bluuebunny/crossref_metadata_2025 huggingface dataset:
Facial nerve recovery after acoustic neuroma removal
Authors: Moffat D. A. , Croxson G. R. , Baguley D. M. , Hardy D. G.
Published: November 2007

A retrospective analysis of 76 patients who underwent acoustic neuroma removal is reported. Facial nerve function prior to surgery and tumour size are assessed with respect to final facial nerver recovery and the need for surgical rehabilitation. Both pre-operative facial weakness and tumour size greater than 2.5 cm. are shown to be predictive factors of poor facial nerve recovery. Multiple surgical rehabilitative procedures are often required when inadequate function and/or cosmetic results are obtained. Primary nerve repair and facial-hypoglossal anastomosis give better rehabilitative results than dynamic and static procedures. The association of tumour size greater than 2.5 cm. with increased risk of poor facial recovery re-emphasizes the need to detect and remove acoustic neuromas at an early stage.
Chronic aspiration and laryngeal competence
Authors: Bevan K. , Griffiths M. V.
Published: November 2007

Aspiration into the lower respiratory tract can be detrimental to life. Ten patients, suffering from neurological dysphagia with aspiration, were studied. Neurological disorders can cause inadequate glottic closure resulting in aspiration. It has not been well recognized however, that even patients who have full glottic closure are still capable of aspirating in the pre- and post-deglutition stages of swallowing. The combined techniques of videofibrolaryngoscopy and videofluoroscopy are found to be the best methods for demonstrating these abnoralities. Development of new techniques, in the prevention of aspiration, should also take into account silent, pre- and post-deglutitional aspiration.
Cryptococcosis of the larynx
Authors: Smallman Lesley A. , Stores Olga P. R. , Watson M. G. , Proops D. W.
Published: November 2007

An unusual case of cryptococcosis of the larynx is described in a non-immunocompromised patient. To our knowledge this is the second reported case in the literature.
Metastatic bone marrow involvement from supraglottic squamous cell carcinoma
Authors: Toner G. C. , Thomas R. L. , Schwarz M. A.
Published: November 2007

A case of an aggressive supraglottic squamous cell carcinoma, which was managed with neo-adjuvant chemotherapy and radical surgery, is described. The post-operative course was of rapid deterioration and death due to progressive metastatic disease involving bone marrow and liver. This is the first reported case of bone marrow infiltration by squamous cell carcinoma of the head and neck diagnosed ante-mortem. The incidence and pattern of metastatic disease from head and neck tumours is reviewed, and the importance of initial staging in determining the risk of distant metastatic disease is emphasised.
Bacteriology of otitis media with effusion
Authors: Sriwardhana K. B. , Howard A. J. , Dunkin K. T.
Published: November 2007

A study was undertaken to evaluate the prevalence and antibiotic susceptibility of bacteria present in the middle ear of patients with otitis media with effusion. Middle ear effusions (MEE), nasopharyngeal and throat swabs were obtained at operation and cultured for aerobic and anaerobic bacteria. Two hundred and fifty-nine effusions were obtained from 152 subjects examined.Haemophilus influenzaewas isolated from 32 (12.3 per cent) effusions.Streptococcus pneumoniaefrom seven (2.7 per cent),Staphylococcus aureusfrom seven (2.7 per cent), Branhamella catarrhalis from one (0.4 per cent)—Group A β haemolytic streptococci from one (0.4 per cent) andStaphylcoccus epidermidisfrom three (1.9 per cent). The occurrence of respiratory pathogens in MEE reflected their prevalence in the upper respiratory tract. Significantly fewer children who had received antibiotics prior to surgery had organisms present in the MEE. Eight and a half per cent ofH. influenzaeand 64 per cent ofB. catarrhaliswere resistant to ampicillin. The present study confirms that bacteria are present in the middle ear in a significant number of patients with otitis media with effusion.
Cerebrospinal fluid in the rhinitis clinic
Authors: Brockbank M. J. , Veitch D. Y. , Thomson H. G.
Published: November 2007

The Rhinitis Clinic at the Royal National Throat Nose and Ear Hospital is a direct referral clinic dealing with approximately 300 new cases a year. Last year three cases of spontaneous CSF rhinorrhoea were liagnosed. In each case long term topical steriod sprays had been prescribed and the patients had been eferred for further management of their ‘rhinitis’. Spontaneous CSF rhinorrhoea is potentially life hreatening as failure to recognize the problem may lead to the development of meningitis and possibly death. The diagnosis is simple and is based on a good clinical history which may be confirmed by chemical pathology. Radiology is often non-contributory, the site of the leak may have to be identified at surgery. Morbidity and mortality are reduced if an extracranial, trans-nasal/external ethmoid route for repair of the istula is employed.

