Congenital cholesteatoma is typically an expanding cystic mass of keratinizing squamous epithelium located medial to the intact tympanic membrane in patients with no prior history of perforation, otorrhea and ear. It is generally thought to be a progressive disease and is usually surgically removed upon detection as the first-choice treatment. As such, it is rare to be observed for a long term without progression. Here we report a rare case of congenital cholesteatoma that remained in an undetectable size and did not deteriorate mild hearing loss for 12 years. A seven years old boy was referred to us with right hearing impairment. Pure-tone audiometry found conductive hearing loss with an air-bone gap of 25 dB and a high-resolution computed tomography (CT) scan found the eroded long process of incus but did not detect any soft tissue density indicating congenital cholesteatoma. He initially did not wish to undergo surgery. His hearing level and image finding remained virtually unchanged during the next 12 years of the follow-up period. Twelve years later, endoscopic ear surgery was performed, which revealed a very small cholesteatoma mass, an eroded long process of the incus and ossicular chain discontinuities. We suspect that the cholesteatoma was originally larger, partially eroded the incus, then regressed to a very small size, and remained small for at least 12 years under our observation.

No abstract

Postoperative vertigo is one of the common complaints after cochlear implantation (CI). Recently, development of new electrode designs and minimally invasive surgery have enabled preservation of residual hearing. At our department, an atraumatic electrode, FLEXSOFT of MED-EL, is inserted via the round window approach (RWA) and dexamethasone is administered intraoperatively and postoperatively to preserve vestibular function, regardless of the level of residual hearing ability. This retrospective study was aimed at determining the frequency of equilibrium dysfunction after minimally invasive CI.Between April 2018 and March 2019, 10 adult patients underwent minimally invasive CI surgery at our institution. The equilibrium function in these patients was assessed based on the symptom of vertigo, nystagmus, results of the caloric reflex test, measurement of vestibular evoked-myogenic potential (VEMP), and static stabilometry, before surgery and at various intervals after the surgery. One year after the surgery, 1/10 patients (10 ) reported dizziness, and nystagmus was observed in 2/10 patients (20 ). There were no abnormal results of the caloric reflex test after the surgery (0/4 side). Examination of the ocular VEMP (oVEMP) showed abnormal values before surgery on all sides. Examination of cervical VEMP (cVEMP) showed abnormal values after surgery on 5/9 sides (56 ). In the static stabilometer test, there was no significant deterioration in either the Romberg's ratio of velocity with foam rubber or the foam ratio of velocity with eyes closed after the surgery.Our study showed that the functions of the saccule can become impaired after minimally invasive CI. cVEMP may be most sensitive for detection of problems after CI surgery, since the saccule is anatomically closer to the implanted cochlea as compared to other vestibular organs.

We report a patient with severe and prolonged vertigo and ataxia caused by infarction of the bilateral cerebellar nodulus and uvula. Vertigo and nausea persisted for 2 weeks, causing the patient to remain bedridden. The patient showed upbeat nystagmus (UBN) on upward gaze and upon uprighting from the supine position and did not exhibit apogeotropic nystagmus characteristic of central paroxysmal positional nystagmus. Isolated positional UBN may be specific to an uvulo‐nodular lesion, and persistent and marked vertigo suggests extensive damage to the bilateral nodulus and uvula.

Interdigitating dendritic cell sarcoma (IDCS) is an extremely rare neoplasm derived from antigen-presenting cells of the immune system. It mostly occurs in the lymph node of the neck or axilla. We report a case of IDCS occurring in an 82-year-old female who presented with multiple masses in her right parotid gland. The patient was successfully treated with conservative surgery preserving the facial nerve followed by radiotherapy for the macroscopic lesion remnants. Most localized diseases were treated by surgery with or without irradiation, while advanced diseases were treated with systematic chemotherapy, such as CHOP. Radiotherapy may be an effective alternative to complete resection in patients with localized IDCS that involves functional and/or vital structures. The present case demonstrated that conservative surgery preserving the facial nerve followed by radiotherapy is an effective alternative option for the treatment of IDCS.