bluuebunny/crossref_metadata_2025 huggingface dataset:
Idiopathic tracheal stenoses
Authors: Harries P. G. , Mason P. S. , Ramsay A. D. , Carruth J. A. S.
Published: November 2007

The case histories are presented of three patients with circumferential subglottic stenoses who presented, over a six-month period, to a teaching hospital's Otolaryngology department. No recognisable cause for their subglottic stenoses was found. Traumatic, iatrogenic, infectious and specific inflammatory processes were excluded. The histopathological evidence suggested a chronic inflammatory process. All patients were treated by resecting the stenosis with a carbon dioxide laser. One patient required an emergency tracheostomy for airway obstruction. A review of the published literature on this rare condition is given.
Caustic injury of the oesophagus. Sixteen years experience, and introduction of a new model oesophageal stent
Authors: Berkovits R. N. P. , Bos C. E. , Wijburg F. A. , Holzki J.
Published: November 2007

Caustic ingestion can lead to oesophageal stenosis. We studied 251 patients, 205 of whom were children, in a sixteen-year period. Seventeen patients, of whom one was an adult, acquired deep burns in the oesophagus which had to be treated, to prevent the development of oesophageal strictures. These patients were treated with long-term stenting of the oesophagus with specially designed, silicone rubber stents, impregnated with silicone oil 20 cS, designed by one of us (R.N.P.B.) as the only treatment. Of all models, the twin-tube dilatator was the most satisfactory. No corticosteroids were administered. Only one patient developed a mild stenosis. It is therefore our opinion that, when life-saving operations are not indicated, twin-tube stenting of the oesophagus is helpful in treating caustic lesions of the oesophagus and will prevent stricture formation. Corticosteroids were not given in this series, and should be abandoned in the treatment of caustic lesions.
Airway obstruction in children due to plexiform neurofibroma of the larynx
Authors: Ejnell Hasse , Järund Mia , Bailey Martin , Lindeman Pontus
Published: November 2007

Plexiform neurofibroma of the larynx is a rare disease. Three cases in children with airway obstruction are presented. After tumour reduction via a lateral pharyngotomy their tracheostomies could be closed. The surgical treatment of plexiform neurofibroma of the superior laryngeal nerve is discussed and conservative, subtotal resection is recommended.
Estimation of otitis media in ancient populations: A study of past and present Greenlandic Inuit
Authors: Homøe P. , Lynnerup N. , Skovgaard L. T. , Rasmussen N.
Published: November 2007

Examination of disease patterns in the past has often been difficult due to lack of morphological evidence. This study presents a new unbiased method estimation of occurences of infectioous middle ear disease (IMED) in childhood. The method is based on the relation between IMED in childhood and small or asymmetric pneumatized cell areas in the temporal bones as seen on standrdised X-rays.

A Polychotomous logitic regression mofel was applied on 434 pneumatized cell areas in temporal bones from 34 adult living Greenlandic Inuit, 56 adult crania from the 18th to the 19th century A. D. and 127 adult inuit crania from the Pre-European colonization period (before A. D. 1721) of Greenland. The occurence of IMED as designated by the model was eight out of 34 (23.5 per cent) in living Inuit, 10 out of 56 (17.9 per cent) in crania form the 18th to 19th century and six out of 127 (4.7 per cent) in crania form the pre/colonization period. These frequencies differed significantly (p<0.002). The mean area size also differed significantly, thus indicating a change in occurence of IMED and a decrease in area sizes from past to presentin Greenland.
Rhinoentomophthoromycosis. Report of two cases
Authors: Ochoa Luis F. , Duque Carlos S. , Velez A.
Published: November 2007

Two cases of rhinoenetomophthoromycosis are presented. This rare disease can prodice progressive deformity of the nose and facial structures. A review of the clinical symptoms along with its diagnosis and treatment is described.
Cystic lesions of the nasal cavity and the paranasal sinuses: report of two unusual cases
Authors: Vele D. D. , Sengupta S. K. , Dubey S. P. , Dokup M. K.
Published: November 2007

The clinicopathological features of two unusual cystic lesions, one arising in the nose, a calcified mucocoele or a calcified retention cyst and the other in the maxillary sinus a dentigerous cyst originating in a supernumerary tooth, are described. The literature on these two rare lesions is briefly reviewed.
The Scottish tonsillectomy audit
Authors: Blair R. L. , McKerrow W. S. , Carter N. W. , Fenton A.
Published: November 2007

Regional specialist societies offer a valuable mechanism for the conduct of medical audit. The experience of the audit sub-committee of The Scottish Otolaryngological Society in conducting an audit on laryngeal cancer encouraged us to undertake a larger audit of tonsillectomy practice in Scotland. Although the number of tonsillectomies performed has declined over the last 10 years, they still account for about 20 per cent of all operations performed by otolaryngologists and as such are a major consumer of resources (Personal communication – Directorate of Information Services, Information and Statistics Division. NHS in Scotland, Management Executive, Edinburgh). The Scottish tonsillectomy audit was devised to define current practice, review indications for surgery and recommend such modifications in practice as may be necessary to optimise patient care and the use of resources. Funding was obtained from the Clinical Resource and Audit Group (CRAG) of the Scottish Home and Health Department.