Three case reports are presented and the diagnosis and management of CSF rhinorrhoea is reviewed.
Psychogenic stridor
Authors: Skinner D. W. , Bradley P. J.
Published: November 2007

Obstruction of the laryngeal airway is a life threatening problem due normally to obstructive pathology within the upper aero-digestive tract. We describe four cases of laryngeal stridor (two adults and two children) of psychogenic origin, one of which required a tracheostomy. The literature is reviewed and the subsequent pattern of this disease documented on the basis of 28 patients previously described.
Eyelid necrosis complicating acute maxillary sinusitis
Authors: Hill J. , Alun-Jones T.
Published: November 2007

Orbital cellulitis is a well recognized complication of paranasal sinusitis. Fearon et al. (1979) reviewed 6,770 cases of sinusitis, of which only 159 had orbital cellulitis. We report a case in which orbital cellulitis progressed to necrosis of the eyelids. This was treated by desloughing and split skin grafting.
Dermoids (‘hairy polyps’) of the oro-nasopharynx
Authors: McShane D. , El Sherif I , Doyle-Kelly W , Fennell G , Walsh M
Published: November 2007

Dermoids, or hairy polyps, are rare lesions affecting the head and neck region. To date approximately 120 cases have been recorded. They arise during early embryogenesis and are invariably benign. Unlike the more differentiated types of teratoma, hairy polyps are derived from only two germinal layers, ectoderm and mesoderm. Most originate in the oro-nasopharyngeal region, either as pedunculated or sessile masses. They usually present at, or soon after, birth with signs of upper aerodigestive tract obstruction. Treatment consists of surgical removal. In young children with airway compromise, the expertise of an experienced paediatric anaesthetist is essential.

Three new cases of hairy polyp are described to add to the present literature. Two originated in the nasopharynx and one in the oropharynx. Interestingly, one patient, a neonate, also suffered from severe osteopetrosis. All lesions were removed by simple surgical excision under general anaesthesia. There were no operative or post-operative complications.
Carcinoma of the ear: Retrospective analysis of 61 patients
Authors: Golding-Wood D. G. , Quiney R. E. , Cheesman A. D.
Published: November 2007

Malignant tumours of the ear canal and middle ear retain a poor prognosis despite the development of increasingly radical procedures. We report the combined experience of 61 patients presenting to our hospital over the past 30 years with this condition. Radiotherapy was the preferred initial treatment in almost all patients. Early surgical treatment by local resection just before or just after radiotherapy and radical mastoidectomy produced disease free survival for two to 20 years in 59 per cent (16 of 27) patients. Long term survival was achieved in 50 per cent of patients with carcinoma of the external auditory meatus and only 24 per cent of those with middle ear carcinoma. Salvage surgery produced a variable degree and duration of palliation but few survivors. Little was gained in the quality of life by petrosectomy.
Changing incidence of sinus infection in children
Authors: Knight L. C. , Lesser T. H. J.
Published: November 2007

This study presents the results of a 20 year review of maxillary sinus wash-outs performed on children. The results show a decreasing incidence of purulent sinusitis over the study period.

Only 17 per cent of antral wash-outs undertaken yielded pus, indicating that surgical practice has failed to adequately take account of the changing disease incidence.
Carcinoma of the laryngeal saccule: a novel biopsy technique to make a difficult diagnosis
Authors: Habashi S. , padel A. F. , Capper J. W. R.
Published: November 2007

Tumours of the laryngeal ventricle and saccule are rare and difficult to diagnose endoscopically. We present a case in which the tumour remained confined within the saccule, and describe how the problem of obtaining a positive biopsy was overcome.
Intravagal parathyroid adenoma
Authors: Takimoto T. , Okabe Y. , Ito M. , Umeda R.
Published: November 2007

An extremely rare case of intravagal parathyroid adenoma is presented. The tumour caused fusiform swelling of the left vagus nerve was shelled out. Post-operatively the left recurrent nerve palsy was recovered in the two months. Serum calcium level returned to normal on the tenth day after the surgical operation without symptoms of hypocalcaemia.
Carcinomas ex monomorphic adenoma of salivary glands
Authors: Luna Mario A. , Batsakis John G. , Tortoledo M. Eugenia , Junco G. W. Del
Published: November 2007

A clinicopathological analysis of eight examples of carcinomas arising from salivary gland monomorphic adenomas, carcinomas ex monomorphic adenoma, is presented. These uncommon to rare neoplasms have a predilection for the parotid glands, are diagnosed about a decade later than their benign precursors, and most often arise from the dermal analogue type of monomorphic adenoma. As judged by follow-up periods of two to 16 years, carcinomas ex monomorphic adenoma are locally aggressive neoplasms with the clinical course marred by recurrences but without regional or distant metastases.
Radical neck dissection: a 19-year experience
Authors: Maran A. G. D. , Amin M. , Wilson Janet A.
Published: November 2007

A series of 394 radical neck dissections performed over the 17 year period 1969–1986 is presented. The shortest period of follow-up is two years. Of the major complications reviewed, wound breakdown was associated with T stage, prior radiotherapy and incision used but not with age or N stage. Cervical recurrence was associated with N stage, prior radiotherapy and surgical incision and inversely associated with age. Wound breakdown and recurrence were lowest in parotid primary tumours. Carotid artery rupture occurred in 17 patients (4.3 per cent), was fatal in all cases and was strongly associated with wound breakdown and previous radiotheraphy. The importance of the choice of incision, clearance of the posterior belly of the digastric muscle and carotied artery protection are discussed.
Three cases of inter-sterno-costo-clavicular ossification associated with tonsillar infection
Authors: Furukawa M. , Miwa T. , Kamide M. , Sakumoto M. , Umeda R.
Published: November 2007

