bluuebunny/crossref_metadata_2025 huggingface dataset:
Monitoring of intra-operative visual evoked potentials during functional endoscopic sinus surgery (FESS) under general anaesthesia
Authors: Hussain S. S. M. , Laljee H. C. K. , Horrocks J. M. , Grace A. R. H.
Published: November 2007

Functional endoscopic sinus surgery (FESS) is an effective treatment for inflammatory sinus disease. The potential for major complications during FESS is high particularly under general anaesthesia. The most serious of these is injury to the eye leading to blindness. We looked at the feasibility of monitoring flash visual evoked potentials (VEP) simultaneously from both eyes during FESS. Five patients were included in this preliminary study. A haptic contact lens connected by fibreoptic cable to a photostimulator was placed on the eyes and stimulus of comparable intensity to a conventional strobe was delivered. We found that an increase in P100 latency to be an indicator of optic nerve compression. However, for this to be useful the diastolic blood pressure should not fall below 50 mmHg, the oxygen saturation should be maintained at 98 per cent and bleeding should be minimized during surgery. The changes in the amplitude of P100 was not found to be useful.

While there is no substitute for learning endoscopic surgery by cadaveric dissection and supervised training we believe that in selected cases VEP monitoring can be employed with profit.
Sudden deafness as the sole presenting symptom of diabetes mellitus – a case report
Authors: Ravi K. V. , Henderson A.
Published: November 2007

This paper reports an undiagnosed diabetic presenting to an otolaryngologist with sudden deafness of six days duration as the only symptom. Appropriate investigative and treatment measures resulted in recovery of hearing.
Tuberculous parotitis: limiting the role of surgery
Authors: Weiner Graeme M. , Pahor A. L.
Published: November 2007

The diagnosis of parotid gland involvement with tuberculosis has traditionally been made after superficial parotidectomy. We present four cases that suggest that fine needle aspiration cytology followed by antituberculous therapy can avoid the need for surgery in this uncommon condition.
Subcutaneous diffuse neurofibroma of the neck: a case report
Authors: de Varebeke Sebastien Janssens , De Schepper Arthur , Hauben Esther , Declau Frank , Van Marck Eric , Van de Heyning Paul H.
Published: November 2007

A case of a rare and unusual variant of neurofibroma, diffuse neurofibroma (paraneurofibroma), in a young patient is presented. The clinical, radiological and histopathological features of this case are reported. The magnetic resonance imaging (MRI) features of the diffuse neurofibroma are comparable with those described in other neurofibromas.
Levels of substance P and IgE decapeptide in nasal polyp fluid and matching sera: a preliminary study
Authors: Drake-Lee A. , Jones V. , Lewin I. , Nayyar S. , Wells A. , Stanworth D.
Published: November 2007

Sixteen unselected patients with nasal polyps had the levels of substance P and IgE decapeptide measured by ELISA in the oedema fluids and their matched sera. All 16 samples had low levels of substance P in their sera and had high level of substance P in eight samples of nasal polyp oedema. There was a considerable variation in the values of IgE decapeptide found in the sera but 14 polyp oedema fluids had high levels of IgE decapeptide. This study supports the idea that there is a linkage between the cellular and neurovascular responses. High levels of IgE decapeptide suggest that mast cell reactions occur in the majority of cases and that IgE may be implicated in the process of mast cell degranulation.
Air travel induced meningitis following vestibular schwannoma (acoustic neuroma) surgery
Authors: Callanan Vincent , O'Connor A. F. Fitzgerald , King T. T.
Published: November 2007

Two cases are presented in which patients flying home shortly after translabyrinthine removal of a vestibular schwannoma (acoustic neuroma) developed acute bacterial meningitis on landing. This complication has not been described before. The incidence and management of CSF leaks after vestibular schwannoma surgery is also discussed.
Blindness due to electrocoagulation following functional endoscopic sinus surgery
Authors: Abeele D. Vanden , Clemens A. , Tassignon M. J. , van de Heyning P. H.
Published: November 2007

A case is presented with irreversible blindness in one eye and restriction of the infratemporal visual field in the other eye, due to electrocoagulation performed for delayed bleeding after functional endoscopic sinus surgery (FESS). Although blindness due to rhinosurgery is a well-known, but rare complication, a review of the recent literature did not reveal a similar incident. The use of electrocoagulation especially under conditions of poor visualization, that may be the case in post-operative bleeding following (endoscopic) sinus surgery, is strongly discouraged.
Nasal lipomas presenting as part of a syndromic diagnosis
Authors: Hollis L. J. , Bailey C. M. , Albert D. M. , Hosni A.
Published: November 2007

An important part of the initial assessment of children presenting with congenital nasal masses is to exclude an intracranial extension using either magnetic resonance imaging (MRI) or computed tomography (CT) imaging.

