bluuebunny/crossref_metadata_2025 huggingface dataset:
Characteristics of Groningen tracheo-oesophageal speaking valves prior to insertion and after removal for failure
Authors: Parker A. J. , Stevens J. C. , Wickham M. H. , Clegg R. T.
Published: November 2007

The Groningen valve was first used in Sheffield in 1986 in a patient who underwent laryngectomy for malignant disease. Since then it has been the main tracheo-oesophageal prosthesis used on our Unit for speech rehabilitation post-laryngectomy. This biflanged device inserted primarily or as a secondary procedure remains in situ until failure occurs either because of leakage or because increased effort is required to produce satisfactory phonation. This in vitro study we examined the differences between new valves prior to insertion and those removed for failure. The mean forward opening pressures were shown to be similar in the two populations but the mean forward resistances were increased in those valves which were defective (P<0.001). In addition the mean reverse opening pressure was found to be significantly lower in the defective valves when compared with their new counterparts (p<0.05).
Penetrating injuries to the oropharynx
Authors: Kosaki Hiroko , Nakamura Naoya , Toriyama Yasuji
Published: November 2007

A review was made of 12 cases of penetrating injuries to the oropharynx seen at Musashino Red Cross Hospital during the period from 1984 to 1988, and their records were compared with those of past cases with similar injuries reported in a survey for the period between 1949 and 1959. Most of the patients were children under the age of four and were injured when they fell with a sharp-edged object in the mouth. Penetrating injuries to the oropharynx occasionally cause severe complications, including retropharyngeal abscess and mediastinitis. This type of injury should be called a ‘pencil injury’.
Adrenal suppression with intranasal betamethasone drops
Authors: Flynn M. D. , Beasley P. , Tooke J. E.
Published: November 2007

Intranasal betamethasone sodium phosphate drops (Betnesol) are frequently used to relieve nasal congestion due to polyposis. We report a case of significant hypothalamic-pituitary-adrenal suppression secondary to the long-term use of intranasal betamethasone drops. This case emphasizes that the topical application of potent corticosteroids may produce systemic effects.
Laryngo-tracheo-bronchopathia chondro-osteoplastica
Authors: Šmid L. , Lavrenčak B. , Žargi M.
Published: November 2007

Two cases of laryngo-tracheo-bronchopathia chondro-osteoplastica (LTBCOP) are discussed regarding the pathogenesis of the disease. Our observations support the belief that chronic irritation of the perichondrium in the region of subglottis, trachea and bronchi plays an important role in the aetiology of this disease.
Osteoma of the internal auditory canal presenting with sudden unilateral hearing loss
Authors: Singh V. , Annis J. A. D. , Todd G. B.
Published: November 2007

A case of an unilateral sensorineural hearing loss of sudden onset, due to an osteoma in the internal auditory canal is presented. As far as the authors are aware an osteoma at this site associated with a hearing loss occuring within a few hours has not previously been reported.
Glue under pressure: A bad prognostic sign for recurrence of otitis media with effusion
Authors: Salam M. A. , Wengraf C.
Published: November 2007

One hundred and thirteen children with bilateral otitis media with effusion (OME) underwent myringotomy and insertion of Shah grommets. They were classified into three groups according to the presence or absence of ‘glue under pressure’ unilaterally or bilaterally. The follow up period ranging between 18 and 32 months determined the comparative rate of recurrence of OME and the number of grommet reinsertions. This study shows a significantly higher incidence of recurrent OME, requiring grommet reinsertion, in ears with glue under pressure (60 per cent) compared to those with glue not under pressure (7.4 per cent). Thus it was possible to identify a subset of children with OME who have a poorer prognosis for recurrence and who should be treated with long-stay grommets in the first instance.
Carcinoma of the maxillary antrum treated by pre-operative radiotherapy or radical radiotherapy alone
Authors: Neal A. J. , Habib F. , Hope-Stone H. F.
Published: November 2007

The results of pre-operative radical radiotherapy and subsequent maxillary resection are reported in 54 consecutive patients with carcinoma of the maxillary antrum treated at The Royal London Hospital from 1965 to 1989. The actuarial two and five year survivals were 50.3 per cent and 38.5 per cent respectively. Patients with adenocarcinomas fared better when compared with squamous and undifferentiated carcinomas (log rank p = <0.01). Undifferentiated carcinoma and involved regional lymph nodes were both very poor prognostic factors. In those patients who were either unfit for or refused maxillary resection, radical radiotherapy alone was still an effective treatment, with only a slight disadvantage in terms of local control and survival.
Pharyngolaryngeal migration: a delayed complication of an impacted bullet in the neck
Authors: Nicol J. W. , Yardley M. P. J. , Parker A. J.
Published: November 2007

We present a case of a patient who sustained a bullet wound to the mouth and face resulting in impaction of the foreign body in the neck. This was initially managed conservatively until migration into the supralaryngeal area occurred. This resulted in airway obstruction, dysphagia, and dysphonia necessitating resuscitation and per-operative intrapharyngeal removal.