Data on current practice was collected during the period February 1992 to January 1993. Proformas were completed by medical, administrative and secretarial staff in all participating hospitals, collected by an audit secretary and passed to the relevant data collection centre. Data was then entered into a specially designed database before being forwarded to the audit co-ordinator based in Dundee for collation. Six and 12 months following surgery, all inpatients were sent a questionnaire to obtain data on the efficacy of the operation.

Data were obtained from a total of 9 773 patients. Two thousand and seventy-nine of these were seen as both outpatients and inpatients, 4 309 were outpatients only and 3 385 were inpatients only. Four thousand, one hundred and one patients returned at least one follow-up questionnaire.

The topics audited included source and reason for referral, indications for surgery, grade of staff involved, type of surgery and length of stay in hospital. In agreement with previous studies (H.M.S.O., 1989), differences were found in the rates of tonsillectomy performed in different Health Boards. Although the highest referral and operation rates were found in the Highland region, referral and operation rates did not correlate in all other areas. Recurrent tonsillitis was the most frequent principal reason for the decision to operate although there were differences between Health Boards for other indications including obstructive symptoms. Most patients had symptoms for two to three years although some patients had been affected for 40 years prior to being listed for tonsillectomy. Some area ENT services were consultant-based while others involved more junior staff. The grade of staff involved did not appear to affect the decision made at the Outpatient Department (OPD) or the outcome of the operation.

Ninety-eight per cent of patients who returned the questionnaire were glad that the operation had been performed.

Recommendations regarding changes in tonsillectomy practice are given.
The Birmingham bone anchored hearing aid programme: surgical methods and complications
Authors: Proops David W.
Published: November 2007

Since 1988, 309 patients have been referred to the Birmingham bone anchored hearing aid programme for assessment. One hundred and eighty-eight have been fitted with bone anchored hearing aids (BAHA). Of these 169 have been fitted with a BAHA alone and 20 with a BAHA and auricular prosthesis(es).

Only four (2.1 per cent) are not wearing their BAHAs. Three cases because the hearing had continued to deteriorate and in one case because of repeated failure to integrate. Nineteen patients (10.1 per cent) have lost fixtures but all but one of these have been successfully reimplanted. Of these 19 patients 10 (52.6 per cent) were syndromal and 10 (52.6 per cent) were under 16 years of age.

A surgical method has been evolved both to cope with predictable failure of integration and soft tissue control.
The Birmingham bone anchored hearing aid programme: referrals, selection, rehabilitation, philosophy and adult results
Authors: Cooper H. R. , Burrell S. P. , Powell R. H. , Proops D. W. , Bickerton J. A.
Published: November 2007

The Birmingham bone anchored hearing aid team is part of the Birmingham osseointegrated programme. In the first seven years of its existence it has received 309 referrals. Twenty-six per cent had suffered a congenital conductive hearing loss and 74 per cent had an acquired conductive hearing loss; the majority secondary to chronic suppurative otitis media.

This report is of 68 out of 106 adults wearing bone anchored hearing aids (BAHAs). Ninety-eight per cent showed audiological improvement with the congenital group demonstrating marginally the best freefield thresholds and speech discrimination. Questionnaire data as to the patient experience confirms the benefits especially hearing in noise, and comfort, and the vast majority were more satisfied with the bone anchored hearing aid than their previous aid.
The Birmingham bone anchored hearing aid programme: paediatric experience and results
Authors: Powell R. H. , Burrell S. P. , Cooper H. R. , Proops D. W.
Published: November 2007

Over a five-year period, 34 patients have been referred to the Birmingham bone anchored hearing aid programme, paediatric section, of whom 21 are now wearing the bone anchored hearing aid (BAHA) and four are awaiting surgery for fitting of the BAHA. Of the patients assessed, found to be suitable and who proceeded to surgery for the BAHA, 44 per cent had Treacher Collins syndrome, 28 per cent had bilateral atresia or microtia, 16 per cent had Goldenhaar's syndrome, four per cent (one patient) had branchio-oto-renal syndrome and eight per cent had chronic suppurative otitis media. This paper presents objective and subjective data collected from these patients. It is shown that the BAHA is a very effective hearing aid for children with congenital hearing loss.
The bone anchored hearing aid—The third option for otosclerosis
Authors: Burrell S. P. , Cooper H. C. , Proops D. W.
Published: November 2007

The bone anchored hearing aid (BAHA) has mainly been used for the treatment of hearing loss in patients with congenital conductive problems or chronic suppurative otitis media.

