bluuebunny/crossref_metadata_2025 huggingface dataset:
Expression of EGF, EGFR and PCNA in laryngeal lesions
Authors: Wen Q. H. , Nishimura T. , Miwa T. , Nagayama I. , Furukawa M.
Published: November 2007

The expression of EGF/EGFR in 47 laryngeal surgical specimens from 44 patients was examined. PCNA analysis as an index of proliferating cells was also performed in 32 cases of laryngeal cancer, six cases of pre-cancerous lesions and nine cases of normal laryngeal mucosa. EGFR failed to show a significant correlation with tumour behaviour, but EGF expression was statistically significantly higher in malignant (SCC) than in non-malignant tissues (pre-cancerous and normal tissues) (p<0.006), and PCNA also showed a statistically significant difference (p<0.016) between the two. In malignant tissues when EGF/EGFR in ‘double-positive’ and ‘double-negative’ cases was compared, a statistically significant difference in PCNA was found (p<0.029); but this was not seen in non-malignant tissues. Our results support the hypothesis that an autocrine mechanism exists in laryngeal cancer and in this mechanism EGF may play an important role in tumour progression, especially when EGFR is overexpressed.
The importance of thyroid scanning in neck lumps – a case report of ectopic tissue in the right submandibular region
Authors: Morgan N. J. , Emberton P. , Barton R. P. E.
Published: November 2007

We describe the case of a 50-year-old previously well female, who presented with a slowly growing mass in the right submandibular region. Imaging confirmed the absence of a normally placed thyroid and the presence of a lingual thyroid. The submandibular mass was excised and histological examination confirmed ectopic thyroid tissue. The embryological descent of the thyroid and the Sistrunk procedure are discussed as well as the importance of thyroid scanning in neck lumps.
Carcinoma ex-pleomorphic adenoma of the nasal cavity: a report of two cases
Authors: Cho Kyung Ja , El-Naggar Adel K. , Mahanupab Pongsak , Luna Mario A. , Batsakis John G.
Published: November 2007

Carcinoma ex-pleomorphic adenoma is exceedingly rare in sites other than the major salivary glands and the oral cavity. We present the first two histopathologically documented examples to occur in the nasal cavity.

From the Department of Pathology, University of Texas, M. D. Anderson Cancer Center, Houston, Texas, USA.
Causes of failure of combined approach tympanoplasty in the treatment of acquired cholesteatomas of the middle ear and the mastoid
Authors: Kapur T. R.
Published: November 2007

Forty cases of failed combined approach tympanoplasty were analysed. The commonest cause of failure was adhesions between the facial ridge and the tympanic membrane, causing segmental attico-mastoid malaeration in 51.3 per cent of cases followed-up continually. Other causes were, large dermoids, incomplete removal of squamous epithelium, and eustachian tube obstruction. Eustachian tube dysfunction did not appear to be a major cause of failure.
Clinical photographs as teaching aids: how reliable are they?
Authors: McCombe Andrew , Williamson Peter , Hawke Michael
Published: November 2007

A study to investigate the value and reliability of clinical photographs as teaching aids was undertaken. Twenty colour photographs were taken using the StarMed video-otoscopic system. The pictures, which were a mixture of normal and abnormal ears, were shown to 21 experienced otolaryngologists from the UK and Canada. These clinicians were asked to identify the abnormality if any.

The median score for correctly identified pictures was 15 (range 12–18). This score was identical for both the UK and Canadian subgroups. Although the abnormalities were consistently well recognized with an average correct identification rate of 90 per cent (range 67–100 per cent), the ‘normals’ were recognized significantly less well at only 41 per cent (range 5–71 per cent) (chi-squared = 110.6; 1 df; p<0.001).

This result is probably due to failure of the camera to capture the huge variation and subtleties in the range of normal, and the clinicians' natural inclination to identify pathology, when in doubt. We would conclude that as long as this failing is recognized, clinical photographs, and specifically those from the video-otoscope, represent a useful and reliable teaching tool.
Management of retraction pockets of the pars tensa in children by excision and ventilation tube insertion
Authors: Walsh R. M. , Pracy J. P. , Harding L. , Bowdler D. A.
Published: November 2007

Retraction pockets of the pars tensa in children can result in erosion of the ossicles leading to hearing loss and eventually cholesteatoma formation. Several different types of treatment for the more severe grades of retraction pocket have been described. The aim of this pilot study was to assess the outcome following simple excision and ventiolation tube insertion of grade II, III and IV retraction pockets of the pars tensa. The eardrums were grades according to Sadé's classification (1979).

There were seven grade II and four garade III ratractions. Ten eardrums healed completely in a mean time of 3.6 months (mean follow-up 16 months) and there was one residual perforation. Two retractions recurred and both of these were only grade I. Clinically, an improvement in hearing was reported in seven children (eight ears) and the average air conduction threshold gain for these patients was 16 dB. A larger prospective study is currently underway.
Enophthalmos secondary to maxillary sinus disease: single-stage operative management
Authors: Beasley N. J. P. , Jones N. S. , Downes R. N.
Published: November 2007

Maxillary sinus disease can lead to dehiscence of the orbital floor. Using endoscopic sinus surgery it is possible to simultaneously reconstruct the orbital floor and to assess and treat underlying sinus disease.
Ameloblastic carcinoma of the maxilla
Authors: Lolachi Christopher M. , Madan Shashi K. , Jacobs John R.
Published: November 2007