Bullet wounds are uncommon in this country and experience with these cases is lacking. This paper discusses the various management options and the mechanism of how the bullet became lodged in the tissues of the neck.
The need for and development of a single use disposable nasal spray
Authors: Coakley Jeremiah F. , Arthurs Graham J. , Wilsher Tina K.
Published: November 2007

Nasal sprays, which work on the Venturi principle, have the disadvantage of suck-back which makes them unhygienic for use in more than one patient. In Wrexham we have developed a disposable nasal spray system, which is safe and would be of benefit to other ENT departments.
Nasal muco-ciliary clearance in snuff users
Authors: Chetan Shashi
Published: November 2007

The inhalation of nasal snuff (powdered tobacco) is widely prevalent in the Indian sub-continent. The effect of snuff application on the nasal mucociliary clearance (NMMC) time has been suspected but not demonstrated before. In this study the saccharin test is used to demonstrate the rate of nasal mucociliary clearance among chronic snuff users. The study demonstrates the depressant action of snuff on the nasal mucociliary clearance rate. A pharmacological and pathological basis for the depressant action of snuff on the NMMC rate is hypothesised on the basis of the results obtained.
Knot to be condemned
Authors: Evans Peter H. Rhŷs
Published: November 2007

It is common practice following mastoid and middle ear surgery to apply a pressure bandage to the ear for a short postoperative period to reduce local swelling. The bandage is usually secured in such a way as to lift it away from the eye, sometimes with a length of ribbon gauze tied in a knot over the temporal region. Pressure from the knot may cause injury to the underlying tissues leading to post-operative complications which hitherto have not been described.
Bilateral auricular pseudocyst: a case report and discussion
Authors: Saunders M. W. , Jones N. S. , Balsitis M.
Published: November 2007

Pseudocyst is a rare, often misdiagnosed condition affecting the pinna. A case of bilateral pseudocyst is reported and the recent literature discussed with respect to aetiology and treatment.
Post laryngectomy diverticulum—a case report
Authors: Al Saati A. , Mitchell D. B. , Toynton S. , O'Connor A. F. Fitzgerald
Published: November 2007

A case of a pharyngeal diverticulum complicating a total laryngectomy is presented. Possible aetiology and management are discussed.
Penicillamine-induced changes in elastic tissue of the upper respiratory tract
Authors: Manohar M. Babu , Boldy D. A. R. , Bryan R. L. , Pearman K.
Published: November 2007

We describe a patient who developed upper respiratory tract symptoms following long-term treatment of Wilson's disease with penicillamine. These symptoms were attributed to areas of pharyngeal thickening and were treated with a laser. Histological examination of the lesions showed proliferations of abnormal elastic fibres similar to those previously described at other sites, especially the skin, in patients receiving penicillamine. This drug impairs the maturation and reduces the stability of elastic fibres and although elastic tissue throughout the body is affected, we are aware of no previous reports of penicillamine- induced changes presenting with upper respiratory tract symptoms.
Malignant oncocytoma of the parotid gland: a case report with an immunohistochemical and ultrastructural study
Authors: Sugimoto Takuya , Wakizono Shigeki , Uemura Takuya , Tsuneyoshi Masazumi , Enjoji Munetomo
Published: November 2007

A rare case of a 71 -year-old man with malignant oncocytoma is presented. The tumour was found in the left parotid region with enlarged lymph nodes in the neck. The resected parotid mass consisted of three discrete nodules, each histologically characterized by a uniform proliferation of oncocytic tumour cells. The patient underwent repeated operations for recurrences and metastases, and eventually died of acute pneumonia 18 months after the first admission. Metastases to the lymph nodes, ribs, spine and liver had been clinically pointed out. Immunohistochemically, the tumour cells were positive for a-1-antitrypsin, a-1-antichymotrypsin, lactoferrin, secretory component and carcinoembryonic antigen (CEA), while they were negative for S-100 protein and HHF35 (muscle specific actin). Ultrastructural pictures disclosed numerous mitochondria in the cytoplasm of the tumour cells, revealing neither myofibrils nor secretory granules. These findings therefore support the concept that this tumour is of a glandular epithelial origin.
Radiotherapy and complications of laryngectomy
Authors: McCombe A. W. , Jones A. S.
Published: November 2007

In an effort to establish factors responsible for our post laryngectomy fistulae we reviewed 357 patients who underwent total laryngectomy between 1965 and 1990, for laryngeal carcinoma. Pharyngocutaneous fistulae occurred in 84 cases (23 percent). There was no difference between the fistula group and the non-fistula group with regard to age, sex, general condition, or tumour differentiation. The only significant, positive association was with previous radical radiotherapy (10 fistulae out of 167 primary laryngectomies (4 percent) versus 74 fistulae out of 190 salvage laryngectomies (39 percent)). The median time to occurrence of a fistula was day seven in both groups. However, in the non-radiotherapy group the median duration of the fistula was 28 days; the majority healing spontaneously, with only one patient requiring surgical closure. There were no ‘hospital’ deaths. In the radiotherapy group the median duration of fistulae was 112 days with 30 patients requiring a total of 66 procedures to achieve closure of the fistula. There were six ‘hospital’ deaths in this group.