Three cases of inter-sterno-costo-clavicular ossification (ISCCO) associated with chronic tonsillitis are reported. Two cases had additional symptoms of pustulosis palmaris et plantaris (PPP). All the patients underwent tonsillectomy. The histological changes of the palatine tonsils of case 1 and case 2 were characterized by so-called focal small lacunar ulcers and periarteriolar fibrosis (onion-skin lesion). Some multinucleated giant cells were observed in case 2. Following tonsillectomy, symptoms in the clavicular region and the PPP improved. It is possible to consider that ISCCO is caused by focal tonsillar infection.
Otitis media with effusion as a presenting symptom of chronic sinusitis
Authors: Finkelstein Y. , Talmi Y. P. , Rubel Y. , Bar-Ziv J. , Zohar Y.
Published: November 2007

Otitis media with effusion was the presenting symptom in 23 per cent of patients suffering from chronic sinusitis. The inter-relationship between chronic sinusitis and otitis media with effusion was studied in 29 patients. Endoscopic evaluation of intranasal structures including sinus ostia and Eustachian tube orifices was carried out. We further suggest that otitis with media with effusion is not a separate entity but a presentation of sinus disease, predominantly of the ethmoid system. Patients with otitis media with effusion should be evaluated for sinusitis andvice versa. The value of careful nasendoscopy is demonstrated.
Transmastoid extracranial repair of CSF leaks following acoustic neuroma resection
Authors: Robson A. K. , Clarke P. M. , Dilkes M. , Maw A. R.
Published: November 2007

Acoustic neuromas may be resected either by a suboccipital craniectomy or translabyrinthine approach; the latter gives good access without unduly traumatising the brainstem, but can lead to a higher incidence of cerebrospinal fluid (CSF) leaks. The surgical management of these leaks can be difficult; we describe a transmastoid extracranial technique using pedicled sternomastoid muscle that has produced complete resolution of the leak in all cases managed in this way.
Nasal mucociliary clearance in patients with diabetes mellitus
Authors: Yue W. L.
Published: November 2007

Fifty insulin-dependent diabetics and 50 non-diabetics without a history of nasal disease have been studied for nasal problems including mucociliary function complicated by diabetes mellitus. For the diabetics, the mean value of nasal mucociliary clearance was considerably decreased and this was more often associated with dry noses but increased pH-values, both of which were higher than those for non-diabetics (p<0.05). As suggested in earlier literature, more aggressive nasal moistening therapy must be recommended for those patients presenting with these conditions in the light of systemic diabetic abnormalities.
Langerhan's cell histiocytosis in the sphenoid sinus: a case of diabetes insipidus
Authors: Hussain S. S. M. , Simpson R. D. , McCormick D. , Johnstone C. I.
Published: November 2007

We present a case of diabetes insipidus in a young man caused by Langerhan's cell histiocytosis of the sphenoid sinus with involvement of the pituitary gland. Diagnosis and management of this rare condition is discussed, along with a brief view of the literature.
Nasal airflow: resistance and sensation
Authors: Jones A. S. , Willatt D. J. , Durham L. M.
Published: November 2007

For many years nasal resistance to airflow measured by rhinomanometry has been regarded as the objective measure of nasal patency. However, recently it has become apparent that this may not be the case.

The present study was designed to affirm or refute this view by using large numbers of subjects and observations.

Five hundred estimations of (objective) nasal resistance to airflow and (subjective) nasal sensation of airflow where carried out.

No correlation could be demonstrated between these two parameters.

It is concluded nasal resistance to airflow and nasal sensation of airflow are two separate modalities which are not directly related. The possible reasons for this finding are discussed with reference to previous work on nasal sensation.
The lingual tonsil. A neglected symptomatic structure?
Authors: Golding-Wood David G. , Whittet Heikki B.
Published: November 2007

Surgical treatment of the lingual tonsil is seldom performed because problems attributable to chronic lingual tonsillar hypertrophy are infrequently diagnosed. We have reviewed a series of 25 patients with symptoms from enlarged lingual tonsils. The variety of presentation of lingual tonsillar lessions and the methods of surgical treatment are discussed.
Recurrent laryngeal nerve palsy following heart-lung transplantation: three cases of vocal cord augmentation in the acute phase
Authors: Murty G. E. , Smith M. C. F.
Published: November 2007

Three cases of left recurrent laryngeal nerve palsy following heart-lung transplantation are described. In each case, within twelve hours of extubation, the left vocal cord was injected with Teflon, and the paralyzed vocal cord thus displaced to the midline. Effective closure of the glottis was then possible, permitting an adequate cough, adequate clearing of the bronchial tree and minimising the risk of aspiration. Augmentation under general anaesthesia as soon as possible after discovery of vocal cord dysfunction is advocated. Suitable materials for injection are discussed. To our knowledge, this is the first reported series of vocal cord augmentation in the acute phase following heart-lung transplantation.
Adenosquamous carcinoma of the thyroid gland
Authors: Nicolaides A. R. , Evans P. Rhys , Fisher C.
Published: November 2007

A case of adenosquamous carcinoma of the thyroid gland is presented. This rare form of cancer behaves in an aggressive manner similar to anaplastic carcinoma and is characterized histologically by the intimate blending of the squamous and glandular elements. The prognostic significance of identifying areas of malignant squamous epithelium within papillary carcinoma as opposed to the much more common benign squamous metaplasia, is highlighted. The pathogenesis, differential diagnosis and management of the condition are discussed.
Symmorphosis in relation to the relative dimensions of the glottic and tracheal area in the mammalian larynx
Authors: Harrison D. F. N. , Denny Susan
Published: November 2007