We present three patients with such lesions in which unusual radiological findings were noted as part of the investigations.
Medial meatal fibrosis: current approach
Authors: Magliulo Giuseppe , Ronzoni Roberta , Cristofari Piera
Published: November 2007

Medial meatal fibrosis is a rare entity which is linked to inflammatory and traumatic factors. This pathology significantly benefits from surgical management. Criteria for achieving successful results are strict and concern the complete removal of the fibrous tissue and covering of the bony canal with skin graft. The aim of this paper is to present our experience with this rare pathology and to discuss current approaches.
Mucormycosis of the sphenoid sinus in an otherwise healthy patient. Case report and literature review
Authors: Zapico A. Del Valle , Suárez A. Rubio , Encinas P. Mellado , Angulo C. Morales , Pozuelo E. Cabrera
Published: November 2007

Paranasal and rhinocerebral mucormycosis refers to uncommon opportunistic fungal infections, reported to occur especially in association with diabetic acidosis (the most common), immunosuppressive therapy, malignancy, or other chronic debilitating disorders. However, patients who have no underlying disease have occasionally been affected. According to the literature reviewed, only 13 well-documented cases without any predisposing factor have been previously reported. We describe a unique case of sphenoidal mucormycosis in an otherwise healthy individual, and the first patient to present with headache as the only symptom. We emphasize the importance of a high index of suspicion for early diagnosis and prompt management.
Exophthalmos and facial swelling: a case of limited Churg-Strauss syndrome
Authors: Khan N. A. , Shenoy P. K. , McClymont L. , Palmer T. J.
Published: November 2007

We report a case of vasculitis causing facial swelling and exophthalmos which on clinical and histological grounds is thought to be limited Churg-Strauss syndrome. An excellent response was achieved to high doses of systemic steroids and cyclophosphamide.
Submucosal glands after maxillary sinus surgery. An experimental study in rabbits
Authors: Melgarejo-Moreno Pablo J. , Ribera-Cortada Inmaculada , Hellin-Meseguer Diego
Published: November 2007

Thirty New Zealand White rabbits underwent unilateral partial or complete removal of maxillary sinus mucosa in order to evaluate submucosal maxillary sinus glands. After three months, specimens were taken for examination from all operated on and control sinuses. Bacteriological cultures, light and electron microscopy were performed. Histopathological findings showed a decrease in the number of serous glands and significant inflammation was present in the sinus in which there was complete surgical removal. Electron microscopy revealed changes in the secretory cells of the serous glands in the regenerated postsurgical mucosa.
Unilateral choanal atresia in siblings – a rare occurrence
Authors: Bhattacharyya Abir K. , Lund Valerie J.
Published: November 2007

The genetic aspects of choanal atresia have not been clearly defined though it is probably a multifactorial trait as in cleft lip and cleft palate. The appearance of the condition in both single and successive generations supports this contention.

Choanal atresia can occur as an isolated anomaly, but is more commonly associated with one or more concomitant congenital anomalies. In this report two sisters both in their teens presented with unilateral choanal atresia as an isolated anomaly. Endoscopic trans-nasal repair of choanal atresia was performed in both of them as this offers excellent visualisation and access.
Recurrent frontal sinusitis complicating orbital decompression in Graves' disease
Authors: Lee W. C.
Published: November 2007

An unusual case of recurrent frontal sinusitis with abscess formation secondary to orbital decompression for Graves' disease is described. The infection was refractory to antibiotics treatment, external drainage and the sinus obliteration procedure. Since the sinus outflow was obstructed by prolapsing tissue following excessive removal of the orbital walls, sinus re-aeration by supporting the prolapsed tissue with a silastic sheet and stenting the sinus drainage tract was attempted. This led to a complete resolution of the infection with an excellent long-term result.
Aggressive cutaneous squamous cell carcinoma of the head and neck in patients with chronic lymphocytic leukaemia
Authors: Hartley B. E. J. , Searle A. E. , Breach N. M. , Rhys-Evans P. H. , Henk J. M.
Published: November 2007

We describe multiple cutaneous squamous cell carcinomas of the head and neck in five patients with chronic lymphocytic leukaemia (CLL). When associated with CLL, cutaneous squamous cell carcinomata behave in a much more aggressive manner than otherwise expected. Four patients developed local recurrence after primary treatment. All five patients developed lymph node metastases containing squamous cell carcinoma. Three of five patients (60 per cent) had multiple primary lesions.

Whereas the increased incidence of second cancers in CLL and notably of skin cancers is documented, little has been written to describe the aggressive behaviour of these tumours. It is important, when treating these patients, to be aware of the high tendency towards local recurrence and lymph node metastasis and to consider an aggressive management plan and careful follow-up.
Problems in assessing the audiogram in patients with severe hearing impairment
Authors: Giles M. , Browning G. G. , Gatehouse S. G.
Published: November 2007

Severe hearing impairment (SHI) is an impairment of hearing in which the air conduction mean over 0.5–4 kHz in the better hearing ear lies between 70 and 90 dB. Masking of bone and air conduction thresholds is seldom possible with SHI, leading to difficulties in assessing the pure tone audiogram whenever there is a potential air bone gap in either ear.

