Otosclerotic cochlear involvement is a rather frequent disease that has not been clearly understood in terms of diagnosis and management. Objective evaluation methods are needed to confirm the clinical diagnosis, investigate the relationship with hearing impairment, and validate the results of treatment. In this study two ear groups with bone conduction hearing loss (BCHL) were investigated with audiometry and high-resolution computed tomography (HRCT). In the first group (n = 22) the diagnosis of fenestral otosclerosis was confirmed at operation; the second group (n = 9) was composed of ears clinically suspicious for purely cochlear involvement. Additionally, a control group (n = 14) of otologically normal ears was also studied. Foci of demineralization were demonstrated in 58% of the ears in the two groups; the sensorineural hearing loss (SNHL) in those ears was significantly worse than in those with normal radiologic findings. Three methods of HRCT densitometry were used to determine the abnormal regions in the cochlear capsule; the results suggested that hypodense regions were consistent with a greater degree of SNHL, in contrast to the hyperdense ones in ears with better cochlear reserves. Agreement was found between the location of the density change and the frequency topography of the SNHL; densitometric values were correlated with the bone conduction thresholds for certain frequencies. It is concluded that the spongiotic foci are responsible for the SNHL, since there was a correlation between their location and the SNHL frequency. The determination of better hearing in those ears with sclerotic foci supports the hypothesis that the sclerotic phase may not be a healing process following the spongiotic phase, and that it can be the first stage of the disease.

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We suggest that a 1-session low-frequency TENS may induce analgesic effect through modulation of discriminative, affective, and motor aspects of central pain perception.

Sialometaplasia, squamous metaplasia of salivary gland lobules, is a benign condition occasionally presenting with lesions clinically simulating malignancy. ''Necrotising sialometaplasia'', recognised by lobular infarction, necrosis, and simultaneous squamous metaplasia of ducts and acini is a well known condition. There are only a few reports of the ''proliferative type of sialometaplasia'', which is recognised by a more mature morphology of larger and more irregular metaplastic nests, lacking necrosis. This report describes a unique case of ''proliferative sialometaplasia of multiple intraparotid lymph nodes'' occurring in a 55 year old woman, presenting with multiple parotid lumps. This interesting case points to the importance of intraparotid lymph nodes as sites for multiple lesions of the parotid region. S ialometaplasia, squamous metaplasia (SM) of salivary gland lobules, is a benign condition occasionally presenting with lesions mimicking malignancy. Since the description of the necrotising type, 1 many cases have been published. The proliferative form has only been reported in a few cases in intraparotid lymph nodes (LNs).2 3 This type of sialometaplasia is recognised by solid squamous metaplastic nests involving ductal structures and lacking atypia and necrosis. CASE REPORTA 55 year old woman presented with left infra-auricular multiple lumps, of two years duration. She had undergone stapedectomy of the right ear five years previously.The patient had a 1.5 6 1.5 cm, non-tender, semimobile mass in the left preauricular region, and a similar mass in the tail of the left parotid gland. The functions of the facial nerve were bilaterally normal and the examination of the other head and neck sites including the other salivary glands was unremarkable. She had no complaints of xerostomia. Sonography revealed hypoechoic parotid nodules. The lesions were hyperdense with contrast enhancement on computed tomography scans. Magnetic resonance imaging demonstrated two spherical discrete masses. Lesions were hypointense on the T1 images and isointense on the T2 images with contrast enhancement (fig 1). The radiological conclusion was consistent with a benign tumour, in particularly pleomorphic adenoma, and the clinical diagnosis was that of pleomorphic adenoma and associated lympadenomegaly of intraparotid LNs. The routine laboratory examinations were not remarkable: white blood cell count, 8.1 610 9 /litre; haemoglobin, 135 g/litre; haematocrit, 39.3%; erythrocyte sedimentation rate, 21 mm/hour; antinuclear antibodies, antineutrophil cytoplasmic antibodies, human immunodeficiency virus were negative.Left superficial parotidectomy with preservation of the facial nerve was performed. Pathological examinationSuperficial parotidectomy revealed two encapsulated, 1.5 cm, grey/white nodules located at the poles. Histology showed that they were both LNs and six additional LNs were also identified. Five LNs revealed ductal salivary gland inclusions, almost totally replaced by SM, but retaining the lobular architecture of duct...

Objectives: This study aims to compare the clinical and pathological TN stages of patients with oral cavity cancer and to identify the factors leading to staging discrepancies. Patients and Methods:The medical records of 125 patients (77 males, 48 females; mean age 57 years; range 19 to 82 years) who underwent primary tumor resection and neck dissection simultaneously for oral cavity cancer were retrospectively analyzed. Clinical and pathological TN stages of all patients were compared. Sensitivity, specificity and predictive values of clinical staging were calculated. Results:Computed tomography (CT) with contrast which was used to examine the cervical lymph node metastasis showed a sensitivity of 71.9%, a specificity of 75%, a positive predictive value of 70.6%, and a negative predictive value of 76.1%. The diagnostic accuracy of CT for detecting mandibular invasion was as follows: sensitivity, 92.6%; specificity, 97%; positive predictive value, 96.1%; and negative predictive value, 94.3%. Conclusion:High correlation between clinical and pathological stages for assessment of mandibular invasion and neck metastasis supports the reliability of CT in our study. Diagnostic contribution of magnetic resonance imaging is necessary for assessment of extrinsic tongue muscle involvement; in cases of tongue cancer which are surrounded by induration on palpation and extending to the floor of the mouth.Key Words: Cervical lymph node; clinical staging; extrinsic tongue muscle; mandible; oral cavity cancer; pathological staging. Amaç:Bu çalışmada oral kavite kanseri olan hastalarda klinik ve patolojik TN evreleri karşılaştırıldı ve evreleme farklılıklarına yol açan faktörler belirlendi. Hastalar ve Yöntemler:Çalışmada oral kavite kanseri nedeniyle primer tümör rezeksiyonu ve eş zamanlı boyun diseksiyonu yapılan 125 hastanın (77 erkek, 48 kadın; ort. yaş 57 yıl; dağılım 19-82 yıl) tıbbi kayıtları retrospektif olarak incelendi. Tüm hastaların klinik ve patolojik TN evreleri karşılaştırıldı. Klinik evrelemenin duyarlılığı, özgüllüğü ve prediktif değerleri hesaplandı. Bulgular: Servikal lenf nodu metastazını incelemek için yapılan kontrastlı bilgisayarlı tomografide (BT), %71.9 duyarlılık, %75 özgüllük, %70.6 pozitif prediktif değer ve %76.1 negatif prediktif değer tespit edildi. Bilgisayarlı tomografinin mandibüler invazyonun tespitinde tanısal doğruluğu ise şöyleydi: %92.6 duyarlılık; %97 özgüllük; %96.1 pozitif prediktif değer; %94.3 negatif prediktif değer.Sonuç: Çalışmamızda mandibuler invazyon ve boyun metastazının değerlendirilmesinde klinik ve patolojik evreler arasındaki yüksek düzeydeki ilişki, BT'nin güve-nilirliğini desteklemektedir. Palpasyonda endürasyon ile çevrili olan ve ağız tabanına doğru uzanan dil kanseri olgularında, ekstrensek dil kası tutulumunu değerlendirmek için manyetik rezonans görüntülemenin tanısal katkısına ihtiyaç vardır.Anahtar Sözcükler: Servikal