Archives of Otorhinolaryngology-Head & Neck Surgery (AOHNS) is a branch of SciTeMed publishing group. AOHNS provides a new avenue for clinical investigators, clinicians, and trainees to publish their research. AOHNS is a journal with a vigorously, timely peer-review policy and a rapid publication process. AOHNS aims to bring about a change in modern scholarly communications to accelerate scientific discoveries and to help disseminate research to a wider readership, gain media attention and demonstrate professional achievement through publication. The mission of AOHNS is to promote research in science for the benefit of humanity and to advance the science and practice of otorhinolaryngology as well as head and neck surgery. AOHNS is a reliable journal with a scope of high-quality science information that will lead in terms of attracting the best possible science that can provide the best impact.
The content area of AOHNS is broad, and it will encompass all of the subspecialties of Otorhinolaryngology-Head and Neck Surgery. Subject areas include, but are not limited to, general otolaryngology, allergy, rhinology, otology, neurotology, laryngology, bronchoesophagology, head and neck surgery, sleep medicine, pediatric otolaryngology, facial plastics and reconstructive surgery, oncology, and communicative disorders. AOHNS features original research, analyses and reviews, news, practice updates, thought-provoking editorials, expert opinion articles, forward-looking perspectives, commentaries, image, and book reviews. The journal will also accept contributions that present innovative and improved methods, or resources that advances basic research with broad interests. AOHNS embraces new and emerging trends quickly by periodically publishing special issues.
Professor Holger Sudhoff completed his training on otolaryngology, head and neck surgery in June 2000. During his training, he has had exposure to a broad spectrum of otorhinological procedures, as well as more specialized areas described below. As a fellow, he gained invaluable basic science research and laboratory skills. He has had broadened surgical experience by operating both independently and within a team framework. His passion for teaching has created an atmosphere receptive to learning. His Skull-Base fellowship in Cambridge provided him with outstanding skills in that surgery as well as insights into the NHS structure. In his current post, he has undertaken all the administrative, teaching and on-call duties associated with a professorial chairmanship in a busy teaching hospital serving a population of eastern Westphalia in Bielefeld. This post has provided Professor Sudhoff with the opportunity to gain vast experience at the level of executive responsibility and to gain further insight into all management issues and public relations, pertaining to running an ENT unit, such as organization and prioritization of operating lists, outpatient clinics and overseeing all financial developments. Professor Holger Sudhoff and his team have created one of the largest German ENT units over the last 10 years. In February 2013 Professor Sudhoff co-founded the German Skull Base Center in Bielefeld treating currently 120 major skull base cases annually. Professor Sudhoff served as President of the West-German ENT society in 2015 and was elected for Focus magazine of “Top Medical Doctors” for Otorhinolaryngology in Germany in 2013 to 2017. He was elected as a board member of Politzer Society in July 2015 in Niigata, Japan.
Professor Sudhoff worked with Professor Henning Hildmann and Professor Jan Helms, his otology supervisors, leading otologists / lateral skull base surgeons at the Bochum and Würzburg Universities. During Professor Sudhoff training and work as a Consultant, Professor Sudhoff has a extensive experience in middle ear procedures. He has participated as an invited lecturer in many national and international courses performing live surgery. Professor Sudhoff has received further training in the management of lateral skull base tumours and acoustic brainstem implants (ABI) in Cambridge, UK under the supervision of Mr. David Moffat, Mr. Patrick Axon and Mr. Robert Macfarlane (Neurosurgeon). Professor Sudhoff organized the multidicipinary skull base meetings as well as the NF2 clinics. He received training in all aspects of middle ear and skull base surgery, and reached the stage of developing independently new procedures (e.g. Balloon Eustachian Tuboplasty) in middle-ear surgery and in the management of all diseases of lateral skull base pathologies). He has developed the cochlear implant service in Bielefeld and started an implantable hearing devices program for active middle ear implants and bone anchored hearing aids During a humanitarian medical trip to Egypt in 01/2011 he treated several patients with gunshot injuries. Additionally, Professor Sudhoff along with the neurosurgeon Pofessor Falk Oppel supports a humanitarian project initiated by Professor Henning Hildmann in Ruanda, Africa and in the Ukraine.
