bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary extramedullary plasmacytoma of the salivary glands
Authors: Kerr Paul D. , Dort Joseph C.
Published: November 2007

Primary extramedullary piasmacytomas (PEMP) are uncommon plasma cell neoplasms that generally occur in the submucosal tissue of the upper airway. Salivary gland PEMP is an extremely rare condition. This report describes a unique case of PEMPin the parotid gland asociated with pulmonary amyloidosis. A review of all salivary gland PEMP's suggests that they behave similarly to PEMP's in other locations. The treatment of choice forlocalized disease is radiotherapy which should include regional lymphatics. Local controlcan be achieved in the majority of cases. The minority of patients develop systemic metastases and die from their disease. Chemotherapy can control disseminated disease and may induce remission.
Verrucous carcinoma of the maxillary antrum
Authors: Daoud A. , Lannigan F. J. , McGlashan J. A. , Keen C. E. , Bowdler D. A.
Published: November 2007

Verrucous carcinoma is a rare variant of squamous cell carcinoma which occurs most frequently in the oral cavity and larynx. In this article we describe a patient with verrucous carcinoma of the maxillary antrum. and present a review of the literature.
Glycoconjugates in the human fetal endolymphatic sac as detected by lectins
Authors: Yamashita Hiroshi , Bagger-Sjöbäck Dan , Wersäll Jan , Sekitani Toru
Published: November 2007

The distribution of glycoconjugates in the 11 to 16 weeks old human fetal endolymphatic sac (ES) was analyzed using six biotinylated lectins; Wheat germ agglutinin (WGA), Abrusprecatorius agglutinin (APA), Ulexeuropaeus agglutinin I (UEA-I), Ricinus communis agglutinin 120 (RCA120), Helixpomatia agglutinin (HPA), Concanavalin A (ConA). In the 11 week old human fetus, fluorescent reactions with WGA, APA, RCA120 and ConA were detected in the ES. There was almost no reaction with HPA and UEA-I. In the 14 week old human fetus, however.fluorescent reactions with HPA and UEA-I appeared. This result suggests that the presence of glycoconjugates changes during the maturation process of the ES. Glycoconjugates detected with HPA were related to the epithelial cell elements of the ES epithelium. The reaction with UEA-I suggests that the stainable substance present in the ES lumen may be secreted locally by the ES itself.
The deep oval window
Authors: Kapur T. R.
Published: November 2007

This article presents the results of an analysis of the variable and surgically important relationship between the oval window, the fossular walls and the related posterior tympanic recesses in 50 temporal bones. The visual impressions of superficial and deep oval windows seem to correspond fairly closely to the depth of the inferior wall of the fossula fenestra vestibuli (FFV). The depth of the superior and anterior walls of the FFV by themselves, did not appear to have such a dominating relationship in determining the deep oval window. There does not appear to be a well defined posterior wall in the vast majority of the specimens (86 percent). In the event of scar tissue forming between the superior, inferior and anterior walls, the gap between the postero-superior part of the promontory and the posterior tympanic wall (posterior communication) could allow aeration of the region of the deep oval window in such an instance. Closure of this gap by a solid shelf of ponticulus or scar tissue could cause a localized malaeration of the fossula in most cases of deep oval windows. This is an entirely new concept of the likely problems of malaeration of a deep oval window which could arise due to anatomical variations and of the possible safety valve mechanism which could prevent such malaeration and its consequences.
Measurement of drill-generated noise levels during ear surgery
Authors: Hickey S. A. , Fitzgerald O'connor A. F.
Published: November 2007

The results of intraoperative monitoring of the electrocochleogram in patients undergoing surgery for poorly controlled Menières Disease are presented with particular reference to the masking effect of drill-generated noise. The results obtained using a direct,in vivo, electrophysiological method of assessment of drill-generated noise levels are compared with previous postmortem and intraoperative studies and the implications with respect to the likelihood of drill-generated noise induced acoustic trauma are discussed.
Stapedius tendon ossification: A rare cause of congenital conductive hearing loss
Authors: Grant William E. , Grant William J.
Published: November 2007

Two cases are presented of bilateral conductive deafness in siblings. An initial presumptive diagnosis of otosclerosis was made in the first case, that of a nine-year-old girl with a bilateral hearing loss of 45 dB. Exploratory tympanotomy revealed normal ossicles but the stapedius ‘tendon’ was found to be a solid bony bar fixing the stapes. Division of the ‘tendon’ resulted in normal ossicular mobility and return of hearing with closure of the air-bone gap. Identical ossification was found in her other ear, and some years later in both ears of one of her brothers. Similar surgery restored hearing successfully in each case. An acquired aetiology has been proposed in one of the three previously reported cases; this report, however, suggests the congenital nature of the anomaly. No previous cases have been described occurring in siblings.
Experience with a subcutaneous implantable bone conduction hearing aid (Xomed Audiant) in a district general hospital
Authors: Whitehead Edward
Published: November 2007

Patients with a conductive hearing loss may find conventional hearing aids unsatisfactory for a variety of reasons. Efforts to overcome some of these difficulties have led to the development of the osteointegrated hearing aid.

