H & N

Question 1

Sinonasal inverted papilloma
Definition?
Epidemio?
Clinical presentation?
Cmplications?

Answer 1

Def: benign neoplasm arising from Schneiderian mucosa, demonstrating folds that grow into stroma, but not breaching the basal membrane.

Epidemio:
Male.
30-60yo. (middle age)

Clinical presentation:
Chronic sinusitis. Obstruction symptoms. Discharge.

Complications:
-10% either malignant transformation or concomitant malignancy present.
-Recurrence after surgery.
-Invasion into deep spaces.

Question 2

Sinonasal inverted papilloma
Forms?
Path?

Answer 2

Forms:
-Exophytic, most frequent. Tend to arise from nasal septum
-Endophytic/inverted. malignant potential.
-Oncocytic/cylindrical. malignant potential.

Path:
-Focal hyperostosis indicates site of origin.
-Benign but locally destructive.
-40% multifocal
-10% Ca+.

Question 3

Sinonasal inverted papilloma,
Dx?

When to suspect malignancy?

Answer 3

-Arises from lateral wall of nasal cavity, mainly middle turbinate/meatus.
-Loca hyperostosis - origin.
-Local bone expansion, remodeling, destruction.
-Spreads into adjacent sinuses:
(maxillary 70%, ethmoidal 50-90%, orbits/CNS 30%, sphenoid 20%, frontal 15%)
10% Ca+
40% multifocal

Malignancy:
-loss of cerebriform appearance.
-Central necrosis.

Question 4

Otospongiosis/Otosclerosis
Definition?
Affected population?
Clinical presentation?
Treatment?

Answer 4

Def: appearance of lytic/spongy bone foci affecting the otic capsule.
Could be fenestral otosclerosis (affecting the Fissula ante fenestram)
or Retro-fenestral Cochleal otosclerosis.

Affects young adults 20-30yo.
M:F 1:2

Presentation:
Bilateral conductive hearing loss (more frequent) / or mixed hearing loss.

Treatment: surgical

Question 5

Otosclerosis
Diagnosis

Answer 5

Dx: Best: Temporal bone CT shows lytic (otospongiotic) foci involving bony labyrinth
-FOto: Starts at anterior margin of oval window (fissula ante fenestram). Plaques more common.
-COto: Affects pericochlear bony labyrinth. Ovoid/curvilinear/halo like.

-Late/Chronic (healing phase): May present abnormal thickening of otic capsule bone near oval window w/bulging contour.
FOto: “Heaped up” new bone along oval & round window margins, they become occluded by plaques
COto: Mixed radiolucent-radiodense foci present in bony labyrinth

MR: limited: T1+Gad: enhancing foci in affected area.

Check list: If Coto present, Foto also is present, so look for it