We conclude that previous radical radiotherapy strongly predisposes towards the occurrence of a postlaryngectomy fistula. Fistulae in this group tend to be longer lasting and are more likely to require surgical repair.
Beware bleeding from the ear
Authors: John D. G. , Porter M. J. , Van Hasselt C. A. , Med M.
Published: November 2007

We present the case of a 55-year-old man who presented with intermittent, profuse bleeding from the ear five years following radiotherapy for a nasopharyngeal carcinoma. He had developed osteoradionecrosis of the temporal bone, and the bleeding was shown to originate from an aneurysm of the internal carotid artery within his temporal bone. This has not previously been reported as a complication of radiotherapy for nasopharyngeal cancer.
Bay-leaf: an unusual oesophageal foreign body
Authors: Ahmed K. , McCormick M. S.
Published: November 2007

Bay-leaf as a foreign body causing oesophageal obstruction has rarely been reported. We presenttwo such cases, and review their management.
Paraganglioma of the external auditory canal
Authors: Singh K. B. , Hanna G. S. , Dinnen J. S.
Published: November 2007

A rare case of paraganglioma of the external auditory canal is presented. It was treated by excision and no recurrence has been noted after 18 months of follow up.
Osteomyelitis as a complication of a tracheo-oesophageal puncture
Authors: Cullen J. R. , Primrose W. J. , Vaughn C. W.
Published: November 2007

Two cases of osteomyelitis of the cervical spine complicating tracheo-oesophageal puncture are reported. There was considerable delay between onset of symptoms and diagnosis in both cases due to pre-existing cervical arthritis. Previous radiotherapy was felt to be a contributory factor in both cases.
Solitary fibrous tumour: Report of two new locations in the upper respiratory tract
Authors: Safneck Janice R. , Alguacil-Garcia Antonio , Dort Joseph C. , Phillips Susan M.
Published: November 2007

Solitary fibrous tumours are uncommon spindle cell neoplasms generally associated with serosal surfaces, especially the pleura (‘localized fibrous mesothelioma’). Recently, these tumours have been documented in extraserosal sites. We report two solitary fibrous tumours, including one occurring in the paediatric age group, arising in two previously unreported locations, parapharyngeal space and epiglottis. These cases expand the range of sites where this tumour may originate and confirm the tendency of extrapleural cases to involve the upper respiratory tract and adjacent structures.
Clinical correlates of acoustic neuroma morphology
Authors: Moffat David A. , Golledge Jonathan , Baguley David M. , Hardy David G.
Published: November 2007

Thirty–eight patients with vestibular schwannomas were reviewed. A correlation was found between tumour morphology and clinical presentation. Based on our knowledge of the variability in the neurilemmalneuroglial junction and therefore the site of origin of these tumours in relation to the internal auditory canal, a classification into three different appearances on magnetic resonance imaging was possible. Dumbbell shaped tumours (21 per cent) represented laterally arising schwannomas, lollipop shaped tumours (18 per cent) were medially arising and cone shaped tumours (61 per cent) were the more common intermediate form. Patients with laterally arising dumb–bell shaped tumours were more likely to present early with hearing loss and had smaller tumours than patients with medially arising lollipop shaped ones. The relatively well preserved hearing in patients with medially arising tumours made them more likely to present at a later stage with signs of trigeminal compression, cerebellar dysfunction and raised intracranial pressure.
A strangulated antrochoanal polyp. a case report
Authors: Ole-Lengine L. , Manni J. J.
Published: November 2007

A rare case of a strangulated antrochoanal polyp is reported.
Isolated sphenoid sinusitis due toPseudallescheria boydii
Authors: Watters G. W. R. , Milford C. A.
Published: November 2007

A case of sphenoid sinusitis due toPseudallescheria boydiiis described in a 52-year-old non-immunocompromised woman. Treatment should always involve surgical drainage, and antifungal chemotherapy may be of benefit if there is histological evidence of invasion of surrounding tissue. ForP. boydiiinfection miconazole should be the agent of choice, rather than amphotericin B. For this reason it is important to obtain culture and histological examination of sinus contents if fungal infection is suspected.
Complications of pharyngeal myotomy for alaryngeal voice rehabilitation
Authors: Scott P. M. J. , Bleach N. R. , Perry A. R. , Cheesman A. D.
Published: November 2007

Over the eight-year period to May 1991,256 patients were referred for post-laryngectomy voice rehabilitation. Videofluoroscopy identified 81 (32 per cent) who required pharyngeal myotomy for a spastic pharyngooesophageal segment. Forty-two of these (37 male, 5 female and average age 63 years) had their surgery performed at this unit with a complication rate of 17 per cent and an average post-operative stay of 10 days (range 4–41 days). The place of the operation for pharyngeal myotomy in post-laryngectomy voice rehabilitation is discussed.
Cannabis in the external ear
Authors: Mason Julian , O'Flynn Paul , Gibbin Kevin
Published: November 2007

ENT surgeons may well be asked to remove cannabis from the external ear where it has been lodged for various reasons. We report two cases and review four other cases we found in the literature to illustrate some of the difficulties. It is important that anyone working with people who abuse drugs are aware that cannabis can be concealed in the external ear.
A new technique using cultured epithelial sheets for the management of epistaxis associated with hereditary haemorrhagic telangiectasia
Authors: Milton Catherine M. , Shotton J. C. , Premachandran D. J. , Woodward Barbara M. , Fabre J. W. , Sergeant R. J.
Published: November 2007

A new technique for the treatment of severe epistaxis associated with hereditary haemorrhagic telangiectasia is described. The nasal septum and inferior turbinates, surgically denuded of respiratory epithelium, were grafted using autografts of cultured epithelial sheets derived from buccal epithelium. All patients upon whom this technique has been used have shown considerable lessening in the frequency and severity of their epistaxes although two patients received grafts on two occasions, in each case approximately three months apart. It is postulated that a nasal lining of stratified squamous epithelium is likely to be more resistant to trauma than the normal respiratory type, and this is supported by the observation that bleeds very seldom occur from the oral cavity in this syndrome.
The management of multiple paraganglioma of the head and neck
Authors: Sillars Hamish A. , Fagan Paul A.
Published: November 2007