In a five-year period, 32 otosclerotic patients have been referred to the Queen Elizabeth Hospital for consideration of a BAHA. Ten of these patients have been fitted and gained benefit compared to their previous hearing aid. The benefits are not necessarily those in hearing ability but in some cases relate to cosmetic or comfort improvements. This paper demonstrates that the BAHA offers a third treatment option for otosclerosis in patients who cannot or will not undergo stapedectomy and experience difficulty with conventional hearing aids.
Closure of the nasal cavities in the treatment of refractory hereditary haemorrhagic telangiectasia
Authors: Lund Valerie J. , Howard David J.
Published: November 2007

From a cohort of 35 patients with hereditary haemorrhagic telangiectasia (HHT), 12 patients have undergone closure of the one or both nasal cavities during the last three years for refractory epistaxis. All had failed other forms of treatment including hormone therapy, laser coagulation and septodermoplasty. All patients were available for follow-up at six months or longer. In all patients where complete closure was achieved (11 out of 12) bleeding ceased completely from the operated side.
Results of reconstruction with free forearm flap following laryngopharyngo-oesophageal resection
Authors: Akin Istemihan , Torkut Ahmet , Ustünsoy Engin , TaŞkoparan Gürkan , Gürzumar Ata
Published: November 2007

The main challenge after total laryngopharyngeal and cervical oesophageal resection for laryngopharyngeal carcinoma, is to provide a suitable feeding conduit which improves the quality of life for the patient. Reconstruction with a tubed free forearm flap can solve the feeding problem to some extent, providing a thin and pliable fasciocutaneous conduit that accommodates well with the thin mucosa of the pharynx and oesophagus.

In this study immediate reconstruction of the pharyngo-oesophagus by free forearm flaps is reported in nine patients with advanced laryngopharyngeal and oropharyngeal carcinoma. The vascularization of the flap is very good, thus rendering this flap to be reliable. The average time for the commencement of oral feeding was 16 days. There was one flap failure (11 per cent), due to venous thrombosis which was replaced by a deltopectoral flap. Long term stenosis did not occur because of the two triangles created at the distal end of the flap which were inserted to the opposite triangular defects at the proximal oesophageal stump.

Donor site morbidities were minimal and scarring of the forearm was acceptable for all the patients.
Fat graft myringoplasty in children – a safe and successful day-stay procedure
Authors: Mitchell R. B. , Pereira Kevin D. , Lazar Rande H.
Published: November 2007

The surgical closure of dry tympanic membrane perforations in children remains a controversial issue due to conflicting opinions on the appropriate technique, graft material and success rate. We present a review of 342 children who underwent fat graft myringoplasty as a day-stay procedure over a six-year period. Successful closure of the tympanic membrane perforation was achieved in 92 per cent of ears. Subsequent recurrent otitis media with effusion required insertion of ventilation tubes in 12 per cent. No relationship was observed between the age of the child and a successful outcome. We conclude that day-stay fat graft myringoplasty is a safe and successful procedure which results in a dry and safe ear in the majority of children.
Predictive assessment of vocal efficiency (PAVE). A method for voice therapy outcome measurement
Authors: Gordon M. T. , Pearson L. , Paton F. , Montgomery R.
Published: November 2007

A prospective study was carried out to examine the degree to which a standard voice assessment could discriminate between the potential benefits of two different voice therapy programmes for individual patients. The study encompassed 200 dysphonia subjects who were referred for voice therapy and had completed treatment within a prescribed two-year period. A standard assessment procedure was carried out on first attendance for each patient and guidelines were used to assign patients to different treatment programmes on the basis of the assessment results. The assessment discriminated well between patients requiring voice therapy to change physiological parameters of voice usage and patients able to self adjust voice usage, and provided an objective means of measuring outcomes.
Diffuse neurofibroma obstructing the external auditory meatus
Authors: Coakley Darragh , Atlas Marcus D.
Published: November 2007

A case is presented of a 36-year-old male with narrowing of the external meatus due to a diffuse neurofibroma. This unusual variety of neurofibroma spreads superficially and has many ectatic blood vessels. The size, vascularity, uncertain edges and a tendency to recur makes surgical removal difficult. The treatment options are discussed.
Cemento-ossifying fibroma of the petromastoid region: case report and review of the literature
Authors: Brademann Goetz , Werner Jochen A. , Jänig Ute , Mehdorn Hubertus M. , Rudert Heinrich
Published: November 2007

The cemento-ossifying fibroma (COF) is a mesodermal, non-odontogenic tumour of ectopic multipotential periodontal membrane blast cells. It is aggressive, locally destructive, and has a high recurrence rate. A case report of COF of the petromastoid region is presented. This location has not been described until now. Trauma may act as a trigger to sudden growth of the atopic periodontal tissue. Due to the aggressive behaviour of this tumour and its frequent recurrence radical surgery is needed.
Acute oesophageal obstruction 18 months after an abdominal shotgun wound
Authors: Riley N. , McNeill J. , McCloskey B. , Thomson M. P. , Mackle E.
Published: November 2007

A 32-year-old man presented to the otolaryngology department with acute dysphagia after vomiting. Radiological investigation suggested a piece of meat lodged in the lower oesophagus and rigid oesophagoscopy was performed. However, a plastic shotgun cartridge wad was found and removed. This had gained access to the stomach when the patient had been shot at point-blank range 18 months previously, and appeared to have been forced into the oesophagus by the vomiting, where it caused obstruction.
The incidence and detection of HPV in the upper aerodigestive tract using brush and biopsy techniques
Authors: Vowles Richard H. , Myint Steven , Croft Charles B.
Published: November 2007

The association between human papillomavirus (HPV) and squamous carcinoma is well established. In the polymerase chain reaction (PCR) we have an effective technique for detecting small quantities of viral DNA, but the assay requires tissue taken at endoscopy to reveal the presence or absence of HPV. Brushings have been used effectively elsewhere in the body to obtain cytological material. This study set out to ascertain if sufficient viral DNA could be obtained, using a laryngeal brushing and the PCR, to detect the presence or absence of HPV.

