Isolated malleus fractures are a rare occurrence with few reported cases in the literature. Symptoms include sudden otalgia, hearing loss, tinnitus and aural fullness. Work-up and diagnosis are based on a combination of thorough anamnesis and careful otoscopic evaluation or high-resolution computer tomography. We present two cases of isolated malleus handle fractures who were diagnosed based on a combination of pneumatic otoscopy and tympanometry. Both fractures were surgically repaired using hydroxyapatite bone cement as showcased in the supplemental video material. Post-operative audiometry showed improvement in the pure-tone-average of both patients as well as normalisation of tympanometry. Isolated malleus fracture should be suspected in cases of sudden hearing loss and tinnitus following digital manipulation of the outer ear canal together with a conductive hearing loss with a mostly high-frequent air-bone-gap and hypercompliant tympanometry with hypermobility of the tympanic membrane on pneumatic insufflation. Surgical repair of the fracture using bone cement has good hearing outcomes and leads to improvement in auditory symptoms.

Gout is the most common cause of monoarthritis in men occurring classically in the great toe and the knee. Extra-articular gout manifestations are rare. Only a few cases of head and neck urate crystals deposits have been described in the literature. Precipitations in the middle ear cause conductive hearing loss with common otoscopic anomalies and difficult imaging diagnosis. We report a case of a healthy 58-years-old man with a middle ear urate deposit causing a progressive hearing loss as the very first symptom of gout. The nature of the deposit was unsure on computer tomography (CT) due to atypical density. The final diagnosis was revealed after surgical procedure and histologic examination. A review of the literature is also presented. Seven cases of middle ear urate deposit as the first symptom of gout were found and compared. Progressive conductive hearing loss in middle-aged patients with abnormal otoscopy and middle ear atypical density mass on CT scan must lead to a minimal surgical procedure with a histologic examination to exclude urate crystals deposits.

This is a report of death due to direct lightning strike that was witnessed, with description of the injuries. The associated clothing and jewelry were examined microscopically for lightning-related findings. For the first time, we report a lightning strike on a victim that led to crater formations in the brass clasp of the basil wood bead necklace, brass teeth, and brass button of the zipper. Blackening, fissuring, and charring of basil wood beads were noted. There was blackening and fusion of cowrie shell teeth, which were in the black thread necklace. The silver necklace chain vaporized and caused deep burns on the nape of neck. A few links of the silver chain necklace were found embedded in the clothing. All this damage provides important insight into the behavior of lightning.

Eosinophilic otitis media (EOM) is a difficult-to-treat otitis media (OM) characterized by eosinophilic accumulation in the middle ear mucosa and secretion. Associated sensorineural hearing loss can eventually lead to (functional) deafness. EOM is strongly associated with type 2 inflammation driven respiratory disease, i.e. asthma and chronic rhinosinusitis with nasal polyps (CRSwNP), for which biological treatment is available. This case report discusses a patient suffering from EOM with severe mixed hearing loss, nearing functional deafness. Dupilumab treatment resulted in complete and enduring remission of the EOM, enabling adequate hearing rehabilitation. Concurrent control of the comorbid asthma and CRSwNP was obtained. Laryngoscope, 131:2649-2651, 2021.

BACKGROUND: Vitiligo is characterized by the destruction of functional melanocytes in the skin. This destruction can target melanocytes anywhere in the body, in turn affecting the function of the organs in which the affected melanocytes reside. Melanocytes in the skin, uveal tract and ear are similar in their physiology and morphology, and share a common embryological origin.
OBJECTIVE: To study the association of vitiligo with ocular and auditory abnormalities.
METHODS: This case-control study was carried out on 40 patients with vitiligo and 20 healthy controls (HCs). All patients and HCs underwent auditory examination (otoscopic examination and immittance audiometry to assess middle ear pressure and exclude tympanic membrane perforation; pure tone audiometry to assess peripheral hearing sensitivity; and transient evoked otoacoustic emissions to assess central hearing ability) and standard ocular examination including visual acuity test, slit lamp biomicroscopy and optical coherence tomography.
RESULTS: Compared with controls, there was a significantly higher prevalence of hearing loss and ocular abnormalities in patients with vitiligo but no significant difference in visual acuity.
CONCLUSIONS: Vitiligo is a systemic disease that can be associated with impairment of melanocyte function organs other than the skin, including the eyes and ears. The function of auditory melanocytes is related to the hearing process and thus their destruction could lead to hearing impairment. By contrast, ocular melanocytes do not play a direct role in detection or transfer of visual information, and thus should not affect vision. Vitiligo may be associated with ocular abnormalities and hearing loss.