Professor Sudhoff has received extensive training in the management of benign and malignant head and neck disease. He is competent and confident in performing a wide range of head and neck surgical procedures, ranging from thyroid and parotid surgery to managing tertiary referral oral and oropharyngeal tumours, and complex transfacial approaches for malignant skull base disease in both adult and paediatric patients. The latter includes midfacial degloving (e.g. for angiofibroma’s), lateral pharyngotomy as well as maxillary swing and other facial disassembly approaches. He also received extensive training in transoral laser microsurgery for primary and post-radiation-failure management of head and neck cancers. With regards to reconstruction, while he prefers to work in a multi-disciplinary team with plastic surgeons.
Professor Sudhoff has developed many research protocols from planning to implementation, publication and finally leading to a change of clinical practice. He was able to establish two research laboratories (Bochum University and Bielefeld) and generated the funding for both labs without intramural funding. Professor Sudhoff has experience in tissue processing, cell culture, ELISA, Radio-Immunoassay, Gel Electrophoresis, Transmission Electron Microscopy, Scanning Electron Microscopy, Immune Electron Microscopy, Molecular Biological Techniques such as m-RNA/DNA Extraction, Reverse Transcription, PCR, Mircoarray analysis, In-situ hybridisation, genetic probe analysis and zymography. Additionally he established a temporal bone dissection laboratory.
Professor Sudhoff has been successful in obtaining appropriate ethical and grant approvals of several Million Euros, the latter from numerous sources, both at a formal Scholarship Level to National Research Agency (Deutsche Forschungsgemeinschaft, DFG. Professor Sudhoff has also been involved in several multi-centre clinical trials as well basic science research resulting in more than 190 publications in peer reviewed journals, 43 book chapters and 6 books. The overall impact factor now 400 and there is a Hirsch index of 27. Research on Eustachian tube dysfunction led directly to the development of the novel technique of balloon dilation tuboplasty (BET), which is now scattered worldwide. Several research projects are currently performed in Bielefeld, also in cooperation with Harvard University, USA and Cambridge University, UK. Professor Sudhoff is on the editorial board of 12 peer reviewed journals.
Holger Sudhoff, MD, PhD, FRCS (London), FRCPath (London)
Archives of Otorhinolaryngology-Head & Neck Surgery
Department of Otolaryngology-Head and Neck Surgery
Bielefeld Academic Teaching Hospital, Muenster University, Bielefeld, Germany
Dr. Grossan is a consultant for: Los Angeles County District Attorney, U.S. Department of Labor, Freemont Insurance, Water and Power, Industrial Indemnity, Los Angeles City, L.A. County, Culver City, Manhattan Beach, and others President, Los Angeles Chapter of Phi Lambda Kappa Medical Fraternity. He was awarded the Certificate of Merit for the Scientific Exhibit "Nasal Mucociliary Flow", by American Medical Association
Dr. Grossan is an expert in bio-feedback and teaches his patients his action program which includes using a mirror as a bio-feedback mechanism. He is known for original thinking, especially for drug free therapies he has developed for tinnitus, empty nose syndrome, allergy, sinusitis and others.
Murray Grossan, MD
Archives of Otorhinolaryngology-Head & Neck Surgery
Board Certified Otolaryngology and Head and Neck Surgery
Department of Otolaryngology-Head and Neck Surgery
Cedars Sinai Hospital Medical Towers
8631 W. 3rd Street Suite 440 E, Cedars Sinai Hospital Medical Towers,
Los Angeles, USA
Prof. Meiho Nakayama was graduated from Aichi Medical University, Nagoya, Japan in 1985. He completed his residency and obtained a PhD degree in 1992. He spent three years (1992-1995) working as a visiting professor and research fellow in the Department of Otolaryngology, Southern Illinois University School of Medicine, USA with Prof. Horst R. Konrad, Dr. Robert Helfert, and Dr. Leonard Rybak. Prof. Nakayama specializes in vestibular function, rehabilitation, and basic research of vestibular organs. After returning from the USA, Prof. Nakayama established a sister school relationship between Aichi Medical University and Southern Illinois University and continued a good relationship with numerous students and researchers. Prof. Nakayama became Assistant Professor (1995-2001) and Associate Professor (2001-2007) in the Department of Otolaryngology, Aichi Medical University. During this time (2000-2007), he was also engaged as the Associate Director with the Sleep Center of Aichi Medical University.