Implantable bone conduction hearing aids are an important advance in the treatment of well selected patients. Only 18 patients, who have been implanted with the Xomed Audiant bone conduction hearing aid, have so far been reported on in the UK. This report concerns a further six patients who have been implanted in one centre.

Five of these patients continue to use their Audiant hearing aid 14 to 24 months after being fitted. They regard it to have significant advantages over their previous hearing aids. Four of the five patients use an ear level processor.

Two of the patients who had previously used conventional bone conduction hearing aids now use the ear level processor.
Obliterative otosclerosis
Authors: Raman R. , Mathew John , Idikula John
Published: November 2007

An analysis of 420 consecutive cases of obliterative otosclerosis seen in the Christian Medical College Hospital, Vellore is presented. The proportion of truly obliterative otosclerosis is 33.09 per cent (139 ears). Our male to female ratio in truly obliterative otosclerosis is 1.48:1, while in the non-obliterative group it was 1.34:1. The mean age at onset in the obliterative group was 19.14 while in the non-oblierative group it was 25.60. This is statistically (P<0.001). The age at presentation was 25.90 in the obliterative group while in non-obliterative group it was 30.86; this is also statistically significant (P<0.001). However the time interval between the age at onset and the age at presentation is not statistically significant.
Role of Surgery in tuberculous mastoiditis
Authors: Singh Bharath
Published: November 2007

A study was understand in 43 patients to determine the role of surgery in tuberculous mastoidits. Cortical mastoidectomy was performed on five patients (Group I). Incision and drainage of a post-auricular abscess, removal of sequestrum and meatoplasty in eight (Group II).

Thirty patients had no ear surgery (Group III). Of the 17 Patients with facial palsy, three were in Group I, two in Group II, 12 in Group III. The patients in all three groups were treated with anti-tuberculous drugs for a period of no less than six months.

The average time taken for the otorrhoea to subside and granulation issue to resolve completely was two months in all three groups. The facial nerve recovery in the non-operated ears (Group I and II) 80 per cent.

The conclusion is that chemotherapy is the management of choice in tuberculous mastoidits. The only role of surgery is incision and drainage of a post-auricular abscess and removal of sequestrum if present.
Survey of immunosuppressive acidic protein and other immunological parameters in head and neck cancer patients
Authors: Nakashima Tadashi , Tanaka Motosuke , Okamura Sei-ichi
Published: November 2007

Serum levels of immunosuppressive acidic protein (IAP) and other immunological parameters were examined in 95 head and neck cancer patients and 27 control patients. The mean values of IAP in patients in the advanced stage were significantly higher than in early stage patients. Statistically significant increases in the mean concentration of IAP were also observed in patients with a recurrence, as compared to findings in those in the advanced stages. The mean values of blastogenesis response to PHA and NK cell activity in the cancer patients were lower than in disease free individuals, but with no statistical differences. In the endstage patients, the lAP concentration was considerably elevated and the blastogenesis response showed a statistically significant decrease. Thus, the monitoring of serum lAP, in combination with other immunological parameters, aids in planning and assessing clinical staging in head and neck cancer patients.
Aggressive papillary middle ear tumour
Authors: Forrest A. W. , Turner J. J. , Fagan P. A.
Published: November 2007

A rare middle ear tumour is reported. The clinical presentation was similar to that of a glomus tumour but the pathology that of an aggressive papillary middle ear tumour. This is a recently recognized subgroup of middle ear glandular tumours. Clinical findings, imaging, pathology and treatment are presented.
Congenital cholesteatoma
Authors: Laskiewicz B. , Chalstrey S. , Gatland D. J. , Jones N. , Michaels L.
Published: November 2007

We present a British series of eleven patients with primary cholesteatoma, including one patient with bilateral disease. Eight children presented with a history of hearing loss, while one child had had recurrent otitis media and another had had carache. Operative findings were: in five ears, cholesteatoma confined to the antero-superior segment with intact ossicles, in a further four, cholesteatomas extending throughout the mesotympanum with ossicular erosion in one, and in two ears posterior disease throughout the middle ear and mastoid, which had eroded the ossicles in both cases. The five cases of antero-superior cholesteatoma lend most support to Michaels' concept of epidermoid formation as a possible source of congenital cholesteatoma. With a greater awareness of the problem and careful examination of the antero-superior quadrant of the tympanic membrane, earlier diagnosis may be possible enabling removal of small intact cholesteatoma sacs and preserving the structures of the middle ear and therefore the hearing.

A screening programme for infants included as part of their routine examination which would be undertaken by examiners who are trained to be more aware of the problem and skilled at otoscopy, would help in the earlier detection of such cases as is shown by reports from the U.S.A.
Differential diagnosis of pleomorphic adenoma by immunohistochemical means
Authors: Nishimura Toshiro , Furukawa Mitsuru , Kawahara Ei , Miwa Atsuo
Published: November 2007