Ameloblastic carcinoma is an unusual tumour. There have been a total of 34 cases of ameloblastic carcinoma in the English literature to date. Of these only 11 cases have occurred in the maxilla. The authors report the 12th such case. The histological classification for odontogenic carcinoma has been debated for many years and recently revised, thus differentiating between malignant ameloblastoma and ameloblastic carcinoma. The authors review the current literature regarding diagnosis and treatment of this unusual lesion, and support the use of the term malignant ameloblastoma for the tumours that metastasize in spite of their benign histological appearance, whereas, the ameloblastic carcinoma is referred to as the primary tumour with malignant transformation, regardless of its metastatic potential.
Comparison of the repair of permanent tympanic membrane perforations by hydrocolloidal dressing and paper patch
Authors: Spandow Odd , Hellström Sten , Dahiström Michael , Bohlin Lennart
Published: November 2007

Thirty consecutive patients with permanent perforations of their tympanic membranes (TM) present from 2.5 to 50 years (mean 18.7 years) were admitted to a prospective study using two alternative methods of dressings for closure of the perforations. An adhesive-coated hydrocolloid material was compared with a conventional dressing of vaseline impregnated rice paper patch after de-epithelialization of the perforation border. Nine of the permanent TM perforations (30 per cent), five with the hydrocolloidal dressing and four with the rice paper patch had healed when followed-up after one year. The size of eight of the central perforations that had healed was equal to or less than 25 per cent of the TM. Also one perforation with a size of 65 per cent had healed. Seven perforations were located in the posterior part of the TM:Jour in the posterior-superior quadrant, one in the inferior quadrant, one had engulfed the posterior half of the TM and one included the anterior-inferior quadrant. Only two perforations out of 14, with a size of 25 per cent or less, located in the anterior-inferior quadrant, healed. No significant difference was demonstrated between the two types of dressings. Both groups noted an immediate improvement in hearing of 10.8 and 9.3 dB, respectively, after application of the dressing.

The study demonstrates that application of an occlusive dressing or paper patch in 30 per cent of patients can promote the healing of long-standing perforations. The chances for healing are better if the perforation is located in the posterior part of the TM. This simple technique immediately improved hearing and should be tried before a patient is referred for myringoplasty surgery.
Provox™ valve use for post-laryngectomy voice rehabilitation
Authors: Callanan Vincent , Gurr Paul , Baldwin David , White-Thompson Morwenna , Beckinsale Jane , Bennetf Jane
Published: November 2007

The Provox™ voice prosthesis has been used in our department since September 1992 for postlaryngectomy voice rehabilitation. This prosthesis is an indwelling low-resistance tracheoesophageal valve. The cohort consisted of 28 laryngectomees with a mean follow-up time of 352 days. The average valve life before failure was 148 days. Speech intelligibility of 85 per cent was achieved for complete sentences. No major surgical problems were associated with the valve insertion or its use. Replacement of the prosthesis as an outpatient procedure was accomplished without difficulty.
Latex-Induced allergic rhinitis in a laboratory nurse
Authors: Kujala V. , Pirilä T. , Niinimäki A. , Reijula K.
Published: November 2007

A case of occupational rhinitis in association with natural rubber latex hypersensitivity is presented. In the nasal provocation test for natural rubber latex glove powder the nurse experienced rhinorrhoea. A significant increase in the amount of nasal secretion and mucosal oedema could be detected. The patient also showed a positive skin prick test to natural rubber latex allergens, and an elevated natural rubber specific IgE level in her serum. This, to our knowledge, has not been previously reported in the literature.
Air gun pellets in the sinuses
Authors: O'Connellf J. E. , Turner N. O. , Pahorm A. L.
Published: November 2007

Three cases of penetrating sinus injuries due to air gun pellets are presexnted in order to illustrate the potentially serious consequences of air gun injuries. Primary surgery was performed in all cases.

The clinical presentation, methods of accurate pre-operative localization and surgery are discussed.
Giant cell reparative granuloma of the cricoid cartilage
Authors: Thomas D. M. , Wilkins M. J. , Witana J. S. , Cook T. , Jefferis A. F. , Walsh-Waring G. P.
Published: November 2007

Giant cell reparative granuloma (GCRG) is an uncommon benign lesion which has been reported at several sites in the head and neck. We present a case of a GCRG of the cricoid cartilage not previously described in the literature. It must be differentiated from the brown tumour of hyperparathyroidism and true giant cell tumours of bone. These were excluded on clinical, biochemical, radiological and histological grounds. The lesion responded well to surgical debulking and curettage and the patient remained disease-free 15 months after treatment.
Would day-case adult tonsillectomy be safe?
Authors: Moralee S. J. , Murray J. A. M.
Published: November 2007

Day-case surgery is increasing to improve health care efficiency. Adult tonsillectomy is performed on an inpatient basis in the UK because of safety concerns regarding primary haemorrhage. This study aims to investigate the likely safety of day-case tonsillectomy in adults, by defining the incidence and timing of primary haemorrhage and therefore to establish a safe time period for same-day discharge.

Prospectively recorded data on 2 157 adult tonsillectomies over a five-year period were reviewed. Serious primary haemorrhage was uncommon (0.8 per cent). The 95 per cent reference range of time to primary haemorrhage was within 0 to 6.8 hours of surgery and the 95 per cent confidence interval (C.I.) of its upper limit was 5.2 to 8.4 hours. The results compare favourably with the UK inpatient and US adult day-case literature.