During the years 1984 to 1991, of 32 patients who had one large glomus or carotid body tumour, six were found to have other paragangliomas. Excluded from the above total of 32 are patients whose only lesion was a solitary glomus tympanicum. No two patients had identical problems and no pattern emerged on which patient management in any particular case could be based. The major problems associated with the tumours themselves and their treatment is the risk to hearing and the lower cranial nerves. Individual cases and their treatment are discussed.
Co-N reaction – a new serological activity index – on Wegener's granulomatosis
Authors: Ikeda Makoto , Tsuru Sumiaki , Ohmori Toshihiro , Kitahara Satoshi , Inouye Tetsuzo , Healy Gerald B.
Published: November 2007

Cordyceps ophioglossoides is one of the Japanese old ’Kanpoh‘ drugs used for metrorrhagia as a decoction. We found that CO-N, a galactosaminoglycan from Cordyceps ophioglossoides, reacted with sera from patients with some collagen diseases. By using CO-N, we made a new serological activity index (CO—N reac tion). In the present study, we investigated CO-N reaction on patients with Wegener's granulomatosis (WG). The aggregation titres of CO-N (CO-N numbers) displayed a possible correlation with their clinical activity. CO-N reaction might also serve an important role in supporting the diagnosis of active WG and in helping to assess the degree of disease activity. The purpose of this report is to introduce this new serological activity index for Wegener's granulomatosis.
Hearing loss fluctuating with blood sugar levels in Ménière's disease
Authors: Rudd Michael J. , Harries Meredydd L. I. , Lynch Cathy A. , Moffat David A.
Published: November 2007

An unusual case of a patient with bilateral Meniere's disease is described whose disease presented in the second ear as a sensorineural hearing loss which fluctuated with the patient's level of blood glucose. The literature concerning the role of abnormal glucose metabolism in Meniere's disease is reviewed and the investigation and management of this patient's condition is discussed.
Acquired aphasia without deafness in childhood – the Landau-Kleffner syndrome
Authors: Hughes A. P. , Appleton R. E. , Hodgson J.
Published: November 2007

A young boy presented with loss of speech and behaviour disturbance and was thought to be deaf. He was subsequently found to have the Landau-Kleffner syndrome (LKS), or acquired aphasia with epilepsy. Children with this disorder commonly present to an audiology or ENT clinic. Early recognition is important to initiate supportive, speech and educational care.
Recurrent laryngeal papillomatosis: a case of florid papillomatosis following a remission of 30 years
Authors: Daya H. , Gallimore A.
Published: November 2007

Laryngeal papillomatosis is the commonest benign tumour affecting the larynx. Two forms are found i.e. juvenile onset and adult onset. Typically the juvenile onset form has a greater rate of recurrence and often remits with the onset of puberty (Corbitt et al., 1988). The human papilloma virus (HPV) is the causative agent (Abramson et al., 1987; Corbitt et al., 1988), specifically types HPV6 and 11. Attempts have been made to correlate the clinical behaviour of these two modes with the viral serotype and other aetiological factors such as smoking and hormonal factors (Abramson et al., 1987; Rimmel et al., 1992). Studies, however have shown that there is considerable variation in behaviour (Steinberg et al., 1983; Corbitt et al., 1988; Crissman et al., 1988). It is widely accepted that the disease ‘burns’ itself out, particularly with respect to the juvenile form. It is interesting and unusual therefore when the disease reappears after many years of remission. The following case report illustrates this point.
Parapharyngeal space tumour presenting as recurrent uvular oedema
Authors: Wareing M. J. , Irving R. M. , Moffat D. A.
Published: November 2007

Neoplasms of the parapharyngeal space are uncommon and usually present as an intra-oral or neck mass. They often elude early diagnosis due to their deep-seated nature. Here we report a case presenting with recurrent oedema of the uvula. The pathophysiology of this previously unreported mode of presentation is discussed.
Post-surgical necrotizing palisading granuloma of the nose
Authors: Parham D. M. , Padgham N. D.
Published: November 2007

The finding of granulomata in nasal polyps is rare. In this report we describe a case with necrotizing granulomata occurring after surgery. The differential diagnosis of such a finding is discussed.
Day-case tonsillectomy: a review of the literature
Authors: Tewary A. K.
Published: November 2007

Abstarct

Adenotonsillectomies are performed increasingly as day cases in North America and Canada. This paper analyses reports where such tonsillectomies were performed. It is possible to successfully select a group with lower risk of complications. Haemorrhage occurs either early in the post-operative period or later than 24 hours after operation. With good organization tonsillectomies can be safely performed as day cases.
A study of haemostasis following tonsillectomy comparing ligatures with diathermy
Authors: Watson M. G. , Dawes P. J. D. , Samuel P. R. , Marshall H. F. , Rayappa C. , Hill J. , Meikle D. , Murty G. E. , Deans J. A. J. , Telios G. , Aldren C. , Birchall J. P. , Pritchard A. J. N. , Livesey J. , Appleton D.
Published: November 2007