Prof. Nakayama moved to the Department of Otolaryngology, Nagoya City University as Associate Professor from 2008 to present and established the Good Sleep Center as its Chief Director. Since then, He started new research on sleep disorders. In addition to equilibrium research, he combined his skills in otoneurology and discovered a new relationship between otoneurological diseases and sleep disorders. Since he could speak Japanese, English, Taiwanese, and Chinese, he was invited for teaching and research cooperation, and also received researchers from Asian countries such as Xian Jiotong University and Dalian Medical University China. Recently, he has been engaged as a visiting professor with the Sleep Medicine Center and the Department of Otolaryngology, National Cheng Kung University, Taiwan. Rarely in the history of medical science, as a physician working on both otoneurology and sleep medicine, he is creating a new medical field connected with the two mysterious diseases.
After completion of his PhD degree on vestibular function and microscopic research of the vestibular organs, Professor Nakayama was trained as an otology surgeon under Prof. Isao Takimoto, Professor Horst Konrad, and Professor Shinzo Murakmi, and had experienced more than a thousand ear surgeries. Since the establishment of Good Sleep Center, he had focused on sleep apnea surgeries, especially for children. In 2010, he cooperated with Prof. David Gonzal in the Department of Pediatrics, University of Chicago, and discovered seasonal changes on sleep apnea children that offered new information for surgical indication internationally in 2013.
Prof. Nakayama spent most of his time on vestibular research for the last thirty years. While he worked with Professor Horst Konrad at the School of Medicine, Southern Illinois University, the group paid attention to working on vestibular rehabilitation that was not recognized well in 1992. Prof. Nakayama attended vestibular teaching courses as a lecturer and played an important role in publishing the rehabilitation textbook, entitled Vestibular Rehabilitation Therapy for the Patient with Dizziness and Balance Disorders: Exercise Protocols, with the Southern Illinois University group at that time. Prof. Nakayama is a good friend of Dr. John Epley and supported his research for Benign Paroxysmal Positional Vertigo to complete the study on OMIAX chair in 2002. He is a leader and takes more than a thousand dizzy patients a year in his clinic with a balanced group in Nagoya City University Hospital. Prof. Nakayama has been the Chief Director of the Good Sleep Center since 2010 and has brushed up on his skills in sleep apnea surgeries. He also discovered a new research on both balance and sleep medicines.
Prof. Nakayama has identified several patients with Meniere's disease who suffered from sleep disorders. Attracted by this new topic, he was invited by the American Academy of Otolaryngology Society to introduce his new research in the balance disorders series in the journal entitled Current Opinion in Otolaryngology & Head and Neck Surgery in 2013. In clinical practice, he has focused on sleep apnea. A polysomnogram test was performed in more than 400 patients annually, with most of the cases sleep disorders such as hypersomnia, circadian rhythm sleep-wake disorders, or sleep-related movement disorders. Recently, his group has not only reported a new finding on the relation of globus pharyngeus and sleep disorders, but also offered a new expectation between otolaryngology and sleep disorders to all otolaryngologists in the world.
Meiho Nakayama, MD, PhD
Chief of Good Sleep Center, Nagoya City University, Japan
Associate Professor of the Department of Otolaryngology, Nagoya City University, Japan
Dr. Chin-Lung Kuo is the Director of the Department of Otolaryngology, Taoyuan Armed Forces General Hospital, Taiwan, ROC. Dr. Kuo received his medical degree from the National Defense Medical Center and earned his PhD degree at the Institute of Brain Science, National Yang-Ming University, Taiwan, ROC. He completed his otolaryngology residency, chief residency, and fellowship training at the Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taiwan, ROC. Dr. Kuo continues to make contributions to the scientific community. His primary field of study is otology, and his research is focused on middle ear surgery and hearing loss. Dr. Kuo has been invited to speak at international conferences and institutes. Dr. Kuo has been the first or corresponding author on more than 50 published articles in the last 5 years, including SCI original papers, review articles, as well as book chapters. In 2012, his research paper was chosen as the cover story of the journal Audiology and Neurotology. In addition, Dr. Kuo received the Outstanding Paper Award from the Laser Medicine Education and Research Foundation in 2013, and was awarded the 2015 Hayashi SPIO (Society for Promotion of International Otorhinolaryngology) Scholarship in Japan. Dr. Kuo believes that increased availability of research data can benefit both medical research and science education. For further details regarding his research, please use the following link to access his blog.
