Opinion Poll of this week

Is the National AOI Defunct?

Participate in Poll at www.entindia.net

himanshu said...
Not just defunct,it's amongst the most hopeless bodies I have seen. Only those guys should be the office beares who can do atleast a speck to take the association forward and updated.

Voice Therapy versus Speech Therapy

Voice Therapy versus Speech Therapy
by Christopher Y. Chang, MD •


There is often confusion when a patient is referred for speech or voice therapy. The first question most patients have is WHY even bother? The reason is just like an athlete who hurts his knee gets referred for physical therapy, a patient's speech/voice can also get "injured" and require therapy in order to obtain a normal voice/speech as quickly as possible without further damage. Even if surgery is done to correct an underlying injury (whether knee or voice), therapy may be required both before and after in order to obtain the best result.

The next question patients have is whether there is a difference between a voice therapist and a speech therapist. Another question, may be what type of therapy is better for a given patient? Can a given therapist provide both speech and/or voice therapy or are there therapists that can only do one kind and not the other? This confusion is quite understandable given people (and even health professionals) often use "voice" and "speech" interchangeably. Rest assured, speech and voice are two completely different words with different meanings and as such are treated differently.

Well, before going into what type of therapy is best for a given patient, one must understand the difference between speech and voice.

Audiological deficits after closed head injury.

J Trauma. 2010 Jan;68(1):13-8; discussion 18.

Audiological deficits after closed head injury.

Munjal SK, Panda NK, Pathak A.

Departments of Otolaryngology, Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India. sanjaymunjal1@rediffmail.com


BACKGROUND: Damage to the peripheral auditory structures has long been recognized as a common component of head injury. It is estimated that a majority of patients with skull trauma have resultant hearing impairment. Damage to the peripheral and/or central auditory pathways can occur as a primary or secondary injury. Considering the high incidence of hearing loss, it was considered worthwhile to conduct an in-depth investigation by administering a comprehensive audiological test battery on head-injured patients.

METHOD: The sample population consisted of 290 subjects with closed head injury (study group) and 50 subjects with otologically normal subjects (control group). The subjects in the study group were further divided into mild (n = 150), moderate (n = 100), and severe (n = 40) category on the basis of Glasgow Coma Scale score. The audiological assessment consisted of pure tone audiometry, speech audiometry, tympanometry, acoustic reflex testing, auditory brain stem response audiometry, and middle latency response audiometry.

RESULTS AND CONCLUSIONS: It is concluded that there is higher prevalence of hearing impairment in the study group compared with control group. Majority of the patients who incur hearing loss after closed head injury have mild degree of hearing impairment. A significant difference between the study and control group observed on majority of the auditory brain stem response and middle latency response parameters studied.

Surgery for optic nerve injury: should nerve sheath incision supplement osseous decompression?

Skull Base. 2009 Jul;19(4):263-71.

Surgery for optic nerve injury: should nerve sheath incision supplement osseous decompression?

Thaker A, Tandon DA, Mahapatra AK.

Department of Otolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.


Objective: To evaluate the benefits and risks of performing an optic nerve sheath incision to supplement standard osseous optic canal decompression for traumatic optic neuropathy. Methods: Before-after analysis of 57 cases undergoing optic nerve decompression at a tertiary referral centre from 1988-2006. Fifty-five cases had adequate post surgical follow-up for evaluation for improvement. Group A (n = 35) had decompression of the osseous optic canal and surgical slitting of the optic nerve sheath; Group B (n = 22) had osseous decompression alone. The groups were comparable for age, injury severity, and injury-surgery interval. Main outcome measure: Percentage visual improvement, which was calculated by conversion of the pre- and post-intervention visual acuity measurements to the logarithm of the minimum angle of resolution (logMAR) scale. Results: No significant recovery was noted in subjects with persistent complete blindness (PL-ve vision). In subjects with residual pre-op vision, the quantum of recovery was greater in Group A than in Group B (46% and 33% respectively, p = 0.10). The difference was especially evident in subjects with no optic canal/posterior orbit fracture (p = 0.07). Three cases with the sheath incision developed transient CSF rhinorrhea in the initial experience, but this was subsequently alleviated with modification of surgical technique. Conclusion: The addition of optic nerve sheath incision to osseous decompression may improve recovery in optic nerve injury, especially in subjects without optic canal fracture.