Immunohistochemical study of major salivary gland tumours was performed on 60 pleomorphic adenomas, five basal cell adenomas and 10 adenoid cystic carcinomas to determine the diagnostic value of each antigen. Immunoreactivity examined were intermediate filaments (keratin, vimentin, desmin and glial fibrillary acidic protein [GFAP]) and related substances (actin, S-100 protein and secretory component). In pleomorphic adenomas, there was positive immunoreactivity for GFAP which was not observed in normal tissue or other neoplastic tissues. Immunoreactivity of GFAP was closely related to myxomatous and early chondromatous differentiation in pleomorphic adenoma. It is considered that GFAP immunoreactivity should be assessed in the occasional differential diagnostic dilemma of pleomorphic adenoma versus adenoid cystic carcinoma and basal cell adenoma, because of its ability to show potential and definite myxochondromatous differentiation.
Acute isolated sphenoid sinusitis: a disease with complications
Authors: Deans J. A. J. , Welch A. R.
Published: November 2007

A case of acute isolated sphenoid sinusitis is described in a twelve year old boy who presented with ophthalmic complications. The literature is reviewed to emphasize the potential dangers of this condition.
Giant cell variant of malignant fibrous histiocytoma of the head and neck
Authors: Singh Bhuvanesh , Santos Vladimir , Guffin Thomas N. , Alexis Richard , Har-El Gady
Published: November 2007

The giant cell variant of malignant fibrous histiocytoma is a rare entity in head and neck. Only eight well documented cases of this type are reported in the English literature. These tumours affect the superficial and deep structures of the neck most often and are best treated with prompt radical surgery. The prognosis of the giant cell type of malignant fibrous histiocytoma is dependent on the location of the tumour, with superficial tumours having a much better outlook.
Aneurysmal bone cyst of the hyoid
Authors: Shadaba Akhtar , Zaidi Shabih
Published: November 2007

Aneurysmal bone cyst is a rare lesion usually of the long bones, well documented in the literature. It is a cystic, osteolytic vascular tumour, replete with giant cells and fibrous septa, yet devoid of endothelial lining. It has been reported in the larynx and maxillary sinus. This appears to be the first report Qf an aneurysmal bone cyst occurring in the hyoid bone.
B-mode ultrasound demonstration of non-luminal carotid artery invasion by tumour
Authors: Gaffney R. J. , Viani L. , McShane D. P.
Published: November 2007

Invasion of the adventitia of the carotid artery by tumour is not demonstrated by contrast CT scanning. We report a case in which B-mode ultrasound was successfully used to demonstrate this.
The fibrous annulus in myringoplasty
Authors: El-Seifi Alaa , Fouad Bassem
Published: November 2007

Graft cholesteatoma is a serious complication of tympanic membrane grafting. It is due to burying keratinizing epithelium under the graft. Its occurrence in the anterior angle has been attributed to the presence of epithelial rests within the annulus in this area, and consequently is considered inevitable with overlay technique.

In the present study we propose that this complication is due to inadequate surgical technique rather than due to factors inherent in underlying pathology or in the technique itself.
Water used to visualize and remove hidden foreign bodies from the external ear canal
Authors: Peltola Timo Johannes , Saarento Rainer
Published: November 2007

Small foreign bodies lodged anteriorly in the tympanic sulcus are usually not visible, due to the curve of the external ear canal. Such objects can be seen with the aid of an otomicroscope and micromirror or with an endoscope, and removed by irrigation. If irrigation fails, epithelial migration on the tympanic membrane may remove lodged foreign bodies, although this may take months. Our new method, which uses water to locate small objects lodged in the tympanic sulcus, includes irrigation of the ear, adjustment of the water level to the middle curve of the external ear canal, and use of the water surface as a concave lens, making the tympanic sulcus visible. With otomicroscopy a curved ear probe can then be used to remove lodged foreign bodies from behind the curve.
Medical management of pseudocyst of the auricle
Authors: Job Anand , Raman R.
Published: November 2007

Four male patients with pseudocyst of the auricle were successfully treated with oral corticosteroids. This condition is an asymptomatic, non-inflammatory, cystic swelling, usually located in the scaphoid or triangular fossa of the anti-helix which if untreated, leads to deformity of the pinna. All successful methods of treatment described in the literature so far have been invasive. All four patients in the above series responded to oral steroid therapy alone.
Trichinosis and cancer of the larynx
Authors: Simaskos Nicholas , Palaiologos Yannis , Eliopoulos Panayotis N.
Published: November 2007

A case of trichinosis of the laryngeal muscles which was discovered accidentally during total laryngectomy for cancer of the larynx is presented. Trichinosis is a rare parasitic disease, particularly for the ENT specialist. It is difficult to identify during life. No specific treatment is available. In our case it is suggested that the chronic irritation of the larynx may have resulted in the growth of the cancer.
Revision of classification of laryngeal cancer, is it long overdue?
Authors: Kleinsasser O.
Published: November 2007

The TNM-classification of laryngeal carcinomas of the UICC contains a number of weaknesses which diminish their prognostic relevance. Based on clinical observations and microscopic investigations of surgical specimens, several changes are proposed to improve the existing TN-classification.