An audiological survey of 83 patients with severe hearing impairment was conducted. In 16 per cent of patients there was no possibility of a material air bone gap in either ear and no difficulty in interpreting the audiogram. In 23 (28 per cent), the audiogram was consistent with, but did not prove the presence of, an air bone gap in the poorer hearing ear. In 25 patients (30 per cent of 108) the better hearing ear could not be determined, and in 22 (27 per cent) a profound sensorineural impairment in the poorer hearing ear could not be excluded. The implications of this for the otologist are discussed.
Experimental study on neurorrhaphy of the recurrent laryngeal nerve in dogs
Authors: Rubio A. , Fernández M. R. , Figols J. , Rama J.
Published: November 2007

The effectiveness of anastomosis of a divided recurrent laryngeal nerve was evaluated in six adult mongrel dogs. Videolaryngoscopy and evoked compound muscle action potentials in the intrinsic laryngeal muscles were performed at six months and the posterior cricoarytenoid muscles and recurrent laryngeal nerves were processed for histomorphometric studies. Recovery of compound muscle action potentials in all re-innervated muscles and histomorphometric findings confirmed a good grade of axonal regeneration. The most significant histomorphometric changes observed were: a reactive hypertrophy of type I fibres in the posterior cricoarytenoid muscles of the re-innervated side, and a high nerve fibre density in the distal stump to the anastomosis. However, incomplete recovery of motion and fasciculated movements of the reinnervated vocal folds were observed. Reduction of effective motor units in the re-innervated muscles might be a factor that cause incomplete restoration of vocal fold movements.
Cowpox infection of the nose
Authors: Lee W. C. , Manjaly G. , Skinner D. W. , O'Neil P. M.
Published: November 2007

A case of cowpox infection presenting as a necrotising cellulitis of the nasal tip and vestibule is reported. Diagnosis was established by identification of the pox virus particles from tissue culture of the nasal biopsy using electronic microscopy and the characteristic lesions on chorio-allantoic membrane produced by the virus. Cowpox of the external nose and transmission of the infection from a dog have not to our knowledge been reported previously.
Invasive candidiasis of a late presentation laryngeal chondroradionecrosis
Authors: Hollis L. J. , Montgomery P. Q. , Hern J. D. , Mahadeva U. , Tolley N. S.
Published: November 2007

Introduction

Laryngeal chondroradionecrosis is an unusual condition which may present many years after the initial radiotherapy. We present a case of late onset chondroradionecrosis which was complicated by invasive candidiasis of the arytenoid cartilages which had themselves been extruded through the laryngeal mucosa.
Wegener's granulomatosis presenting as a temporal headache
Authors: Makura Z. G. G. , Robson A. K.
Published: November 2007

Formerly a fatal condition, Wegener's granulomatosis is now treated with good results. Clinical morbidity is often due to failure by clinicians to make the diagnosis. Many patients (including our cases reported here) present with atypical symptoms, and only a high index of suspicion will ensure early diagnosis. Classical chest and renal symptoms often indicate late stage disease. We present two cases that underline the limitations of current ‘diagnostic’ immunological tests whilst emphasising the importance of clinical features in diagnosis.

Standard treatment with Cytotoxic agents and corticosteroids are effective but carry considerable morbidity. We have followed the current trend of incorporating a less toxic antibiotic agent in the management of this enigmatic condition.
Bacteriology of the adult middle meatus
Authors: Klossek J. M. , Dubreuil L. , Richet H. , Richet B. , Sedallian A. , Beutter P.
Published: November 2007

The aim of this work was to assess the commensal flora in the adult middle meatus. Thus, 139 samples were taken from subjects of both sexes, over 16 years of age, seen in the community or hospitalized for less than 72 hours for non-rhinological conditions. They had had no nasal or sinus conditions in the previous three months. One hundred and thirteen samples contained at least one aerobic or anaerobic bacterium. Fifty-nine samples yielded a single organism in culture. A maximum of five organisms were isolated from a given patient. These results show that the adult middle meatus contains a mixed commensal flora and should prove useful in interpreting endonasal swab cultures during acute and chronic sinus infection.
Treatment of unresectable recurrent head and neck carcinoma with 13-cis-retinoic acid and interferon-α. A phase II study
Authors: Nikolaou Angelos C. , Fountzilas George , Daniilidis Ioannis
Published: November 2007

