Purpose: Chronic rhinosinusitis (CRS) is a prevalent chronic disease observed on a global scale. The utilization of endoscopic sinus surgery (ESS) has gained significant recognition as an effective intervention for individuals with CRS and nasal polyps who have not responded to conventional treatments. The need (or not) for revision surgery frequently relies on the promotion of optimal wound healing. The impact of platelet-rich plasma (PRP) on tissue healing has been extensively examined in various surgical fields. Methods: The present prospective study involved 30 patients suffering with nasal polyposis who underwent endoscopic sinus surgery. 15 patients were assigned to the PRP group, and 15 patients to the control group. The clinical follow-up of the patients took place at specific intervals, at weeks 1, 2, 3, 4, 8, and 12 after the surgical procedure. The evaluator identified the existence of adhesions, crusting, bleeding, granulation and infection using a visual analogue scale score. The patients also completed the SNOT 22 questionnaire prior to surgery and at each postoperative visit. Results: The present study observed a lower incidence of adhesion, infection, hemorrhage and granulation in the PRP group. Furthermore, a statistically significant difference was detected between the groups. Conclusion: Based on the findings of the present investigation, it seems that platelet-rich plasma (PRP) is beneficial on wound healing during the early stages following the surgical procedure. The technique is characterized by its limited invasiveness, which contributes to its low risk profile and the achievement of clinically good outcomes.

Background and Clinical Significance: Lymphoepithelial cysts are uncommon benign lesions of the head and neck, rarely encountered within the oral cavity and exceedingly infrequent in the palatine tonsils. Their nonspecific clinical presentation and ability to mimic more common benign entities often render diagnosis challenging. Case Presentation: We report the case of a 68-year-old woman with a four-year history of persistent foreign-body sensation in the oropharynx despite multiple normal otolaryngologic examinations. Flexible nasoendoscopy was non-diagnostic, as the lesion was deeply concealed within the superior tonsillar pole between the palatine pillars. Targeted tonsillar manipulation ultimately revealed a small pedunculated mass and contrast-enhanced computed tomography demonstrated a well-circumscribed, non-enhancing cystic lesion confined to the tonsillar parenchyma. Surgical excision under general anesthesia confirmed an oral lymphoepithelial cyst on histopathologic analysis. The patient remained asymptomatic with no recurrence at four months. Conclusions: This case underscores the rarity of tonsillar lymphoepithelial cysts, highlights the diagnostic limitations of endoscopic evaluation for cryptic superior-pole lesions and emphasizes the importance of meticulous dynamic oropharyngeal examination. Complete surgical excision is both definitive and curative, with an excellent prognosis.

Background and Clinical Significance: Thyroid metastasis from clear cell renal cell carcinoma (ccRCC) is uncommon and may occur after radical nephrectomy despite no evidence of residual or metastatic disease at that time. Diagnosis can be challenging because imaging and fine-needle aspiration (FNA) may mimic benign or primary thyroid lesions. Case Presentation: A 55-year-old man underwent left radical nephrectomy for WHO/ISUP grade 3 ccRCC with focal grade 4 differentiation. Two years later, surveillance ultrasonography detected a suspicious lesion involving the thyroid isthmus and left lobe. FNA was interpreted as Bethesda II (benign), but metastatic ccRCC was subsequently confirmed after total thyroidectomy. Histopathology showed focal vascular and capsular invasion. Tumor reached the margin of the main thyroid specimen, whereas separately submitted perithyroidal soft tissue had tumor-free margins, resulting in a final R0 resection. The tumor was positive for CK8/18, PAX8, EMA, vimentin, and CD10 and negative for TTF-1, thyroglobulin, calcitonin, and CD5. Postoperative 18F-FDG PET/CT showed no additional metastatic disease. Conclusions: Benign thyroid cytology should be interpreted cautiously in patients with previous ccRCC when clinical or imaging findings remain suspicious. Diagnosis requires integration of oncological history, imaging, histopathology, and immunohistochemistry. Surgical resection may provide local disease control in selected patients, with surveillance.

