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Chondrosarcoma of the larynx is a rare slow-growing malignant tumour with approximately 240 cases reported in the literature: the cricoid cartilage is the most commonly affected site (72-75%), in rare case was described of epiglottis (1-2%). We report a case of a chondrosarcoma of the epiglottis treated with CO2 laser epiglottectomy. The patient was referred with dysphonia, dysphagia and halitosis that started four months before. Indirect laryngoscopy revealed a large smooth mass with a roundish appearance and a pearly-grey colour, as big as a nut, apparently arising from the laryngeal surface of the epiglottis, causing obliteration of the piriform fossa. The definitive histopathological report showed microscopically, the tumour was low-grade (grade I) chondrosarcoma. A literature review regarding chondrosarcomas of the epiglottis is presented. The diagnosis, histology and treatment of these tumours are discussed. In particular we examine the controversy of conservative surgery vs. total laryngectomy. A conservative surgical approach is typically appropriate in light of this tumour's low-aggressive nature.

Objective: The objective of this study was to identify the incidence and to monitor the progression of hearing loss in children and young adults with beta-thalassemia major.

Methods: One hundred and four (104) patients aged 6-35 years (mean 17,2 years) participated in the study. All patients were on a regular transfusion-chelation program maintaining a mean hemoglobin level of 9.5 gr/dl. Subjects were receiving desferrioxamine (DFO) chelation treatment with a mean daily dose of 50-60 mg/kg, 5-6 days a week during the first six years of the study, which was then reduced to 40-50 mg/kg for the following eight years. Patients were followed for 8-14 years.

Results: Overall, 21 out of 104 patients (20.2%) presented with high frequency sensorineural hearing loss (SNHL), either unilateral or bilateral. No ototoxic factor, other than DFO, was present in any of the patients. Patients with SNHL presented with relatively lower serum ferritin levels than those with normal hearing, however, no statistically significant difference was observed. Subjects with SNHL were submitted to DFO reduction or temporary withdrawal. Following intervention, 7 out of 21 affected patients recovered, 10 remained stable and 4 demonstrated aggravation.

Conclusion: The findings are indicative of DFO's contributing role in the development of hearing impairment. Regular audiologic evaluation is imperative in all thalassemic patients so that early changes may be recognized and treatment may be judiciously adjusted in order to prevent or reverse hearing impairment.

Introduction: The primary aim in cholesteatoma surgery is the removal of the disease. As a result, most residual disease is found in sites which are both adjacent to the ossicles and hidden from direct view. An ideal instrument should be able to remove disease without movement and should be able to remove disease from regions to which there is no direct access. The laser fullfills this criteria.

Materials and methods: Ears which underwent canal wall-up cholesteatoma surgery without the laser were compared with ears which underwent surgery which included the KTP laser since 1991.

Results: A total of 514 procedures was analysed (313 without laser and 201 with laser). We obtained respectively 83 (26.5%) and 21 (10.4%) residual disease (P < 0.0001). The procedures involving the KTP laser resulted in no cases of facial nerve injury and no cases of total sensorineural hearing loss.

Conclusion: We can conclude that the appropriately use of the KTP laser during cholesteatoma surgery does improve significantly the complete removal of disease and presents no extra risk to the vital structures within the temporal bone.

This study reports the evaluation of "second ear" stapedotomiesy results in 23 patients with otosclerosis. All pre- and post-operative audiological data, all relevant surgical information and patients' features were analyzed retrospectively. The air-bone gap showed a significant improvement in all patients. The bilateral audiometric thresholds improved in 20 (87.0%) patients; in 1 (4.3%) patient, unilateral improvement occurred with no changes in the other ear and in 2 (8.7%) patients improvement occurred in first operated ear and dropped in the second ear after the last procedure. During the follow-up, there were no incapacitating complications. Based on these findings, we can conclude Our study concluded that second ear stapedotomy is a safe procedure with good results.

Objective: Diagnosis of Meniere's disease in patients without classical symptoms may present some difficulty. Detection of hydrops in patients with normal or near to normal hearing or presenting unpredictable balance problem with great variability of severity, periodicity and duration is the major concern in reaching the accurate diagnosis to start the therapy as early as possible.

Method: To investigate the diagnostic role of vestibular diuresis, electronystagmographic (ENG) evaluation of 20 patients with "probable" or "possible" Meniere's disease before and after intravenous furosemid administration has been reviewed in a prospective and blinded study and the results have been compared with 20 age-matched control subjects.