Dr. Akdagli is a physician at the Department of Anesthesiology, SUNY Downstate Medical Center, New York. She received her medical degree from Cerrahpasa Medical School, Istanbul; completed her training in Otolaryngology- Head and Neck Surgery (OHNS) at Goztepe Training Hospital Department of OHNS, Medeniyet University. Following her specialty training she practiced medicine at Tuzla Public Hospital, Istanbul and Etlik Training and Education Hospital, Ankara for two years. She was a visiting scholar at Stanford Department of OHNS between 2013-2016 with a focus on plastic surgery and rhinoplasty. During this time she also developed a keen interest in anesthesiology and from 2015 collaborated and worked together simultaneously with Stanford Department of Anesthesiology and Stanford Department of OHNS while authoring and co-authoring many peer reviewed publications in plastic surgery, rhinoplasty and anesthesiology. Her clinical interests focus primarily on critical airway management. She is married and has one child. Her hobbies include yoga, hiking and cooking techniques in authentic Asian and Mediterranean cuisine.
Dr. Hu is an ENT specialist in the ENT-HNS department of Shanghai General Hospital, Shanghai Jiaotong university. He has obtained his MD & PhD from The Shanghai Medical College, Fudan University in 2011, and accomplished the resident training in Eye & ENT hospital of Fudan university in 2013. His primary clinical interest is endoscopic sinus and skull base surgery. His research interests include the basic and clinical research of chronic rhinosinusitis, allergic rhinitis, olfactory dysfunction, and skull base tumors.
Dr. Mohammad Waheed Mohammad El-Anwar is an assistant professor and consultant in the Department of Otorhinolaryngology, Head and Neck surgery from Zagazig University, Egypt. He received his Masters’ degree in Otorhinolaryngology from Zagazig University in 2008.
Dr. Luca D’Ascanio received his medical degree from Campus Bio-Medico University of Rome. He attended the preceptorship in Otology, Ear and Lateral Skull Base Surgery at the “House Ear Institute & Clinic”, Los Angeles (California, USA) under the supervision of Prof. A. De La Cruz in 2006. He then worked as an ENT specialist at Città di Castello Civil Hospital between 2007 and 2010. He expanded his experience in Laryngeal - Head & Neck Surgery, working as a full-specialist at the Department of Otolaryngology -Vittorio Veneto Laryngeal Cancer Center in 2010-11. In 2012 he was called to work at the Department of Otolaryngology-Head & Neck Surgery of “Carlo Poma” Civil Hospital of Mantova, where he is in charge of the ENT cancer center.
The study assesses the correlation between lipid-laden macrophage index in tracheal secretions (tLLMI) acquired at the time of direct laryngobronchoscopy (DLB) with the bronchoalveolar LLMI (aLLMI) collected via flexible bronchoscopy. Assessment of lipid-laden macrophages within bronchoalveolar lavage fluid has been proposed to be diagnostically helpful in evaluation of tracheobronchial inflammation. However, measurement requires flexible bronchoscopy with bronchoalveolar lavage, which can be associated with oxygen desaturation and post-operative fever. Quantification of lipid-laden macrophages in tracheal material has not been explored. The study demonstrates that the LLMI in tracheal aspirates collected at the time of DLB correlates with that of aspirates measured directly from the lower airways.
The study aims to assess the predictive values of certain psychological factors on the quality of life in patients with Head and Neck Cancer after radiotherapy. The authors conclude that the identification and the understanding of the depressive symptoms of patients, their beliefs about their illness as well as their coping strategies may provide the basis for timely implementation of appropriate intervention that may improve the quality of life in patients.
Ectopic hamartomatous thymoma is a rare neoplasm with classic anatomical location and characteristic histological and immunohistochemical features. Awareness of ectopic hamartomatous thymoma is essential to accurately diagnose these lesions which clinically mimics lipoma. Based on the morphologic and immunophenotypic features, the authors stress the need to discontinue the existing term of ectopic hamartomatous thymoma and replacing it with suitable nomenclature that aptly denotes its phenotype and possible histogenesis. The authors propose a new terminology “Triphasic Epithelial Myoepithelial Mesenchymal Branchial Anlage Tumor” as it encompasses three important constituents of the lesion (epithelial, myoepithelial, and mesenchymal) and its possible histogenesis in relation to branchial remnants.
Joseph Campbell has explained many of the ancient and current myths and how they reflect our emotional needs. But the myths surrounding tinnitus are causing harm because doctors are not offering patients therapy that is available and patients are not seeking these therapies.
