bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary mycobacterial infection of the uvula
Authors: Murray A. , Gardiner D. S. , McGuiness R. J.
Published: November 2007

Tuberculosis, and non-tuberculous mycobacterial infections are becoming more common thus it is more likely that otolaryngologists will encounter these conditions. We describe an otherwise well patient, with symptoms and signs from chronic uvular inflammation, who proved to have a primary mycobacterial infection. This is an unique presentation in the literature and reminds clinicians of the need, where uncertainty exists in diagnosis, to consider mycobacterial infections.
Myasthenia gravis presenting with dysphagia and postoperative ventilatory failure
Authors: Haider-Ali A. M. , MacGregor F. B. , Stewart M.
Published: November 2007

We report a case of myasthenia gravis presenting to the department of otolaryngology with acute dysphagia on two separate occasions over a one-year period. Diagnosis of myasthenia gravis was made when the patient developed ventilatory failure after his second general anaesthetic for rigid oesophagoscopy. Our patient required emergency transfer to the intensive therapy unit for ventilation. He improved after treatment with corticosteroids, anticholinesterase and immunosuppressive medications. Our case was unusual in that cricopharyngeal spasm causing dysphagia and significant aspiration was demonstrated by a barium swallow and this was completely resolved after treatment of the myasthenia gravis.
Topical aminoglycosides in the management of active mucosal chronic suppurative otitis media
Authors: Lancaster J. L. , Makura Z. G. G. , Porter G. , McCormick M.
Published: November 2007

Debate has currently re-emerged following a renewed warning issued from the Committee on the Safety of Medicines (CSM) regarding the relative risk of ototoxicity from the use of aminoglycoside-containing drops in patients with tympanic membrane perforations. We present the findings of a survey of ENT consultants, questioning their views and current practice, and we add to the debate by means of a review and discussion of the literature.
Non-insulin-dependent diabetic microangiopathy in the inner ear
Authors: McQueen Chapman T. , Baxter Andrew , Smith Timothy L. , Raynor Eileen , Yoon Sang Min , Prazma Jiri , Pillsbury Harold C.
Published: November 2007

Hearing loss has long been associated with diabetes mellitus. Microangiopathy, associated with thickening of the basement membranes of small vessels, has been implicated as a major source of multiple system organ disease.

Objective This study was designed to evaluate changes in basement membrane thickness in the inner ear of laboratory animals suffering from non-insulin-dependent diabetes mellitus (NIDDM) with, and without, exposure to moderate intensity noise exposure in an attempt to extrapolate the same disease process in humans.

Design Spontaneously hypertensive-corpulent non-insulin-dependent rats (SHR/N-cp) were selected as a genetic model for the above study. Both lean and obese rats were used in this study. A genetically similar control group of animals (LA/N-cp) were used as controls. These animals express both the lean and obese phenotypes, but they lack the NIDDM gene. Forty-eight animals in each group were sacrificed at the end of the study. The cochleas were dissected and fixed. The basement membrane of the stria vascularis was examined using transmission electron microscopy.

Setting This study was a laboratory-based, standard animal study.

Main outcome This study was designed to show microangiography of the inner ear as related to NIDDM with, and without, obesity and noise exposure.

Results/Conclusions NIDDM alone does not cause statistically significant basement membrane thickening; however, NIDDM in combination with obesity and/or noise exposure did show significant thickening and the combination of all three showed the greatest thickening. NIDDM appeared to be the greatest contributing factor.
Endoscopic ultrasound-guided brachytherapy of head and neck tumours. A new procedure for controlled application
Authors: Maier Wolfgang , Henne Karl , Krebs Annette , Schipper Jörg
Published: November 2007

Brachytherapy is an established procedure in primary and in recurrent cancer. We perform afterloading brachytherapy during general anaesthesia. The target organ is punctured with hollow needles which are loaded with 192iridium via remote control. The depth and number of needles depend on tumour extension. In the interdisciplinary approach of our departments, this method has been improved and supplied by B-scan ultrasound control. Needles are positioned under continuous ultrasonographic guidance, and adjacent structures (e.g. the carotid artery) are localized ultrasonographically. Thus violation of the large vessels is avoided and the exact position of the needles within the tumour is improved.

In this paper, we report results on 22 patients suffering from recurrent carcinoma of the head and neck following surgery and curative radiation, and 17 patients with first onset of cancer. We did not observe any severe complications such as haemorrhage, osteomyelitis, or dyspnoea. The only side-effect was temporary oedema, sometimes associated with a short-term increase of pain. No systemic side-effects occurred.

The method is described and results from both patient groups are reported in detail. We conclude from our data that ultrasonographically-controlled endoscopic brachytherapy is a valuable procedure in locally-advanced primary, and in recurrent head and neck cancer.
Functional results after CO2laser surgery compared with conventional phonosurgery
Authors: Hörmann K. , Baker-Schreyer A. , Keilmann A. , Biermann G.
Published: November 2007

Treatment of benign vocal fold lesions by the use of the CO2laser is discussed critically. The aim of the present prospective randomized study was to examine the post-operative functional results after laser phonosurgery in comparison to those after cold phonosurgery. In total, 44 patients with benign vocal fold lesions underwent surgery. Conventional cold phonosurgery was performed in 23 patients, and 21 patients were treated by laser phonosurgery. To determine vocal function, examinations were performed preoperatively, on the second post-operative day, and one and four months post-operatively. The examinations included direct videolaryngoscopy, determination of maximal phonation, speech voice field as well as singing voice field. The results four months after surgery showed an improvement of vocal function in both treatment groups in comparison to the pre-operative findings. The improvement is only statistically significant after cold surgery.
Reconstructive techniques currently used following resection of hypopharyngeal carcinoma
Authors: Ayshford C. A. , Walsh R. M. , Watkinson J. C.
Published: November 2007

There is no general consensus as to the best method of reconstruction following total laryngopharyngectomy for hypopharyngeal carcinoma. The aim of this study is to attempt to establish the current practice amongst British ENT Consultants and to ascertain the reasons for their choice of reconstructive technique.