www.entindia.net Subscribers touches 1000


Ethical and Moral Practice in Speech & Hearing

Greetings from AudiologyIndia.com

We are happy to inform that AudiologyIndia.com is attracting quiet a lot of Audiology professionals from all over the world. Currently we are trying to sensitize our community about several issues mainly in relation to professional ethics and sanctity. We started specifically campaigning against the inappropriate use of 'Dr' title amongst our speech and hearing community.We all agree that it is unethical and also immoral to advertise or call ‘Dr’ when one doesn't possess that level of education and amounts to malpractice. Just the way we take pride, we should also take steps to protect the purity in the practice of our profession. We started sending emails to various people across India to inform us about such practices. We are happy to inform that we got support from RCI and ISHA regarding this issue. We welcome you to join AudiologyIndia.com in its activities.

Mumbai Otolaryngologist Boycott Cashless Mediclaim

MUMBAI: It's unlikely that consumers will see a quick resolution to the medical insurance imbroglio. Even as the Association of Fellow Gynaecologists and the Association of Ear, Nose and Throat (ENT) specialists operating in the western suburbs decided to boycott treatment under the cashless mediclaim policies offered by public sector insurance companies on Monday, third party administrators who settle claims on behalf of insurance companies have noticed a drop in processing cases over the past few weeks. While doctors say the drop is as high as 50%, TPAs claim otherwise, saying it is a mere 5%-15%.

Read more:

Computerised Platform based Vestibular Rehabilitation Program

It is no secret that the existing parameters set out for vestibular rehabilitation mostly involve a patient information leaflet detailing the Cawthorne Cooksey (Nonspecific) Exercises, and compliance and technique remain issues that need to be resolved to achieve any perceived or documented benefit.

Computerised Platform Based VRT is different as the patient’s progress can be quantified, the exercises are fun to perform and Virtual Biofeedback is incredibly motivating to the patient who works to achieve good equilibrium.

By improving overall Balance function and promoting mechanisms of central adaptation and compensation, Computer Aided Vestibular Rehabilitation Therapy aims to Augment balance, Minimize falls, Decrease subjective sensations of dizziness, Improve stability during locomotion, Reduce over-dependency on visual and somato-sensory inputs, Improve neuromuscular coordination and Decrease anxiety and somatization due to vestibular disorientation

CPVRT Program can help with a variety of vestibular ailments including


· U/L and B/L vestibular hypo-function associated with

o Ménière’s disease

o Labyrinthitis

o Vestibular neuritis

o Individuals with long-term unresolved inner ear disorders who have undergone a period of medical management with little or no success may benefit.

Using this program VRT can also help people with an acute or abrupt loss of vestibular function following surgery for vestibular problems.

Through this mailer, I invite you to our centre and experience the Principles of Modern Day Balance Rehabilitation being laid out in Vestibular Medicine. I would also put a humble request for you to kindly refer patients that might benefit from the Vestibular Rehabilitation Program.

With many thanks and regards,

Dr Kshitij Malik

Dr Kshitij Malik
Hearing & Balance Physician


Dear Sir,
Greetings from ISAM-2010, the International Symposium on Audiological Medicine scheduled to be held at Bhubanewar as the biggest show of all the professionals involved in Ear & Hearing Care, which includes the Oto-laryngologists, Audiologists, Hearing aid dispensers, AVT therapists. The event focuses on information dissemination on the current know-how, emerging and future trends in diagnostics as well as rehabilitative intervention. The focus of the conference is wide ranging; from normal hearing sciences to futuristic dimensions of dealing with vestibular & hearing impairments. These include:

- Hearing Sciences

- Infant and adult Diagnostic Testing

- Implantable hearing systems

- Medical conditions associated with hearing impairment

- Medical conditions and medications causing hearing loss

- Tinnitus

- Frontier areas for Research Across the Discipline

- Vestibular / Balance Disorder & Rehabilitation

- Auditory Processing Disorders

- Auditory Neuropathy & Other related issues

ISAM-2010 is a three day program starting on 3rd Dec, the International Day for for the Disabled persons and culminating on 5th Dec. The ISAM-2010 will attract about 600 delegates from all over the country and from abroad. Eminent speakers will deliver their oral presentations while the researchers will have poster presentations. The ISAM-2010 will be strictly for the registered delegates. But simultaneously HEAR-EXPO will be conducted for the general public where the professionals will interact with the general public offering free guidance, consultancy and explain about Prevention of deafness. Colleges offering the Audiology education in India are invited to set up stalls in the Expo for public awareness and public education.