A large number of non-human mammalian larynges have been studied in an attempt to relate body mass to maximum glottic and tracheal area in order to confirm symmorphism.
Calcium alginate fibre (Kaltostat 2) for nasal packing after trimming of turbinates—a pilot study
Authors: Sirimanna K. S.
Published: November 2007

Following surgical trimming of the inferior turbinates, 32 nostrils were packed with Calcium alginate fibre (Kaltostat 2 gramme fibre packs 80:20 per cent calcium:sodium) for 36–48 hours to achieve haemostasis. There was no bleeding while the packs were in place or after they were removed. These results were compared with two retrospective groups of patients who had undergone the same surgical procedure but the nostrils had been packed with alternative materials.
Myxoid tumours in the temporal bone
Authors: Charabi S. , Engel P. , Bonding P.
Published: November 2007

Myxoid tumours have the essential common feature, that they are difficult to remove radically because of their gelatinous consistency. Only one previous report describes a myxoid tumour—a myxoma—located to the temporal bone. This paper presents two such tumours in the temporal bone, a myxoma and an extraskeletal myxoid chondrosarcoma. The clinical and histological features of these tumours and the operative treatment are described and discussed.
Kawasaki syndrome in an adult
Authors: Thompson A. C. , Lamey P. J.
Published: November 2007

Kawasaki syndrome is a panvasculitis occurring principally in childhood. Symptoms include fever, ‘strawberry tongue’, cervical lymphadenopathy and dermatological signs. A rare case of Kawasaki syndrome in an adult presenting to the Otolaryngology department is reported. The clinical features of the disease are described highlighting its systemic nature. Treatment options and possible complications are discussed.
Laryngeal foreign bodies
Authors: Kent S. E. , Watson M. G.
Published: November 2007

This paper presents our experience with four cases of impacted laryngeal foreign bodies. A review of the literature reveals that the condition is rare, but far more dramatic and life threatening than bronchial foreign bodies. The history may not indicate the diagnosis, especially in the ethnic minority races where there is a language barrier. Suspicion of the diagnosis by the causalty officer and the immediate attendance of an experienced otolaryngologist may be life saving.

Radiological examination is not necessary where the diagnosis is obvious. If the diagnosis is in doubt it must be remembered that many foreign bodies are not radio-opaque. The patient must be accompanied at all times by an otolaryngologist until the foreign body is removed.
Blindness: A potential complication of bilateral neck dissection
Authors: Balm A. J. M. , Brown D. H. , De Vries W. A. E. J. , Snow G. B.
Published: November 2007

Permanent blindness, is a very rare, but devastating complication of simultaneous bilateral neck dissection. Most otolaryngologists/head and neck surgeons are unaware that amaurosis can result from this surgery, and this paper is meant as a poignant reminder of that end. A case report is presented, followed by a discussion of possible aetiology; a management protocol is proposed.
Sinusitis and the acute orbit in children
Authors: Swift A. C. , Charlton G.
Published: November 2007

Acute orbital infection is an uncommon condition which is often secondary to acute sinusitis. Although it can present in any age group it is most prevalent in children and may cause impaired vision, blindness, intracranial complications and death. This paper documents the experience at the Royal Liverpool Childrens Hospital, Alder Hey, from 1973 to 1989. Clinical details were recorded retrospectively from the hospital case notes. Sixty-eight children had orbital sepsis of whom 30 had associated acute sinusitis. Of these 30 children, orbital sepsis was always unilateral with a preference for the left side; ten had diplopia of whom four had a sub-periosteal abscess which was subsequently drained. There were no serious complications although two children had diplopia for two to three months.
Our experience in the surgical treatment of T1 carcinoma of the vocal cord
Authors: Daniilidis J. , Nikolaou A. , Symeonidis V.
Published: November 2007

From 1971 to 1986, 94 patients suffering from T1 glottic carcinoma underwent cordectomy at the University ENT Clinic of Thessaloniki, Greece. There were five female and 89 male patients with a median age of 61.7 years.

Two year survival rate was 93.7 per cent; five year survival rate was 93.2 per cent. Seventeen of the patients suffered recurrence, but 11 of them after laryngectomy or radiotherapy are alive with no sign of the disease. Tracheostomy was not performed in the majority of our cases. The relationship between the site of recurrence and survival as well as the role of radiotherapy before and after cordectomy in some of our patients are discussed.