Abstarct

The use of diathermy to achieve haemostasis after tonsillectomy remains controversial. We have reviewed the English language literature, and found no convincing evidence that diathermy is any more likely to cause post-operative haemorrhage than the use of ligatures. The results of a prospective, randomized study of 1036 consecutive tonsillectomies are presented. No significant difference was found in post-operative haemorrhage rates when either diathermy or ligatures were used. Diathermy was found to reduce operating time compared to ligatures. The possibilities for day-case tonsillectomy are discussed.
Temporal bone dissection using a low cost miniature electric drill
Authors: Lindsey L. A. , Hopper I.
Published: November 2007

Abstarct

The performance of various specialzed and general purpose drills was assessed for use in temporal bone dissection. The Minicraft MB120 and MB130 were found to be as effective as specialized drills but with grater convenience and much reduced cost. The use of these drills allows high quality temporal bone dessection to be performed on a limited budget.
Leiomyoma of the paranasal sinuses
Authors: Harcourt J. P. , Gallimore A. P.
Published: November 2007

Abstarct

The paranasal sinuses are a rare site for tumours of myogenic origin. There has been only one previously reported case in the English literature. We present a case of a leiomyoma filling the anterior ethmoid sinus and middle meatus which was excised via a Patterson's external ethmoidectomy.
Cystic hygroma of the parotid gland
Authors: Goshen S. , Kfar-Saba D. Ophir
Published: November 2007

Cystic hygroma of the parotid gland is an uncommon benign congenital neoplasm that presents as an asymptomatic soft fluctuant mass. Cervical ultrasonography, computerized tomography (CT) and magnetic resonance imaging (MRI) are used to assess the size and extent of the lesion and to assist in planning the surgical approach. Ultrasonography may demonstrate a multilocular cystic mass containing septa of variable thicknesses. Extension of the mass into deeper structures is more accurately assessed by CT or MRI. A CT scan may show thin-walled cystic masses filled with material of density close to that of water. The use of contrast medium can demonstrate the relationship of the lesion to the surrounding structures. Magnetic resonance imaging is superior to CT in defining the nature and extent of the lesion.
Nasal packing after routine nasal surgery—is it justified?
Authors: Schoenberg Marcelle Von , Robinson Philip , Ryan Rowena
Published: November 2007

Ninety-five patients undergoing routine nasal surgery were enrolled into a randomized, prospective trial to investigate the efficacy and morbidity of nasal packing. The patients were randomized to receive a bismuth iodoform paraffin paste (BIPP) pack, a Telfa pack or no pack. Patients for septal surgery were randomized between the BIPP and Telfa groups only. They were independently randomized to receive or not receive, a silastic nasal splint for the first post-operative week.

Post-operative pain levels were analysed using a visual analogue scale. Mean pain scores were increased 50 per cent by the use of nasal packs and pack removal, particularly BIPP which, was a most painful event (p<0.001).

Reactionary haemorrhage occurred in only two patients (2.1 per cent), both of whom had packs in situ. Vestibulitis was unique to the patients with a silastic splint, who were packed with BIPP, occurring in 21 per cent of them. Similarly septal perforation was unique to this group. There was no significant difference in the incidence of adhesions between the groups which received packs and those who did not.

Routine nasal packing, especially with BIPP, would seem difficult to justify in view of the increased pain levels and increased complications which occur without any demonstrable benefit in the majority of patients. Therefore packing should be reserved for cases where there is concern about persistent haemorrhage. In these cases Telfa would be preferable to BIPP.
A comparison of radiotherapy and surgery as primary treatment in the management of T3N0M0glottic tumours
Authors: Simpson D. , Robertson A. G. , Lamont D.
Published: November 2007

Seventy-four patients with Stage T3NOMOsquamous carcinoma of the glottis were treated initially by either surgery or radiotherapy between 1980 and 1985. The treatment adopted was determined by consultant preference. The long-term survival in both groups was approximately the same. Of 38 patients treated initially by radiotherapy, 25 had local recurrence. Fifteen of these underwent salvage surgery and 10 died of disease. Thirteen patients (33 per cent) retained their larynx. One of the major advantages of treating patients with stage T3NOMOcarcinoma of larynx by radiotherapy initially is that approximately one-third will retain their larynx. Local recurrences can usually be treated readily by salvage surgery.
Extranotochordal chordoma presenting as multiple neck masses: report of a case
Authors: Thakar A. , Tandon D. A. , Bahadur S. , Vijayaraghavan M.
Published: November 2007

Chordomas are rare tumours which arise from notochordal remnants. A primary cervical chordoma of extranotochordal origin, sparing osseous structures, was excised by a bilateral neck dissection. The patient was disease-free two and a half years later.
Cervical thymic cyst–a case record
Authors: Shenoy P. K. , David V. C.
Published: November 2007

Cystic lesions of the thymus are rare. In a large series of over 200 mediastinal cysts only 12 cases of thymic cysts have been reported (Seltzer et al., 1968). Cervical thymic cysts are so rare that only 35 cases have been documented in the English literature. (Al-Shihabi and Jackson, 1982).
Carotid sinus syndrome in parapharyngeal tumours
Authors: Richardson Helen C. , Mccombe Andrew W.
Published: November 2007

We describe three cases of metastatic carcinoma in the parapharyngeal space associated with the Carotid Sinus Syndrome. This has not been previously described.
The behaviour of tympanic membrane perforations in tissue culture: a scanning electron microscopic study
Authors: Olsen Erling Grønvold , Stenfors Lars-Eric
Published: November 2007

