Background Patients presenting with unilateral sinus symptoms or nasal polyps raise concerns about sinister pathology. Yet despite the relatively common occurrence of this presentation, and its potential severity, an organized diagnostic approach to unilateral sinus disease (USD) has never been defined. The purpose of this work was to propose a diagnostic algorithm for managing patients with USD based on prior experience. Methods We performed a retrospective review of the medical records of all patients with USD who underwent surgical intervention and had pathological specimens during a 15-year period at an urban academic center. Nasal endoscopy and computed tomography (CT) scan findings, demographic characteristics, presenting symptoms, medical histories, and previous treatments were analyzed. Results A total of 191 patients met the inclusion criteria, 153 of whom were initially diagnosed at our center. Among the latter group, 51 (33%) presented with a nasal mass or polyp observed by endoscopy. Inverted papilloma was present in 16% of those cases, and malignant tumors comprised 14%. In contrast, of patients without an obvious nasal polyp (n = 102), 2% had inverted papilloma and 3% had malignancies. Overall, chronic rhinosinusitis was the most common diagnosis both in patients with polyps (67%) and those without nasal polyps (69%). Conclusion Although USD is most likely to represent chronic inflammation, there exists a fair likelihood of finding malignant pathology, particularly in cases where patients have a unilateral polyp. Based on this review, we propose a strategy for the management of new presentations of USD.

MRIs are the gold standard for determining retrocochlear pathology in the setting of sudden deafness and ASNHL but are expensive. Approximately one-third of the respondents still use ABR and acoustic reflex testing as screening tools before ordering MRI. MRI typically have a low yield in finding an abnormality (usually <1%-4%). Neurotologists in our survey seem to recognize this quandary: they usually order an MRI, although they know it will usually be negative, and 40% of them cite medicolegal concerns as one of the motivations for their decision. This suggests that routine use of MRI partially reflects the practice of defensive medicine rather than medicine based on evidence. Perhaps MRIs are rarely indicated as the initial screening tool in ASNHL and sudden deafness, given their high cost and low yield of abnormal findings, and their routine use should and could be reduced to contain medical costs.

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For this study 22 temporal bones from patients with profound sensorineural deafness of various causes were selected. Graphic reconstruction of each cochlea and acoustic ganglion was performed, together with a quantitative evaluation of three types of sensorineural elements: hair cells, peripheral auditory fibers, and ganglion cells. The numbers of acoustic ganglion cells were compared with those in 16 normal temporal bones. The temporal bones were divided into five groups, based on the relative degree of degeneration found in each of the three types of elements studied. Severe to complete hair cell loss was noted in all five groups; degeneration of peripheral nerve fibers ranged from moderate to complete in all but one group; and ganglion cell counts varied widely within all groups. In a qualitative comparison no relationship was found between the clinical data and the histopathologic correlates. The results of the study suggest that neither the clinical data nor the histopathologic findings provide any criteria for selecting patients for cochlear implants.

The seventh family manifesting an entity described as automosal dominant optic atrophy with hearing loss is reported here. This disorder shows great inter- and intrafamilial variation in the onset time and the degree of loss of both vision and hearing. Unlike autosomal dominant optic atrophy without hearing loss, it appears to be associated with a red-green (deutan) defect in color vision.