We believe that despite the good results of radiotherapy in T1 carcinoma of the vocal cord and the introduction of other treatment modalities such as CO2 laser, cordectomy by laryngofissure is still of value with very good survival results and minimal discomfort for the patient.
Tracheal stenosis in infants and young children
Authors: Laing M. R. , Albert D. M. , Quinney R. E. , Bailey C. M.
Published: November 2007

Eight cases of intra-thoracic tracheal stenosis presenting to the ENT department at the Hospital for Sick Children, Great Ormond Street, over the past 10 years are reported. The varied aetiology and presentation of these cases is discussed and the frequency of associated cardio-pulmonary anomalies emphasized. Difficulties in diagnosis and investigation are outlined, in addition to an overview of current management. While the overall outlook for many of these children remains poor there is reason to believe that a balance of conservative management and surgical reconstruction in selected cases will result in improved survival figures.
Patulous Eustachian tube: A radiological perspective
Authors: Tolley N. S. , Phelps P.
Published: November 2007

The diagnosis of a patulous Eustachian tube relies mainly upon the history, examination and a clinical awareness of the condition. More recently, objective tests such as tympanometry and sonotubometry have been shown to be useful in confirming the diagnosis. This paper describes how computed tomographic imaging may also be useful in aiding the diagnosis. Supporting this, clinical cases of patulous tubes are demonstrated radiologically associated with congenital hemifacial microsomia and following radiotherapy for a nasopharyngeal carcinoma. The role of computed tomographic imaging in the diagnosis, research and monitoring of treatment for his condition is discussed.
Electrocochleography: a new technique
Authors: Hickey S. A. , Mitchell D. B. , Buckley J. G. , Fitzgerald O'Connor A. F. , Wunderlich J L.
Published: November 2007

The near field monitoring of an auditory evoked response from the cochlear (electrocochleography) is a tried and trusted clinical tool. Conventional techniques for performing electrocochleography are cumbersome to use and frequently uncomfortable for the patient. We present a simple, modified technique which provides more flexibility with regard to where and when electrocochleography may be performed and also improves patient comfort during the test.
Lymphogranuloma venereum of the tonsil
Authors: Watson D. J. , Parker A. J. , Macleod T. I. F.
Published: November 2007

A case of lymphogranuloma venereum of the tonsillar lymph tissue is presented. The similarities of tonsils to cervical lymph nodes are discussed and the importance of histological examination of abnormal tonsil tissue is reiterated.
Spontaneous dissection of the intrapetrous internal carotid artery
Authors: Saeed S. R. , Hinton A. E. , Ramsden R. T. , Lye R. H.
Published: November 2007

Two cases of cervicocephalic arterial dissection of the intrapetrous carotid artery are described. One patient presented with intolerable objective pulsatile tinnitus, the other with a cerebral infarction. Both were successfully treated with anticoagulants. The significance of minor degrees of trauma and of neck extension in the aetiology of these apparently spontaneous lesions is discussed.
Unusual case of bilateral conductive deafness
Authors: Hoare T. J. , Aldren C. J. , Morgan D. W. , Bull T. R.
Published: November 2007

A 30-year-old female presented with a ten-year history of bilateral conductive deafness. A pre-operative diagnosis of otosclerosis was made but at tympanotomy, the stapes crura in each ear was found to be disconnected from the foot- plate, the ossicular chain being otherwise normal. A Teflon-wire prosthesis was used to join incus and footplate, with good results. In the absence of a history of trauma or sepsis this may be a late presentation of a congenital stapedial anomaly which has not previously been reported.
Midline sublingual dermoid cyst
Authors: Al-Khayat M. , Kenyon G. S.
Published: November 2007

The case of an 18-year-old man who presented with a large cystic mass in the floor of the mouth extending into the left submandibular triangle of the neck is reported. Histopathology of this mass, which was totally excised by a combined intra-oral and cervical approach, confirmed it to have originated in ectodermal remnants (congenital dermoid cyst) and to be actively secreting sebum. This case is reported both because dermoids at this site are rare because they may present some problems in management.
Comparison of electro and chemical cautery in the treatment of anterior epistaxis
Authors: Toner J. G. , Walby A. P.
Published: November 2007

In the ENT Department of the Royal Victoria Hospital, Belfast, the impression (supported only by anecdotes) was that electro-cautery was superior to chemical cautery in the treatment of simple anterior epistaxis. Since no evaluation of the relative merits of electro and chemical cautery has been reported, a prospective randomized study was conducted to assess the effectiveness of electro-cautery and cautery with silver nitrate. The results of the study showed that there was no statistically significant difference between the two methods in either controlling the epistaxis or in the incidence of complications. It is concluded that since cautery with a silver nitrate tipped applicator is simpler, and of equal effectiveness, it would appear to be the treatment of choice for simple anterior epistaxis.
Radiation therapy of laryngeal cancer: A twenty year experience
Authors: Robson N. L. K. , Oswal V. H. , Flood L. M.
Published: November 2007

This paper reviews a 20 year experience of radiation treatment of 286 laryngeal cancers and presents results with a minimum five year follow-up. All cases presented had glottic or supraglottic squamous cell carcinomas with no clinical evidence of nodal metastasis. A policy of primary radiotherapy, with surgery for salvage of treatment failures, produced control of primary disease and prevention of metastases superior to most other regimes documented in the literature.
A long term view of myringoplasty in children
Authors: Blanshard J. D. , Robson A. K. , Smith I. , Maw A. R.
Published: November 2007