An anonymous questionnaire was sent to 546 consultants in the UK and the results of 363 (66.5 per cent) were analysed. One hundred and twenty-eight (35.3 per cent) consultants replied that they performed surgery for hypopharyngeal carcinoma. Sixty-five (50.8 per cent) performed a stomach pull-up procedure, 23 (18 per cent) used a jejunal free flap, 36 (28.1 per cent) used both and four (3.1 per cent) used other techniques. In the stomach pull-up group, the main reasons given for their choice were because there was no lower resection margin (48 out of 65) and because of tradition in the way they were trained (37 out of 65). In the group using the jejunal free flap, lower morbidity (18 out of 23) and mortality (14 out of 23) were the main reasons for their choice. The questionnaire also found that amongst the 60 consultants who would consider using a jejunal free flap, the majority (39) aimed for a lower clearance margin of 2–4 cm, while 17 aimed for >4 cm clearance.

This study provides a good indication of the current practice in the UK of reconstruction following resection for hypopharyngeal carcinoma. It appears that the stomach pull-up remains the most commonly used method of reconstruction, but the jejunal free flap is becoming increasingly more popular because of its lower morbidity and mortality.
Positioning of the receiver-stimulator for the CI–24M cochlear implant in infants
Authors: Mitchell T. E. , Gibson W. P. R.
Published: November 2007

A new cochlear implant (CI–24M) has recently been released by Cochlear Ltd. The shape and size of the receiver-stimulator differs from that of the CI–22M. Infants as young as one year of age are now receiving cochlear implants. We have examined the likely effect of skull growth following the implantation of a CI-24M cochlear implant in an infant of this age.
Retropharyngeal haematoma causing acute airway obstruction – first presentation of metastatic carcinoma
Authors: Draper M. R. , Sandhu G. , Frosh A. , Clarke P. M.
Published: November 2007

A case of acute airway obstruction due to an acute retropharyngeal haematoma secondary to indirect trauma as a first presentation of metastatic prostatic adenocarcinoma is described.
Facial palsy after glomus jugulare tumour embolization
Authors: Marangos Nikolaos , Schumacher Martin
Published: November 2007

Facial palsy after pre-operative embolization of glomus tumours is a rare complication. In our case, complete facial palsy occurred within four hours after embolization with polyvinyl alcohol foam. Three days later, embolization material was found in the perineural vessels of the facial nerve in its mastoidal segment. Six months after complete tumour removal, facial decompression with perineural incision, and steroid therapy, facial function recovered completely. In cases of embolization of both stylomastoid and branches of the middle meningeal artery with resorbable material, temporary facial palsy can occur.
The acceptance of hearing aids for children with otitis media with effusion
Authors: Jardine A. H. , Griffiths M. V. , Midgley E.
Published: November 2007

Conservative treatment for otitis media with effusion (OME) led us to consider the use of hearing aids as a way of managing the associated hearing loss. This study aimed to assess the compliance of patients and acceptance of hearing aids for the management of children with OME.

Thirty-nine children who had been given binaural hearing aids to manage OME were assessed at routine follow-up after six months. A clinician who did not prescribe the aid administered a questionnaire to assess compliance, change in symptoms and acceptance of the aids.

Thirty-eight parents thought the aids were easy to use and 25 (66 per cent) were completely satisfied with the management. Aided hearing improved by a mean of 17 dB (Range 10–30) over three frequencies, 0.5, 1.0, 2.0 Khz and all parents reported subjective hearing improvement in their children. The stigma of an aid was reported as minimal under the age of seven.

Hearing aids provide a non-invasive way of managing the problems associated with OME which is acceptable to certain parents and children. Long-term effects of using aids need to be evaluated before they can be recommended.
Effect of caffeine on the vocal folds: a pilot study
Authors: Akhtar S. , Wood G. , Rubin J. S. , O'Flynn P. E. , Ratcliffe P.
Published: November 2007

Caffeine is considered to be a dehydrating agent with detrimental effects on the quality of voice of persons ingesting it. This has led medical personnel dealing with voice disorders, especially in the case of professional voice users, to give advice against the use of caffeine. Yet this is an anecdotal truth as an extensive Medline literature search did not reveal any scientific evidence of caffeine being proven to have adverse effects on the vocal folds. We, therefore, initiated this pilot study to ascertain the connection between caffeine and voice quality on a laboratory basis. Two hundred and fifty mg of caffeine were provided to eight volunteers in tablet form, and blood levels along with laryngograph readings were recorded to document the changes produced. Analysing the irregularities of frequencies in a) free speech b) a reading passage and c) singing ‘Happy Birthday’, substantial changes were seen to authenticate the fact that caffeine does produce alterations in voice quality but these alterations have considerable intrasubject variability. A full study with wider parameters is to be performed on this subject as we consider it to be of importance in the management of voice disorders.
Lateral thyrotomy for neurilemmoma of the larynx
Authors: Sanghvi Vikram , Lala Murad , Borges Anita , Rodrigues Gabriel , Pathak K. A. , Parikh Deepak
Published: November 2007