We invite you to join the unique show of ISAM-2010 and be a part of the progress of Indian Professional care for the Hearing Impaired. The professionals intending to attend the event can register online or can download the registration form from the event websitewww.isam2010.com. Those requiring accommodation need to book before hand.
During December, Orissa is at its picturesque best form, with temperature around 15 to 20 degree. Please plan for your participation and enjoy the hospitality of Orissa.

With kind regards,
Prof. Satya Mahapatra
Mob. 09437005096

Live Auditory Brain Stem Surgery ,Delhi,Sepember 15,2010

I am happy to inform you that the Live Auditory Brain Stem Surgeries will now be performed at BLK Memorial Super Speciality on the 15th of September 2010. We have 3 ABI surgeries which would be telecast Live, to the registered delegates. This would be on 1st come 1st registered basis.
Kindly contact the undersighned for registration.
Prof. Dr J.M.Hans
Chairman, Dept of ENT & Cochlear Implant,
BLK Memorial Super Speciality Hospital,
New Delhi (INDIA)
(M) +91 9718126565 / 9811703926

Clinical Meet at AIIMS ,Delhi ,Friday,August 20,2010

AIIMS is hosting the Delhi Branch monthly meeting on this Friday, 20th August,

1:30 pm to 4:00 pm.

The schedule is as such-
1:30-2:30- case demonstration, ENT OPD
simultaneously 1:30-2:30 - Lunch- Auditorium/ Conf Hall Foyer- Ist floor
2:30 -- Case presentation and
discussion- Conference Hall

Dr. Alok Thakar
Department of Otolaryngology & Head Neck Surgery
All India Institute of Medical Sciences
New Delhi

Registration of Phonocon 2011 from 15 Aug 2010

Dear Sir

We have commenced online registration of Phonocon 2011 from 15 Aug 2010 at the websitehttp://www.phonocon2011.in

The early bird registrations are till 31 aug only.
thanks and regards

Jai Hind
Lt Col (Dr) Rakesh Datta


Relative distribution of the tumours of ear, nose and throat in the paediatric patients.

Int J Pediatr Otorhinolaryngol. 2007 May;71(5):801-5. Epub 2007 Mar 21.
Relative distribution of the tumours of ear, nose and throat in the paediatric patients.
Biswas D, Saha S, Bera SP.

Department of Otolaryngology, Queens Medical Centre, University of Nottingham, Derby Road, Nottingham NG7 2UH, UK. drdiswas@hotmail.com
OBJECTIVE: The purpose of this study is to observe the type and anatomical distribution of various tumours of the otolaryngological region in the paediatric age group of patients. METHODS: A prospective study was carried out over a period of 2 years between May 2001 and April 2003 in a Teaching Hospital and tertiary referral centre in India. Patients 15 years of age or under who presented with a tumour of the otolaryngological region to the department of Otolaryngology were included in this study. Lymphoma of the cervical lymph nodes was not included in this study. Site of origin and histology of the tumours were noted. The minimum follow-up period was 18 months. RESULTS: Forty-three patients of above age group with a neoplasm of the otolaryngological region were managed in our department, the incidence was 0.5%. The ratio of benign to malignant lesion was 7.6:1. Juvenile nasopharyngeal angiofibroma was the commonest tumour (11 cases, 26%) and embryonal rhabdomyosarcoma was the commonest malignant tumour (3 cases, 7%). The commonest site of neoplasm was the nose and paranasal sinuses (13 cases, 30%). CONCLUSION: A tumour in the otolaryngological site in the paediatric population is rare, the incidence being 1 in 200 new cases in the age group of 15 years or under, 12% of the tumours were malignant. Awareness of relative distribution of neoplastic lesions is valuable for early detection and correct management. This study indicates that the distribution of otolaryngological tumours in the Indian subcontinent is different from the western countries, particularly the

Evaluation of tracheal diameter after surgical tracheostomy

Am J Otolaryngol. 2006 Sep-Oct;27(5):310-3.
Evaluation of tracheal diameter after surgical tracheostomy.
Sivakumar K, Prepageran N, Raman R.