Fifty-nine type 1 tympanoplasties in children under 14 years of age were assessed by recall to a special follow-up clinic up to 15 years post-operatively. Overall 78 per cent of tympanic membranes were found to be intact with a late failure of grafts noted in 6 per cent of cases. An improvement in the audiological threshold was found in 51 per cent, 24 per cent were unchanged, the remaining 25 per cent suffered a deterioration which was seen both immediately post-operatively and thereafter until reviewed in the special clinic. The age at operation, size of the perforation, grade of surgeon carrying out the operation and prior adenoidectomy had no statistically significant influence on the success rate or the audiologicaloutcome. Revision procedures achieved similar graft take rates to the initial procedures but fared worse audiologically. We conclude that in the majority the operation was successful but hearing gain was not as good as expected and subject to late deterioration. A long term follow-up is important to detect this and other complications.
Temporal arteritis presenting as a submandibular swelling
Authors: Porter M. J.
Published: November 2007

Temporal arteritis (giant cell arteritis) is a disease of protean manifestation. A case which presented as a submandibular swelling is reported.
Pharyngeal pouch carcinoma: two unusual cases
Authors: Burton M. J. , Lund W. S.
Published: November 2007

Two patients with carcinomata arising in pharyngeal pouches are reported. In one, the tumour was detected preoperatively by a contrast radiographicstudy. In the second the lesion was acarcinoma in situ. The English literature is reviewed with reference to these two unusual features.
Quelprud's Nodule: a post-auricular cartilaginous nodule
Authors: Khanobthamchai Kiti , Bingham Brian , Hawke Michael
Published: November 2007

A number of minor variations to the configuration of the external ear are well recognized. This paper brings attention to one entity which is characterized by a small cartilaginous nodule or prominence arising from the posterior surface of the pinna and which we have named Quelprud's nodule. A prospective clinical survey of 208 patients attending an ENT clinic revealed that nearly one-third of the population studied possess this nodule. There was an equal sex incidence. The Quelprud's nodule was identified within families in a distribution which suggests an autosomal dominant inheritance with variable expressivity.
Conservative management of epistaxis
Authors: Monux A. , Tomás M. , Kaiser C. , Gavilán J.
Published: November 2007

A retrospective study to assess the clinical usefulness of non-surgical management of epistaxis was performed on 340 patients requiring hospitalisation at the ENT Department of La Paz Hospital (Madrid). The previous history, type of management, hospitalisation time, and volume of transfusion were considered. Nasal packing was employed in 94.1 per cent of the patients. Most patients (82.9 per cent) were hospitalised less than seven days, and 84.1 per cent of the patients required no transfusion. There was one death.

This study supports the clinical usefulness of conservative management in the treatment of patients with epistaxis.
Cartilaginous metaplasia of the epiglottis
Authors: Lee A. H. S. , Ramsay A. D.
Published: November 2007

Metaplastic elastic cartilaginous tissue has been described in the vocal cord, vestibular fold and ventricle of the larynx. This report documents a case in which cartilaginous metaplasia developed in the soft tissue of the epiglottis following an episode of epiglottitis.
Tympano–cartilago–stapediopexy: a method to improve hearing in open technique tympanoplasty
Authors: Moustafa H. M. , Khalifa M. A.
Published: November 2007

Canal wall-down technique tympanoplasty was indicated in about 41 per cent of our cases with chronic suppurative otitis media. In this series done during the last four years, of 576 tympanoplasties, 240 cases needed type III tympanoplasty. In 145 cases, myringostapediopexy was carried out using temporalis fascia grafting over the head of the stapes. Tympano-cartilago-stapediopexy was performed in the other 95 cases by using tragal cartilage and perichondrium over the stapes. A comparison between the results of both methods of grafting is discussed. Improvement in hearing was achieved after tympano-cartilago-stapediopexy. This method proved to be suitable for those cases which need open technique tympanoplasty.
Immunopathology of olfactory mucosa following injury to the olfactory bulb
Authors: Inamitsu Mayumi , Nakashima Tadashi , Uemura Takuya
Published: November 2007

Removal of the olfactory bulb was performed on rats in an attempt to elucidate the processes of olfactory dysfunction following head injury. Degeneration and regeneration of the olfactory mucosa were examined, histopathologically and immunohistochemically. We used antisera to olfactory marker protein (OMP) and neuron specific enolase (NSE) as a marker of the mature olfactory receptor neurons. Following rapid degeneration after bulbectomy, the olfactory receptor neurons regenerated. OMP and NSE containing cells re-appeared 49 days later. However, the cell population of the neuroepithelium did not revert to the numbers observed in the non-operated neuroepithelium, even three months later. The lack of a connection between regenerated axons and the olfactory bulb may result in immature neuronal replacement and reduce the number of olfactory receptor neurons.
Cricoid release in a preterm neonate
Authors: Farrell M. L. , Gray R. F.
Published: November 2007

A baby born at 23 weeks gestation could not be extubated at 34 weeks and nine weeks intubation was causing laryngeal granulation. Anterior cricoid release saved the infant from a tracheostomy.

The case is reported because of (a) the prematurity and small size of the neonate and (b) the microsurgical technique and non-penetration of tracheal mucosa, neither of which have been addressed in previous publications.
An unusual treatment for a rare dilemma (oesophageal foreign body)
Authors: Harihar V.
Published: November 2007

Identification of an intramural oesophageal fishbone at operation is difficult. Such a case is discussed with an attempted accurate radiological localization of site pre-operatively. No such case has so far been reported.
Lateral cephalometric analysis of children with otitis media with effusion: A comparison with age and sex matched controls
Authors: Maw A. R. , Smith I. M. , Lance G. N.
Published: November 2007

Previous reports from this department have established significant differences in the morphology of the nasopharynx between patients with otitis media with effusion (OME) and normal controls. This study has used lateral cephalometric analysis to investigate these differences in greater detail.