We present a rare case of neurilemmoma of the larynx, which was excised through a lateral thyrotomy approach with resulting restoration of laryngeal function. The advantage of the lateral thyrotomy approach for submucous tumours of the larynx is discussed.
Chondromyxoid fibroma of skull base: a tumour prone to local recurrence
Authors: Shek T. W. H. , Peh W. C. G. , Leung G.
Published: November 2007

Chondromyxoid fibroma of the skull base is extremely uncommon. Sometimes involvement of the nasal cavity may occur and the patients may present with nasal symptoms. The biological behaviour of this tumour has not been well studied, primarily because of the limited number of reported cases and the short duration of followup. We report a histologically confirmed case of chondromyxoid fibroma of the skull base that recurred repeatedly over a 10-year period after the initial operation. Histologically it showed identical morphology to the original tumour with no evidence of histological progression or dedifferentiation. Ultrastructurally, the spindle tumour cells in the fibromyxoid area showed dual chondroblastic and fibroblastic differentiation, suggesting that these spindle fibroblastic cells and the better differentiated chondroid cells were of the same cell type with different histological morphology.
Anti-neutrophil cytoplasmic antibody-associated mucocutaneous allergic vasculitis with oral manifestations caused by propylthiouracil
Authors: Sorribes M. M. , Welinder N. R. , Stangerup S.-E.
Published: November 2007

A 49-year-old woman treated with increasing dosage of propylthiouracil (PTU) in order to control hyperthyroidism, developed progressive necrotic ulcers in the oral cavity, oropharynx and rhinopharynx and vasculitic ulcers on both auricular pinnae after a few days. The PTU treatment was immediately discontinued and the mucosal and skin manifestations resolved promptly. Laboratory findings, including anti-neutrophil cytoplasmic antibodies (ANCA), suggested allergic vasculitis. This is to our knowledge the first reported case of oral manifestations of PTU-induced allergic vasculitis.
Fibromatosis
Authors: Yoskovitch Adi , Hier Michael P. , Bégin Louis R. , Nachtigal Dan , Black Martin J.
Published: November 2007

Fibromatosis represents a diverse group of fibroproliferative tumours. Their behaviour and pathological qualities are situated in an intermediate position between benign and malignant disease. The following represents the pathological and radiological presentation of a 29-year-old female with fibromatosis.
Cochlear implantation in Thailand
Authors: Vaewvichit Kanate , Luangpitakchumpol Parinya
Published: November 2007

This article evaluates and compares the benefits of a House/3M single channel cochlear implant or a Nucleus 22-channel cochlear implant on speech recognition in Thai-speaking patients. From 1986–1989, four profoundly deaf adults were implanted with the House/3M prosthesis. Since 1994, nine post-lingually deaf adults and three pre-lingually deaf children have been implanted with the Nucleus prosthesis. One case was implanted with the House/3M prosthesis and in the contralateral ear with the Nucleus prosthesis. The post-operative results were determined according to the ability to understand Thai monosyllabic, bisyllabic open-word sets and everyday sentence tests with, and without, lip reading. The scores were then compared in the House/3M users and the Nucleus users and compared between the House/3M cochlear implant and the Nucleus cochlear implant in the same user. The speech recognition scores on monosyllabic and bisyllabic open-word set demonstrated that the Nucleus users perform at a much higher level than the House/3M users. The results of four pre-lingually deaf children will be reported later after a period of auditory and speech rehabilitation.
The incidence of symptoms consistent with cerebellopontine angle lesions in a general ENT out-patient clinic
Authors: Harcourt J. P. , Vijaya-Sekaran S. , Loney E. , Lennox P.
Published: November 2007

To quantify the potential burden for screening for cerebellopontine angle lesions, all adult new patients attending the ENT outpatient department of a district general hospital were documented to see if their presenting symptom(s) could be consistent with the presence of a cerebellopontine angle lesion. Of the patients, 19.7 per cent were found to be potential candidates for screening. A 15 decibel asymmetry at one frequency was found in 11.8 per cent of patients. The burden of screening with a variety of audiological and symptomatic protocols was quantified. Effective age limits to reduce the burden for screening were found to be either 65 or 75 years of age. With such a large potential pool of patients for further investigation, the results of this study could be used to suggest protocols which are likely to produce a load of cases, which matches local resources for screening.
Culture of the organism that causes rhinosporidiosis
Authors: Ahluwalia Karvita B.
Published: November 2007

The causative agent of rhinosporidiosis is a microscopic round body in polypoidal masses that is believed to be the sporangium of a fungusRhinosporidium seeberi. But fungal aetiology can not be proved with certainty. Attempts to culture the fungus on various media have also been unsuccessful. In a recent study pond water samples, from water in which patients had been bathing, were analysed and a unicellular prokaryotic cyanobacteriumMicrocystis aeruginosawas isolated. The same cyanobacterium was demonstrated in clinical samples from patients with rhinosporidiosis. Consequent to these findings, attempts were made to culture the causative organism of rhinosporidiosis under conditions that support growth of cyanobacteria.