Department of Otolaryngology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
PURPOSE: The aim of this study was to evaluate the narrowing of the trachea in head and neck surgical patients who had undergone elective tracheostomy. MATERIALS AND METHODS: This is a prospective study. Twenty-five patients were included in this study. All these patients had a preoperative elective tracheotomy, preceding major head and neck surgery for head and neck malignancies. An x-ray of the lateral soft tissue neck was taken after a minimum of 6 weeks after the dissimulation of tracheotomy tube. Diameter of the trachea above the stoma (around 2 cm below the cricoid ring that can be clearly seen in lateral x-ray corresponding to the second tracheal ring) was taken as controls. Data were entered into a computer database and statistically analyzed using SPSS for Windows (version 12.0; SPSS, Chicago, Ill). In addition to descriptive statistics for all patients, inferential statistics were used to compare the 2 tracheal diameters across all patients and within the subgroups of men and women. Associations between outcome and other variables were evaluated statistically using an chi 2 test for the categorical data. Other parametric and nonparametric statistical tests were used when appropriate. Criterion for statistical significance was set at P < .05 (Student t test and 2-tailed test). RESULTS: From this study, 92% (23/25) patients developed narrowing of trachea, all less than 50%. Very early decanulation of tracheotomy shows low or no narrowing at all. There is gradual narrowing in patients in whom dissimulations were performed after 14 days. Ethnicities of Indian decent (13/25) predominate in this study population. Male patients in this study have shorter decanulation period compared with female. CONCLUSIONS: Elective surgical tracheotomy is a relatively safe procedure resulting in minimum asymptomatic tracheal stenosis.

23rd Temporal bone dissection course ,MAMC ,Delhi,December 11-12,2010

23rd Temporal bone dissection course due to be held on 7th and 8th August 2010 at MAMC has been deffered due to upgradation work going on in the temporal bone lab.

Tentative dates for the next workshop are 11th(Saturday) and 12th(Sunday) December 2010.

Registered delegates for the August workshop may ask for the refund or may also ask for adjustment in the next workshop.

Dr. J.C.Passey
Officer in charge
Temporal bone lab, MAMC
Contact no. 9968604233

Pleomorphic adenoma of minor salivary gland with therapeutic misadventure: a rare case report.

BMC Ear Nose Throat Disord. 2010 Jan 8;10:2.
Pleomorphic adenoma of minor salivary gland with therapeutic misadventure: a rare case report.
Thakur JS, Mohindroo NK, Mohindroo S, Sharma DR, Thakur A.

Department of Otolaryngology - Head & Neck Surgery, I. G. Medical College, Shimla, HP, 171001, India.
BACKGROUND: The benign tumors of nasopharynx are least encountered tumors in otolaryngology, as nasopharynx is considered one of notorious anatomical site for the malignant tumors. Pleomorphic adenoma of the minor salivary gland of nasopharynx and parapharyngeal space is rare. We present a pleomorphic adenoma of minor salivary gland which was mismanaged. CASE PRESENTATION: An adult male presented with left nostril obstruction for five months. The examination found big mass extending from nasopharynx to oropharynx. On CT scan, this tumor was quite big and extending to the parapharyngeal space. The FNAB found it a carcinoma but it did not respond to radiotherapy. The excision biopsy of tumor revealed it as pleomorphic adenoma. We found only five published reports on this tumor arising from nasopharynx. DISCUSSION AND CONCLUSION: Although, in this case report exact origin of the tumor could not be ascertained as it also appeared to be a parapharyngeal tumor but we kept the possibility of a nasopharyngeal tumor on the basis of clinical features. The pleomorphic adenoma of nasopharynx is rare. It can be misdiagnosed as malignant epithelial tumor on histopathology. The differentiation from its malignant variant is also difficult. A possibility of benign tumor should always be kept in nasopharyngeal growth with no evidence of metastasis, and histopathological diagnosis of growth should be available before any definitive treatment.