Skeletal and soft tissue measurements were recorded in 50 patients with bilateral OME and were compared with 50 age and sex matched normal controls.

Various points were plotted enabling 23 different linear dimensions and three angles in and around the nasopharynx to be compared. The results show significant differences between the two groups in the skeletal and soft tissue dimensions of the nasopharynx. The children with OME have a smaller nasopharynx with a suggestion that this may be due to a difference both in the rate and timing of growth.
BIPP induced methaemoglobinaemia
Authors: Nigam A. , Ruddy J. , Robin P. E.
Published: November 2007

Bismuth subnitrate, one of the constituents of BIPP is known to cause methaemoglobinaemia. Ten patients had blood estimations for methaemoglobin levels before and after nasal packing with BIPP impregnated gauze. Only one patient exhibited abnormal levels of methaemoglobin and this was most probably the result of the large quantity of BIPP used. It is unlikely that significant methaemoglobinaemia occurs during the routine use of BIPP in the nose.
Sleep Apnoea Syndrome associated with maxillofacial abnormalities
Authors: Colmenero Cesar , Esteban Rosa , Albarino Apolinar R. , Colmenero Bartolome
Published: November 2007

Four cases with Obstructive Sleep Apnoea Syndrome (OSAS) are presented. They consisted of two cases with TMJ ankylosis with micrognathia, one case with Treacher Collins Syndrome, and one case with the Long Face Syndrome.

Standard and specific cephalometric parameters were obtained to detect the site of the obstruction. Polysomnographic studies yielded information regarding the patient's sleep-wake state, respiratory and cardiac functioning, pre- and post-operatively. A temporary tracheostomy corrected the symptoms in one patient but the syndrome recurred when it was closed. Surgical correction of the maxillofacial anomalies will reestablish normal sleep patterns preventing OSAS.
CT of the paranasal sinuses and functional endoscopic surgery: a critical analysis of 100 symptomatic patients
Authors: Lloyd G. A. S. , Lund V. J. , Scadding G. K.
Published: November 2007

CT scans of 100 patients from the Rhinology Clinic at the Royal National Throat, Nose and Ear Hospital were reviewed in order to test the precepts forming the basis of functional endoscopic sinus surgery, especially as they relate to the radiological investigation. These were: (a) the site of origin of sinus infection. (b) The relevance of certain anatomical variants in the middle meatus to sinus infection and (c) The use of CT as the radiological method of diagnosis in all cases.

Obstruction in the middle meatus and ostiomeatal complex was associated with an increased incidence of opacity in the sinuses but the primary site of disease was not established: the concept that sinus disease takes origin in the middle meatus was not proven.

Anatomical variants in the middle meatus were not associated with an increase in sinus opacity and there was no evidence that these anomalies have any effect on sinus disease by causing middle meatal stenosis.

The radiological assessment of patients with inflammatory naso-sinus disease should start with plain X-ray. CT is unnecessary as a routine examination. It should be reserved for the pre-operative assessment of patients for endoscopic surgery, its main function being to show important anatomical landmarks.
Solitary fibrous tumour of the nasopharynx
Authors: Job A. , Walter N. , David T. M.
Published: November 2007

A case of benign ‘Solitary Fibrous Tumour of the Nasopharynx’, a rare, recently recognized entity, is presented and the clinical and pathological details discussed.
Subglottic cyst in a newborn
Authors: Triglia J. M. , Portaspana T. , Cannoni M. , Pech A.
Published: November 2007

Subglottic laryngeal cysts in the newborn are extremely rare. It is difficult to establish if the cyst is acquired or congenital because respiratory distress requires intubation in the I.C.U. generally without prior endoscopy. A case report is presented, followed by a discussion of possible aetiology and management protocol; the advantages of the CO2 laser make excision of the cysticsac possible without tracheotomy.
Perilymph fistula—a diagnostic dilemma
Authors: Vartiainen Eero , Nuutinen Juhani , Karjalainen Seppo , Nykänfn Kalkvi
Published: November 2007

A retrospective series is presented of 51 cases operated on for suspected perilymph fistula. In 26 ears a fistula was identified at surgery. A positive fistula test was found to strongly indicate a perilymph fistula but was more often negative than positive in surgically demonstrated fistula ears. Other vestibular tests were found to be of little value in the pre-operative diagnosis. Ears with a surgically demonstrated fistula and sensorineural hearing loss had either flat or downward-sloping audiograms. Difficulties in diagnosing a perilymph fistula at tympanotomy are discussed. At follow-up, vestibular symptoms were found to be eliminated or improved in 96 per cent of cases with surgically demonstrated fistulae and in 68 per cent of cases in which no fistula was detected at tympanotomy but hearing improved significantly in only one ear (4 per cent) of the former group and in five ears (20 per cent) of the latter group.
Primary mucoid adenocarcinoma of the larynx
Authors: Tsang Y. W. , Ngan K. C. , Chan J. K. C.
Published: November 2007