The larynx is subdivided by the UICC into the supraglottic, the glottic and the subglottic main area and their tumours. There are embryological, anatomical, functional and oncological reasons to divide the larynx into two main areas only—the supraglottis and the glottis (vocal folds) without any further subsites and to abandon a separate group of subglottic tumours. The T size of a tumour should not be assessed according to the extent of an ill-defined anatomical region, but measured in millimetres of greatest surface extent only. The T2category of vocal fold tumours should not contain those which lead to an inhibited mobility of the fold. All tumours with reduced vocal fold mobility or fixation should be classified as T3or T4according to the dimension of invasion. Post-operative pathological examinations (pT/pN) allow an assessment of the true extent of a tumour in three dimensions. A validation study using a ‘metric’ T pT-classification shows very distinct groups of tumours with a significantly different prognosis from Tis 1 to T4. Studies of lymph node metastases in the neck have shown that, number, size, site of metastasis and the presence of extracapsular tumour spread have a significant influence on the prognosis. An improved N/pN-classification taking these factors in consideration is proposed.
Malleomyringoplasty using a silicone prosthesis
Authors: Schiller A. , Wormald P. J.
Published: November 2007

Successful replacement of the sound conducting mechanism of the ear has been hampered by infection, perforation, prosthesis instability and extrusion. In this animal study on thirty rats a silicone prosthesis was inserted between two layers of fascia as a total replacement of the tympanic membrane and ossicular chain. After four months the graft was found to be intact without evidence of infection or extrusion in all but one of the 30 rats. These results justify a trial of a similar silicone prosthesis in humans.
Renal cell carcinoma metastasis to the tongue
Authors: Okabe Y. , Ohoka H. , Miwa T. , Nagayama I. , Furukawa M.
Published: November 2007

Metastases to the tongue from distant primaries are very rare. A case of renal cell carcinoma metastasis to the tongue, occurring in a 58-year-old man, is presented and previously reported cases are reviewed.
Synovial sarcoma of hypopharynx
Authors: Chew K. K. , Sethi D. S. , Stanley R. E. , Sng Ivy
Published: November 2007

Synovial sarcoma of the hypopharynx is a rare neoplasm. To date only 23 cases of synovial sarcoma of the hypopharynx have been reported in the literature. An additional case in an 18-year-old male is presented. This is the first case of synovial sarcoma in the hypopharynx to be reported in Singapore. The presentation was that of a mass in the hypopharynx; progressive dysphagia, intermittent hoarseness and gradual airway compromise. A CT scan was valuable in determining the site of origin and extent of the lesion. Histopathology was diagnostic. Treatment comprised of wide surgical excision of the tumour and post-operative radiotherapy.
Paediatric otoscopy—clinical and histological correlation
Authors: Ruah Carlos B. , Barros Ezequiel , Ruah Samuel B. , Penha Rui S. , Schachern Patricia , Paparella Michael M.
Published: November 2007

Otoscopy is a subjective clinical method. Its subjectivity has led physicians to verify its accuracy through correlations with findings of otomicroscopy, pneumatic otoscopy, tympanometry, and myringotomy. In the very young population, however, the interpretation of otoscopic findings becomes more difficult. To improve the interpretation of normal otoscopy in young children, an otoscopic-histological correlation was attempted in children up to nine years of age. Twenty-one temporal bones from 15 children aged from two days to nine years who had no evidence of otological disease or congenital anomalies were examined under light microscopy; the thickness of the pars flaecida, posterior superior quadrant, and umbo were measured. Twenty-five eardrums of 15 healthy children without past or present history of otological disease were examined using otoscopy; a photograph of each eardrum was obtained. Our study demonstrates that structural changes in the tympanic membrane during these years of childhood have a good correlation with otoscopic findings. Understanding normal histological changes in the paediatric eardrum may improve our interpretation of otoscopic findings.
Conservative treatment in the management of inflammatory aural polyp
Authors: Hussain S. S. M.
Published: November 2007

This prospective study assesses the role of intensive outpatient based conservative treatment in the management of aural polyp.

All cases of aural polyp that presented to the department during 1990 were included. Patients with obvious cholesteatoma or in whom inner ear or intracranial pathology was suspected were excluded as were children and patients who had undergone previous ear surgery.

We found that treatment with topical steroid/antibiotic decreases disease activity and renders subsequent surgery less extensive.
Autologous fibrin glue in the repair of dural defects in craniofacial resections
Authors: Toma Abbad G. , Fisher Edward W. , Cheesman Anthony D.
Published: November 2007

Cerebrospinal fluid leakage is a serious and well recognized complication of craniofacial resection for ethmoidal tumours in which the integrity of the dura has been breached. Autologous fibrin glue is a safe, inexpensive and simple method of improving the seal of dural repair and hence minizing CSF leakage. The principles and method of autologous fibrin glue preparation are described. The technique has proven satisfactory in 20 consecutive craniofacial resections with dural defects and is recommended as an adjunct to current techniques of dural repair.
Nasal teeth
Authors: Pracy J. P. M. , Williams H. O. L. , Montgomery P. Q.
Published: November 2007

Ectopic and supernumerary teeth occur in a wide variety of sites. Those that have been reportedinclude the mandibular condyle, coronoid process, orbit, palate, nasal cavity and the maxillaryantrum. Eruption of teeth into these sites is rare, and easily overlooked. We present two casesin which eruption of teeth into the nose and paranasal sinuses was associated with significant morbidity and show how this was relieved by appropriate surgery.
Antimicrobial Prophylaxis for Major head and neck cancer surgery with piperacillin and ornidazole
Authors: Dominici L. , Gondret R. , Broc V. , Dubos S. , Viallard M. , Deligne P.
Published: November 2007

A prospective study in 53 eligible patients, undergoing major head and neck cancer surgery was carried out to assess the combination of an ureido penicillin, piperacillin with a nitro imidazole agent, ornidazole, in order to prevent post-operative general and wound infections. Both antibiotics were administered for five days. Each patient had piperacillin 4 gm every eight hours and ornidazole 1 gm every 24 hours.