Six patients with squamous carcinoma of the larynx and seven controls who were having laryngoscopy for other reasons underwent laryngeal biopsy. In addition, in the patients with carcinoma, biopsies were taken at the tumour margins and brushings from both sites. The samples were tested for the presence of HPV types 6, 11, 16, 18 and 31 by means of the PCR. The distribution of HPV types was as expected in the biopsy specimens, but only one brushing detected any HPV type at all. We conclude that laryngeal brushing is an inadequate technique for assessing the presence of HPV in the larynx.
Revision stapes surgery
Authors: Somers Thomas , Govaerts Paul , de Varebeke Sebastien Janssens , Offeciers Erwin
Published: November 2007

This paper reports on the analysis of 332 otosclerosis revision operations. The results have been evaluated with reference to the type of the procedure at primary surgery, the alleged cause of failure and the applied technical solution.

The need for revision surgery was found higher after primary totalstapedectomy (3.4 per cent) than after partial stapedectomy (2.2 per cent) or stapedotomy (two per cent). The reason for revision varied according to the originally applied technique eg a migrated piston, a too short piston and a lateralized graft are almost exclusively foundafter total stapedectomies.

The median hearing gain after revision of stapedotomy and partial stapedectomy was higher (20 dB and 18 dB respectively) than that after revision surgery for total stapedectomy (12 dB), but significantly lower than hearing gain after primary surgery (32 dB).

Revisions yielded better results in the case of primary interventions with the use of a piston or piston- wire than in the case of primary interventions with a wire-type prosthesis. The risk for sensorineural loss (one per cent) was not higher than in primary surgery.
Pre-admission clinics in ENT: A national audit of UK practice and opinion
Authors: Naggar Mohammed El , Welsh Andrée , Dickenson Andrew J. , Flood Liam M. , Gibb John G.
Published: November 2007

A one-year prospective audit (1989) of patient non-attendance for elective surgery in our department showed that of those summoned, five per cent defaulted on the day of admission without contacting the hospital (Hampal and Flood, 1992). Contributing factors such as lengthy waiting lists and inefficient communication with the patients were amenable to correction by the hospital. However, the current admission policy made inevitable a significant waste of theatre time.

The pre-admission clinic (PAC), an outpatient attendance shortly before planned surgery, was recommended in ENT practice by Robin (1991) and introduced into our department that year. Failure to attend the PAC allowed adequate time' for replacement on the theatre list and was recommended as a solution to the problem of unfilled theatre sessions (Dingleet al., 1993).

A subsequent four-year experience of conducting PACs has confirmed several expected advantages. However, some of the hopes for development expressed in our earlier work (Dingleet al., 1993) have failed to materialize. This study aims to review retrospectively our experience and compare it with the admission practice and desires of ENT departments in the United Kingdom as revealed by a postal survey. The findings are of relevance to all surgical specialties and to anaesthetic departments wishing, to adopt this system of admission.
Thoraco-cervical fibromatosis: treatment by surgical excision
Authors: Conlon B. J. , O'Dwyer T. P.
Published: November 2007

We present a case of massive thoraco-cervical fibromatosis treated by sternotomy and simple excision. The patient remains disease-free after careful follow-up of three years. We suggest that if the lesion is encapsulated and position or size prevents en bloc removal, simple excision may be curative.
Cochlear implant extrusion in a child with keratitis, ichthyosis and deafness syndrome
Authors: Hampton S. M. , Toner J. G. , Small J.
Published: November 2007

We present a child with keratitis, ichthyosis and deafness (KID) syndrome implanted with a Nucleus device. We discuss the wound complications of this child and the steps taken to deal with the problems encountered when the wound failed to heal, followedby the partial extrusion of her implant. Early surgical management involved resuturing the wound but when this failed a rotational flap was required to cover the implant package and allow eventual healing. Despite the wound problems and revision surgery she has a good audiological result.
Surgical management of bilateral immobile vocal folds and long-term follow-up
Authors: Gupta A. K. , Mann S. B. S. , Nagarkar Nitin
Published: November 2007

Sixty-one cases of bilateral immobile vocal folds were classified as traumatic (52.46 per cent), idiopathic (39.34 per cent) or iatrogenic (8.20 per cent). During follow-up the idiopathic group of patients had a better prognosis (p<O.O5) compared to the traumatic or iatrogenic group. A spontaneous recovery was seen in 58.33 per cent of cases in the idiopathic group, 56.25 per cent in the traumatic group and 40.0 per cent in the iatrogenic group within a period of one year. Patients who failed to show spontaneous recovery were either subjected to arytenoidectomy with fold lateralization, endoscopic fold lateralization or laser cordectomy, showing 70.0 per cent, 66.67 per cent and 80.0 per cent recovery respectively. These cases have been discussed.
Extensive cholesteatoma: long-term results of three surgical techniques
Authors: Nyrop Mette , Bonding Per
Published: November 2007

