A young girl presented to the ENT acute clinic with a persistent cough and a bulge in the left oropharynx. As there were no clinical signs suggestive of a quinsy, an MRI was performed that showed a large mass extending from the base of the skull to the epiglottis medialising the lateral and posterior pharyngeal walls. The patient subsequently underwent an excision biopsy which demonstrated a ganglioneuroma, however developed a left-sided Horner's syndrome and mild vocal cord palsy after.

Background: Hearing loss is considered to be one of the most common factors of moderate to severe disability specially in the developing countries. Ototoxicity is inner ear damage due to usage of chemical substances, which can lead to either reversable or permanent hearing loss and/or vestibular loss. Ototoxic hearing impairment can impact the quality of life by many ways; therefore, we should be very careful when it comes to choose drug therapy to minimize the risk. Aim of the work:To identify the commonly implicated ototoxic medications among the adult Egyptian population and to study its presenting features.Patients and Methods: This is a retrospective study, that involved review for the medical notes of all adult patients, who attended the Audio-Vestibular Unit with otological problems between January 2014 and December 2018. A total of 1110 medical folders were reviewed, and data were manually extracted. Results:The prevalence of ototoxic medication among the adult attendees was 26.6%. The most common manifestation was hearing impairment, as it was reported in 83.2% of the cases. Tinnitus came second by 70% followed by vertigo in 31%. Aspirin was the most common drug used [44.7%] of the patients, followed by aminoglycoside in 15% of our study sample, then the non-steroidal anti-inflammatory drugs [NSAIDS] in 14.3%. Conclusion:Audiometric screening is critical to capture the true prevalence of hearing loss. Baseline audiometric and vestibular function test should be performed before prescribing any ototoxic medication especially in patients with other associated risk factors.

Background: The incidence of congenital sensorineural hearing loss in the newborn is higher than the combined incidence of all the metabolic conditions that we currently screen for with blood tests, the tool we are using, and the timing of screening are very important. Aim of the work: To evaluate the possible effects of pre-eclampsia on the neonate's hearing and determine the best timing to perform the screening. Patients and Methods: Seventy neonates were included, they were divided into two groups: control group included 40 neonates born to healthy mothers and study group included 30 neonates born to pre-eclamptic mothers. All neonates in this study subjected to the following: screening with handheld transient evoked otoacoustic emission [TEOAEs] within the first 48 hours after delivery. Infants who failed the first TEOAEs, were reexamined two weeks later. If failed, they were reexamined for the third time with TEOAEs two weeks later. Results: There were statistically significant difference between the study and the control group as regards the TEOAES results [p-value = 0.001] in the first and second screening tests. In the control group, 73.8% passed from the first time, versus 41.7% of the study group. In the second TEOAEs, 17.5% control versus 41.7% of the study group. Conclusion: Preeclampsia has some temporary effect on hearing in the newborns of pre-eclamptic mothers. So, it's better to postpone the first neonatal hearing screening of these babies, to be performed 2 weeks after delivery.

Background: Involvement of the brainstem in multiple sclerosis [MS] has significant implications on the disease course and can be presented with different symptoms. There are many tests able to detect brain-stem involvement in MS with various degrees of success. Aim of the work: To study the changes in vestibular evoked myogenic potential [VEMP], in patients with MS, and to detect its sensitivity for detection of the brain-stem lesions previously diagnosed with magnetic resonance imaging [MRI] in MS patients. Patients and Methods: Sixty participants had been enrolled and divided into two groups: 30 healthy subjects [Control group] and 30 MS patients [Study group]. Both groups had been subjected to otological examinations, pure tone audiometry, acoustic impedance, cervical vestibular evoked myogenic potential [cVEMP], ocular vestibular evoked myogenic potential [oVEMP] and MRI. Results: In MS group, oVEMP mean latencies of n1 and p1 and cVEMP mean p13 and n23 latencies were significantly prolonged. In addition, 14 MS patients [46.7%] had brainstem lesions as confirmed by MRI. Finally, oVEMP test had higher sensitivity than the cVEMP in prediction of brainstem lesions. Conclusion: oVEMP seems to be useful and more sensitive than cVEMP as an adjunct test in the evaluation of brain-stem dysfunction in MS patients.

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