone ACC reporting for the first time simultaneous bony and pulmonary distant metastases. The origin, the pathology, the imaging techniques, the differential diagnosis, the treatment options and the prognosis of these tumors are discussed.

Inverted nasosinusal papilloma is a benign tumor accounting for less than 4% of all nasal masses. The lesion originates in the mucosa lining the nasal cavities, the locations in decreasing order of frequency being the lateral wall of the nasal fossa, ethmoid sinus, and maxillary sinus; the sphenoid sinus is only rarely affected. Despite its benign histology, the tumor shows aggressive behavior and can be associated to carcinomas. Surgery is therefore indicated in such cases.

When assessing a patient with a sensorineural hearing impairment, the most simple and most widely available technical investigation is pure-tone audiometry. Although it is a subjective measure, the test is very reliable if the patient is cooperative. In this paper we review standards and test-retest reliability for pure-tone audiometry. A pure-tone threshold measurement at a single frequency has a chance of 90% to be repeated between -10 dB and +10 dB compared to the first measurement, assuming no real change in hearing thresholds has occurred. It is also of great importance to use correct gender- and age-specific reference values when interpreting pure-tone threshold measurements. Several large-scale epidemiological studies have been conducted during recent years, and have provided us with reliable gender- and age-specific references. A method to take into account the age-related deterioration is presented. In this method, Z-score audiograms represent traditional thresholds in an age- and gender-independent way. At each frequency, the Z-score value is the number of standard deviation units that the threshold differs from the median value for the otologically normal population (ISO 7029).

Various recognized prognostic factors in squamous cell carcinoma of the larynx influence the therapeutic option offered to an individual patient in order to extend the survival expectancy. Additional prognostic indicators are required in specific patient subgroups. We performed a retrospective study by using a standard immunohistochemical technique in order to evaluate the accumulation of cathepsin-D as possible prognostic marker of laryngeal squamous cell carcinoma. Formalin fixed, paraffin embedded tumor materials were obtained from a series of 64 patients with cancer of the larynx. Immunostaining was evaluated by computerized image analysis. Cathepsin-D immunostaining was observed in tumor parenchymal and stromal cells (31.25% and 37.5% of all cases respectively); it was found to be useful in defining patient subgroups with differences in relapse-free survival. Among patients with positive lymph nodes, those with cathepsin-D immunopositive tumor cells were in higher risk for relapsing (p = 0.0395). Although the classical prognostic factors of laryngeal carcinoma retain their predominance, cathepsin-D immunoreactivity may serve as an additional prognosticator in specific patient subgroups.

Pneumomediastinum and surgical emphysema of the neck as a result of blunt chest trauma occurs rarely. We report a case of pneumomediastinum and extensive surgical emphysema of the face and neck due to blunt chest trauma (assault), without evidence of laryngotracheal or pharyngoesophageal tear from the clinical assessment and the radiological examinations. Diagnosis, management, evaluation of investigations and potential mechanisms are discussed. In the presence of suspicious tracheal rupture bronchoscopy is mandatory but not the gold standard to confirm the location of the tear, as seen in our case. In the absence of respiratory compromise, conservative management is appropriate.

It has been suggested that the rotatory test using videonystagmoscopy can also be applied for identification of vestibular canal paresis. In this study, we test this hypothesis by comparing the results of a canal impulse rotatory test with those of the caloric test using the method described by Freyss. Our study indicates that only in 38% of all tested patients, the same results between the two tests have been obtained. Furthermore, when the group with abnormal findings is observed separately, in 24% patients only these two test methods lead to the same results. Consequently, the canal impulse rotatory test cannot replace the caloric test.