Background and Clinical Significance: To report an unusual case of a bilateral low-frequency air–bone gap consistent with an apparent conductive audiometric pattern following spinal anesthesia and discuss a possible underlying mechanism; Case Presentation: A 56-year-old man underwent elective inguinal hernia repair under spinal anesthesia. On the second postoperative day, he developed a severe postural headache followed by bilateral hearing loss. Otoscopic examination was normal. Tuning fork tests and pure-tone audiometry demonstrated a bilateral low-frequency air–bone gap consistent with an apparent conductive audiometric pattern. Laboratory findings were unremarkable. The patient was managed conservatively with bed rest, hydration and systemic corticosteroids, resulting in gradual clinical improvement; Conclusions: Hearing loss after spinal anesthesia is typically sensorineural and attributed to cerebrospinal fluid pressure alterations. This case highlights a rare apparent conductive audiometric pattern in the absence of clinically evident middle-ear pathology. A possible mechanism may involve altered inner-ear pressure dynamics leading to transient mechanical restriction of stapes mobility. Awareness of this atypical presentation may facilitate prompt recognition and appropriate management.

Background and Clinical Significance: Foreign body aspiration is an important cause of morbidity and mortality in children younger than three years of age. Although laryngeal foreign bodies are uncommon, they may be life-threatening and are frequently misdiagnosed because of their variable clinical presentation. Eggshell aspiration is exceptionally rare, with only a few cases reported in the literature. We report a case of delayed diagnosis of a glottic eggshell foreign body in a toddler presenting with persistent upper airway symptoms. Case Presentation: A 16-month-old previously healthy girl was referred to our hospital for evaluation of persistent hoarseness and barking cough following a witnessed choking episode while eating boiled egg. The choking episode had occurred 15 days before presentation during an episode of viral upper respiratory tract infection. Initial symptoms were attributed to laryngitis and persisted despite medical treatment. Flexible laryngoscopy revealed a foreign body impacted at the glottic level, while neck radiography demonstrated a radiopaque calcified lesion corresponding to the foreign body. Microlaryngoscopy under deep sedation was performed, and an approximately 10-mm eggshell fragment was successfully removed. A small amount of granulation tissue was observed at the posterior commissure, corresponding to the site of foreign body impaction. The postoperative course was uneventful, and repeat endoscopic examination on postoperative day three demonstrated satisfactory laryngeal healing with regression of the granulation tissue. Conclusions: This case highlights the importance of considering a retained laryngeal foreign body in young children with persistent hoarseness or barking cough following a choking episode, even in the presence of concomitant respiratory infection. Early endoscopic evaluation is essential to avoid diagnostic delay and facilitate prompt treatment. In addition, this report emphasizes the importance of food choking prevention and caregiver education in children younger than three years of age.

IntroductionTolosa Hunt syndrome (THS) is a disorder that is related to inflammation of cavernous sinus (CS) as well as superior orbital fissure although the exact etiology is unknown.1 THS affects any age group (10-80 yr.) and can present with headache, ophthalmoplegia, oculomotor nerve palsies or even loss of visual acuity. The duration of symptoms ranges from days to weeks and they can be ipsilateral or even contralateral. Moreover, recurrence of symptoms has been noted in some cases despite the initial remission.Currently, the neuroimaging modalities that are performed for the diagnosis of THS are MRI and high-resolution CT scans. However, the review of the literature shows that CT scan is less sensitive than MRI scan. 4 Other laboratory tests performed in cases of suspected THS are blood tests (complete blood count, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)). THS seems to be associated with leukocytosis and raised erythrocytes sendimentation rate5. Usually the treatment for THS involves intravenous corticosteroid administration. However, some studies have reported the efficacy of immunosuppression therapy such as cyclosporin or methotrexate6 while even infliximab has been reported as a successful treatment to a patient with steroid resistant THS.7THS is a diagnosis of exclusion, as other causes can mimic this condition. The differential diagnosis includes neoplastic conditions such as meningioma or chordoma, vascular conditions such as intracavernous artery or posterior artery aneurysms, and finally inflammatory conditions such as sinusitis, or sarcoidosis5. Therefore, every patient should be evaluated thoroughly before the diagnosis is confirmed.Cavernous carotid aneurysm (CCA) accounts for 2-9% of all internal carotid aneurysms. The causes for CCA include trauma, inflammation or idiopathic. Usually patients are asymptomatic in the first stages of the aneurysm but as it is enlarged the patients manifest diplopia, ptosis, ophthalmoplegia. Finally, one must underline the possibility of aneurysm rupture, that requires prompt medical intervention and in the majority of cases can be fatal.In our study we present a patient suffering from an intracavernous aneurysm (ICA) mimicking Tolosa Hunt syndrome.