This study describes a simple method for laboratory culture of this organism. Observations based on laser-scanning confocal microscopy, light and electron microscopy confirm that a cyanobacterium,Microcystissp. is the causative agent of the disease. Rhinosporidiosis is the first human disease to be shown to be caused by a cyanobacterium. The findings have opened the way for development of therapy.
Cricohyoepiglottopexy: long-term results in 55 patients
Authors: Lallemant J. G. , Bonnin P. , El-Sioufi I. , Bousquet J.
Published: November 2007

Near total laryngectomy with cricohyoepiglottopexy (CHEP) allows cure of glottic carcinomas with voice preservation. The subject of this study was to evaluate CHEP in terms of tumour control and functional result in T1and T2glottic carcinomas.

This study reviewed retrospectively 55 consecutive cases of CHEP performed between January 1, 1981 and September 1, 1992 with the exclusion of post-radiotherapy salvage surgery. CHEP was indicated for a T1alimit to the anterior commissure and/or with dysplasia of the other vocal fold (10 cases), T1b(11 cases) and T2(34 cases) glottic carcinomas. All our patients have a follow-up of more than five years.

The post-operative course after this surgery was generally uneventful. The median time to decannulation was 18 days, to removal of the nasogastric tube was 15 days and to discharge from hospital was 23 days. No significant difference was observed according to the preservation of one or both arytenoid cartilages. The long-term functional result can be considered to be good in three-quarters of cases, with normal oral swallowing and an easily understood voice. The remaining one quarter had a whispery voice and sometimes episodes of aspiration when swallowing liquids. In terms of oncological results, the five-year recurrence-free survival rate was 94 per cent for T1and 84 per cent for T2. The ultimate tumour control (taking into account four cases of total laryngectomy) was 94 per cent for T1and 93 per cent for T2.

Primary surgery by CHEP therefore appears to be a good option for early glottic carcinomas. The main problem remains that voice recovery is mediocre in one quarter of patients.
Giant cell tumour of the hyoid – first reported case
Authors: Commins D. J. , O'Malley S. , Athanasou N. A. , Jalloh S.
Published: November 2007

Giant cell tumours of bone are most commonly found in the epiphyses of weight-bearing long bones. They are rarely found in the head and neck and only 17 cases involving the laryngeal framework have been reported. To date, there have been no reports of a giant cell tumour arising from the hyoid bone. We present such a case which presented as a lump overlying the greater cornu of the hyoid, review the literature and discuss the management of this locally aggressive tumour.
Spindle-cell variant of intralingual lipoma – report of a case with literature review
Authors: Dutt Sunil N. , East David M. , Saleem Yousuf , Jones E. L.
Published: November 2007

A true lipoma is a rare lesion in the oral cavity. A histologically distinct variant is the spindle-cell variety, which is an innocuous lesion that can simulate a myxoid liposarcoma.

We report a case of intra-oral spindle-cell lipoma in a 42-year-old female and have reviewed the literature pertaining to this unusual histopathological entity. A wareness of the condition is essential for both clinicians and pathologists to avoid any misinterpretation of the benign nature of this condition.
Factors contributing to delayed diagnosis in nasopharyngeal carcinoma
Authors: Leong Jern-Lin , Fong Kam-Weng , Low Wong-Kein
Published: November 2007

Nasopharyngeal carcinoma (NPC) can be difficult to diagnose. Not only is the post-nasal space (PNS) inaccessible to examination, it is frequently occupied by normal lympho-epithelium which can make differentiation from NPC difficult. Together with its frequent atypical presentation, it is not surprising that the diagnosis is missed or delayed. This is undesirable as the treatment of early NPC carries an excellent prognosis. The aim of this study is to ascertain the extent of the problem of missed or delayed diagnosis and to study the factors responsible.

This was a retrospective study of all newly diagnosed patients with NPC from the Singapore General Hospital and treated in the Department of Therapeutic Radiology in the year 1996 (1 January-31 December).

A total of 126 patients were studied. Eighteen patients (14.3 per cent) were found to have delayed diagnosis of more than a month. The delay ranged from 1.2 to 25 months (mean 7.2 months). Factors identified which contributed to delayed diagnosis included i) Clinicians not considering a diagnosis of NPC ii) Clinicians suspecting NPC but misled by the results of investigations iii) Patients refusing investigation or defaulting follow-up.

Nearly a fifth of patients with NPC had delayed diagnosis. Many of the factors responsible for the delays appear to be preventable by better patient education and counselling, doctors having sharper clinical acument and skills in NPC diagnosis and the hospital administration having a system of tracking down high risk patients who default.
ENT open access clinic: an audit of a new service
Authors: Wheatley A. H. , Temple R. H. , Camilleri A. E. , Jones P. H.
Published: November 2007

Ear, nose and throat emergencies constitute a heavy but unpredictable workload for the junior otolaryngologist. Patients are often seen in the treatment room on the ward or in the casualty department. Many patients referred as emergencies can in fact be seen the following day without detriment.

This audit examined the change in treatment room workload when an open access ENT clinic was set up each weekday morning.