Disorders of mucociliary clearance (MCC) occur from thickening of the mucus so that cilia function is impaired. Or cilia may be impaired directly, as in chlorine exposure. Increased attention to MCC will aid in the reduction of antibiotic abuse.
Complete extirpation of the mucocele may be guaranteed by performing surgical excision of the lesion along with the associated glandular components to avoid recurrences. This is because the Blandin-Nuhn glands are not encapsulated, but are embedded to the musculature of the anterior tongue ventrum.
Clinicians should remain on high alert for oropharyngeal masses while evaluating chronic cough patients. When a mass lesion is observed in the tongue base, ectopic lingual thyroid must be considered in the differential diagnosis, and the diagnosis must be verified using USG and scintigraphy. It is important to pay more attention to a local irritation that is related to the increased physiological demand for thyroxine during puberty and pregnancy.
A comprehensive understanding of the mechanism underlying vertigo is essential to elucidate the reciprocal causal relationship between laryn-gopharyngeal reflux and Eustachian tube obstruction.
COX-2 expression in primary lesions, as well as lymph node metastases, appears to identify HNSCC patients at higher risk in all tumor sites. Adjuvant therapeutic approaches targeting COX-2 might be a promising tool in this patient population.
The present study demonstrated that TEES could be a satisfying alternative to traditional microscopic surgery for the management of congenital cholesteatoma, even in pediatric patients. However, one-handed surgery demands greater skill and requires more practice to achieve a good outcome.
Nasal aging is a continuous process that may alter the organ aesthetics and physiology, causing great distress to patients. Current nasal rejuvenation techniques allow minimally invasive corrections with minimum downtime, consistent and natural results, and should be in the armamentarium of trained specialists.
In every double blind clinical study of therapies, a certain percentage of subjects obtain the same benefit from a placebo, as with the real drug. Using today’s advanced brain imaging; we can identify the specific centers that supply the healing effect when it is a placebo. To augment therapy, reduce the amount of drug use and speed time of healing, the authors suggest to utilize the known principles of placebo physiology.
This article is to evaluate the clinical efficacy of Anioxyde 1000 (5-minute clinic process) and automated-washer (30-minute centralized process) in FNE decon-tamination, and to examine the bio-burden of the FNE following its use.
Newly discovered epidemiological evidence linking cholesteatoma to depression suggests that routine screening and monitoring of psychological status among cholesteatoma patients is warranted. Policies aimed at the early detection and timely treatment of comorbid depression following diagnosis with cholesteatoma could enhance health promotion and disease prevention.
Authors reported a case of cholesteatoma that mimicked facial neurinoma. To avoid confusion in such cases, diffusion-weighted MRI may be useful in preoper-ative differential diagnosis.
Authors present two cases of dilatory Eustachian tube dysfunction caused by localized nasopharyngeal amyloidosis.
Controversies have recently arisen regarding post-operative haemorrhagic complications in relation to the surgical procedures adopted for tonsillectomy. The authors set out to verify the relationship between surgical techniques and post-operative haemorrhage based on the analysis of data derived from multi-centric studies.
This case reports a 40-year-old male patient with right sinonasal teratocarcinosarcoma. It is a rare malignant lesion with extremely aggressive and commonly recurrent nature. The average survival period is less than two years.
It is normal to have impaired mucociliary clearance after any nasal/sinus surgery. Despite cleansing and antibiotics, infections may occur. However, in the patients with unusual distress, complaints of insufficient air, being unable to breathe – consider ENS – Empty Nose Syndrome.
Using a safe and controlled simulation environment, authors develop an effective and realistic oropharyngeal bleeding mass scenario that was well received by participants in preparing them for real life scenarios.
IM ketorolac appears to be a safe non-opioid pain control measure that can be used with any topical and infiltrative local anesthesia regimen with or without sedation. It can potentially provide increased pain control resulting in a more pleasant experience for the patient and surgeon, and in patients undergoing more extensive rhinology procedures and anxious patients concerned about pain. Providing additional pain control with IM ketorolac in selected patients could be a significant variable allowing completion of planned office rhinology procedures in unexpectedly difficult cases. A well-designed clinical pain control study using IM ketorolac for office rhinology procedures has merit and should be performed, but until this occurs IM ketorolac is an option for the otolaryngologist that can be implemented now for those who desire an additional safe pain control measure.