The effects of keeping rat tympanic membranes with an artificially made pars tensa perforation in tissue culture were observed under a scanning electron microscope. After one day and onwards, spreading and thickening of the keratinizing, outer squamous epithelium (OE) was noted. In addition, ballooning of the innermost cells of the outer epithelium apposing the inner tympanic epithelium (IE) was seen. No appreciable reaction was noted in the connective tissue layer of the drum. The inner tympanic epithelium appeared to be swollen, containing spherical structures in the cytoplasm, especially close to the area of contact with the outer meatal epithelium. No complete cover of the drum defect was seen after 14 days of tissue culture. Hyperplasia and spreading of the keratinizing, outer squamous epithelium of the drum is not sufficient to achieve covering of a drum perforation and complete healing cannot take place unless supported by granulation tissue formation.
Middle ear lipoma
Authors: Abdullah V. , Williamson P. , Gallimore A. , Shah N. S.
Published: November 2007

We report a case of primary middle ear lipoma diagnosed in the right ear of a five-year-old child with concurrent bilateral middle ear effusions. The lipoma occupied a site favoured by congenital cholesteatoma and was occlusive to the eustachian tube contributing to its dysfunction. This is the first case of de novo middle ear lipoma diagnosed in the UK, and the third in world literature. Our CT scans are suggestive of a similar but smaller lesion in the left ear of the same child.
Malignant mesenchymoma of the retropharyngeal space
Authors: Leong H. K. , Kwan C. Y. W. , Stanley R. E. , Tow S.
Published: November 2007

Malignant mesenchymoma is a very rare head and neck tumour. To date only 15 cases have been reported in world literature and all in children under 16 years of age. We present here a case of a 40-year-old man with malignant mesenchymoma of the retropharyngeal space. The clinical picture is that of progressive dysphagia, voice change, snoring and dyspnoea. CT scan showed a soft tissue space-occupying lesion of the retropharyngeal space which enhanced very well with intravenous contrast. The tumour was excised in toto and the patient given post-operative radiotherapy. Histopathology showed two unrelated differentiated tissue types (bone and fat) in addition to the fibrosarcomatous element thus satisfying Stout's criteria (Stout, 1948) for a diagnosis of malignant mesenchymoma.
Tumours metastasizing to the head and neck – a report of seven cases
Authors: Mochimatsu Izumi , Tsukuda Mamoru , Furukawa Shigeru , Sawaki Shuji
Published: November 2007

Metastatic tumours involving the head and neck region are rare. Over the past 18 years, seven such cases were treated at our clinic. Of those, four were in one of the paranasal sinuses, three had arisen from a primary hepatocellular carcinoma and one from an osteogenic fibrosarcoma of the leg. In the remaining three cases, metastases to the larynx, the tonsil, and the parotid gland arose from a primary renal cell carcinoma, a thyroid carcinoma, and a breast carcinoma, respectively. In metastatic tumours, the primary site can often be identified by the histopathological features. Accordingly, when malignant head and neck tumours are suspected of being metastatic in character, it is important to search carefully for the primary site.
The deafness, pre-auricular sinus, external ear anomaly and commissural lip pits syndrome – otological, vestibular and radiological findings
Authors: Marres H. A. M. , Cremers C. W. R. J. , Huygen P. L. M. , Joosten F. B. M.
Published: November 2007

Commissural lip pits, pinna dysplasia, pre-auricular sinus and hearing loss constitute a recently described autosomal dominant branchial arch syndrome. In a large family, eight out of the 74 members were also affected by conductive hearing loss. No inner ear abnormalities could be demonstrated on the CT scans. In three patients (four ears) out of four patients (six ears), exploratory tympanotomy revealed serious ossicular chain anomalies. In one ear, round window aplasia was also present. Long-term hearing improvement could only be achieved in one ear.
Use of the Carden anaesthetic tube for surgery around a tracheostome
Authors: Strachan David R. , Grace Andrew R. G. , Jackson Ian J. B. , Richardson Gill L.
Published: November 2007

This short communication describes the use of the Carden anaesthetic tube during surgery in and around a tracheostome. The technique, which greatly facilitates access to the operating field, is described along with it's indications and contraindications.

We would like to recommend extending the use of the Carden tube to operations around a tracheostome, thereby maximizing surgical access.
True mailgnant mixed tumour of a minor salivary gland
Authors: Toynton S. C. , Wilkins M. J. , Cook H. T. , Stafford N. D. S.
Published: November 2007

True malignant mixed tumours (carcinosarcomas) of salivary gland origin are rare and not widely recognized lesions. These tumours account for approximately 0.2 per cent of all malignancies of the major salivary glands (Stephen et al., 1986). They usually occur in pre-existing pleomorphic ademonas of major salivary glands and have an aggressive and often rapidly fatal progression.

We report a case of carcinosarcoma in a minor salivary gland of the upper lip. Its management and the use of immunocy-tochemical stains to demonstrate the separate epithelial and connective issue components are discussed.
Sudden deafness in vestibular schwannoma
Authors: Moffat David A. , Baguley David M. , von Blumenthal Hubertus , Irving Richard M. , Hardy David G.
Published: November 2007