During the years 1979–81, three different surgical techniques were used in the treatment of 87 ears with extensive cholesteatoma. All procedures were performed in one stage by the same surgeon. Ten to 13 years after the operations about 70 per cent of ears operated on by the canal wall up technique had developed a new cholesteatoma, which in most cases was recurrent, or a deep retraction pocket. A modification of this technique with mastoid obliteration resulted in a similar failure rate. In contrast, ears operated on by the canal wall down technique (in most cases with mastoid obliteration) had acceptable stability with a long-term recurrence rate of about 15 per cent. Most patients in the canal wall down group had a dry ear without significant cavity problems. Hearing in these patients was as least as good as hearing in patients with a preserved canal wall. We conclude that a meticulous one-stage canal wall down technique in ears with extensive cholesteatoma results in a high percentage of unproblematic, stable ears with satisfactory function. In contrast, if the posteriorcanal wall is preserved, recurrent cholesteatoma is the rule more than the exception.
The use of Indermil (n-butyl cyanoacrylate) in otorhinolaryngology and head and neck surgery. A preliminary report on the first 33 patients
Authors: Samuel P. R. , Roberts A. C. , Nigam A.
Published: November 2007

The authors present their initial experience of a new sterile medical grade cyanoacrylate adhesive (Indermil) in otolaryngeal and head and neck surgery.

Thirty-three patients who underwent a variety of head and neck operations consented to have their skin incisions closed using the adhesive and 10 of those also underwent repair of the tympanic membrane, either as part of tympanoplasty or mastoid surgery. The history of the use of this class of adhesive is presented with an explanation of the chemical properties of these compounds. Advantages of using cyanoacrylate adhesives and future possible applications in otolaryngology and head and neck surgery are discussed.
Parotidectomy. Preserving the posterior branch of the great auricular nerve
Authors: Christensen N. R. , Jacobsen S. D.
Published: November 2007

The great auricular nerve is often sacrificed in superficial parotidectomy, even though its posterior branch often can be preserved. By cautious dissection of the great auricular nerve it is possible to preserve the posterior branch in 70.5 per cent of the operations.

Ninety-five patients who had undergone superficial parotidectomy were included. A significantly higher number of patients had subjective sequelae if the posterior branch of the nerve had been cut, compared to the patients with a preserved nerve. A significantly higher rate of sensory morbidity was found if the nerve had been cut. In patients with a preserved posterior branch of the great auricular nerve there was no increase in other potential sequelae after parotidectomy.

Therefore, this additional dissection should be considered, where appropriate, in routine parotid surgery.
An unusual case of laryngeal carcinoma metastasizing to the small intestine
Authors: Yoshihara Toshlo , Yamamura Yukie
Published: November 2007

An unusual case of laryngeal carcinoma metastasizing to the small intestine is reported. The patient was admitted to our hospital due to hoarseness, sore throat and dyspnoea. Pathological examination on the laryngeal mass revealed it to be moderately differentiated squamous cell carcinoma, staged as T4N0M0. A total laryngectomy and right modified neck dissection were performed. Over two years after the operation a small intestinal tumour was found, with a resultant resection of the ileum and sigmoid colon. An infiltration of the cell nests of squamous cell carcinoma were present at the submucosal regions of the ileum. These findings indicated that the laryngeal cancer had already metastasized to the small intestine at the time of the initial treatment.
Combined forceps and catheter extraction of an oesophageal foreign body
Authors: Al-Shahi R. , O'Connell M. , Huchzermeyer P. , Moore-Gillon V.
Published: November 2007

The extraction of impacted foreign bodies from the oesophagus is frequently performed using forceps under endoscopic guidance. We report the case of a 23-year-old prisoner who ingested a lump of cannabis resin which could not be removed from the upper oesophagus with forceps alone. We recommend the use of a Fogarty balloon catheter in conjunction with toothed forceps in such cases.
Extracapsular haemorrhage form a parathyroid adenoma presenting as a massive cervical haematoma
Authors: Hellier W. P. L. , McComber A.
Published: November 2007

Spontaneous massive haemorrhage form a parathyroid adenoma is rare. It can cause extensive cervical ecchymosis as well as compression of structures within the neck. We present a case, discuss the diagnostic features and review the literature
Capillary haemangioma of the parotid in an adult: an unusual case and a review of the literature
Authors: Hughes R. G. M. , Oates J.
Published: November 2007

Haemangioma of the parotid gland is a well-described condition that accounts for 50 per cent of parotid tumours presenting during the first year of life. Parotid haemangiomas in adults are much rarer and until now only the cavernous variety have been reported. We report a case of a capillary haemangioma in an adult and discuss the literature.
Bacterial colonization of pacifiers of infants with acute otitis media
Authors: Brook Itzhak , Gober Alan E.
Published: November 2007

The presence of aerobic and facultative anaerobic bacteria on the surface of pacifiers used by children with acute otitis media was investigated. The surface of 40 recently used pacifiers was swabbed after they were allowed to dry for five to six minutes. The swabs were processed quantitatively for the presence of aerobic bacteria. The antibacterial activity of the pacifier material was testedin vitro. Microorganisms were isolated from 21 (52.5 per cent) pacifiers. The number of colonies per pacifier varied between one and 35 (average six). The isolates included eight α-haemolytic streptococci, sixStaphylococcus epidermis, fiveCandida albicans, five α-haemolytic streptococci, threeNeisseriaspp. and twoStaphylococcus aureus. The pacifier material was shown to be inhibitory againstS. aureus. This study illustrated that pacifiers do not contain high numbers of organisms and therefore are not likely to serve as a source of persistence of transfer of organisms.
Multiple cutaneous metastases from laryngeal carcinoma
Authors: Bhandarkar P. , Green K. M. J. , de Carpentier J. P.
Published: November 2007

