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The distinction between tuberculosis and sarcoidosis presents sometimes a clinical challenge. Their sequential occurrence in the same patient is uncommon. We present the case of a 42-year-old female with a proven diagnosis of tuberculous lymphadenitis who has developed successively nasal tuberculosis and pulmonary sarcoidosis respectively after 10 and 14 months of antituberculosis treatment. The patient presented with bilateral cervical lymphadenopathy. Tuberculin skin test was negative. Chest radiography was normal. An excision biopsy was taken and histopathological examination established tuberculosis diagnosis. Therapy with antituberculosis drugs was started, and cervical lymphadenopathy showed progressive resolution. Subsequently, nearly 10 months after, the patient developed new cervical lymphadenopathies and nasal obstruction. Tuberculosis of the nasal mucosa was confirmed by biopsy. Antituberclosis bitherapy was enhanced by ofloxacin and ethambutol. Thoracic CT scan showed several nodular elements in both lungs, with bilateral enlarged mediastinal adenopathy. Bronchoalveolar lavage showed a lymphocytic alveolitis with a CD4/CD8 ratio of 5, consistent with the diagnosis of pulmonary sarcoidosis. Corticosteroid treatment, in form of oral prednisolone was introduced, 3 months after sarcoidosis diagnosis have been setteled; because of pulmonary fibrosis noticed on thoracic CT. Systemic corticotherapy was continued for a further period of 3 years, until all the lesions cleared out. The present case emphasizes the possible association between tuberculosis and sarcoidosis.

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Non-recurrent Laryngeal nerve is constantly associated with Arteria Lusoria. Knowing this association is the basis of predicting this condition preoperatively. Ultrasonography assessment before thyroid and parathyroid surgery should include identification of brachiocephalic trunk division. Absence of its visualization indicates Arteria Lusoria and then non-recurrent laryngeal nerve.

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Ectopic thyroid tissue (ETT) lateral to the midline is rare. Its occurrence in the carotid bifurcation is exceptional. We present a 45 years woman who consulted with a slow growing right cervical swelling. Clinical examination Ultrasonography, contrast enhanced CT and cervical MRI concluded to a paraganglioma. Intra-operatively, the tumor didn't have the characteristic aspect of a paraganglioma. Complete excision was performed. Histology concluded to an ectopic micro-vesicular thyroid adenoma.Previous literature was reviewed to summarize clinical and radiologic characteristics of such rare entity. Despite its rarity, ETT must be included in the differential diagnosis of cervical paraganglioma.

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A 41-year-old patient was hospitalised for a chronic right parotid mass. A cervical ultrasound revealed a cystic mass of the parotid. Cervical MRI found a ductal ectasia of the parotid and submandibular glands associated with a retention cyst of the right parotid. He had a right total parotidectomy. Histopathological examination of the lesion revealed a multilocular cystic mass with a diffuse glandular ectasia of salivary ducts. The patient had an uneventful postoperative course without any recurrence of symptoms.

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OBJECTIVES: The aims of this study were to determine predictive factors of paradoxical reaction in patients with cervical lymph node tuberculosis (TB) and to discuss the therapeutic management of this condition. MATERIALS AND METHODS: A retrospective study was performed of 501 patients managed for cervical lymph node TB over a period of 12 years (from January 2000 to December 2011). Statistical data were analyzed using IBM SPSS Statistics version 20.0. RESULTS: Paradoxical reaction occurred in 67 patients (13.4%), with a median delay to onset after starting TB treatment of 7 months. Lymph node size ≥3cm and associated extra-lymph node TB were independently associated with paradoxical reaction. Treatment consisted of surgical excision (71.6%), restarting quadruple therapy (10.4%), reintroduction of ethambutol (23.8%), and addition of ciprofloxacin (20.8%); steroids were given in two cases . All patients recovered after an average treatment duration of 14.91±7.03 months. CONCLUSION: The occurrence of paradoxical reaction in cervical lymph node TB seems to be predicted by associated extra-lymph node TB and a swelling size ≥3cm. The treatment of paradoxical reaction remains unclear and more randomized trials are necessary to improve its management.

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OBJECTS: To discuss clinical presentation and therapeutic approaches of facial paralysis in acute otitis media. METHODS: We present five cases of facial palsy in children with acute otitis media managed in our ENT department during a period of 12 years (2001-2012). RESULTS: The mean age was 14.2 years; sex ratio was 0.66. All patients presented with a facial asymmetry, but only 3 of them had otalgia before the onset of facial asymmetry. The facial palsy delay was 3.3 days. The ear examination showed that the tympanic membrane was congestive in 4 patients, associated with a bulging in 2 patients, and a small perforation in one patient. Our patients presented grade III to IV initial facial palsy according to House and Brackmann staging. Computed tomography scan revealed a dehiscence of the bony facial canal in one patient. Antibiotic therapy associated with intravenous corticosteroids was administered in all patients. All patients underwent a facial kinesis therapy. A progressive improvement of facial palsy was observed in 4 patients and complete recovery of facial function in one case. DISCUSSION: Conservative treatment associating intravenous antibiotic and corticosteroids with or without myringotomy is the standard approach.

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