Mucous gland carcinomas of the larynx are rare, with most being represented by ‘non-specific’ adenocarcinoma and adenoid cystic carcinoma. Here we report a unique case of mucoid adenocarcinoma of the larynx occurring in a 46-year-old woman. Despite the presence of regional lymph node metastasis, she remained well four years after surgery.
Distribution of ear drops in normal ears
Authors: Wilson P. S. , Grocutt Mark , Dingle Ann , Reid A. P.
Published: November 2007

Ear drops are prescribed widely with little thought for the distribution inside the ear canal. This study compares the distribution of water and oil based drops. The results indicate that, under the test conditions, the penetration of ear drops is extremely variable. Water provided the greatest overall coverage, while the most viscous drops fared worst. It is suggested that in diseased ears even poorer penetration may result, which may explain the lack of response in some circumstances.
Myxoma of the external auditory meatus
Authors: Palva T. , Saksela E. , Ramsay H.
Published: November 2007

A case of myxoma of the external auditory meatus is described. The patient presented with a recurring tumour which had not been correctly diagnosed although the growth had been removed ten times over a period of two years. The tumour was skin covered, contained gelatinous material and was attached to the tympanic membrane and anterior canal wall. Following recognition of the tumour as myxoma, removal was performed with sufficiently wide margins and there has been no recurrence during follow-up for one year.
Randomized, cross over study to assess patient preference for an acoustically modified hearing aid system
Authors: MacKenzie K. , Browning G. G.
Published: November 2007

It seems reasonable to postulate that if a patient has a hearing impairment at particular frequencies, selective amplification at those frequencies would be an advantage. Attempts have been made in the laboratory to show that when this is done scores on various audiometric tasks will improve. Whether such laboratory benefit will be preferred by patients in their daily life is another matter. Despite a lack of knowledge on this subject, modifications are frequently made to a hearing aid system in the expectation that this will improve auditory performance and hence be preferred by the patient. The most common modifications made to an ear level aid in the British National Health Service are adjusting the tone control and venting the ear mould with the aim of emphasizing the higher frequencies.

A randomized crossover study was carried out in 83 first time hearing aid users with a mild to moderate hearing impairment to assess whether a hearing aid at the ‘H’ tone setting and with a 2 mm vented mould would be preferred by those with a more marked high frequency impairment. BE series aids were used so that any findings could be directly translated to NHS practice.

No consistent preference for the modified system was identified when patients were subgrouped according to the overall slope (0.5 to 4 kHz) of their audiogram. However, when the slope between 0.25 and 1 kHz, which corresponds to the real ear effect of these modifications, was analyzed patients with a slope at these frequencies preferred the high-tone emphasis system (p<0.005). A second but lesser predictor of preference was age, those under 66 years preferring a modified and those over 69 years preferring an unmodified system (p<0.05).

These findings need to be confirmed using different methods of altering the frequency response. What acoustical effect these achieve in a specific patient need to be confirmed using ‘in the ear’ measures before any preference they might have can be related to the configuration of their audiogram.
Mastoid obliteration with the temporoparietal fascia flap
Authors: East C. A. , Brough M. D. , Grant H. R.
Published: November 2007

Obliteration of persistently discharging open mastoid cavities is one surgical option to achieve a dry ear. All the currently described techniques involve the use of random pattern local tissue flaps or free grafts. Ten patients have undergone obliteration procedures using the vascularized temporoparietal fascia flap. This resulted in rapid epithelialization by six weeks in seven out of 10 cases. The remaining three patients have persistent non healed areas over the medial attic wall, but are not troubled by otorrhoea. The indications, technique and complications of mastoid obliteration by this axial pattern flap are described.
High recovery ofHaemophilus influenzaeand group A streptococci in recurrent tonsillar infection or hypertrophy as compared with normal tonsils
Authors: Stjernquist-Desatnik A. , Prellner K. , Schalén C.
Published: November 2007

One hundred and twenty-six patients who underwent tonsillectomy because of recurrent acute tonsillitis, tonsillar hypertrophy or sleep apnoea were evaluated by tonsillar core culturing. The sleep apnoea patients served as controls, since none of them had tonsillar hypertrophy at ENT examination or any history of recurrent acute tonsillitis, and thus their tonsillar core flora could be regarded as normal.

The isolation rate ofH. influenzaewas much lower among sleep apnoea controls (2.7 per cent) than among either the patients with recurrent acute tonsillitis (20.3 per cent) or those with tonsillar hypertrophy (36.7 per cent) (p<0.05), as was that of group A streptococci, 5.4 per centversus16.9 and 20 per cent, respectively (though the latter differences were not statistically significant). The isolation frequencies ofB. catarrhalis, pneumococci, group C and G streptococci did not differ between the three groups.

The high tonsillar core recovery rates ofH. influenzaeand group A streptococci both in patients with recurrent acute tonsillitis and in those with tonsillar hypertrophy, as compared with normal controls, suggests the possible involvement of these bacteria in both conditions.
Lingual thyroid: the diagnostic value of magnetic resonance imaging
Authors: Guneri A. , Ceryan K. , Igci E. , Kovanlikaya A.
Published: November 2007

Lingual thyroid is an uncommon developmental aberrationof embryogenesis. It may present as a mid-line, non-tender, painless, reddish appearing swelling in the throat. Magnetic resonance imaging (MRI) is a relatively new diagnostic method for this condition. Two cases of lingual thyroid are reviewed with their MRI's and surgical results.