PMID: 20157428 [PubMed - in process]PMCID: PMC2821363Free PMC Article

Audiologic disturbances in long-term mobile phone users.

J Otolaryngol Head Neck Surg. 2010 Feb 1;39(1):5-11.
Audiologic disturbances in long-term mobile phone users.
Panda NK, Jain R, Bakshi J, Munjal S.

Department of Otolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
INTRODUCTION: There is general concern regarding the possible hazardous health effects of exposure to radiofrequency electromagnetic radiation emitted from mobile phones. This study aimed to assess the effects of chronic exposure to electromagnetic waves emitted from Global System for Mobile Communication (GSM) mobile phones on auditory functions. MATERIAL AND METHODS: A retrospective, cross-sectional, randomized, case control study was carried out in a tertiary care hospital. One hundred twelve subjects who were long-term mobile phone users (more than 1 year) and 50 controls who had never used a mobile phone underwent a battery of audiologic investigations including pure-tone audiometry (both speech and high frequency), tympanometry, distortion product otoacoustic emissions, auditory brain responses, and middle latency responses. Changes in the various parameters were studied in the mobile phone- and non-mobile phone-using ears of subjects and corresponding ears of the controls to ascertain the effects of electromagnetic exposure. RESULTS: There was no significant difference between users and controls for any of the audiologic parameters. However, trends for audiologic abnormalities were seen within the users. High-frequency loss and absent distortion product otoacoustic emissions were observed with an increase in the duration of mobile phone use, excessive use of mobile phones, and age more than 30 years. Additionally, users with some complaints during mobile phone use demonstrated absent distortion product otoacoustic emissions and abnormalities in auditory brainstem response. CONCLUSION: Long-term and intensive mobile phone use may cause inner ear damage. A large sample size would be required to reach definitive conclusions.

AOICON 2011 WEBSITE http://aoicon2011.com/index.htm

Dear Colleagues,
Warm Greetings from Chennai.

It is with great pleasure that we invite you to the AOICON 2011 being held in Chennai.

Theme: “The Inner Ear & Beyond”

This conference will bring together an eminent “Star Studded” Galaxy of internationally acclaimed
experts in various disciplines of Otorhinolaryngology.

The conference is being conducted in one of the best venues in the country.

The organizers are taking all efforts to ensure that you have a memorable time.

We welcome you to experience the tradition of hospitality deeply ingrained in every Chennaiite.


Don't miss the ENT event of a life time


Posterior Commissure of the Human Larynx Revisited

Volume 24, Issue 3, Pages 252-259 (May 2010)
Journal of Voice

Posterior Commissure of the Human Larynx Revisited

John A. Tucker∗†, Sean T. Tucker∗†
Accepted 9 December 2008. published online 08 June 2009.

The existence of the posterior commissure (PC) of the human larynx has been disputed (Hirano M, Sato K, et al. The posterior glottis. Trans Am Laryngol Assoc. 1986;107:70–75). “The term posterior commissure has no relevance to anatomical structure. The term commissure means a joining together. The bilateral vocal folds never join at their posterior ends. The posterior aspect of the glottis is a wall. The posterior lateral aspect of the posterior glottis is also the lateral wall of the posterior glottis” (Hirano M, Sato K, et al. The posterior glottis. Trans Am Laryngol Assoc. 1986;107:70–75). This study is intended to clarify the development of anatomical and morphological aspects of the PC in conjunction with a clinical classification of the larynx in sagittal view. This study uses human embryo and fetal laryngeal sections from the Carnegie Collection of Human Embryos (the world standard) and whole organ laryngeal sections from the Tucker Laryngeal Fetal Collection. Correlation of histologic and gross anatomical structure is made with the Hirano et al atlas, the Vidić Photographic Atlas of the Human Body, and the O'Rahilly Embryonic Atlas. Embryologic data clearly describe and illustrate the posterior union of the cricoid cartilage with formation of the PC. The anatomical functional aspects of the posterior lateral cricoid lamina as the supporting buttress of the articulating arytenoid cartilages are illustrated.