The overall rate of infections was 13.2 per cent (n = 7), with 3.8 per cent (n = 2) wound infections and 11.3 per cent (n = 6) general infections (one patient presented both complications).

There was no wound infection in the total surgery group (n = 12). General infections who only consisted of pneumonias were respectively 12.2 per cent (n - 5) in the group with partial procedures (n = 41) and 8.3 per cent (n = 1) in the total surgery group.

This antibioprophylaxis can be recommended in major oncological neck surgery, specially in the case of partial procedures.
Combined therapy in advanced head and neck cancers
Authors: Bahadur Sudhir , Kumar Subirendra , Tandon D. A. , Rath G. K. , De Sudarsan
Published: November 2007

The results of single modality treatment using surgery or radiotherapy alone in advanced head and neck cancers are known to be unsatisfactory. The present study analyses 252 cases with stage III and IV resectable cancers of the head and neck region selected to be treated by a combined regime of pre- or post-operative radiation and radical surgery. Only 193 patients completed the treatment protocol. There were 58 cases (33.5 per cent) who failed either at primary or regional sites or both. Nine cases (five per cent) developed distant metastasis. Absolute and determinate four year disease-free survival was 55 per cent and 61 per cent respectively. Early lesions (stage I and II) have been excluded from the study. The study indicates that a reduction in primary and regional failures correlates well with a combined therapy, though prolonged treatment may affect patients' compliance to some extent.
A difficult intubation—Fatal respiratory arrest secondary to an oral epulis
Authors: Farrell Roy W. R. , Mckenna Deirdre M. , Anaes Desmond Breen F.C. , Parker Andrew J.
Published: November 2007

We report an unusual case of cardio-respiratory arrest and eventual death secondary to a benign tumour of the oral cavity obstructing the oropharynx. We review the literature of similar occurrences causing difficulty with respiration and intubation, and highlight the importance of early diagnosis and treatment.
Laryngeal chondrosarcoma—an unusual presentation
Authors: Dekker P. J. , Andrew A. C.
Published: November 2007

Laryngeal chondrosarcoma is an uncommon tumour, approximately 200 cases having been reported in the world literature. We report a case which was noted by chance in a patient undergoing general anaesthesia for an unrelated procedure.
Recovery ofChlamydia pneumoniae, in six patients with otitis media with effusion
Authors: Ogawa* Hiroshi , Hashiguchi Kazuhiro , Kazuyama Yukumasa
Published: November 2007

Six cases of otitis media with effusion associated withChlamydia pneumoniae, a currently recognized respiratory tract pathogen, are presented. The organism was isolated from the middle ear fluids and serological evidence confirmed it as the infectious agent. The study population is small; however, these reports suggestC. pneumoniaeas a causative agent of middle ear diseases.
Oesophageal foreign body: an unusual cause of respiratory symptoms in a three-week-old baby
Authors: Chowdhury C. R. , Bricknell M. C. M. , MacIver D.
Published: November 2007

Impaction of a foreign body in the oesophagus is common in children. If the event is not witnessed by an adult or the object is radiolucent the diagnosis is difficult as respiratory symptoms may predominate. We report a three-week-old child with respiratory symptoms who had both a respiratory syncytial virus infection and a radio-lucent oesophageal foreign body. This case is the youngest yet reported and serves as a reminder of the difficulties in the diagnosis of this important condition.
Necrotizing sialometaplasia
Authors: Russell J. D. , Glover G. W. , Friedmann I.
Published: November 2007

Necrotizing sialometaplasia is a benign self-limiting disorder which can simulate malignancy. We report the third such case of nasal fossa involvement in the literature. The pathology of this condition is discussed.
Role of prophylactic antibiotics in surgery for advanced head and neck cancer
Authors: Tandon D. A. , Bahadur S. , Laldina H. C. , Sundaram K. R.
Published: November 2007

Four regimens of prophylactic antibiotics were utilized in 122 consecutive patients of stages III and IV carcinoma of the upper aero-digestive tract undergoing major resections in a randomized single-blind study. Ampicillin, gentamicin, cephalexin and metronidazole were used in different combinations for periods of 5 or 10 days. A cephalexin-metronidazole protocol for 10 days was associated with lowest post-operative infection rate. Oral-oropharyngeal resection and use of pectoralis major myocutaneous flap were the most important factors contributing to infection.
Nasal polpectomy: should antral washout be a routine?
Authors: Dowell Marque , Pahor Ahmes L.
Published: November 2007

Seventy patients with nasal polyps were studied. Forty-seven of these had pre-operative sinusradiographs and all seventy patients had antral washouts at the time of nasal polypectomy. One hundred and seventeen antral aspirates were sent for culture and microscopy. The naked eyeappearance of aspirates were turbid in 34 patients. Bacteria were cultured from 15 of the specimens in 10 patients.