We conclude that day-case tonsillectomy would probably be safe in adults if the patients are discharged after 8.4 hours.
Medullary carcinoma of the thyroid metastatic to the temporal bone
Authors: Redleaf Miriam I. , Bauman Nancy M. , Robinson Robert A. , Gantz Bruce J.
Published: November 2007

We report a case of proven thyroid medullary carcinoma, metastatic to the temporal bone. Review of the otolaryngology literature demonstrates that this is the first such report. The patient presented with symptoms, physical examination, and imaging studies suggestive of a glomus jugulare tumour. The pre-operative diagnosis of metastatic thyroid medullary carcinoma, however, was made, based on a history of medullary carcinoma of the thyroid with previous metastases as well as an elevation in calcitonin levels. Histological examination of the surgical specimen confirmed the diagnosis.
Orbital and skin metastases in a polymorphous low grade adenocarcinoma of the salivary gland
Authors: Thomas K. M. , Cumberworth V. L. , McEwan J.
Published: November 2007

We report the previously undocumented development of an orbital metastasis and skin metastases in a patient with polymorphous low grade adenocarcinoma (PLGA) 15 years after initial presentation. The clinical course, treatment and changing histological features are discussed.
Pre-operative information in mastoidectomy: what about the facial nerve and hearing loss?
Authors: Wormald P. J.
Published: November 2007

Facial nerve palsy and hearing impairment are accepted risks of mastoid surgery. However, at present there are no guidelines as to whether a patient must be informed of the potential risk to the facial nerve and hearing during mastoid surgery. Currently the law states that the surgeon should do what a ‘reasonable doctor’ would do under similar circumstances but exactly what this entails is not clear. A recent publication established that 16 per cent of British surgeons did not tell their patients about the risk to the facial nerve and 13 per cent about the risk of hearing loss. A survey of South African surgeons showed a different picture with only 57 per cent of surgeons informing their patients of possible facial nerve injury and 71 per cent about hearing loss. One of the reasons stated was that this information might deter the patient from having a necessary operation. This raises the question of excessive information disclosure and its possible legal consequences if excessive information leads a patient into making an unbalanced judgment owing to his/her lack of medical training, prejudices or personality. In this survey 25 per cent of South African surgeons have had patients refuse surgery after being informed of the risk to facial nerve and hearing. The decision whether to inform the patient about these risks should be individualized for every patient after the surgeon has audited his/her results and assessed the patients prejudices, personality and level of education.
Endoscopic ligation of the sphenopalatine artery (ELSA): a preliminary description
Authors: White Paul S.
Published: November 2007

Two cases of transantral endoscopic ligation of the sphenopalatine artery are presented, and the surgical technique described. The main advantage of this minimal access operation being avoidance of the morbidity associated with the conventional Caldwell-Luc approach.
Cervical necrotizing fasciitis: a distinct clinicopathological entity?
Authors: Banerjee A. R. , Murty G. E. , Moir A. A.
Published: November 2007

Necrotizing fasciitis of the head and neck has previously been classified as a homogeneous group. We present two cases of necrotizing fasciitis confined to the neck and demonstrate with a review of the literature that cervical necrotizing fasciitis and craniofacial necrotizing fasciitis are two distinct clinicopathological conditions.
Complications of paediatric tonsillectomy post-discharge
Authors: Lee W. C. , Sharp J. F.
Published: November 2007

A post-operative survey of 291 children was conducted to assess morbidity found at home in the first five days post-tonsillectomy. Analgesic requirement (92.4 per cent), signs of distress (90.4 per cent), otalgia (69.1 per cent), halitosis (66.7 per cent) were common. Physical or behavioural changes (36.8 per cent) and secondary haemorrhage (8.9 per cent) were also prominent features. Nausea was reported in 59 children (20.3 per cent) and delayed return to a normal diet which in turn predisposed to secondary haemorrhage. Return to normal diet was independent of pain. General Practitioners were consulted by 60.6 per cent and more than half were prescribed drugs. The presence of an organized clot in the tonsillar fossa (3.45 per cent) post-operatively did not delay discharge from hospital and none of these patients re-presented with secondary haemorrhage. Based on their child's experience in this study, only one third of the parents approved of day-case tonsillectomy in principle, a finding which has implications for the instigation of day-case tonsillectomy procedures.
The role of stroboscopy in the management of a patient with a unilateral vocal fold paralysis
Authors: Harries Meredydd Lloyd , Morrison Murray
Published: November 2007

Stroboscopy is well established as an essential diagnostic tool in the assessment of the vocal folds during phonation. This paper analyses the stroboscopic findings in 100 patients with a unilateral vocal fold paralysis. Reliable stroboscopic signals were only obtained in patients with the paralysed fold close to the midline. These patients seldom require surgery however, usually responding to speech therapy with laryngeal compensation giving a good voice. Most patients that require surgery have a large glottal deficiency, but in this series these patients did not give an adequate signal for analysis. Although useful in the assessment of the muscle tone of the paralysed fold, the influence of stroboscopy on the surgical treatment in this series was limited.
Adenomatoid hyperplasia of palatal minor salivary glands
Authors: Bryant C. , Manisali M. , Barrett A. W.
Published: November 2007