Key Words: Stages, Histogenesis of cartilage, Interstitial growth, Appositional growth

All India Rhinology Society : http://rhinologyindia.blogspot.com/

The idea of forming All India Rhinology Society was conceived by Dr. VP Sood in 1986 and was formally registered in Delhi after framing the laws & by laws by following signatories from different states, Dr. I.S.Gupta (Delhi), Dr. V.P.Sood (Delhi), Dr. D.K.Gosavi (Maharashtra), Dr. Debratan Nandi (West Bengal), Dr, H.P.Rajmalani (Rajasthan), Dr. R.C. Deka (Assam), Dr. N.R. Dewan (Madhya Pradesh) and Dr. T.V Krishna Rao (Hyderabad).

First All India Rhinology conference was held at Lady Harding Medical College, New Delhi on 7th November 1987. Dr. H. Stammberger from Austria was invited to deliver Smt. Udhi Devi Sood Memorial Oration.
As of now the All India Rhinology Society boasts of 479 Life members

Clinical profile and treatment outcome of tuberculous lymphadenitis in children using DOTS strategy.

Indian J Tuberc. 2010 Jan;57(1):4-11.
Clinical profile and treatment outcome of tuberculous lymphadenitis in children using DOTS strategy.
Sharma S, Sarin R, Khalid UK, Singla N, Sharma PP, Behera D.

LRS Institute of Tuberculosis and Respiratory Diseases, New Delhi.
BACKGROUND: Extra pulmonary TB (EPTB) including tuberculous lymphadenitis is becoming more common probably due to human immuno deficiency virus (HIV) co-infection. While children do experience a high TB related morbidity and mortality, management of TB in children is challenging. The present study was designed to study the treatment outcome of DOTS strategy for pediatric tuberculous lymphadenitis. OBJECTIVE: To study the efficacy of DOTS strategy for pediatric lymphhnode tuberculosis. METHODS: Retrospective analysis of 669 children of lymphnode tuberculosis treated with DOTS strategy over 9 1/2 years. RESULTS: Mean age was 9.8 years with significantly more girls (61.3%) than boys (38.7%) {chi2=34.08, P<0.001 (S)}. Most of the patients were in the age group of 11-14 years (48.0%) followed by 6-10 years (34.5%) and 0-5 years (17.5%) respectively. Cervical tuberculous lymphadenitis (88.2%) was the commonest form for all ages followed by axillary lymphadenitis in 3.3%. TB of other sites was seen in only 57 (8.5%) cases. Out of total 622 (93%) cases of lymphnode TB where fine needle aspiration and/or excisional biopsy was done, it was positive (84.2%) and negative (15.6%) respectively for AFB/cytology, while it could not be done in 47 patients due to inaccessible sites. Category I, II and III was started on 15.4%, 7.5% and 77.1% patients respectively. Overall, treatment completion rate was 94.9% and the default rate was 2.2% with a failure rate of 2.5%. Death rate was 0.3%. CONCLUSION: The study confirms the efficacy of DOTS strategy for pediatric TB lymphadenitis.

PMID: 20420038 [PubMed - indexed for MEDLINE]

Basics of Otology on 23rd and 24th October2010 at The Central Park hotel, Gwalior, MP

Dear Dr.
We are organizing a workshop on Basics of Otology on 23rd and 24th October2010 at The Central Park hotel, Gwalior, MP. It will include lectures and live surgical demonstration.
All the details are given in the brochure attached herewith.
Looking Forward to welcome you in the city of Tansen, for an academic feast.

Please feel free to contact us for any further details.

May we also request you to please forward this mail to your friends whom you feel may be interested .

