Sudden sensorineural hearing loss rarely occurs in patients with chronic myeloid leukaemia.

We present a case report of a patient who presented with sudden sensorineural hearing loss as the first manifestation of chronic myeloid leukaemia, and review the mechanisms responsible for sudden sensorineural hearing loss in leukaemic patients.

A 31-year-old female presented to our clinic with unilateral sudden sensorineural hearing loss and tinnitus. Pure tone audiometry revealed profound sensorineural hearing loss in the left ear at all frequencies. During an investigation into her hearing loss, the patient was found to have chronic myeloid leukaemia.

Every case of sudden sensorineural hearing loss must be carefully evaluated, and haematological disorders must be considered in the differential diagnosis of sudden hearing loss.

There are only very few reports of cervical toxoplasma lymphadenitis being diagnosed exclusively via fine-needle aspiration cytology (with serology).

We describe a case of toxoplasma lymphadenitis that was successfully diagnosed by fine-needle aspiration cytology. The case involved a male patient who was immunocompromised as a result of recurrent acute myelogenous leukaemia with cervical lymphadenopathy. The biopsy showed typical features of a well-defined pseudocyst containing Toxoplasma gondii tachyzoites.

Toxoplasma lymphadenitis is a common cause of lymph node enlargement. Fine-needle aspiration cytology is a useful method for diagnosing and differentiating toxoplasma lymphadenitis from more serious causes of lymphadenopathy, such as metastatic lymphadenopathy or lymphoma.

To report and discuss the surgical use of ultrasonography for draining a parapharyngeal space infection in a child.

The use of image-guided surgery for draining a parapharyngeal abscess has been previously reported, with computed tomography for an intra-oral approach and ultrasound for an external approach. We present the first case report of a four-year-old child with a retropharyngeal abscess and a deep parapharyngeal abscess in whom neck ultrasound was used to assist intra-oral drainage.

Neck ultrasound may be used in paediatric patients to visualise access to the parapharyngeal space through the intra-oral route for abscess drainage.

Patients with laryngectomy tracheostomas are at risk of developing acute airway obstruction due to mucous crusting. Current management relies on saline nebulisers, followed by suction and manual evacuation to remove the obstruction. This paper describes the first reported case of using N-acetylcysteine nebulisers in addition to saline to adequately soften the mucous plugs in order to facilitate removal.

A 68-year-old female attended the emergency department with a partial obstruction of her laryngectomy tracheostoma as a result of mucous crusting. Saline nebulisers did not provide adequate softening to allow the obstructing mucous plugs to be removed. N-acetylcysteine nebulisers were used to further soften the mucous plugs which successfully resulted in their removal.

N-acetylcysteine nebulisers can be used to assist in the removal of mucous plugs in saline-resistant cases.

We report three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging findings in a patient with relapsing polychondritis.

Case report.

A 76-year-old woman initially presented with bilateral auricular swelling together with dyspnoea. Three months later, she experienced left hearing loss and recurrent vertigo. A biopsy of the auricle was performed and relapsing polychondritis was diagnosed. The patient underwent three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging 4 hours after intravenous injection of a standard dose of gadolinium. Gadolinium enhancement was visible throughout the vestibule and the endolymphatic space could not be visualised, suggesting breakdown of the blood–labyrinth barrier.

This is the first radiological report to demonstrate breakdown of the blood–labyrinth barrier in a case of relapsing polychondritis with inner ear impairment.

Scytalidium dimidiatum is a soil and plant pathogen that frequently affects fruit trees, but can also cause human infection. There are only two reported cases of invasive fungal sinusitis involving this rare micro-organism.

This paper reports the first case of invasive fungal sinusitis caused by Scytalidium dimidiatum occurring in a young immunocompetent patient from a non-endemic region, and discusses potential sources of exposure and relevance of local factors.

Case report.

The patient was treated successfully with a combination of functional endoscopic sinus surgery, and antifungal and corticosteroid treatment.

This paper describes the first reported case of invasive fungal sinusitis secondary to Scytalidium dimidiatum in a young immunocompetent patient from a non-endemic region. Importance is placed on following a systematic process of investigation and management, and adhering to well-defined basic surgical principles.

We report a case of a patient with symptomatic primary hyperparathyroidism who was found, through a thorough radiological investigation, to also have papillary and medullary thyroid carcinomas.

A 59-year-old female was diagnosed with primary hyperparathyroidism. A further radiological investigation found suspicious areas within both thyroid lobes that were later diagnosed as foci of papillary and medullary thyroid carcinomas. Appropriate treatment was commenced. Reports of similar occurrences of synchronous thyroid and parathyroid pathologies are discussed.

To our knowledge, this is the first reported case of two synchronous thyroid cancers occurring in the context of primary hyperparathyroidism. We strongly recommend a thorough radiological investigation of all patients with primary hyperparathyroidism to prevent missing concurrent thyroid cancers.

Anomalies of the stapedius tendon have been reported to cause conductive hearing loss; in theory, such anomalies limit the movement of the stapes.

To demonstrate a rare cause of conductive hearing loss resulting from anomaly of the stapedius tendon and to compare the clinical findings of this patient to other stapedius tendon anomalies reported in the literature.

Case report of a single case of shortened stapedius tendon and a review of the English literature on stapedius tendon anomalies.

This is a case report of a 15-year-old boy with shortened stapedius tendon causing unilateral hearing loss, accompanied by a review of the literature. Contrary to other reported cases, this patient did not have an ossified tendon, but rather an extremely short tendon. The boy regained normal hearing following excision of the stapedius tendon.

A shortened stapedius tendon is a very rare diagnosis, yet it should be considered as a possible cause of conductive hearing loss.

Zenker's diverticulum is a propulsion diverticulum in the pharynx. Current practice for the management of symptomatic pharyngeal pouches includes endoscopic pharyngeal stapling, performed trans-orally, and external approaches via a cervical incision. There is no published recommendation on how to approach diverticula with extension into the mediastinum, which may not be adequately treated with the above methods.

We describe two cases in which thoracoscopic mobilisation of Zenker's diverticulum was performed using video-assisted thoracoscopic surgery together with traditional transcervical mobilisation and excision of the pouch. This allowed safe surgical access to the inferior limit of the pouch, and delivery of the sac into the neck incision following division of any inferior adhesions (to the great vessels in one case).

In the first report of this technique, we describe a thorough, safe method of dissecting large diverticula that extend into the mediastinum, which minimises the risk to mediastinal structures.

Synovial sarcoma is a high-grade, soft tissue, malignant disease associated with poor outcome. Typically, synovial sarcoma involves the extremities, with less than 10 per cent of cases occurring in the head and neck region. Synovial sarcoma of the paranasal sinuses is a rare entity. This paper presents a case of an elderly patient with synovial sarcoma of the ethmoidal sinus.

An 80-year-old woman who had right epistaxis underwent nasal endoscopy and biopsy. The pathology indicated synovial sarcoma and the patient underwent endoscopic excision of the tumour.

Synovial sarcoma of the ethmoidal sinus is very rare. Patients should undergo excision of the tumour with post-operative radiotherapy. However, the prognosis remains poor and usually the patient succumbs to death within a year.