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Labyrinthine fistula is a complication of ear cholesteatoma that increase the risk of sensorineural hearing loss. The management of the fistula must be done contextually with mastoidectomy by: leaving cholesteatoma matrix over the fistula, or remove the matrix reconstructing the defect. Objective : analysis of the two techniques to treat labyrinthine fistula. Methods : retrospective review with case series analysis. Results: a labyrinthine fistula was present in 14% of cholesteatoma patients; CT scan was predictive in all cases; the hearing preservation was obtained with both techniques; a recurrence was detected only in one case; postoperative nystagmus incidence was higher in those cases with matrix left in situ and when the size of the fistula was larger than 2 mm. Conclusions : the labyrinthine fistula have to be treated contextually with cholesteatoma removal, both techniques had good postoperative hearing preservation rate. The postoperative vertigo with nystagmus is more frequent in larger fistulas. 


The use of image analysis methods has allowed us to obtain more reliable and reproducible immunohistochemistry (IHC) results. Wider use of such approaches and simplification of software allowing a colorimetric study has meant that these methods are available to everyone, and made it possible to standardize the technique by a reliable systems score. Moreover, the recent introduction of multispectral image acquisition systems methods has further refined these techniques, minimizing artefacts and easing the evaluation of the data by the observer. 


Padua (Italy) 29 September—3 October 2015


 Retropharyngeal abscesses (RPA) are rare in adults. We report a case of a healthy adult with RPA presenting with clinical symptoms of acute thyroiditis. A 37-yr-old female presented with a painful mass in the anterior region of the neck, sore throat, mild fever and dysphagy for liquids and solids. Neck emergency US dis-closed normal thyroid ventrally displaced by a huge retropharyngeal hypoechoic mass. Direct laryngoscopy revealed erythema of the posterior pharyngeal wall with bulges (8 cm) preventing the correct visualization of the glottic plane. CT confirmed the pres-ence of retropharyngeal abscess and laryngoscopic drainage was performed. The pa-tient was discharged on 11th post-operative day, in good condition. The high mortality rate of retropharyngeal abscess is related to its association with invasion of contiguous structures and mediastinum: once mediastinitis occurs, mortality reaches 50%, even with antibiotic therapy. CT is fundamental for the diagnosis, but in many cases, as our, ultrasonography of the neck may play a pivotal role as quickly as possible. Surgi-cal treatment (intraoral incision and drainage) is the better definitive and resolutive treatment. The clinical diagnosis of retropharyngeal abscess in adult can be difficult because of the lacking and non specificity of clinical presentation.  It is recommended to collect accurate clinical history, careful examination of the head and neck and use of early ultrasound examination of the neck, which in real time can give precise indications to guide the diagnosis and therapy.  The management of a retropharyngeal abscess depends on the patient’s clinical condi-tion, moving from conservative treatment with steroids and antibiotics to reanimation and aggressive surgical drainage.

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