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Background/Objectives: Rhinogenic contact point headache (RCPH) is a controversial secondary headache disorder involving mucosal contact points in the nasal sinuses. The efficacy of surgical versus medical management has been debated, with some studies showing excellent long-term outcomes but others citing placebo effects. This study aimed to clarify the correlation with nasal anatomical variation detected by CT and RCPH treatment outcomes. Methods: A prospective cohort study was conducted on 90 RCPH patients undergoing surgery or medical therapy. Patients were diagnosed using CT scans, endoscopy, and lidocaine testing. The surgery group had endoscopic procedures to remove contact points. The medical group received intranasal steroids. Outcomes were measured by visual analog scale (VAS) for pain and headache frequency. Predictors like age, gender, and nasal anatomical variations were analyzed. Results: The surgery group showed significant reductions in VAS scores (6.02 to 2.51, p < 0.001) and headache frequency (9.11 to 3.04, p < 0.001). The medical group did not improve significantly. All nasal subtypes improved with surgery but concha bullosa had worse VAS outcomes (4.0) than septal deviation (1.8, p < 0.001) or spur (1.73, p < 0.001). Multivariate analysis found nasal anomalies predicted postoperative VAS scores (p < 0.001) but not headache frequency (p = 0.255). Conclusions: Surgery demonstrated superiority over medications for RCPH. This study provides new evidence that preoperative CT scans should be considered a non-invasive gold standard for analyzing nasal subtypes as they significantly influence surgical success, with concha bullosa associated with worse pain relief. Larger studies should validate these findings to optimize RCPH management. [ABSTRACT FROM AUTHOR]

BACKGROUND: Branchial cleft anomalies are congenital aberrations of the first to fourth pharyngeal pouches. First branchial cleft anomalies are classified into 2 subtypes according to anatomical and histological features. Their diagnosis can be difficult and depends on radiological and histological findings. In contrast, the required treatment is surgical removal, owing to the high risk of infection or malignancy. This case report introduces a first branchial cleft anomaly in an older woman with exclusive involvement of the external auditory canal (EAC). CASE REPORT: This case report introduces a first branchial cleft anomaly in an 82-year-old woman with exclusive involvement of the EAC. She reported a history of mixed moderate hypoacusis and recurrent otitis media in the last year, without facial nerve involvement. Computed tomography and magnetic resonance imaging were performed to plan surgical treatment, which consisted of canaloplasty and Thiersch grafting. The histopathological examination on operative findings revealed a cystic lesion that was lined by cylindrical epithelium adjacent to the squamous cells, compatible with a diagnosis of first branchial arch malformative residues. CONCLUSIONS: This is the unique case of first branchial cleft anomalies reported in an adult patient that exclusively involved the EAC. The onset of the disease was atypical, and surgery with the total removal of the lesion was the only possible treatment. Histopathology results revealed cylindric epithelium not represented in the EAC, compatible with first branchial arch malformative residues. This rare condition is a potential diagnostic option that should be considered in the differential diagnosis of cysts of the EAC. [ABSTRACT FROM AUTHOR]

Chronic obstructive Eustachian tube dysfunction (ETD) is a common disorder of the middle ear. In recent years, two main diagnostic tools have become available: Eustachian tube score (ETS-7) and computed tomography (CT) combined with Valsalva maneuver. The aim of this study is to evaluate the outcomes of ETS-7 and CT in a group of patients affected by middle ear atelectasis with a strong suspicion of ETD. Three males and nine females, affected by middle ear atelectasis with retraction of the TM were enrolled. Each patient underwent to Eustachian tube dysfunction evaluation adopting the ETS-7 score and a temporal bone CT with Valsalva maneuver. The ears analyzed at steady state were divided into 2 groups: ETS<7 group and ETS≥ 7 group. The same division was applied for the ears analyzed after the Valsalva maneuver: ETS<7 group and ETS≥ 7 group. ETs were categorized as "well defined" (WD) and "not defined" (ND). The results of the analysis of the ETS-7 score in all 24 ears showed that 42% presented ETS ≥7, while 58% had ETS <7, indicating a diagnosis of ETD. In the ETS<7 group after Valsalva, ET was visualized in 33% of patients. In the ETS≥7 group it was WD in 29% after the Valsalva manoeuver. In both groups the comparison between the visualization of the ET before and after the Valsalva manoeuver did not present a statistical difference. No correlation emerged between ET evaluation with CT scan during Valsalva maneuver and ETS-7 score. It confirms that there is not a gold standard for the study of ET dysfunction. [ABSTRACT FROM AUTHOR]

Cholesteatoma is a non-neoplastic, keratinized squamous epithelial lesion that affects the temporal bone. The middle ear is the most frequent, while the isolated cholesteatoma of the mastoid is rare. The aim of this study was to describe a rare case of isolated mastoid cholesteatoma with no involvement of aditus ad antrum and middle ear including a literature review of the topic. This case report describes the case of a 58 years old female with a cholesteatoma isolated in the mastoid region, evidenced by imaging (computer tomography and magnetic resonance). A mastoidectomy was performed: mastoid process was completely involved, but antrum was not reached. Moreover, it reached the soft tissue of stylomastoid foramen as well as the posterior belly of the digastric muscle. In the literature few articles described cases of cholesteatoma isolated in the mastoid region. Research was conducted using PubMed and reference list and there were considered only reports about cholesteatoma exclusively located in the mastoid process without involvement of antrum or middle ear. Fourteen articles were included in this review, with a total number of 23 cases of cholesteatoma isolated in the mastoid region. All papers analyzed reported the cases of isolated mastoid cholesteatoma that presented a congenital origin. Its diagnosis is difficult, therefore, imaging evaluation is mandatory and surgery is the treatment of choice. Mastoid cholesteatomas without involvement of aditus ad antrum and middle ear are rare and only 23 cases are reported in literature. Our case is in line with all clinical and diagnostic features of this rare disease, but it is the only one that evidenced an exposure of the soft tissue of stylomastoid foramen as well as the posterior belly of the digastric muscle. The treatment of choice was the surgical one, avoiding damaging of important anatomo-functional structure. [ABSTRACT FROM AUTHOR]

A 20-year-old female presented a history of isolate left external ear pain. ENT valuation showed no alteration of the district, but an aberrant styloid process was tender to palpation in the left tonsillar fossa. Computer tomography was performed and confirmed it. Thereafter, the diagnosis of Eagle syndrome was made. The auricular branch of the vagal nerve (ABVN) was pressed by the styloid process causing the pain. This case pointed out the importance to consider anatomical alteration as elongated styloid process as a possible cause of external ear pain. [ABSTRACT FROM AUTHOR]