A case of laryngeal squamous cell carcinoma recurrence presenting as multiple cutaneous metastases is presented. Such metastases are rare and are associated with a poor prognosis. Treatment is usually aimed at providing pain relief in these patients with a limited life expectancy.
Pharyngeal lipoma with cartilaginous metaplasia (chondrolipoma): a case report and literature review
Authors: Nwaorgu O. G. B. , Akang E. E. U. , Ahmad B. M. , Nwachokor F. N. , Olu-Eddo A. N.
Published: November 2007

The relative rarity of pharyngeal lipomas and paucity of clinical manifestations in the early stages of tumour growth conspire to task the diagnostic acumen of the clinician. A high index of suspicion and meticulous examination are essential in order to arrive at the diagnosis, which may be achieved pre-operatively by computerized axial tomography, revealing a mass lesion with a characteristic low attenuation value. A case of pharyngeal chondrolipoma in a 25-year-old male is reported. It is suggested that this conceptually intriguing and rarely encountered lesion can be explained on the basis of neoplastic transformation of the second to fourth pharyngeal cleft mesenchymal rests displaying both adipose and cartilaginous differentiation. Alternatively, the cartilage could represent vestigial remnants of non-neoplastic pharyngeal cleft tissue entrapped within a primarily lipomatous neoplasm. Slow growth may occur over a period of several years, prior to overt clinical manifestation.
Posterior tracheal wall diverticula-an unexpected finding
Authors: Collins Melanie M. , Wight Richard G.
Published: November 2007

Two cases of asymptomatic posterior tracheal wall diverticula, one single and one multiple, found unexpectedly at laryngectomy are described. The embryonal development and pathogenesis of tracheal abnormalities are discussed, and possible clinical implications speculated upon.
Infantile (desmoid-type) fibromatosis of the parotid gland
Authors: Ramanathan Ramesh Chandran , Thomas J. Meirion
Published: November 2007

Infantile fibromatosis, one of the fibrous tumours of infancy and childhood, is a fibroproliferative lesion characterized by aggressive local invasion without any tendency to metastasize, the absence of cytological evidence of malignancy and a high rate of local recurrence when incompletely excised. We report a case of infantile (desmoid-type) fibomatosis in a seven-year-old girl arising from the deep lobe of the parotid gland that was treated by complete surgical excision with preservation of the facial nerve. The clinical features, pathology and treatment are briefly discussed.
Oncocytoma of the nasal cavity: report of a case and review of the literature
Authors: Comin Camilla E. , Dini Mario , Russo Giulia Lo
Published: November 2007

The authors present a case of oncocytoma of the nasal cavity in a 60-year-old woman. The tumour shows the same histological and ultrastructural characteristics of oncocytomas arising in minor salivary glands of other sites and major salivary glands. The authors stress that the biological behaviour of oncocytomas of the nasal cavity seems related to their local growth rather than to the cytological characteristics of the tumour. The extreme rarity of this tumour in the nasal cavity is particularly emphasized. The few cases reported previously in literature are briefly reviewed.
Microcystic adnexal carcinoma
Authors: Kirkland P. M. , Solomons N. B. , Ratcliffe N. A.
Published: November 2007

Microcystic adnexal carcinoma (MAC) is a rare adnexal tumour which has only recently been recognized as a separate clinicopathological entity. It typically affects the face of the middle-aged and often requires extensive surgical excision, due to its locally invasive nature. Its clinical significance is that, despite being locally invasive, MAC is typified by a lack of metastatic spread. We present a case and review of the literature.
The Groote Schuur hospital classification of the orbital complications of sinusitis
Authors: Mortimore S. , Wormald P. J.
Published: November 2007

The complications of sinusitis have been well described. The most common classifications used for orbital complications have been that of Chandleret al.(1970) and Moloneyet al.(1987). With the ready availability of high-resolution computed tomography (CT) scanners, limitations of these classifications have become apparent. The aims of this study were to determine the relative frequency of the various complications associated with acute sinusitis, to determine which groups of sinuses were most frequently involved and to correlate the orbital signs with a new proposed classification of orbital complications. Over a five-year period, 87 consecutive patients were admitted with acute sinusitis. Sixty-three patients (72.4 per cent) had one or more complications. When orbital complications were classified under the proposed classification, all patients with proptosis and/or decreased eye movement had post-septal infection. Visual impairment occurred only in the post-septal group. Most complications had a combination of sinus involvement with the maxillary/ethmoid/frontal combination being the most common. The authors propose a modification of Moloney's classification for orbital complications of acute sinusitis that allows a clear differentiation between pre- and post-septal infection and a radiological differentiation to be made between cellulitis/phlegmon and abscess formation. The latter is of importance when a decision is made on whether surgical intervention is appropriate or not.
Diathermy tonsillectomy: comparisons of morbidity following bipolar and monopolar microdissection needle excision
Authors: Akkielah A. , Kalan A. , Kenyon G. S.
Published: November 2007

Tonsillectomy is frequently associated with a considerable post-operative morbidity. In some cases reactionary or secondary haemorrhage occurs and all patients suffer a degree of post-operative pain. The use of bipolar diathermy excision has become popular because it reduces intra-operative blood loss, but all diathermy inevitably produces a degree of damage to adjacent normal soft tissues. In turn this inadvertent injury must act to increase the post-operative pain.