It was concluded that antral washout should be recommended in all patients who have nasal polypectomy and that there is no need for sinus radiographs in those patients who have uncomplicated nasal polyps.
Tracheostomy self care: The Nottingham System
Authors: Mason J. , Murty G. E. , Foster H. , Bradley P. J.
Published: November 2007

Tracheostomy self care at home can be a problem for some patients. The Nottingham System attributes a competence ratio to each patient. Those liable to develop problems can be identified early and the appropriate support provided. The Nottingham System is described.
Ceruminous gland tumours: a reappraisal
Authors: Mansour P. , George M. K. , Pahor A. L.
Published: November 2007

Ceruminous glands should no longer be regarded as purely apocrine glands, but as apoeccrine glands with both apocrine and eccrine modes of secretion. We present two cases of pleomorphic adenoma of ceruminous glands, among the rarest of such tumours. The use of such terms as ‘ceruminoma’ and ‘hidradenoma’ should finally be abandoned, and ‘ceruminous gland tumour’ used instead as a generic term. Classification should be based on Wetli's prototype (adenoma, pleomorphic adenoma, adenoid cystic carcinoma and adenocarcinoma), with the addition of benign eccrine cylindroma and syringocystadenoma papilliferum; the inclusion of mucoepidermoid carcinoma should await full validation. Wide local excision is necessary for all tumours, with only follow-up for histologically benign neoplasms. Malignant tumours need early aggressive surgery and radiotherapy. If marginal invasion cannot be assessed histologically, then adenoma and adenocarcinoma cannot be distinguished and we suggest that the tumour be reported as ‘of uncertain malignant potential’. Long-term studies are needed to confirm or refute the view that all ceruminous gland tumours are potentially malignant.
Vestibular neurectomy by the infralabyrinthine approach
Authors: Magliulo G. , Vingolo G. M. , Petti R. , de Vincentiis M.
Published: November 2007

There are a variety of approaches for treating vertigo with selective vestibular neurectomy but each has definite limitations proving that no ideal technique is yet available. An original posterior-inferior approach to the internal auditory canal (infralabyrinthine approach) has been recently proposed. It attempts to overcome the limitations and to combine the advantages of the previous procedures. This report presents our preliminary results using this particular technique in the management of vestibular symptoms of Meniere's disease.
A conservative approach to the management of otitis media with effusion in cleft palate children
Authors: Robson A. K. , Blanshard J. D. , Jones K. , Albery E. H. , Smith I. M. , Maw A. R.
Published: November 2007

Otitis media with effusion (OME) is almost universal in children born with a cleft palate. Early placement of a ventilation tube to alleviate hearing problems is common. A retrospective study has been carried out to assess whether the practice of tube placement only for definite clinical indications is successful in terms of subsequent hearing levels and speech and language development. This was assessed by a case note review, analysis of speech therapy data and by means of a special follow-up clinic.

There was no difference in speech development between those treated with tube insertion for OME and those untreated. Audiological thresholds were worse in the treated group. A similar number in each group required regular speech therapy. More abnormal otological findings were present at follow up in those who had tubes inserted, some of these were directly attributable to the presence of tubes.

A conservative management of OME in cleft palate children, with tube insertion for only definite clinical indications, is an appropriate management, and will lead to fewer otological complications of tube insertion.
Allergic aspergillus sinusitis with proptosis
Authors: Daghistani K. J. , Jamal T. S. , Zaher S. , Nassif O. I.
Published: November 2007

Allergic aspergillus sinusitis has recently been increasingly recognized. Five cases are discussed. All presented with proptosis, signs and symptoms of allergic rhinitis and radiological evidence of expansile masses with calcification and bony erosions involving multiple sinuses. Greenish cheesy material was seen at surgery. Histologically the lesions contained eosinophils, Charcot-Lyden crystals and fungal septate hyphae.Aspergillus fumigatuswas grown from all cases. Surgical removal with drainage and aeration were performed. The follow-up period ranged between three to 18 months. Recurrence occurred in one patient.

Allergic aspergillus sinusitis can mimic malignant disease and should be considered in the differential diagnosis of lesions involving multiple sinuses. It should also be considered in all cases of proptosis.
Guillotine and dissection tonsillectomy in children
Authors: Ünlü Yaşar , Tekalan Şerif Ali , Cemiloglu Refik , Ketenci Ibrahim , Kutluhan Ahmet
Published: November 2007

Tonsillectomy as an outpatient or same day-stay procedure is becoming increasingly popular. A retrospective study was performed on 1,049 children who underwent tonsillectomy and adenotonsillectomy either with guillotine or dissection with snare method. The dissection method was performed both under general anaesthesia and with local anaesthesia, but the guillotine method was performed only with local anaesthesia. Generally, bleeding control required no special intervention in the guillotine method but haemostasis was achieved by ligation and electrocauterization in one-third of the patients in the dissection group operated under general anaesthesia. The greatest percentage of haemorrhage in both methods occurred within the first four post-operative hours. There was a 1.8 per cent incidence of severe reactive haemorrhage required surgical intervention in the dissection group operated under general anaesthesia, but there was no such case in the guillotine group.