Adenomatoid hyperplasia of palatal minor mucous glands is rare but significant because the clinical appearance mimics malignant disease. The typical history of a painless, indolent palatal swelling, together with the histological picture of benign glandular hyperplasia and hypertrophy, are illustrated in this report.
Atypical intramuscular lipoma of the tongue
Authors: Kacker Ashutosh , Taskin Metin
Published: November 2007

Lipomatous tumours of the tongue are rare and most of them are benign ordinary lipomas. In this report, we describe the first case of atypical lipoma of the tongue in a 78-year-old male, and review the current literature and controversies surrounding the nomenclature and biology of this unusual lesion.
Disabililty after labyrinthectomy
Authors: Pereira Kevin D. , Kerr Alan G.
Published: November 2007

A labyrinthectomy is known to relieve vertigo successfully in the majority of patients who suffer from Menière's disease and have non-serviceable hearing in the affected ear. It is assumed that the procedure reduces disability, helps the patient to return to work and improves the quality of life. Eighteen patients who underwent a transmastoid drill-out labyrinthectomy between 1980 and 1990 were interviewed and an attempt was made to evaluate the success of the operation in accordance with the guidelines set out by the AAO-HNS 1985. In the present series it was noted that although vertigo was relieved in 89 per cent of patients after labyrinthectomy, only 50 per cent of them returned to work. In this study, the age and occupation of the patient at the time of surgery and the relief of vertigo did not accurately predict whether or not a patient returned to work.
Hearing loss in multiple sclerosis: localization of the auditory pathway lesion according to electrocochleographic findings
Authors: Marangos N.
Published: November 2007

Multiple sclerosis is known to affect the myelin of the auditory pathway resulting in acute hearing loss. Two cases of sudden deafness due to multiple sclerosis have been evaluated by conventional audiometry, brainstem auditory evoked response audiometry and transtympanic electrocochleography. The abnormalities of the compound action potential in both patients (enhanced latency, abnormal adaptation using fast stimulus rate) and the normal receptor potentials (cochlear microphonic, summating potential), as well as the absence of brainstem responses suggest a disturbance of synchronization at the level of the first auditory neurone. The electrocochleography provides valuable information for the topodiagnosis of this and other neural hearing losses, especially in the absence of reliable brainstem responses.
An unusual foreign body migrating from pharynx to mediastinum
Authors: Sinha A. , Shotton J. C.
Published: November 2007

A case of a swallowed foreign body migrating from the pharynx into the soft tissues of the neck is presented, whose management was complicated by its undetected migration to the superior mediastinum occurring between radiological localization in the neck three days prior to exploration and its attempted removal. A median sternotomy was then required to retrieve the object. Radiological guidance with regard to the localization of a foreign body in the neck can only be relied on when performed immediately prior to surgical removal.
Tonsillar metastasis from adenocarcinoma of the stomach
Authors: Benito Ignacio , Alvarez-Gago Tomás , Morais Darío
Published: November 2007

Metastatic carcinoma of the tonsil is rare with only some 100 cases having been reported in the literature, of which nine have resulted from stomach carcinoma. Tonsillar metastases rarely become apparent before the diagnosis of the primary neoplasm. We describe here the clinical and histopathological findings of a case of unilateral palatine tonsil metastasis as the first sign of a signet-ring cell carcinoma of the stomach. This has not been reported previously.
Intra-operative image guidance in otolaryngology – The use of the ISG viewing wand
Authors: Carney A. S. , Patel N. , Baldwin D. L. , Coakham H. B. , Sandeman D. R.
Published: November 2007

The ISG viewing wand is an intra-operative guidance system with a proprioceptive robotic-like jointed arm. It provides surgeons with almost instantaneously reconstructed computer-generated CT or MRI images in two or three dimensions and can correlate any point within the operative field to its corresponding locus on the reformatted scan images. In addition to having been used in over 400 neurosurgical patients in Bristol, 14 patients with skull-base, cerebello-pontine angle or temporal bone lesions have also undergone wand-guided resections. The wand has proved to be particularly useful in pre-operative planning, allowing minimally-invasive incisions, providing per-operative navigation, identifying the relationship and proximity of important anatomical structures and in assessing the extent of lesion resection. We illustrate the advantages of intra-operative image-guidance by discussing four cases. The potential applications of this form of imaging technology to other otolaryngological procedures are discussed.
Immunoglobulin-coated bacteria on the tonsillar surface during infectious mononucleosis
Authors: Stenfors Lars-Eric , Räisänen Simo
Published: November 2007

Sequential bacterial samples were obtained from the tonsillar surface of 19 consecutive patients (12 females, seven males; mean age 16.1 years, range four to 24 years) suffering from infectious mononucleosis with membranous tonsillitis. The specimens were examined with respect to aerobes (culture on blood and chocolate agar plates) and proportions of bacteria coated with immunoglobulins (secretory IgA, IgG, IgM) by using an immunofluorescence assay. In the early stage of the membranous tonsillitis phase, attachment of secretory IgA (SIgA) and IgG to the bacteria was greatly suppressed, as compared with healthy controls. Coating with IgM was evident only late in the membranous tonsillitis phase but was contracted and still evident even after the clinical throat symptoms had abated. The findings suggest that the B-lymphotropic Epstein-Barr virus, causative agent of infectious mononucleosis, exerts a transient suppression of immunoglobulin-coating of bacteria harboured on the tonsillar surfaces, with consequent abundant bacterial attachment to the epithelial cells and massive bacterial colonization on the palatine tonsils.
The ‘Darling’ elbow rest—an aid to a stable operating position in endoscopic sinus surgery
Authors: Gardiner Q. , Tan L. , Oluwole M. , White P. S.
Published: November 2007