Monopolar dissection using a fine tungsten diathermy needle (the Colorado needle) allows sharp dissection at low power levels and in previous studies has been shown to produce a reduction in collateral tissue damage. In this prospective study the morbidity associated with tonsillectomy using this needle was compared to that following a standard bipolar dissection.

Using the monopolar needle produced no enhanced risk of reactionary or secondary haemorrhage while causing significantly less post-operative pain and a reduction in eschar. We believe that excision using this needle preserves the advantages associated with bipolar dissection while reducing local soft tissue damage.
Osteoblastoma of the nasal cavity arising from the perpendicular plate of the ethmoid bone
Authors: Velegrakis George A. , Prokopakis Emmanuel P. , Papadakis Chariton E. , Karampekios Spyros K. , Koutsoubi Katerina G. , Helidonis Emmanuel S.
Published: November 2007

The presence of a benign osteoblastoma in the ethmoid sinus is rare and only a few cases have been reported. This is a case of a benign osteoblastoma arising from the perpendicular plate of the ethmoid bone with extension to the nasal cavity. The diagnosis and management of this unusual lesion, as well as the histopathology and the imaging characteristics are reviewed. We also review the previously reported cases of benign osteoblastomas of different origin, with nasal cavity involvement.
Vestibular schwannoma showing a dural tail on contrastenhanced magnetic resonance images
Authors: Noguchi Yoshihiro , Komatsuzaki Atsushi , Yamada Ichiro , Okuno Hideji , Haraguchi Hidetoshi
Published: November 2007

The dural tail on contrast-enhanced magnetic resonance (MR) images, frequently observed in meningiomas, has been used to distinguish between cerebellopontine angle meningiomas and vestibular schwannomas. We report on a 66-year-old female with vestibular schwannoma showing the dural tail on contrast-enhanced MR images. Histological examination revealed that the dural tail corresponded to the thickened dura mater comprising of collagen fibres and scattered hyalinization with no tumoral invasion.
Cystadenoma of the parotid gland with unusual prominent lymphoid stroma
Authors: Pahl Stefan , Püschel Werner , Federspil Philippe
Published: November 2007

A rare variant of the cystadenoma of salivary gland origin is presented, which occurred in the parotid of a 36-year-old, otherwise healthy female patient. The tumour showed a dense follicle-containing lymphoid stroma, resembling papillary cystadenoma lymphomatosum (Warthin's tumour). In contrast to that, the epithelial lining gave a more irregular impression and oncocytic metaplasia were completely absent. Light microscopic and immunohistochemical features of the tumour are described and compared with those of classical cystadenoma and papillary cystadenoma lymphomatosum (Warthin's tumour). Other relevant multicystic epithelial parotid lesions, which are commonly associated with a prominent lymphoid component are discussed.
Surgery of tympanosclerosis
Authors: Kamal Syed Akhtar
Published: November 2007

Eighty-five cases with tympanosclerosis of the middle ear were treated surgically in this series from 1984 to 1995. Twelve of them were associated with cholesteatoma and had radical surgery performed. An attempt is made here to classify the tympanosclerosis on a patho-physiological basis. A planned two-stage procedure was performed in 36 cases after an interval of 18 months. The majority of patients had stapes surgery carried out by a two-stage procedure. One of the patients who did not have stapes surgery developed anacusis after 18 months post-operatively and in another patient recurrence was observed. Post-operative hearing improvement was found to be satisfactory in the short-term follow-up period of two to five years. The hearing improvement was analysed by using Chi-square value (x2) and also plotted in the Glasgow Benefit Plot.
Further experience with a straight, vertical incision for placement of cochlear implants
Authors: Gibson W. P. R. , Harrison H. C.
Published: November 2007

Experience with a straight, vertical incision for cochlear implantation in 168 patients of all ages is reported and comparison made with previous experience using a 'C' shaped incision in 173 patients with regard to complications encountered. With the straight incision the only complication was a wound infection which settled in one week; this is in contrast to the 'C'shaped incision, which was associated with a number of serious complications. The straight incision also compared favourably with the other incisions commonly used for cochlear implantation and appears to offer advantages over them.
Carbon dioxide laser turbinectomy. An electron microscopic study
Authors: Elwany Samy , Abdel-Moneim M. Hesham
Published: November 2007

Ten patients with chronic non-allergic rhinitis and presenting mainly with nasal obstruction due to hypertrophied inferior turbinates were subjected to laser turbinectomy using CO2. Tiny biopsies were taken, at the time of surgery as well as one monthlater, and were processed for transmission electron microscopy. The ultrastructural observations included: early epithelial loss which wasfollowed by prompt regeneration of healthy epithelium, decreased number and activity of the seromucinous glands, fibrosis of the connective tissue stroma, as well as diminished number and congestion of the cavernous blood spaces. These observations were discussed in view of the excellent clinical response of the patients.
The use of magnetic resonance imaging to assess tracheal stenosis following percutaneous dilatational tracheostomy
Authors: Callanan Vincent , Gillmore Kaie , Field Stuart , Beaumont Anthony
Published: November 2007