The results of this study show that in carefully selected children guillotine tonsillectomy with local anaesthesia is a safe, time saving and cost-effective procedure.
Fibromatosis on the dorsum of the nose
Authors: Varghese George , Murthy P. S. N. , Puranik K. R. , Kurien Mathew , Narayan K. Ram
Published: November 2007

An extremely rare case of fibromatosis in a 25-year-old Indian male is reported. The clinical examination and pre-operative findings were suggestive of a benign neoplasm, probably of neurogenic origin. The mass was well circumscribed and could be shelled out en masse. Histopathological examination showed it to be fibromatosis. An external rhinoplasty approach enabled a complete wide excision to be performed without any resulting cosmetic defect.
Use of the carbon dioxide laser with the Montgomery T-tube in the management of extensive subglottic stenosis
Authors: Whitehead Edward , Salam M. A.
Published: November 2007

Subglottic and tracheal stenosis frequently present difficulties in management.

Two cases of subglottic stenosis occurring after prolonged endotracheal intubation are presented where the vertical length of complete obstruction by scar tissue was greater than 2.5 cm. One case was successfully managed by the use of the laser and immediate insertion of a stent. The other case still requires subglottic stenting, although an excellent lumen was established by laser vaporization of the stenosed segment.
Isolated bilateral paralysis of the soft palate in an adult
Authors: Izzat M. , Sharma P. D.
Published: November 2007

A case of bilateral paralysis of the soft palate occurring in a 42-year-old patient is presented.

Idiopathic paralysis of the soft palate as an isolated clinical entity was first described by Edin et al. 1976. Since then 22 similar cases have been reported, all in children and all unilateral.

A search of the English language literature has not revealed a case of bilateral palatal palsy in an adult.
Relapsing polychondritis—two cases with tracheal stenosis and inner ear involvement
Authors: Clark L. J. , Wakeel R. A. , Ormerod A. D.
Published: November 2007

Relapsing polychondritis is a rare disease which often presents firstly to ear, nose and throat (ENT) departments. Its complications, respiratory, cardiovascular, renal and neurological are life-threatening; thus it is important to recognize the disease and its complications early. Treatment for relapsing polychondritis may have serious side-effects which should be taken into account when managing these patients. We report two young patients with relapsing polychondritis and their treatments; both had severe tracheal stenosis responding in one case to pharmacological and in the other to surgical intervention.
An apparatus to measure pressure, flow and speech parameters in patients producing speech using the Groningen valve prosthesis
Authors: Parker A. J. , Stevens J. C. , Clegg R. T.
Published: November 2007

We present a validated method of determining in vivo pressure, flow and voice parameters from patients using tracheo-oesophageal voice prostheses post laryngectomy.

This apparatus was constructed simply using equipment which should be available in most large Otolaryngology Departments. There was good agreement between measurements made over two separate sessions of in vivo opening pressure, maximum flow through the device and maximum voice amplitude and these were significant. These measurements may be useful in monitoring patient progress and also in elucidating the mechanics of prosthesis failure.
Relapsing polychondritis—A study of four cases
Authors: Irani B. S. , Martin-Hirsch D. P. , Clark D. , Hand D. W. , Vize C. E. , Black J.
Published: November 2007

Four case reports of relapsing polychondritis, (RP), are presented, together with a literature review and management suggestions. There are approximately 211 reported cases in world literature making RP an uncommon condition associated with high morbidity and mortality rates. The key to the management of RP is based on accurate and early diagnosis though the ideal medical regimen has yet to be elucidated.
Rhinocerebral aspergillosis
Authors: Kameswaran Mohan , Al-Wadei Abdulla , Khurana Praful , Okafor B. C.
Published: November 2007

Aspergillosis is increasingly being recognised as a common fungal infection of the paranasal sinuses. Although the disease is almost endemic in neighbouring Sudan, there are few reported cases from the Kingdom of Saudi Arabia. We report four cases of sinus aspergillosis with involvement of the skull bases and/or intracranial spread; a condition we have termed rhinocerebral aspergillosis. Invasive aspergillosis in our subgroup of patients occurs in otherwise healthy patients with normal immune status, quite unlike most reported cases in the western literature. The causative agent in all our patients was identified as aspergillus flavus, similar to patients reported from Sudan. This is again at variance with the case reports from other geographical locations, where aspergillus fumigatus is the commonest causative agent. Saudi Arabia would appear to represent a distinct geographical enclave, together with Sudan, where rhinocerebral aspergillosis of the sinuses and skull base may be more common than has previously been realised.
Necrotizing fasciitis of the neck
Authors: Kaddour H. S. , Smelt G. J. C.
Published: November 2007

Necrotizing fascitis (N.F.) is a rare but serious infection of subcutaneous tissues and deep fascia with resulting skin gangrene and septicaemia. It is due to mixed anaerobic and aerobic organisms. It has been reported under a variety of synonyms.