Inverted papilloma (IP) of the middle ear as a primary lesion or as an extension of a sinonasal papilloma, is extremely rare. Only 23 cases of primary inverted papilloma of the middle ear have been reported in the literature. They are locally aggressive tumours, with a high rate of recurrence and associated malignancy. We present a rare case of a 59-year-old man presenting with unilateral otorrhoea, tinnitus, and hearing loss. Otoscopy revealed posterior perforation filled by irregular budding neoformation. The temporal CT scan showed tissue filling the tympanic cavity as well as the mastoid antrum without bone lysis. The patient underwent limited tympanoplasty. An intraoperative biopsy of polypoid tissue filling the tymapanic cavity was made and histopathology showed an IP. A recurrence occurred 4 months after surgery. We performed open tympanoplasty allowing complete resection of the lesions, with no recurrence after a follow-up of 30 months.

Tophaceous gout of the middle ear is a rare occurrence that presents as a granular white-colored mass. It is frequently misdiagnosed as cholesteatoma or tympanosclerosis in patients who otherwise may not manifest any clinical or biochemical signs of gout. While uncommon, it can lead to clinically significant disease such as conductive hearing loss. The present report describes 2 cases of middle ear gouty tophi initially mistaken for another entity. Both patients underwent surgery, and the diagnosis of gout was revealed after final histopathological analysis. A review of the literature is also presented.

We present a case of bilateral haemotympanum (HT) during endobronchial ultrasound-guided transbronchial fine needle aspiration (EBUS-TBNA). A 64 year-old-man underwent EBUS-TBNA for mediastinal lymph nodes (LN) staging. Medical history included emphysema and angina. Medication included aspirin until the day before procedure. Full blood count and clotting screen were normal. He received sedation (5 mg midazolam, 1000 mcg alfentanil) and topical anaesthesia (16 mL 1% lignocaine) but coughed excessively throughout the procedure. Left hilar LN was the only area sampled. Spontaneous bleeding ensued from both ears towards the end of the procedure. Patient remained haemodynamically stable. The procedure was aborted and otolaryngology consult sought. Otoscopy showed bilateral haematoma from anterior ear canal with normal tympanic membranes and no hearing loss. Nasendoscopy revealed erythematous ostium of both Eustachian tubes. Bleeding stopped spontaneously and patient required no further imaging or treatment. We report this case to increase awareness of this very rare complication resulting from excessive coughing during EBUS-TBNA.

BACKGROUND: Jugular bulb anomalies are asymptomatic lesions commonly seen in routine practice. However, some patients with jugular bulb anomalies may present with symptoms such as tinnitus or conductive hearing loss (CHL).
UNASSIGNED: A 9 year old boy complained right sided hearing disturbance without any vestibular symptoms. Pure tone audiometry (PTA) revealed a mild right sided conductive hearing loss. Otoscopy showed a red-purplish mass like lesion in his right middle ear cavity, which was regarded as hypervascular tumor.
METHODS: Based on otoscopic findings, preliminary differential diagnoses included jugular bulb anomaly, hemotympanum, cholesterol granuloma and paraganglioma.
METHODS: We performed contrast enhanced computed tomography of the temporal bone (TBCT).
RESULTS: CT scan showed and enhancing lesion which was bulging from his right jugular foramen to the middle ear with dehiscent jugular bulb. The lesion showed the same degree of contrast enhancement with the venous vasculature. This lesion contacted with the tympanic membrane, incudostapedial joint and round window, which might be attributable to interruption of sound transmission mechanics. Otherwise there was no evidence of mass or trauma related lesions in the temporal bone.
CONCLUSIONS: Although most of jugular bulb anomalies are asymptomatic, patients may present with conductive hearing loss due to the interference of sound transmission mechanics.

An inverted papilloma is a benign neoplasm that occurs exclusively in the sinonasal cavity; an inverted papilloma involving the mastoid cavity is extremely rare. We present the case of a patient with an inverted papilloma of the mastoid cavity secondary to cholesteatoma surgery. No case that occurred after acquired cholesteatoma has been reported in literature. A 39-year-old female who was diagnosed with cholesteatoma was treated with a modified radical mastoidectomy in 1988. After recurrence, the patient underwent a canal wall down mastoidectomy in 2006. Four years later, the patient complained of right ear fullness; an examination determined that the right ear canal wall was nearly obliterated by a soft tissue mass. Surgery determined that a papilloma-like mass filled the mastoid cavity. The tumor was surgically resected by revision canal wall down mastoidectomy with canaloplasty. Histologically, it was determined to be an inverted papilloma. There has been no evidence of recurrence to date.