The results demonstrate that around 75 per cent of the patients seen were suitable for waiting until the next day. The clinic was considered a success as it provided benefits for GP access, routine clinics, junior doctor teaching and concentration of aural toilet cases under expert nurse care.
Laryngocele: an anatomical variant
Authors: Ingrams Duncan , Hein Dominic , Marks Nicholas
Published: November 2007

It is commonly believed that external laryngoceles always penetrate the thyrohyoid membrane at the site of penetration of the neurovascular bundle. We present a case where the site of penetration was posterosuperior to this. Careful dissection of the neck of a laryngocele sac is important to prevent damage to the neurovascular bundle.
Bilateral abductor vocal fold paralysis due to myasthenia gravis
Authors: Osei-Lah Victor , O'Reilly B. J. , Capildeo R.
Published: November 2007

We report a case of bilateral abductor vocal fold paralysis due to myasthenia gravis in a 61-year-old man who presented with stridor requiring tracheostomy. The stridor had been preceded by several weeks' history of diplopia.
Free jejunal patch flaps in oral and oro-pharyngeal reconstruction
Authors: Cocks H. C. , Kumar B. N. , Gupta A. R. Das , Simms M. H.
Published: November 2007

Free jejunum has been commonly tubed to provide a reconstructive pharyngeal conduit following pharyngolaryngectomy. It is also common practice to repair small oral and oro-pharyngeal defects with skinlined flaps i.e. radial free forearm or pectoralis major myocutaneous flap.

Free jejunal patch flaps can provide cover for large defects, secrete mucus, tolerate radiotherapy well and do not contract. The operation is associated with a low morbidity and early return of swallowing is feasible. Here we describe the functional results of free jejunal patch flap reconstruction of extensive oral and oro-pharyngeal defects.
Three-dimensional reconstruction of the incudostapedial joint with helical computed tomography
Authors: Yamada Mari , Tsunoda Atsunobu , Muraoka Hideki , Komatsuzaki Atsushi
Published: November 2007

Three-dimensional images of the incudostapedial joint (I-S joint) were reconstructed using helical computed tomography (CT). The images of the joint were most often reconstructed when threshold values were selected at −500 to −700 Hounsfield Units. These shapes were changed by choosing various threshold values. Histological examinations of the cadaver specimen indicate that these changes are due to structure of the I-S joints. We conclude that these 3-D images may be useful in assessing pathology of the I-S joint.
Septal perforations closure utilizing the backwards extraction-reposition technique of the quadrangular cartilage
Authors: Sarandeses-García Adolfo , Sulsenti Giorgio , López-Amado Manuel , Martínez-Vidal José
Published: November 2007

Nasal septal perforations are anatomical defects of the nasal septum, causing dynamic alterations in nasal physiology which may lead to variable symptoms and otolaryngological referral.

Repair of nasal septal perforations continues to remain a difficult surgical problem, and nowadays there is no definitive solution for their successful surgical closure.

Thirty patients with small- or medium-sized anterior nasal septal perforations were treated with a simple technique of backwards extraction-reposition of the quadrangular cartilage. Prior nasal septal surgery and repeated cautery were the most common cause of perforation. After a minimum follow-up of two years the success rate for relief of symptoms and closure of the perforation was 87 per cent.

This technique showed very good results in small-sized and selected cases with medium-sized perforations, but the mucosal dissection employed is not suitable for medium to large perforations.
Nasal splints, revisited
Authors: Malki D. , Quine S. M. , Pfleiderer A. G.
Published: November 2007

A study was carried out to compare the effectiveness of nasal splints (in preventing intranasal adhesions) with the morbidity associated with their use in nasal surgery. One hundred and ten patients undergoing a routine nasal operation were randomly allocated into two equal groups, one with splints and the other without. Post-operative pain and discomfort was assessed by a visual analogue scale at 48 hours and a week following surgery when either nasal suction (non-splinted group) or removal of splints was carried out. All patients were examined after six weeks for development of adhesions.

Results showed that there was no significant difference in the incidence of adhesions between the splinted and non-splinted patient groups. However, the patients with splints had significantly more pain and nasal discomfort when assessed one week after surgery.

It is concluded that the morbidity associated with nasal splints does not justify their use in routine nasal surgery if the aim is to prevent nasal adhesions, but they may still be indicated for enhancing the stability of the septum following septoplasty.
Outcome of using magnetic resonance imaging as an initial screen to exclude vestibular schwannoma in patients presenting with unilateral tinnitus
Authors: Dawes P. J. D. , Basiouny H. E.
Published: November 2007

The improved cost-effectiveness of gadolinium-enhanced magnetic resonance imaging (MRIg) as a diagnostic tool for vestibular schwannoma has resulted in smaller tumours being diagnosed. There has been a change in the clinical presentation of these tumours and up to four per cent may present with unilateral tinnitus. The limitation of auditory brain stem response (ABR) as a screening tool that detects small tumours is recognized and there is a strong argument for using MRIg as the initial investigation.

Various screening guidelines have been proposed, some include submitting patients with unilateral tinnitus for MRIg. This report describes the findings in a group of 174 patients presenting with unilateral tinnitus who underwent MRIg as part of a guideline-directed screen to exclude vestibular schwannoma. Five patients had a cause for their tinnitus diagnosed, one a vestibular schwannoma. Two had intracranial aneurysms and another three had pathology revealed that merited onward referral. A further nine patients had incidental findings that neither accounted for their symptoms nor needed further investigation or referral.

