Even if some of the guidelines are being executed, the local communities are still facing many of the negative impacts.The other negative side of ecotourism is that it transforms nature and the environment into commodities people are interested in paying and visiting. When the environment becomes a product with economic value, people try to advertise and sell it. Some of the ecotourism sites are turning to private sectors, and the government cut off their funding. Hence, they are obligated to make money on their own. Private natural parks and sites are looking for their own advantage by advertising the soundness of natural parks or coastal marines in the Caribbean. They try to show they are protecting nature and attract people interested In ecotourism. However, they will focus on the phenomenon that might be more interesting for tourists and neglect other aspects of nature when they prioritize their profits. Consequently, this policy will result in abandoning rich ecological sites or destroying those valuable sites. For example, in Montego Bay, hotel staff cut the seagrass that appeared to drive back tourists; conversely, they are crucial for local nutrient cycles. The other problem is that the companies try to hide the truth behind the ecotourism to maintain their profit. They dont cover the fact that traveling from other countries to the natural sites burns extensive amounts of aircraft fuel. In Montego Bay and Negril, a considerable amount of run-off is released to the coastal water produced directly or indirectly by ecotourists.
From a pathology perspective, an endolymphatic sac tumor needs to be separated from metastatic renal cell carcinoma, metastatic thyroid papillary carcinoma, middle ear adenoma, paraganglioma, choroid plexus papilloma, middle ear adenocarcinoma, and ceruminous adenoma. Management
Wide excision is the treatment of choice, although attempting to preserve hearing. Based on the anatomic site, it is difficult to completely remove, and so while there is a good prognosis, recurrences or persistence may be seen. There is no metastatic potential. Patients who succumb to the disease, usually do so because of other tumors within the von Hippel-Lindau complex rather than from this tumor. Surgery is the primary treatment modality, but in some rare instances adjuvant radiation therapy may be used. Epidemiology
This is a very rare tumor, since only about 1 in 35,000 to 40,000 people have VHL, of whom about 10% have endolymphatic sac tumors. Patients usually present in the 4th to 5th decades without an gender predilection. The tumor involves the endolymphatic sac, a portion of the intraosseous inner ear of the posterior petrous bone. References
Further reading
Lester D. R. Thompson; Bruce M. Wenig (2011). Diagnostic Pathology: Head and Neck: Published by Amirsys. Hagerstown, MD: Lippincott Williams & Wilkins. pp. 7:64–67. ISBN 978-1-931884-61-7.