The ‘Darling’ elbow rest provides a compact, easily manoeuvrable platform for the surgeon's elbow during endoscopic sinus surgery, stabilizing the endoscope and increasing operative safety.
Cerebellopontine angle metastasis from clear-cell renal carcinoma presenting as bleeding from the ear
Authors: Bhatoe H. S. , Deshpande G. U.
Published: November 2007

Metastatic lesions in the cerebellopontine angle are rare. We encountered one such metastatic lesion from clearcell renal carcinoma that had a striking clinical appearance, bleeding from the ear and multiple lower cranial nerves' involvement. While the overall prognosis in CNS metastasis from systemic malignancy is gloomy, useful palliation can be achieved in patients with solitary lesions.
Persistent nasal crusting due to hypohidrotic ectodermal dysplasia
Authors: Al-Jassim A. H. , Swift A. C.
Published: November 2007

Hypohidrotic ectodermal dysplasia is an hereditary condition of the ectodermal tissues which may escape recognition because of lack of clinical awareness due to its rarity. Otorhinolaryngological features of this syndrome include chronic respiratory tract infections, persistent foul-smelling nasal discharge and crust formation, and hearing problems.

The condition is usually an X-linked recessive disease affecting mainly ectodermal tissue, although nonectodermal tissue may also be affected. The notation ‘ectodermal’ is used because ectodermal tissues are always involved. The syndrome is characterized by complete or partial absence of sweat glands, sparse hair growth, absent or deformed peg teeth, sparse sebaceous glands, occasional absence of salivary and lacrimal glands, scanty mucous glands and deficient cilia.

We describe two children with this disorder with specific reference to the effect on the upper respiratory tract.
Trigeminal neuralgia in nasopharyngeal carcinoma
Authors: Chong V. F. H.
Published: November 2007

Tumours at the skull base may show perineural infiltration of the mandibular nerve. Subsequent retrograde spread into the cavernous sinus, Gasserian ganglion, the trigeminal nerve and the pons may be seen. The patient, a known and treated case of nasopharyngeal carcinoma (NPC), complained of trigeminal neuralgia and difficulty in chewing. Magnetic resonance imaging (MRI) revealed a Gasserian ganglion and trigeminal infiltration with resultant atrophy of the muscles innervated by the mandibular nerve. Proximal cranial nerve involvement should be suspected in patients with skull base malignancy presenting with trigeminal neuralgia. MRI is the modality of choice in delineating the pathological process.
Epithelial-myoepithelial carcinoma – Report of a case arising in the nasal cavity
Authors: Harada Hiroshi , Kashiwagi Sho-Ichi , Fujiura Hitomi , Kusukawa Jingo , Morimatsu Minoru
Published: November 2007

We present an extremely rare case of epithelial-myoepithelial carcinoma (EMC) arising in the nasal cavity. The patient was a 56-year-old Japanese male with a polypoid tumour arising from the nasal septum. Histopathological examination revealed the tumour to consist of a solid proliferation of clear-cells and, in some areas, small or elongated duct structures with a double-layered arrangement of inner cuboidal cells and outer clear-cells. Dual differentiation toward myoepithelial and ductal cells were confirmed immunohistochemically. The occurrence of EMC in the nasal cavity is possible and this entity should be generally recognized by surgical pathologists, not only those engaged in head and neck surgery.
Leiomyosarcoma of the parotid gland
Authors: Öncel Semih , Doǧanay Musa , Özer Ali , Arslanoǧlu Seçil , Ermete Murat , Erdoǧan Nezahat
Published: November 2007

A 36-year-old patient with a primary leiomyosarcoma of the left parotid gland is presented. To our knowledge this is only the second case of a parotid leiomyosarcoma in the world according to the literature review.
An animal model for training in endoscopic nasal and sinus surgery
Authors: Gardiner Quentin , Oluwole Matthew , Tan Luke , White Paul S.
Published: November 2007

An animal model has been devised to allow trainees in nasal and sinus endoscopy to develop basic instrument handling and psychomotor skills, without risk to patients.The sheep's head obtained from the abattoir was modified slightly to simulate more closely the human situation. The model permits nasendoscopy, foreign body removal, septoplasty, turbinate reduction, frontal and maxillary sinoscopy, antrostomy and an epistaxis exercise. To date the tissues have been used freshly thawed, and must be used on the day of preparation.
Inhibition of head and neck metastatic and/or recurrent cancer by local administration of multi-cytokine inducer OK-432
Authors: Kitahara Satoshi , Ikeda Makoto , Inouye Tetsuzo , Matsunaga Takeshi , Yamaguchi Kengo , Takayama Etsuyo , Healy Gerald B. , Tsukuda Mamoru
Published: November 2007

The multi-cytokine inducer OK-432 is a pulverized preparation of the low-virulence SU strain of Streptococcus pyogenes of human origin. A reduction of the tumour mass in the OK-432-injected areas was observed in 11 out of 13 patients with metastatic and/or recurrent head and neck cancer. Complete response (CR), partial response (PR) and minor response (MR) were noted in six, three and two cases respectively. OK-432 local administration therapy could create a new strategy for cancer therapy.
Vestibular nerve dysfunction and decompression in Engelmann's disease
Authors: Hellier William P. L. , Brookes Gerald B.
Published: November 2007