Twelve per cent of a series of 284 patients with vestibular schwannoma presented with sudden deafness. If sudden sensorineural hearing loss is present then it is very likely to be the main presenting symptom. The mean length of patients' history is eight months shorter in this group than in the non-sudden deafness group. Sixteen per cent of vestibular schwannoma patients without sudden deafness present with a 'dead' ear whereas 29.5 per cent of those presenting with sudden deafness have total hearing loss. There was no significant difference between the sudden deafness group and the 'all others' group with regard to tumour size, udiogram shape, caloric test, imbalance, and facial numbness. Although the numbers of patients with sudden deafness in this series were too small to reach significance, on the basis of the clinical correlation of vestibular schwannoma morphology it is possible to postulate that compression of the vasculature within the bony internal auditory canal by a laterally arising tumour may be the aetiological factor and may be more likely to occur than in more medially arising tumours.
Tracheobronchial involvement of laryngeal papillomatosis at onset
Authors: Franzmann Maria-Benedicte , Buchwald Christian , Larsen Per , Balle Viggo
Published: November 2007

A case of adult onset laryngeal papillomas with tracheal and bronchial involvement present at onset is presented. The presence of human papilloma virus (HPV) DNA type 6/11 is demonstrated by in situ hybridization.
Tripod allograft in reconstruction of incudal lesions
Authors: Luntz Michal , Bentacur Talia Mark , Sadé Jacob
Published: November 2007

Long-term results of allograft ossiculoplasty with erosion of the long process of the incus in 44 patients are described. The pyramidal-shaped allograft leans on the stapes, the remaining part of the incus and the side of the malleus - forming a ‘tripod’ shape or construction.

The study includes two groups of patients: group A (34 patients) in whom the pre-operative three-frequency average air-bone gap was 20 dB or more and group B (10 patients), in whom the pre-operative air-bone gap was less than 20 dB. In the latter group the indication for surgery was not their hearing loss, but a different pathological condition (infected retraction pocket, a cholesteatoma, etc.) which necessitated surgical disconnection of the chain during the operation.

The average period of follow-up 46 months for group A and 24.9 months for group B. In group A, the preoperative average air-bone gap was 33 dB. Following surgery, the air-bone gap was 20 dB or less in 27 ears (79 per cent), and 10 dB or less in 18 of them (53 per cent). In group B, pre-operatively, the average air-bone gap was 11 dB. Following surgery, the air-bone gap was either better than before the operation or did not increase by more than 5 dB in eight patients (80 per cent).

Comparison of the audiometric results of 20 patients after mean follow-up times of 23.8 months and 64.9 months shows that no deterioration of hearing occurred in the intervening period. Graft extrusion was not observed in any of the operated ears.
Burning sensation in the throat – should it be named caloripharyngeus?
Authors: Bhargava K. B. , Uppal P. K. , Bhargava S. K. , Nanivadekar S. A. , Shirali G. N.
Published: November 2007

A burning sensation in the throat is often complained of by patients, but this symptom has been neglected in the literature. To emphasize its importance, should we give the name ‘caloripharyngeus’ to the symptom of burning in the throat? A preliminary study of 30 patients with the sensation of burning in the throat is presented in this study. Of the patients studied 73.33 per cent had hyperacidity detected for the first time. Reflux was presented in only one patient; four patients showed oesophagitis in the lower one-third of the oeosphagus; 90 per cent of the patients responded to antacids. We suggest that one of the causes of burning in the throat is a referred sensation due to hyperacidity.
Arterial anomalies of the middle ear associated with stapes ankylosis
Authors: Pirodda A. , Sorrenti G. , Marliani A. F. , Cappello I.
Published: November 2007

An aberrant internal carotid artery in a young woman complaining of pulsatile tinnitus and conductive hearing loss was diagnosed pre-operatively by CT scan and angiographic findings. An exploratory tympanotomy was performed in order to evaluate the cause of the severe conductive hearing loss. It was possible to detect a large persistent stapedial artery associated with a stapedial fixation of unknown cause. Despite these vascular anomalies a stapedotomy was performed successfully.
Vertebro-carotid anastomosis as a cause of uncontrollable epistaxis
Authors: Manohar M. Babu , Sharp J. F. , Johnson A. P.
Published: November 2007

Uncontrolled epistaxis may require a long hospital stay, multiple blood transfusions and multiple arterial ligations. Thiscase report highlights vertebro-carotid anastomosis as a rare cause of uncontrolled epistaxis. The importance ofangiography in the identification of rare arterial anastomoses is stressed.
Unusual association of secondary tonsillar and cerebral tuberculosis
Authors: Adiego M. I. , Millán J. , Royo J. , Dománguez L. , Castellote M. A. , Alfonso J. I. , Vallés H.
Published: November 2007

The patient was a 50-year-old alcoholic man with a left palatine tonsillar ulcer. Histopathological and bacteriological studies established the diagnosis of tonsillar tuberculosis with asymptomatic advanced pulmonary tuberculosis and multiple cerebral supra- and infratentorial tuberculomas previously unnoticed.
Decisive role of immunocytochemistry in aspiration cytology of chordoma of the clivus: A case report with review of the literature
Authors: Gherardi Giorgio , Marveggio Cristina , Cola Claudio , Redaelli Gianantonio
Published: November 2007