The rationale for screening these patients with MRIg is discussed.
Traumatic myositis ossificans of the superior belly of the omohyoid
Authors: Read-Jones M. , Murty G. E. , Ward V.
Published: November 2007

The first case of traumatic myositis ossificans (TMO) involving a strap muscle of the neck is reported. TMO typically presents with an unresolved mass following trauma or surgery, requiring differentiation from other soft tissue and bone neoplasms. Opacification may be present on soft tissue X-rays. Computed tomography (CT) scan may demonstrate a characteristic zoning phenomenon to establish the diagnosis. The disorder is frequently self-limiting but surgery may be required for persistent symptoms.
Adverse effects of nasal continuous positive airway pressure therapy in sleep apnoea syndrome
Authors: Kalan A. , Kenyon G. S. , Seemungal T. A. R. , Wedzicha J. A.
Published: November 2007

Nasal continuous positive airway pressure (nCPAP) is now the treatment of choice for patients with sleep apnoea syndrome. Side-effects and adverse reactions have been described in isolated reports with this device. We have, therefore, systematically studied the side-effects of nCPAP therapy in 300 consecutive patients referred to the London Chest Hospital Ventilatory Support Unit. Ninety-six per cent of patients complained of at least one side-effect resulting from the therapy, with 45 per cent complaining of a side-effect specific to the nasal mask. There was no correlation between the side-effects and level of pressure used during nCPAP. The rate of compliance remained high in spite of the side-effects, with a daily use of 7.8 hours (SD 8.05) and with 83 per cent of the patients using the device every night. Although nCPAP treatment remains acceptable to most patients there exists a high incidence of adverse effects.
Nasal haemophilic pseudotumour
Authors: Raj P. , Wilde J. T. , Oliff J. , Drake-Lee A. B.
Published: November 2007

Haemophilic pseudotumour or haemophilic cyst is a rare complication of haemophilia, occurring in one to two per cent of individuals with a severe factor VIII or IX deficiency. We report a case of a haemophilic pseudotumour in a hitherto unreported site, the bony nasal pyramid, and believe this case is also unique on account of it having occurred in a patient with mild haemophilia. The diagnosis and treatment of this rare condition is also reviewed.
Parapharyngeal lipoma
Authors: Scott R. F. , Collins M. M. , Wilson J. A.
Published: November 2007

Lipomas of the parapharyngeal space provide both a diagnostic and therapeutic challenge. They are extremely rare with only a few cases having been reported. We present the case of a right parapharyngeal space lipoma in a 69-year-old man that was excised via a transcervical approach.
Paraganglioma as a systemic syndrome: pitfalls and strategies
Authors: Maier W. , Marangos N. , Laszig R.
Published: November 2007

Tumours of the neuroendocrine system in the head and neck region are mostly paragangliomas of the glomus tympanicum or jugulare, or of the carotid body. The majority of these tumours are benign, and the coexistence of multiple paragangliomas seems to be rare. Pre-operative embolization and surgery are regarded as primary therapy for these tumours. The treatment regimen in any patient depends on age, general health, hearing status and the function of the lower cranial nerves. Several presentations are possible in which paragangliomas occur as systemic disease.

1. Paragangliomas may occur bilaterally, or, in rare cases, in multiple areas. Pre-operative bilateral angiography is of utmost importance. In case of multicentricity, it might be necessary to proceed without, or just with, unilateral surgery for preservation of adjacent structures. In surgery of jugular vein paraganglioma, we usually perform a modified transmastoidal and transcervical approach with preservation of middle-ear structures and the ossicles. As an alternative or supplement to surgery, radiotherapy or definitive embolization may be used in the treatment of paragangliomas.

2. Paragangliomas may occur as multiple endocrine neoplasia (MEN) syndrome combined with medullary thyroid gland carcinoma, and, facultatively, pheochromocytoma In these cases, endocrinological examination and magnetic resonance imaging (MRI) of the adrenal region, the thorax and the neck are required for an adequate therapeutic strategy. As MEN may be inherited, family history should be evaluated.

3. Paragangliomas can became malignant and metastasize. Thus, cervical lymph node metastases or distant metastases may occur. We recommend the removal of all ipsilateral lymph nodes and their histological examination.
Erythema multiforme after application of aural Gentisone HC drops
Authors: Siddiq M. A.
Published: November 2007

Erythema multiforme is an uncommon acute self-limiting condition characterized by mucocutaneous lesions of varying severity with a variable pattern of recurrence. This is a case of a four-year-old girl who developed erythema multiforme secondary to topical aural application of Gentisone HC drops (hydrocortisone acetate one per cent, gentamicin 0.3 per cent (as sulphate)) prescribed as a treatment for otorrhoea following grommet insertion. The clinical features are described and the literature reviewed. To my knowledge, this is the first reported case in the literature, of erythema multiforme secondary to a topical aminoglycoside/steroid preparation.
Delayed deterioration of hearing following bacterial meningitis
Authors: Jayarajan V. , Rangan S.
Published: November 2007

Bacterial meningitis is an important cause of acquired sensorineural deafness in childhood. Deafness following meningitis may be progressive. Previous reports have shown deterioration in hearing up to 12 years after the illness. We present two cases of sensorineural deafness following meningitis. Severe to profound sensorineural hearing losses were detected immediately after meningitis in these patients. The hearing subsequently deteriorated in both cases. Deterioration in hearing thresholds occurred 17 years after the illness in one case. In the other patient the hearing got progressively worse three years after meningitis. She subsequently required a cochlear implant.
Imaging for cochlear implants
Authors: Phelps P. D. , Proops D. W.
Published: November 2007

All patients in the Birmingham Cochlear Implant Programme underwent computerized tomography (CT) scanning and were assessed and images interpreted by the main author. Of the first 100 cases, 20 were considered to have abnormalities of the inner ears by CT imaging. It is concluded that the commonest abnormality was cochlear otospongiosis followed by labyrinthitis ossificans.