Vestibular nerve dysfunction as the major neuro-otological symptom in one of the osteopetrosis group of bone disorders is unusual. We describe a patient with Engelmann's disease who presented in this manner and who benefited from an eighth nerve decompression procedure. Surgical decompression of the internal auditory meatus to relieve vertigo has to our knowledge not been previously reported in this condition.
Benign fibrous histiocytoma of the larynx: presentation of a case and review of the literature
Authors: Van Laer C. , Hamans E. , Neetens I. , Van Marck E. , Van Oosterom A. , Van De Heyning P.
Published: November 2007

A case of a benign histiocytoma of the larynx in a 39-year-old man is presented. Laryngeal fibrous histiocytoma is extremely rare. Its pathology is described including arguments for benignity. The literature is reviewed and management is discussed.
Hoarseness as the initial manifestation of systemic lupus erythematosus
Authors: Tsunoda Koichi , Soda Yasushi
Published: November 2007

A 51-year-old woman complained of hoarseness of two years duration. The patient's past medical history was significant for autoimmunological hepatitis and arthritis for which she had not received treatment. Laryngoscopy and laryngeal stroboscopy revealed ‘bamboo joint-like nodules’ on both true vocal folds. These nodules resembled rheumatoid nodules and were suggestive of a collagen disease. Previous reports have documented that the treatment for such conditions related to collagen diseases is surgical resection. However, we initially attempted to treat the laryngeal lesions systemically with prednisolone. The hoarseness and the bamboo-like nodules disappeared six months after the treatment. Furthermore, the liver function test returned to normal and arthritis completely resolved. Based on our patient's response to this treatment, we diagnosed atypical-SLE and a lupus laryngitis. This case suggests that studies of the larynx may be helpful in the early diagnosis of collagan diseases and that such conditions may respond to systemic treatment.
The use of Merocel nasal packs in the treatment of epistaxis
Authors: Pringle M. B. , Beasley P. , Brightwell A. P.
Published: November 2007

Over the period of a year, Merocel nasal packs were used routinely as the primary form of packing in patients referred to the hospital with epistaxis that had not resolved with simple measures, and in whom packing was thought to be required. Their effectiveness was assessed. The packing was usually performed by inexperienced senior house officers. The Merocel packs successfully controlled bleeding in 91.5 per cent of the patients in whom they were used. Use of the correct insertion technique is very important but is very easy to learn and perform. The actual insertion takes only a couple of seconds. Discomfort during insertion, whilst in situ and on removal was assessed.

Merocel nasal packing is an effective form of first line treatment in patients with epistaxis.
Misdiagnosis of hearing loss due to ear canal collapse: a report of two cases
Authors: Mahoney Cliodna F. O , Luxon Linda M.
Published: November 2007

Collapse of the external auditory meatus during audiometry can lead to spuriously increased hearing thresholds being obtained, particularly at high frequencies, and may simulate conditions such as noise-induced hearing loss, presbyacusis and retrocochlear pathology. Consequently, inappropriate investigations and management may be undertaken. Two patients with elevated thresholds secondary to ear canal collapse are described. The implications of initially failing to identify the true nature of their ‘hearing losses’ are highlighted and strategies to avoid such pitfalls are discussed.
Cochlear implantation in an intralabyrinthine acoustic neuroma patient after resection of an intracanalicular tumour
Authors: Tono Tetsuya , Ushisako Yasuaki , Morimitsu Tamotsu
Published: November 2007

This case study describes a therapeutic strategy using a cochlear implant for a bilateral acoustic neuroma deafened patient. The cochlear nerve had previously been sacrificed on one side during tumour removal, but on the remaining side a functioning cochlear nerve was assessed by electric promontory stimulation in spite of a neuroma extending into the vestibular labyrinth. The patient was successfully stimulated with a Nucleus 22- channel implant after removal of the intracanalicular portion of the neuroma via a middle fossa approach.
Solitary infantile and adult myofibromatosis of the nasal cavity: a report of two cases
Authors: Walsh R. M. , Leen E. J. , Gleeson M. J.
Published: November 2007

Myofibromatosis is an uncommon, usually cutaneous, condition in which there is a benign proliferation of myofibroblasts. Solitary and multicentric nodular forms with, and without, visceral involvement have been described. Infantile and adult sub-types have been reported, each having distinct clinicopathological features. Presentation in the head and neck is common. It is frequently misdiagnosed because of its peculiar histological features. The first documented cases of infantile and adult myofibromatosis involving the nasal cavity are reported.
Surgical management of lymphangiomas in adults
Authors: Curran A. J. , Malik N. , McShane D. , Timon C. V. I.
Published: November 2007

Lymphangiomas are uncommon benign congenital tumours. Most occur in the head and neck region and the vast majority present before the age of two. This paper describes the presentation and management of four cases presenting after puberty and involving the parotid gland. The cases are unusual in that all were intimately associated with the facial nerve and in an older population. The value of selective neck dissection and facial nerve exposure as an approach to these lesions is discussed.
Barotitis in children after aviation; prevalence and treatment with Otovent®
Authors: Stangerup Sven-Eric , Tjernström Örjan , Harcourt Jonathan , Klokker Mads , Stokholm Jens
Published: November 2007