Authors present a case report of a patient with history of RYGB who underwent thyroidectomy and parathyroidectomy with postoperative development of severe recalcitrant hypocalcemia. Hypocalcemia was managed conservatively initially but subsequently required gastrostomy tube placement with successful resolution of hypocalcemia.
Otolaryngologists and gastroenterologists seem to differ in their definitions and management of laryngopharyngeal reflux (LPR). In this review article, the author suggests a multidisciplinary approach to LPR diagnosis. Based on the latest findings, the author proposes an algorithm to facilitate the assessment and management of LPR.
The Authors report four non-tuberculous granulomatous lymphadenitis cases with temporal and geographic clustering, unresponsive to medical management that warranted modified neck dissection to facilitate cure.
Air gun injuries normally present with a wide variety of clinical forms from minor to life-threatening injuries. The rare case of an air gun pellet retained in the pterygopalatine fossa has the risk of immediate or delayed haemorrhage as illustrated by our patient. Gunshot injuries must be considered as potentially life-threatening and raising awareness regarding its potential threats are required in order to minimize the air gun injuries, especially in children.
This is a case report with a comprehensively systematic review on juxtacortical chondrosarcoma in the head and neck area (HNJCS). According to the study, only nine cases of HNJCS have been adequately described. HNJCS have relatively consistent clinical and diagnostic profile regardless of location in the body. Surgical management yields excellent outcomes with low recurrence rates.
The review article presents an expansive list of otolaryngology-specific surgical simulation training models as described in Otolaryngology literature as well as evaluates recent advances in simulation training in Otolaryngology.
The aim of the study was to characterize children with asymptomatic cervical lymphadenopathy including natural history, radiologic and pathologic findings, and provide guidance in diagnostic and therapeutic intervention and follow-up.
Establishing a relationship between a benign disorder and a malignant disease has a certain influence on clinical practice. Clinicians need to remain vigilant with patients with acid reflux disorders and rule out the possibility and presence of head and neck cancer.
The authors present a case of a neonate born with an enlarging tongue mass whose biopsy revealed IMT with ALK positivity. Treatment included tumor debulking and an ALK inhibitor, crizotinib, which resulted in complete remission.
Auditory evoked potentials provide a non-invasive means by which to record the electrical signals of neural activities from the scalp, thus provide a useful tool for the evaluation of auditory disorder, such as tinnitus and hearing loss.
Total thyroidectomy and adjuvant RIT followed by a suppressive dose of levothyroxine are the established therapeutic procedures of choice for DTC. The treatment of DTC has changed from a one size fits all standard to a more individualized approach. The use of less complete surgery as well as decision to use RIT and the dose administered are to be considered carefully in the treatment of DTC. Surveillance for very low risk DTC is an acceptable option. The aim to lower morbidity, lower the cost of treatment and improve patient quality of life is attainable using these principles.
Dysphagia is an important consequence of cancer treatment and has overarching implications on quality of life. Using the FOIS, we demonstrated that swallowing function may be worse in the long term in patients with OPSCC undergoing triple therapy, although this finding did not reach statistical significance. This study emphasizes the importance of diligent selection in patients undergoing TORS to avoid poor functional swallowing outcomes, particularly in those that may need adjuvant chemoradiation therapy. A study with a larger sample size may determine the significance of these trends.
This article describes how blockchain technology can be used in several key data-driven healthcare areas, including health care records, health claims, interoperability, patient access, and supply chains.
The study identifies how current voice, cough, and daytime breathing problems affect mental and physical quality of life in obstructive sleep apnea patients, as well as how the combination of voice, cough, and diurnal dyspnea impacts quality of life.
The authors review the accuracy of barium swallow studies in the assessment of post-laryngectomy pharyngocutaneous fistula. The findings are significant in that they will help guide practitioners in swallow assessment decision making and perhaps lead to a standardized protocol.
The author reports a case involving a 59-year-old man with delayed presentation of a huge mastoid cholesteatoma complicated by skull base erosion and cerebrospinal fluid leakage. Delayed presentation of this disease entity can have negative health consequences for patients. Regular otologic examinations, audiologic follow-up, and imaging examinations are viewed as the most effective strategies for the prevention of this type of situation. Early recognition of cholesteatomas is essential, as appropriate and timely treatment can prevent this rare comorbid condition from becoming fatal.