Otospongiosis is well shown by CT which gives a good predicator of luminal patency.

However, labyrinthus obliterans, although usually apparent on CT, is not reliably shown in all cases and T2 weighted magnetic resonance imaging (MRI) is better.
Rhabdomyosarcoma of the maxillary sinus
Authors: Suzuki M. , Kobayashi Y. , Harada Y. , Kyo T. , Dohy H. , Kuramoto A. , Etoh R.
Published: November 2007

A rare case of adult rhabdomyosarcoma originating from the left maxillary sinus is reported. A 22-year-old Japanese woman was referred to the Department of Otolaryngology, Hiroshima University, for investigation of the primary source of a metastatic tumor in the bone marrow. An X-ray of the sinuses revealed a tumor in the left maxillary sinus with extension into the nasal cavity, ethmoidal and sphenoidal sinuses. The patient was managed with a chemotherapeutic regimen consisting of high-dose methotrexate, adriamycin, vincristine, cyclophosphamide and prednisolone. After three courses of this chemotherapy, the tumor had decreased in size by about 90 per cent, as indicated by X-rays. The remaining tumor was removed by an extended Denker's operation. Following the surgery another seven courses of chemotherapy were given and during the eight months following the operation the patient has been free from any local recurrence.
Tympanometric findings in patients with adenoid hyperplasia, chronic sinusitis and tonsillitis
Authors: Alhady Rashad Abd , Sharnoubi M. EL
Published: November 2007

Tympanograms were done on 120 patients with adenoid hyperplasia, chronic sinusitis and chronic tonsillitis to measure the middle-ear pressure as a parameter to eustachian tube function. The results were compared with those obtained in 50 normal subjects. The statistical significance of the mean values of middle-ear pressure is very highly significant in patients with adenoid hyperplasia, significant in chronic sinusitis group and insignificant in patients with chronic tonsillitis, as compared to the normal control group. Hence, eustachian tube dysfunction is maximum in patients with obstructing adenoids, less in chronic sinusitis and least in chronic tonsillitis.
Management of middle-ear effusions in children
Authors: Hughes K. B.
Published: November 2007

A double-blind placebo controlled trial of Mucodyne (carbocisteine, Berk Pharmaceuticals), Actifed (triprolidine HCI and pseudoephedrine HCI, Wellcome) and combined Mucodyne and Actifed in the treatment of middle-ear effusions is reported. The trial was undertaken to assess whether either preparation, alone or in Combination, would reduce the number of children requiring surgical treatment for this condition. No statistical difference between the various groups in avoiding surgical treatment with Mucodyne was associated with a significantly greater number of ears restored to a normal appearance and middle ear function as measured by tympanometry. All patients relapsing after surgery belonged to the groups receiving placebo, Actifed or the combination of Mucodyne and Actifed prior to the operation.
Near-drowning, scuba diving
Authors: Rubin Allan M. , Blair Robin L. , Alberti Peter W.
Published: November 2007

This case report illustrates an unusual hazard of underwater sports: vagal neuropathology secondary to early poliomyelitis which resulted in residual palato-pharyngeal paresis. Gag and swallowing reflexes appeared to function adequately but in fact were not normal. When stressed, during water aspiration, they were inadequate, resulting in great risk to the underwater enthusiast. A history of early viral myelitis must be considered as a potential hazard in underwater sports.
Erythromycin in the treatment of Otitis Media with Effusion(OME)
Authors: Ernstson S. , Sundberg L.
Published: November 2007

Previous studies havd shown erythromycin to penetrate into both the middle-ear effusion and the adenoid tissue in children with Otitis Media with Effusion (OME). The levels obtained were similar to the plasma levels. Cultures in long-standing cases of OME have yielded respiratory pathogens—Haemophilus influenzae, streptococcus pneumoniae and Branhamella catarrhalis—in the nasopharynx in 79 per cent and in the middle-ear effusion in per cent.

In the present investigation a group of children with OME of more than three months' duration were given erythromycin (Abboticin®) in standard dosage for the last 10 days prior to scheduled operation (paracentesis or tympanostomy). Resolution was determined as normalization of the middle ear status, and this led to cancellation of surgery. The rate of resolution—12/26 (45 per cent)—was significantly higher than in a similar group of children not treated with erythromycin—11/72 (15 per cent). There are thus rational reasons for using erythromycin in OME, in many cases as an alternative to tympanostomy.
Osteosclerotic Plasmacytoma of maxillary bone (orbital floor)
Authors: Mustone Thomas A. , Fried Marvin P. , Goodman Max L. , Kelly James H. , Strome Marshall
Published: November 2007

Plasma cell neoplasms have been classified as multiple myeloma, solitary plasmacytoma and extramedullary plasmacytoma. They are usually considered as osteolytic lesions of bone except for the rare occurrence of osteosclerotic lesions. This paper describes the first reported osteosclerotic plasmacytoma of the maxillary bone and orbital floor. The difficulties in establishing a diagnosis and the relationship to other plasma cell neoplasms are discussed.