Barotitis is an acute or chronic inflammation caused by environmental pressure changes. The most common cause is the pressure change during descent in civil aviation. To prevent barotitis the middle ear pressure has to be equalised several times during descent. This can be achieved by performing the Valsalva manoeuvre, but for children, many of whom have a dysfunction of the Eustachian tube, this is difficult to perform and they are therefore at high risk of developing barotitis during flight. The traditional treatment modalities of barotitis are inflation by a Politzer balloon, myringotomy or prophylactic grommet insertion. An alternative treatment or prophylactic measure is autoinflation using the Otovent® treatment set. This prophylaxis/treatment can be performed by the child with assistance from its parents as soon as possible or rather before the descent has started. The prevalence of barotitis amongst transit passengers was found to be highest in young children, 25 per cent, compared with adults, five per cent. Only 21 percent of the youngest children with negative middle ear pressure after flight managed a successful Valsalva's manoeuvre, whereas 82 per cent could increase the middle ear pressure inflating the Otovent® set. In conclusion we recommend autoinflation using the Otovent® set by children and adults with problems clearing the ears during flight.
A clinical, genetic and audiological study of patients and families with unilateral vestibular schwannomas. I. Clinical features of neurofibromatosis in patients with unilateral vestibular schwannomas
Authors: Neary W. J. , Newton V. E. , Laoide-Kemp S. N. , Ramsden R. T. , Griffith G. , Evans D. G. , Harris R. , Strachan T.
Published: November 2007

Ninety-three patients with unilateral vestibular schwannomas were examined in a clinical, genetic and audiological study, to determine whether they had features associated with neurofibromatosis Type 1 or neurofibromatosis Type 2. In 91 families, one patient only was found to be affected with a unilateral vestibular schwannoma. Patients did have a few café-au-lait macules, but fewer than six in number. None of the patients satisfied the cutaneous diagnostic criteria for neurofibromatosis Type 1. Neither Lisch nodules nor presenile posterior subcapsular lenticular opacities or cortical opacities were a feature. Five patients with unilateral vestibular schwannomas are described where the clinical findings raised the possibility of neurofibromatosis Type 2. It is suggested that certain individuals with unilateral vestibular schwannomas are at risk of developing neurofibromatosis Type 2. Furthermore, the possibility of neurofibromatosis Type 2 should be considered if more than one individual in a family is found to be affected with a unilateral vestibular schwannoma.
Familial paraganglioma
Authors: Wharton S. M. , Davis A.
Published: November 2007

Non-secreting paragangliomas are rare tumours usually present in the head and neck. We describe an unusual case of familial paraganglioma with cranial nerve palsies. After exhaustive investigation, a vagal paraganglioma was found and excised. The positive family history of paraganglioma was of significance, although this was only present in one of five generations. The diagnosis and management of non-secreting paragangliomas is discussed.
Are the morphology of papillary thyroid carcinoma and the tumour's behaviour correlated?
Authors: Hefer Tsila , Joachims Henry Z. , Eitan Arie , Munichor Mariana
Published: November 2007

Six cases of papillary thyroid carcinoma showing clinically highly aggressive behaviour by invading the upper airway and digestive tract structures were retrospectively reviewed to evaluate the morphological variants of the tumours. Four of them were found to be pure papillary and one was a mixed-papillary and follicular-variants regarded as non-aggressive. Only one case was found to be tall cell variant – regarded as an aggressive variant of papillary thyroid carcinoma. The findings suggest that the prognosis of papillary thyroid carcinoma cannot be predicted from its morphological variant and attention should be given to other clinical parameters.
A comparison of partial inferior turbinectomy and cryosurgery for hypertrophic inferior turbinates
Authors: Rakover Yoseph , Rosen Gabriel
Published: November 2007

A variety of surgical procedures are performed for treatment of hypertrophic inferior turbinates, but there is no completely effective therapy. We evaluated subjectively and objectively 52 patients who underwent one of two procedures: partial inferior turbinectomy (PIT) or cryosurgery of the inferior turbinates (CS). The results of PIT showed good functional results in 77 per cent of cases for long-term effectiveness. The results of CS showed that effectiveness was reduced from a 62 per cent success rate after one year to 35 per cent later, but CS was a simple procedure which was performed on an outpatient basis with no postoperative morbidity.
A survey to determine the extent of previous symptoms and surgery on patients presenting with nasal polyps
Authors: Schumacher D. U. , Randall C. J.
Published: November 2007

The aim of our study was to investigate the prevalence of surgery on the nose prior to first time diagnosis of nasal polyps. We interviewed 60 patients who presented to the ENT Department at the Royal South Hants Hospital Southampton and were diagnosed as suffering from nasal polyps for the first time. Patients who suffered from cystic fibrosis or known primary ciliary dyskinesia were excluded.

The average length of time of nasal blockage as the main symptom prior to the diagnosis of nasal polyps was less than two years. Out of the 60 patients six (10 per cent) had had previous nasal surgery. Out of these six patients, only four patients had a previous procedure on the nose that could be considered to be related to the later diagnosis of nasal polyps. Only one patient had had radiological investigation of his sinuses in the past.

