Adenofibroma of the testis

Adenofibromas of the testicular parenchyma are exceptional with only one case published in the literature. Whereas adenofibromas of mullerian derivatives are well described, testicular tumours resembling surface ovarian epithelium are rare. We describe a case of adenofibroma discovered incidentally while investigating for a hydrocoele in a 57-year-old patient. Histological and immunohistochemical evaluation confirmed the lesion as being a serous adenofibroma with immunohistochemical properties analogous to its ovarian counterpart. These lesions are to be considered in the differential diagnosis of unusual cystic lesions of the testis, in order not to confuse it with more sinister pathology.

Laser myringotomy in different age groups

OBJECTIVE

To study the qualities of laser myringotomy (LM) as a treatment for middle ear ventilation problems.

DESIGN

Prospective study and follow-up of consecutive cases of adults, children, and infants. Patients were observed for up to 2 years.

SETTING

Children underwent LM, with or without adenoidectomy, under general anesthesia in the operating room. Adults and infants underwent LM under topical anesthesia, as an outpatient procedure.

PATIENTS

All consecutive patients with either secretory otitis media (SOM) (adults and children) or acute otitis media (AOM) (infants) who agreed to participate were included without selection.

INTERVENTION

Myringotomy was performed using new laser equipment, enabling a 0.1-second ablation with changeable diameter.

OUTCOME MEASURES

Close follow-up, with microscopic examination of all ears. Findings were noted on the medical charts.

RESULTS

Among all age groups, 136 ears were followed up. Perforation lasted a mean 22 days in adults, 17 days in children, and 11 days in infants. Patient age was found to be a significant determining factor for duration of perforation (P =.002). Laser myringotomy in the anterior and inferior areas lasted longer than posterior LM (P<.001). In patients with SOM, during the time the LM was patent, all ears were ventilated. In children, 38% of SOM cases resolved after a single LM treatment. All infants with AOM recovered promptly without antibiotic treatment.

CONCLUSIONS

Laser myringotomy is a convenient, quick procedure that can be performed in the medical office with the use of topical anesthesia and is suitable for patients with AOM or for those who need short-term ventilation for SOM. It was found to be a safe alternative to ventilation tubes in these patients. In AOM, it was used instead of antibiotics and gave prompt relief from symptoms and cure of the AOM.

Audiometric configurations following exposure to explosions

OBJECTIVE

To determine the configurations in pathologic audiograms obtained in patients shortly after exposure to an explosion.

DESIGN, SETTING, AND PATIENTS

Audiograms were performed in 143 patients (286 ears; 76 males and 67 females, with a mean age of 34.6 years [range, 11-79 years]) sent to the Department of Otolaryngology and Head and Neck Surgery in a city hospital located in the center of Jerusalem, Israel, after being injured in 4 severe explosions occurring in Jerusalem during 1995-1997. Most of the audiograms were obtained within 4 hours after the explosion, and the remaining were obtained within 4 days of the explosion.

RESULTS

Of 200 pathologic audiograms, 93 (46%) showed a downward slope configuration, 82 (41%) showed a dip configuration, and 25 (12%) were flat. There were 38 audiograms (19%) with 6-kHz dips. In 82% of the patients, the audiometric configurations were similar in both ears. Patients with a slope configuration on the audiogram were significantly older than those with a dip configuration (mean age, 40.8 vs 32.8 years; P<.01).

CONCLUSIONS

There does not appear to be a single typical audiometric configuration in patients exposed to explosions. The slope and dip configurations are most frequently seen and are approximately equal in their incidence. This observation may lead to better understanding damage to the inner ear as a result of an explosion. This study is distinctive because of the large number of audiograms obtained and the fact that most of them were obtained immediately after the explosion.