Osteosclerotic plasmacytomas are a rare variant of plasma cell tumors which usually produce osteolytic lesions rather than bony sclerosis. Sixty-eight patients with the osteosclerotic variant have appeared in the world literature, with an overall incidence of about 1 per cent in a large series of plasma cell neoplasms (Dreidger and Pruzanski, 1979). There have been only six previous cases of solitary osteosclerotic plasmacytomas reported (Morley and Schweiger, 1964; Roberts et al., 1974; Rodriguez et al. 1976; Rushton, 1965; Schneinker, 1938; Brigham Medical Review, 1961) involving spine, sternum, or rib. None have previously been reported in the head and neck area.

Plasma cell tumors have been classified into multiple myeloma, solitary plasmacytomas of bone, and extramedullary plasmacytomas. Multiple myeloma is a disseminated plasma cell
malignancy characterized by the production of homogeneous immunoglobulins (whole or fragments) which appear in the serum and urine. Plasma cell tumors can also occur as solitary plasmacytomas, usually in bone, but also in soft tissue. With time, most solitary plasmacytomas develop disseminated disease with all the characteristics of multiple myeloma (Wiltshaw, 1976). Extramedullary plasmacytomas arise in soft tissue rather than bone, and primarily occur in the head and neck region. Clinically, they remain localized and less frequently develop into disseminated myeloma.
Middle-ear pressure changes during general N2O Anaesthesia in Adeno-Tonsillectomies due to post-nasal packing
Authors: Karbonis J. , Ftakas E. , Aidonis A.
Published: November 2007

During adeno-tonsillectomies performed under general anaesthesia with N2O we observed and measured a serious increase in middle-ear pressure (M.E.P.). This is due to the fact that the rate of diffusion of N2O is greater inwards than outwards. This rise in the middle-ear pressure is due to the packing of the nasopharynx after adenoidectomy for haemostasis.
Diagnostic imaging of the nose and paranasal sinuses
Authors: Lloyd G. A. S.
Published: November 2007

There are four principal modalities now used by the Radiologist to investigate the nose and paranasal sinuses. These are: plain X-ray, conventional tomography, computerised tomography (CT), and magnetic resonance (MR). Plain X-ray is the initial examination, and is used as a screening procedure before employing one of the tomographic techniques. Conventional pluridirectional tomography has now been superseded by CT scannning, which has the advantage of providing both good bone detail and soft tissue imaging. Since the introduction of magnetic resonance (MR), this technique has replaced CT as the optimum method of showing the extent of soft tissue tumour in the sinuses. The introduction of the paramagnetic contrast agent Gadolinium (Gd DTPA) has improved its accuracy. In the anterior fossa discrimination between cerebral oedema and tumour invasion is better shown, and in the sinuses tumour is more easily identified from retained secretion and inflamed mucosa. The best method currently available to show pathology in the nose and sinuses is a combination of GdMR and CT: the former to identify the soft tissues and the latter to show bone changes.
Antroscopic study of the maxillary antrum in lepromatous leprosy
Authors: Soni N. K.
Published: November 2007

The technique of antroscopy affords an accurate assessment of chronic sinus disease. It was performed in twelve patients suffering from lepromatous leprosy in order to determine the type, nature and site of the lesion. Antral involvement with lepromatous leprosy may begin with a localized area of erythema progressing to granuloma formation or ulceration. The antero-inferior part of the antrum is the most commonly affected site.
Unusual presentation of neurilemmoma in the cerebellopontine angle
Authors: De S. K. , Basu A.
Published: November 2007

An unusual presentation of a neurilemmoma in the cerebellopontine (CP) angle is reported. The tumour was localised in the CP angle and the case presented with post-auricular swelling and erosion of the squamous part of temporal bone without involvement of the auditory or other cranial nerves.
Recovery from sensorineural deafness in Wegener's granulomatosis
Authors: Clements M. R. , Mistry C. D. , Keith A. O. , Ramsden R. T.
Published: November 2007

Wegener's granulomatosis may present with deafness or other aural symptoms. This report describes two patients with histological evidence of Wegener's granulomatosis who developed reversible sensorineural hearing loss during the course of their illness. The first patient showed complete recovery of a sensorineural hearing loss averaging 50 dB after ten months treatment with cyclophosphamide and high-dose prednisolone. The second patient, who was on maintenance haemodialysis, achieved a 40 dB improvement in sensorineural hearing loss within two weeks of adding cyclophosphamide to pre-existing corticosteroid therapy. These findings suggest that the prognosis of sensorineural hearing loss in Wegener's granulomatosis can be improved with suppression of the vasculitic process by early treatment with combined cytotoxic-immunosuppressive therapy
Isolated sphenoiditis: A diagnostic problem
Authors: Urquhart A. C. , Fung G. , McIntosh W. A.
Published: November 2007

A case of primary isolated sphenoiditis that developed cavernous sinus thrombosis is presented. It is difficult to diagnose and patients are often not seen initially by an ENT surgeon, making it more important for other branches of medicine to be aware of this condition. We discuss isolated sphenoiditis with particular reference to the diagnosis, management and complications of this condition