We conclude that polypoid nasal disease is a de novo diagnosis with a relatively short history in the majority of patients and not preceded by a long history of ENT investigations nor surgery on the nose.
CO2 Laser palatoplasty: early results
Authors: Ingrams D. R. , Spraggs P. D. R. , Pringle M. B. , Croft C. B.
Published: November 2007

It is now widely accepted that snoring causes significant social dysfunction. In the absence of obstructive sleep apnoea syndrome, palatal surgery offers a very good chance of eliminating or reducing snoring. The traditional operation of uvulopalatopharyngoplasty remains the ‘gold standard’, but may be complicated by velopharyngeal incompetence, severe post-operative pain and even nasopharyngeal stenosis. A newer technique to reduce snoring caused by palatal flutter by using a neodymnium: yttrium aluminium garnet laser to stiffen the soft palate has been introduced recently by another unit. We show that this procedure can be carried out using a CO2 laser, and present the initial results of the first 29 patients operated on at The Royal National Throat, Nose and Ear Hospital.
Pseudocyst of the auricle: a new method of treatment
Authors: Hegde Ramesh , Bhargava Samir , Bhargava K. B.
Published: November 2007

Pseudocyst of the auricle is a condition where spontaneous serous fluid collection is seen on the lateral surface of the pinna. The aetiology of this condition is not known. Several methods of treatment have been advocated in the past. We report 10 cases of unilateral pseudocyst who were treated with aspiration and pressure dressing by a plaster of Paris cast over the pinna for two weeks.
Malignant otitis externa in HIV and AIDS
Authors: Hern J. D. , Almeyda J. , Thomas D. M. , Main J. , Patel K. S.
Published: November 2007

Malignant otitis externa is a necrotising infection of the external ear canal which may spread to include the mastoid and petrous parts of the temporal bone, leading to skull base osteomyelitis. It is almost exclusively caused by infection with Pseudomonas aeruginosa, and usually occurs in elderly non-insulin-dependent diabetic patients. However isolated cases have been reported in a small number of non-diabetic patients, particularly in children who are immunocompromised due to malignancy, malnutrition and severe anaemia. In 1984 a case of malignant otitis externa was reported in a child with an acquired immunodeficiency syndrome (AIDS)-like illness, prior to identification of the human immunodeficiency virus (HIV). Since that time further sporadic cases of this invasive infection have been reported in HIV and AIDS. We present two further cases and also a review of the current literature.
T-cell-rich histiocyte-rich B-Cell lymphoma of parotid gland
Authors: McCluggage W. G. , McManus D. , Maxwell P. , Walsh M. Y.
Published: November 2007

We describe a malignant lymphoma of the parotid gland arising in a patient with Sjögren's syndrome. Diagnosis was established on needle biopsy which showed a mixed population of lymphoid cells. Immunohistochemistry revealed B-lymphoid cells, T-lymphoid cells and histiocytes. Clonal immunoglobulin heavy chain gene rearrangement was demonstrated using the polymerase chain reaction. Within the confines of the small biopsy, the lesion qualifies for the designation T-cell-rich histiocyte-rich B-cell lymphoma. The value of molecular techniques in the diagnosis of malignant lymphoma on limited tissue samples is highlighted by this case.
Vestibular nerve section following previous mastoidectomy
Authors: Parikh Abhi A. , Brookes Gerald B.
Published: November 2007

Vestibular neurectomy is an effective procedure in the management of vertigo due to active labyrinthine disease. Various approaches have been developed for selectively sectioning the vestibular nerve, in order to preserve serviceable hearing and avoid facial nerve injury.

In patients who have a mastoid cavity, from previous surgery for chronic otitis media, the approach to the vestibular nerve has to be modified. Considerations taken into account are cavity infection, hearing status, and the presence of associated loud tinnitus.

Vestibular or vestibulo-cochlear nerve section has been undertaken, by the senior author, in eight patients with a mastoid cavity from previous surgery for chronic otitis media. Translabyrinthine, retrosigmoid and middle fossa approaches have all been used; strategies for selection of each specific technique are considered, and the aetiology of post-chronic suppurative otitis media (CSOM) peripheral vestibular disease discussed.
Congenital laryngeal cysts: current approach to management
Authors: Pak Martin Wai , Sang Woo John Kong , van Hasselt Charles Andrew
Published: November 2007

Congenital laryngeal cysts are a rare cause of neonatal upper airway obstruction which may lead to serious morbidity and mortality if diagnosis and treatment are delayed. We reviewed our experience with nine patients over a six-year period. The annual incidence of this condition was 1.82 per 100,000 live births. The diagnosis can be confirmed safely by flexible laryngoscopy before definitive surgery is contemplated. Contrary to other studies, we found that endoscopic removal of cysts can achieve an effective cure without recurrence. Endoscopic deroofing is as effective as endoscopic excision but is technically simpler and thus is recommended as the treatment of choice.
ENT surgery in children with inherited bleeding disorders
Authors: Conlon B. , Daly N. , Temperely I. , McShane D.
Published: November 2007

Inherited bleeding disorders are frequently considered an absolute contraindication to tonsillectomy and other ENT procedures. Over a 15-year period we have performed ten elective tonsillectomies and five bilateral myringotomies on children with inherited bleeding disorders. All procedures were carried out with the close co-operation of the Haematology Department in the hospital. All patients underwent uneventful surgery. One patient returned after tonsillectomy with a secondary haemorrhage which did not require surgical intervention. We present our team approach to the management of these children and demonstrate that necessary surgical intervention can be undertaken safely in this select group of patients.