Thanks and regards

Dr Rahul Agrawal

Bunglow No 1, G R medical College
Gwalior, MP, 474009
Ph No. (R): 91-751-2321511
Ph No. (O): 91-751-2423700
Mobile: 91-9425101601

Dr Rahul Agrawal
Bunglow No 1, G R medical College
Gwalior, MP, 474009
Ph No. (R): 91-751-2321511
Ph No. (O): 91-751-2423700
Mobile: 91-9425101601


Microscopic features: Schwannomas are usually solitary, well circumscribed, encapsulated lesions, mostly confined to the subcutis. Multinodular lesions may be present in the dermis, this is known as 'plexiform neurilemmoma'.
The characteristic features include presence of alternating Antoni A and Antoni B areas
Antoni A area is composed of spindle shaped Schwann cells arranged in interlacing fascicles.There may be nuclear palisading. In between two compact rows of well aligned nuclei , the cell processes form eosinophilic Verocay bodies. Mitotic figures may be present (usually less than 5 per 10 high power field).
Antoni B area consists of loose meshwork of gelatinous and microcystic tissue. Large, irregularly spaced, thick walled blood vessels are noted in Antoni B area. These may contain thrombus material in the lumina.

"ancient" schwannoma

Diagn Cytopathol. 1999 May;20(5):307-11.
Fine-needle aspiration cytology of "ancient" schwannoma.
Dodd LG, Marom EM, Dash RC, Matthews MR, McLendon RE.

Department of Pathology, Duke University Medical Center, Durham, North Carolina 27710, USA. dodd0003@mc.duke.edu
The term "ancient" schwannoma was proposed for a group of neural tumors showing degenerative changes and marked nuclear atypia. Prior to the realization that the observed atypia was a regressive phenomenon, many of these lesions were erroneously diagnosed as sarcomas. Fine-needle aspiration (FNA) cytologic material from five patients is included in this study. Tissue examined histologically included four resected tumors and 18 gauge core biopsies of one tumor. Aspirates of ancient schwannoma showed many of the same features as FNA of regular schwannoma: aggregates of spindled cells with indistinct cytoplasm and elongate nuclei with blunt point ends. The feature unique to these lesions was nuclear pleomorphism, which was identified in all aspirates. Nuclear inclusions were identified in all but one case. Cystic degeneration, xanthomatous changes, and perivascular sclerosis were identified in excised lesions. Ancient schwannomas show most of the FNA features of benign schwannomas but can demonstrate marked nuclear atypia. The FNA features of ancient schwannoma are important to note because of the potential to confuse this lesion with a more serious one such as sarcoma on FNA.

PMID: 10319234 [PubMed - indexed for MEDLINE]

Stereotactic radiation treatment of vestibular schwannoma: indications, limitations, and outcomes.

Curr Opin Otolaryngol Head Neck Surg. 2010 Jul 6. [Epub ahead of print]
Stereotactic radiation treatment of vestibular schwannoma: indications, limitations, and outcomes.
Conley GS, Hirsch BE.

Department of Otolaryngology, Eye and Ear Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
PURPOSE OF REVIEW: Stereotactic radiation treatment is an increasingly performed procedure for patients with vestibular schwannoma and other benign skull base tumors. During the past 30 years, advancements in stereotactic imaging, radiation delivery techniques, and dose planning have improved overall patient outcomes. The specific role of radiation in current management strategies for vestibular schwannoma continues to evolve as long-term outcome data are analyzed and standardized studies are performed. The recent literature regarding the indications, limitations, and outcomes for stereotactic radiation treatment is reviewed. RECENT FINDINGS: Systematic reviews of the Gamma Knife literature demonstrate improved overall outcomes with radiation doses below 13 Gy. Observation of small vestibular schwannomas is recommended over early radiation or microsurgical intervention. Radiation may be used as adjunctive therapy for large tumors and in certain postradiation treatment failures. Stereotactic radiosurgery and fractionated radiotherapy are equally effective treatment modalities. SUMMARY: Long-term outcome data will ultimately define future indications and limitations for the use of stereotactic radiation with benign skull base lesions. Current evidence supports its use for small to medium sized primary and recurrent vestibular schwannomas with optimal dosing below 13 Gy. It is also recommended for adjunctive therapy, recurrent tumors, in poor surgical candidates, and for those who do not desire observation or surgery.

PMID: 20613529 [PubMed - as supplied by publisher]