Result: Eleven of 20 patients with Meniere's disease (55%) and one of 20 subjects in the control group (5%) demonstrated canal paresis at initial ENG testing. Thirteen patients from Meniere group (65%) and 1 subject from control group (5%) demonstrated positive response to furosemid. Seven of 11 patients with canal paresis in the patient group (63.7%) and 6 of 9 patients with no canal paresis at initial testing demonstrated positive response (66%) to furosemid. No statistical difference between these 2 subgroups was found when compared as response to furosemid. It has been found that there is no clear correlation between the duration of the disease and the positive response to furosemid.

Conclusion: It has been concluded that, although some limitation exists, the sensitivity of furosemid test for evaluation of vestibular function in Meniere's disease is promising as compared with controls.

Tympano-ossicular allografts are human transplants of the tympanic membrane alone or with the ossicles included. The authors review its use in their department since the introduction of the technique 40 years ago by J. Marquet. The advantages of the technique (near normal anatomical and physiological reconstruction) are discussed, as well as its disadvantages (time consuming harvesting, risk of disease transmission). Some technical modifications for specific indications have been adapted in our department and are described in detail. The authors believe that the tympano-ossicular allograft is the material of choice in extensively diseased middle ears destroyed by chronic otitis media with or without cholesteatoma.

Hairy tongue or black hairy tongue is a benign condition characterized by hypertrophy of the filiform papillae that give the dorsum of the tongue a furry appearance. The color of the elongated papillae varies from yellowish white to brown or black. The etiology is unclear, but the disorder has been associated with numerous predisposing conditions such as heavy smoking, poor oral hygiene, use of topical or systemic antibiotics, systemic corticosteroid therapy, yeast infections, and radiotherapy for head and neck malignancies. A case is presented in which a hairy tongue appeared in a 67-year-old man.

Problems/objectives: Tumour size, intra-operative electrophysiologic thresholds and postoperative facial nerve function have been demonstrated to be important predictors of ultimate facial nerve function after vestibular schwannoma surgery. In general little attention has been given to the prediction of outcome of facial nerve function in non-vestibular schwannoma tumour surgery of the cerebellopontine angle (CPA).

Methodology: A prospective study was performed to assess the predictive value of patient, tumour histology and electrophysiologic factors in the estimation of ultimate facial nerve outcome after this form of surgery.

Results: Sixteen patients satisfied the requirements of the study. Poor long-term facial nerve outcome was associated with abnormal pre-operative facial nerve function, facial nerve schwannomas, premeatal meningiomas and electrophysiologic stimulation thresholds of greater than 0.1 mA.

Conclusions: It is concluded that tumour histology and pre-operative facial nerve function are additional factors that must be considered in the prediction of facial nerve function after non-vestibular schwannoma surgery of the CPA.

We present two cases of patients with bone cysts in which the suggestion of a bone lesion was made primarily on the basis of ultrasound examination. Examinations were performed with use of a 7.5 MHz linear probe on Siemens Elegra ultrasound scanner (Siemens, Erlangen, Germany) with application of tissue harmonic imaging (THI) and power Doppler mode. On the basis of such features as uneven and irregular bone surface, widening and distorting of the mandible shape or visualization of the mass inside the bone on ultrasound examination, the presence of the bone tumor was suggested. Ultrasound examination may be the first method suggesting the presence of the unsuspected mandible tumor in patients referred to search for underlying pathology in soft tissues. During the examination of the soft tissues of the head and neck also the surface of bones should be each time carefully evaluated.

The aim of this investigation was to study the presence and the characteristics of transient evoked otoacoustic emissions (TEOAE) in ears with ventilation tubes. Theoretically the small mass and the opening of the tube could influence the OAE. We studied a population of children between the age of 3 and 9 years with functional ventilation tubes and a normal hearing on pure tone audiometry (Fletcher index < 25 dB). A total of 110 ears from 62 children were included. According to the criterion of 70% wave reproducibility, TEOAE were present in 86.7% of the ears. Looking at the reproducibility in the different frequency bands of the response, it was found that the TEOAE were strongest in the 2 kHz frequency band. It is concluded that the measurement of TEOAE can be used as a useful hearing test in young children with ventilation tubes, maybe even when pure tone audiometry is not yet possible. However, false negative results were found in about one tenth of the ears.