The incidence of tracheal stenosis following conventional tracheostomy has been reported as lying between one and 30 per cent. Methods used to assess the degree of stenosis include CT scanning, fibreoptic visualization and plain X-ray tomographs. The aim of this study was to assess the degree of stenosis in patients following percutaneous dilatational tracheostomy (PDT) using MRI scanning. This method has not been reported in the literature previously. Nine patients without symptoms of tracheal stenosis were studied for at least six months following PDT performed in the intensive therapy unit. The tracheas were assessed for scarring and stenosis using a three dimensional volume scanning MRI technique. Although scarring could be detected in the wall of the trachea and subcutaneous tissues of all patients, tracheal stenosis was not demonstrated at the insertion site or at the site of the cuff (p>0.05). MRI scanning provides an excellent non-invasive method of assessing the tracheal lumen. Our patients who had undergone PDT do not appear to have any degree of post-operative stenosis.
Orbital decompression for thyroid eye disease: a comparison of external and endoscopic techniques
Authors: Lund Valerie J. , Larkin Genevieve , Fells Peter , Adams Gillian
Published: November 2007

The results of orbital decompression for thyroid eye disease are presented in a cohort of 33 patients. It was performed by an external Patterson approach in 21 individuals and in 13 by an endonasal endoscopic approach. The endoscopic approach was entirely comparable in respect of improvement in axial proptosis, giving a mean improvement of 4.4 mm as compared with a mean of 3.8 mm for the external approach, and produced a demonstrable improvement in visual acuity and perception of colour in three individuals, where this was compromised, and was associated with fewer complications.
The tonsil cup: a simple teaching aid for tonsillectomy
Authors: Pearson C. R. , Wallace H. C.
Published: November 2007

A simple and inexpensive simulator to assist in the teaching of tonsillectomy is presented.
The response of adenoid cystic carcinoma to tamoxifen
Authors: Shadaba A. , Gaze M. N. , Grant H. R.
Published: November 2007

Adenoid cystic carcinoma of the parotid gland often recurs locally, or metastases develop, after initial treatment with surgery and radiotherapy. We report a patient with an inoperable local recurrence of previously irradiated adenoid cystic carcinoma, who was treated with tamoxifen, an oestrogen receptor antagonist. After 18 months of treatment with tamoxifen, MRI showed a partial response, and further clinical progression of the disease was halted.
Long-term observation after soft posterior meatal wall reconstruction in ears with cholesteatoma
Authors: Hosoi Hiroshi , Murata Kiyotaka , Kimura Hiroki , Tsuta Yoshiaki
Published: November 2007

We performed tympanoplasty with reconstruction of the soft posterior meatal wall for the prevention of post-operative retraction pocket formation. Our method is characterized by the reconstruction of the softposterior meatal wall, non-obliteration with permanent or temporary materials, including Gelfoam, no use of a Palva flap and the use of fibrin glue for attaching the fascia to the posterior meatal skin. None of the patients experienced post-operative narrow-neck retraction pocket formation, and whenever aeration of the middle ear was disturbed, a balloon-like retraction was observed. Not all the posterior meatal walls retracted. The final position of the posterior meatal wall varied among the subjects. No serious cavity or hearing problems have occurred since surgery. Due to the strong possibility of post-operative retraction pocket formation in cases with a large balloon-like retraction, we rejected adopting the canal wall up technique or hard posterior meatal wall reconstruction.
Skull base osteitis following fungal sinusitis
Authors: Swift Andrew C. , Denning David W.
Published: November 2007

Aspergillus sp. sinusitis is not uncommon in immunocompromised patients but is unusual in patients who are not immunocompromised. The disease may occur as a saprophytic condition, as an allergic sinusitis or as a potentially lethal invasive disease. The differentiation between non-invasive and invasive Aspergillus sp. sinusitis is crucial and this distinction is fully discussed. The treatment options are also considered. Invasive disease requires aggressive treatment with long-term antifungal agents in sufficient doses combined with wide surgical excision.

We present a patient who presented with invasive Aspergillus fumigatus sinusitis and subsequently developed cranial neuropathies and skull base osteitis. She was initially treated with oral itraconazole (400 mg daily) for 18 months but due to lack of response this was changed to a new experimental oral azole (voriconazole) which was continued for a further 14 months. She has since remained well for the last five years.
Hodgkin's lymphoma of the nasopharynx
Authors: Molony N. C. , Stewart A. , Ah-See K. , McLaren M.
Published: November 2007

The lymphoid tissues of Waldeyer's ring, including the nasopharynx, are very rare sites for Hodgkin's disease and are considered to be relatively resistant to it. This report of a case of Hodgkin's disease of the post-nasal space demonstrates the difficulty of making the diagnosis histologically and the characteristic immunohistochemical features of this disease.

Before immunohistochemistry became so widely available, some authors speculated it might be underdiagnosed (Eavey and Goodman, 1982; O'Reilly and Kershaw, 1987). Judging by its continued rarity, this appears not to be the case.