We describe two cases of necrotizing fasciitis of the neck probably secondary to chronic dental infection, one was diagnosed early and the other late with very different outcomes. We highlight the importance of early and aggressive surgical treatment to complement parenteral antibiotics covering both aerobic and anaerobic organisms.
Histological changes during progression of adenoid cystic carcinoma
Authors: Yamamoto Yuzo , Saka Tetsuro , Makimoto Kazuo , Takahashi Hiroaki
Published: November 2007

Eight cases of adenoid cystic carcinoma were reviewed to determine whether and how the histological features of the tumour vary with the progress of the disease. The tumours were classified by their histological patterns as tubular, cribriform, trabecular or solid. The relative amount of each pattern seen in routine light microscopic sections was calculated histomorphometrically and compared in the primary tumour and recurrent and/or metastatic lesions in the same case. In the early stage, the tubular pattern predominated. Later, the highest percentage shifted to the cribriform, then to the trabecular and finally, in the late stage, to the solid pattern. There was no reverse direction of histological transformation from the solid to the tubular pattern. These results may help to explain previous reports that the tubular pattern usually represents a favourable prognosis, the solid pattern a poor prognosis and the cribriform pattern an intermediate prognosis.
Acute epiglottitis—25 years experience with nasotracheal intubation, current management policy and future trends
Authors: Andreassen U. K. , Baer S. , Nielsen T. G. , Dahm S. L. , Arndal H.
Published: November 2007

During a 25-year period 168 adults and 111 children in Copenhagen County were treated for acute epiglottitis. Four patients, two children and two adults died, of these the two children and one adult had a cardiac arrest on arriving at the hospital.

Most children were treated by nasotracheal intubation while only some adults required nasotracheal intubation in order to secure the airway. Our data indicate that intubation of adults with epiglottitis is technically more difficult than in children.

The fibrelaryngoscope, a new diagnostic tool, is advocated, and was in this study used to establish the diagnosis in 12 unclear cases of acute epiglottitis.

The incidence of acute epiglottitis in children was calculated at 3.2/100,000 with a minor annual variation. As vaccination against Haemophilus influenzae type b becomes more common, the incidence will probably be markedly reduced, maybe even eradicated in children, but in adults the same reduction cannot be expected as the causative agent in this group is less frequently Haemophilus influenzae type b.
Fistulae in the inner canthus associated with ethmoiditis
Authors: Shvero J. , Hadar T. , Feinmesser R.
Published: November 2007

A case of fistulae in the inner canthus arising from the ethmoidal air cell sinuses is presented.

This type of complication is very rare, and to the best of our knowledge no similar case has been reported in the literature.

Clinical findings, imaging, pathology and treatment are presented and discussed.
A clinical, genetic and audiological study of patients and families with bilateral acoustic neurofibromatosis
Authors: Neary W. J. , Newton V. E. , Vidler M. , Ramsden R. T. , Lye R. H. , Dutton J. E. M. , Richardson P. L. , Harris R. , Evans D. G. , Strachan T.
Published: November 2007

The neurofibromatoses consist of at least two distinct autosomal dominant hereditary disorders. Neurofibromatosis type 1 (NF1) is due to a lesion on chromosome 17q. Neurofibromatosis type 2 (NF2) is caused by a defect on chromosome 22q. The hallmark of NF2 is the development, in the second and third decades, of bilateral acoustic neuromas. NF1 is characterized by the appearance of cafe-au-lait spots and neurofibromas in addition to iris hamartomas, or Lisch nodules, of the eye, during the first and second decades.

Ten families were personally studied. A total of 16 members were found to be affected with NF2. A protocol for evaluation and review of subjects and relatives of NF2 families is proposed. A team approach, coordinating the expertise of multiple specialties is recommended.
Prolonged and recurrent tonsillitis associated with sexually transmitted Chlamydia trachomatis
Authors: Ogawa Hiroshi , Hashiguchi Kazuhiro , Kazuyama Yukumasa
Published: November 2007

Chlamydia trachomatis is a common sexually transmitted pathogen. We describe six cases of tonsillitis associated with sexually transmitted C. trachomatis infection. The organism was isolated from tonsillar crypts in all patients, and from uro-genital swabs in five of the six patients. In three partners of the patients, C. trachomatis infection of the uro-genital organ was assessed. They all had a history of orogenital sexual intercourse prior to the illness.
Bilateral carcinomas of the maxillary sinus
Authors: Sakaguchi Masanori , Moriya Kumiko , Taguchi Kiichiro , Katsuno Satoshi
Published: November 2007

We report a 68-year-old male with a rare case of synchronous bilateral carcinomas of the maxillary sinus. A CT scan revealed a large tumour mass that extruded from the left maxillary sinus; tissue of soft density filled the right antrum which had intact bony walls. A probe antrostomy on the right side disclosed a tumour which was diagnosed histologically as the same poorly differentiated squamous cell carcinoma as that in the left antrum. The incidence and aetiology of this disorder are presented, and its diagnosis and management are discussed.
Recurrent laryngeal nerve palsy secondary to massive venous thrombosis
Authors: Keidan Richard D.
Published: November 2007

Retrospective review of all patients with recurrent laryngeal nerve palsy seen at a comprehensive cancer centre over a 30 month period has revealed three patients with this diagnosis apparently related to massive venous thrombosis. All three patients had an underlying diagnosis of malignancy (two colon, one breast) and an indwelling central venous access device with its tip in the superior vena cava. Direct laryngoscopy was otherwise normal in all patients, and two had normal CT scans of the neck and mediastinum. This third patient had mediastinal adenopathy, but this was unchanged from the previous nine months. Although two patients expired shortly after this presentation, the other patient lived for one year and his palsy resolved with the resolution of his superior vena cava syndrome. Mediastinal inflammation secondary to the thrombophlebitis may be the direct cause of this unusual presentation.