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Stapedial surgery is able to obtain excellent hearing results in the long-term in most otosclerotic patients. Nevertheless, some cases have vertigo and/or tinnitus after surgery, that may lead them to revision surgery. Out of a consecutive series on 115 patients, we present three cases (2,6%) with persistent vertigo after stapedotomy. These patients had residual unsteadiness despite good hearing after surgery, with a minimum follow-up of 12 months. Videonystagmography showed spontaneous nystagmus towards the contralateral ear in one case, whereas the other two had a canalicular paresis in the operated side, signs of vestibular hypofunction. After vestibular rehabilitation, unsteadiness resolved in all cases, with good spontaneous compensation, without any further surgery.

Hoarseness due to phonation by the false cords (dysphonia plicae ventricularis) is a common cause of functional dysphonia, in relation to excessive muscular tension in the larynx area. Nevertheless, a mechanic cause can be observed in some cases with dysphonia plicae ventricularis, which is usually due to deformation of the thyroid cartilage. We report a case with hypertrophy of the ventricular bands which was treated by vocal rehabilitation followed by suspension laryngoscopy with partial removal of the ventricular bands, without further improvement. This failure was related to a pseudohypertrophy of the ventricular bands, due to deformation of the thyroid cartilage, which was confirmed by computed tomography.

We report a case of a 63-year-old woman who presented with left otalgia during more than six months. On examination, otoscopy was normal, whereas flexible nasopharyngoscopy revealed an asymmetry in the nasopharynx. CT scans confirmed the presence of a left nasopharyngeal mass. A transnasal endoscopic removal of the nasopharyngeal lesion was performed. Necrotizing granulomatosis was found. Tuberculosis of the nasopharynx was considered the final diagnosis, but oral treatment was not started. After 36 months of follow-up, nasal endoscopy and CT images show no sign of recurrence. Discussion is focused on the inclusion of nasopharyngeal diseases in otalgia differential diagnosis, histopathological diagnosis of granulomas and the need of any further treatment for these limited cases of extrapulmonary tuberculosis.

Temporal bone trauma are more common nowadays related to sports. We report 2 cases with temporal bone fractures in patients younger than 14 years. They were two male, 9 and 12-year-old respectively, that presented traumatism after accidental falls from lowe height. The first case had a longitudinal temporal bone fracture without hypoacusia or vertigo, whereas the second one had an oblique fracture involving the otic capsule, provoking permanent neurosensorial hearing loss, as well as vertigo and unsteadiness that resolved later, related to a vestibular hyporreflexia. Neither case had facial paresia or paralysis. CT scanning was essential to determine the importance of the trauma. Despite the otic capsule rupture, hearing loss in the second case was only significant over 2 KHz, suggesting a selective cochlear trauma. We present clinical and imaging findings, as well as correlation of audiological and vestibular alterations, reviewing the clinical presentation of temporal bone trauma in children.

Although newborn screening of congenital hearing loss through otoacustic emissions allow prompt recognition, imaging techniques, such as CT and MRI are needed to get a morphological diagnosis. Furthermore they can be very useful in unilateral cases, whose clinical presentation is belated and more insidious. Our aim is to show the utility of MRI in the study of inner ear congenital anomalies, whose presentation is belated. Thus from a series of 88 consecutive patients in which a MRI was performed as screening of assymetric sensorineural hearing loss, we selected 6 cases aged between 6 and 20. Four of them showed an inner ear anomaly on MRI. We present these anomalies commenting the findings on CT and MRI. Imaging techniques are required to start hearing rehabilitation programs early on patients with bilateral inner ear anomalies. But also they are very useful in the evaluation of unilateral assymetric sensorineural hearing loss, in young patients, even if only some frequencies are damned, to determine the nature of hearing loss.

Pharyngeal perforations due to foreign bodies are severe when retropharyngeal space infection develops into an abscess. Although the common clinical presentation is sore throat and fever, when the perforation remains occult, torticollis can be a significant symptom. Palatopharyngeal lesions, caused by rigid objects' impactation through the mouth, are common in childhood. Most are not important, but all have the potential hazard of pharyngeal perforation with development of a retropharyngeal abscess. It must be suspected specially when air is shown in the retropharyngeal space on a lateral radiography of the neck, which should always be done. We report a 9-years old boy who had cervical stiffness and torticollis and elevation of the right shoulder, without previous known trauma. Air was shown in the retropharyngeal space on a lateral radiography of the neck in relation to a possible pharyngeal perforation which was later confirmed by a CT scan. We review the literature about diagnosis and treatment of retropharyngeal abscess in childhood.