Immunocytochemistry (ICC) proved to be an essential adjunct in the fine-needle aspiration (FNA) cytological diagnosis of chordoma of the clivus in a 62-year-old woman. The cytological picture in routinely stained smears was not entirely diagnostic for chordoma due to the paucity of typical ‘physalipherous’ cells. To exclude other primary or metastatic neoplasms of the skull base possibly sharing the same cytological picture, additional direct smears were immunostained with antibodies specific for cytokeratin (CK), vimentin (VIM), SI00 protein (SIOOP), carcinoembrionic antigen (CEA), epithelial membrane antigen (EMA), glial fibrillary acidic protein (GFAP), CD68 antigen (KP1) and with the ‘panepithelial’ antibodies B72.3 and Ber-EP4. Chordoma cells showed the following immunoprofile: CK+/VIM−/S100P+/CEA−/EMA+/GFAP−/B72.3−/Ber-EP4−/CD68+. The pattern of immunoreactivity for CK, S100P and CEA confirms previously reported data, while the B72.3−/Ber-EP4−/CD68+ staining profile represents a novel observation. The etection of a CK+/S100+/CEA−/B72.3−/Ber-EP4− immunocytological profile of chordoma cells in aspirates is a basic requirement to exclude pertinent diagnostic differentials, such as metastatic carcinoma, ependymoma and sarcoma, and permits a reliable pre-operative diagnosis of the tumour by aspiration cytology.
Wegener's granuloma – presenting as a unilateral parotid swelling
Authors: Benson-Mitchell R. , Tolley N. , Croft C. B. , Roberts D.
Published: November 2007

Wegener's granuloma is a systemic necrotizing vasculitis which predominantly affects the upper and lower respiratory tracts and kidneys. The nose and paranasal sinuses are often the first or main sites to be affected. Equally ear involvement is common and a recognized early manifestation of the disease. Salivary gland involvement is rare and is usually part of more widespread systemic involvement.

We present a 34-year-old female with a six-week history of hearing loss and a unilateral parotid swelling. One year previously she was diagnosed as having myalgic encephalomyelitis following a long period of post-viral malaise. The case points to the difficulties encountered when Wegener's granuloma presents in an unusual and varied way. A high index of suspicion coupled with early diagnosis and treatment is essential. The patient made a good recovery.
Hyperacusis and Williams syndrome
Authors: Nigam Ajay , Samuel Peter R.
Published: November 2007

Abnormal sensitivity to environmental sounds is a short-term feature often observed following insertion of grommets. Here we describe a child with this symptom who was found to have Williams syndrome, a condition in which hyperacusis is observed in 95 per cent of patients.
Clear cell carcinoma arising in a pleomorphic adenoma of the submandibular gland
Authors: Cassidy Michael , Connolly Charles E.
Published: November 2007

Clear cell carcinoma of salivary gland is a rare neoplasm. We report a third case of clear cell carcinoma arising in a pleomorphic adenoma and also in an extraparotid location. We document the immunohistochemical profile of the tumour including reactivity with a marker for the c-erbh-2 oncoprotein and suggest a myoepithelial origin for these lesions. The presence of a tetraploid stemline may account for the rapid tumour progression in this case.
The ‘Allan Johnson’ voice prosthesis. A modification of the Bivona voice prosthesis for immediate post-fitting aphonia after secondary tracheo—oesophageal puncture
Authors: Spraggs P. D. R. , Perry A. , Cheesman A. D.
Published: November 2007

Abstract The combination of a narrow oesophageal lumen and a hypertonic pharyngo-oesophageal (P-E) segment following laryngectomy and secondary tracheo-oesophageal puncture (TEP) can cause obstruction of a voice prosthesis and consequently prevent phonation. The ‘Allan Johnson’ modification of the Bivona voice prosthesis incorporates a stainless steel slide and has been successfully used to remedy such a circumstance.
Infratemporal hydatid cyst – unusual location of echinococcosis
Authors: Sennaroḡlu Levent , ÖNercĩ Metin , Turan Ergĩn , Sungur Arzu
Published: November 2007

Hydatid disease is an important medical problem in countries of the temperate zones. Only occasional cases are reported in the head and neck region. An unusual location for hydatid disease in the infratemporal fossa is presented. Characteristics of this rare disease together with treatment modalities are discussed.
The role of ultrasound in the management of peritonsillar abscess
Authors: Ahmed K. , Jones A. S. , Shah K. , Smethurst A.
Published: November 2007

A distinction between a peritonsillar abscess and peritonsillitis is useful clinically, as the former requires surgical drainage while the latter merely requires treatment with antibiotics. To evaluate the diagnostic implications of performing ultrasonography of the tonsils in patients with clinically diagnosed peritonsillar abscess, 27 patients underwent ultrasound examination before needle aspiration of the abscess was performed. Ultrasound was able to detect peritonsillar abscess in91 per cent of the cases (sensitivity rate), with a false negative rate of nine per cent and a false positive rate of 20 per cent. The specificity of the test was 80 per cent, and was able to differentiate abscess from peritonsillitis in 88.9 per cent. On the basis of these results we conclude that ultrasonography of the tonsils in patients thought to have peritonsillar abscess is a useful adjunct, enhancing diagnostic accuracy and reducing unnecessary surgical drainage.
Hearing loss after neurosurgery. The influence of low cerebrospinal fluid pressure
Authors: Walsted Alice , Nielsen Ole Amtoft , Borum Peter
Published: November 2007

A prospective study was performed to investigate the effect of neurosurgery on hearing. Thirty-two patients underwent neurosurgery while 32 patients who had surgical procedures not involving puncture or drainage of the subdural space, served as a control group. In the neurosurgical group, a significant loss of hearing was observed in the immediate post-operative period, with recovery over one week. No average threshold shift was observed in the control group. It is suggested that following neurosurgery the mechanism of hearing loss results directly from a decrease in pressure and/or volume of the cerebrospinal fluid, which is reflected within the perilymphatic fluid, comparable to a transitory endolymphatic hydrops.