Sixteen patients with unresectable recurrent head and neck carcinomas were treated with 13-cis-retinoic acid and interferon-α. All patients had presented with recurrences after having been treated primarily with surgery and radiotherapy, while two of them had also received induction chemotherapy. The site of relapse was strictly locoregional in all cases (only at the primary site in three cases, at the cervical lymph nodes only in four cases and both at the primary site and the neck in the remaining nine cases. Two patients were female, and 14 male, with an age range of 47–72 years (median 61 years). Interferon-α was administered subcutaneously at a dose of 3 X 106 IU every second day. The dose of retinoids was 40 mg per os every day. The duration of treatment was two to 14 months (median seven months). There were two cases of partial response (tumour regression >50 per cent), eight cases of stable disease lasting for three to seven months (median four months) and six cases presented with progressive disease. All patients died after a survival of three to 17 months (median 9.5 months). Toxicity was generally minimal. We believe that the results are not encouraging, but also not disappointing. The fact that toxicity was indeed mild, with not a single case of life-threatening sequellae even after prolonged administration of the two agents, allows us to conclude that an increase of the dose of IFN-α might be more beneficial. Selection of patients with more ‘favourable’ recurrences will give a better chance to the treatment combination to prove its real efficacy. Larger numbers of patients have to be treated and evaluated before definite conclusions can be reached.
Rehabilitation of the paralysed face: results of facial nerve surgery
Authors: Saeed Shakeel R. , Ramsden Richard T.
Published: November 2007

The case notes of 34 patients undergoing rehabilitative facial nerve surgery between 1978 and 1994 were retrospectively examined. Thirteen patients underwent facio-hypoglossal transposition with six achieving a facial nerve grade of IV (House-Brackmann scale) at 24 months post-surgery. Twelve patients underwent cable grafting of the facial nerve defect. Of these, 10 achieved a grade III result at 24 months. Nine patients underwent end to end anastomosis of the facial nerve, seven achieving a grade III result at 24 months after the repair. Re-routing of the facial nerve and the use of tissue glue to effect the anastomosis did not have an adverse effect on the outcome. Comparison of rerouted end to end anastomosis with non-re-routed cable grafting showed no difference. Patients presenting pre-operatively with facial weakness and those in whom nerve repair surgery was delayed for more than six months were less likely to have a good result.
Hearing loss in the Saethre-Chotzen syndrome
Authors: Ensink Robbert J. H. , Marres Henri A. M. , Brunner Han G. , Cremers Cor W. R. J.
Published: November 2007

A three-generation family with Saethre-Chotzen syndrome and an isolated case are presented. The proband presented with conductive hearing loss. His mother and grandmother showed minor features of the syndrome including conductive hearing loss.

Symptoms of the craniosynostosis syndromes can include stapes ankylosis, a fixed ossicular chain in a too small epitympanum, and small or even absent mastoids. The proband was treated with a boneanchored hearing aid (BAHA) instead of reconstructive middle ear surgery. Current literature on the results of ear surgery is reviewed. In general, reconstructive middle ear surgery should only be considered if congenital anomalies of the middle ear are the only presenting symptom. In cases with additional anomalies such as atresia of the ear canal or damage due to chronic ear infections, the outcome of reconstructive surgery to correct the anomalous ossicular chain is unsatisfactory. In such cases the BAHA is probably the best solution.
Isolated laryngeal lymphangioma: a rare cause of airway obstruction in infants
Authors: Papsin B. C. , Evans J. N. G.
Published: November 2007

Laryngeal lymphangiomas are uncommon and virtually always represent extension of cervical disease. The exceptionally rare lymphangioma that remains isolated to the larynx has been reported only twice prior to this case.

A six-month male infant presented with an undiagnosed mass in the supraglottis which had caused respiratory compromise requiring a tracheostomy. The diagnosis was made histologically and the treatment was begun. Therapy consisted of staged laser resections carried out cautiously to preserve laryngeal competence. After three laser treatments the lesion was controlled and the patient prepared for decannulation. This interesting case is presented with a review of the literature.
Laryngeal Kaposi's sarcoma in patients with AIDS
Authors: Mochloulis George , Irving Richard M. , Grant Henry R. , Miller Robert F.
Published: November 2007

Over a period of 10 years 17 human immunodeficiency virus(HIV)-infected patients with laryngeal Kaposi's sarcoma were seen and treated at University College London Hospitals. All patients had advanced HIV disease. Their presentation was with symptoms of upper airway obstruction in the majority of cases and the diagnosis was made by fibreoptic examination of the larynx. Biopsy was associated with brisk haemorrhage in one patient, who required a temporary tracheostomy, and was not performed in the other 16 cases. The commonest site of laryngeal involvement was the supraglottis in 11 patients, with glottic lesions noted in eight patients: subglottic lesions were seen in only three. Treatment of laryngeal Kaposi's sarcoma was, in general, conservative, five patients received low dose radiotherapy to the larynx and 10 were treated with systemic chemotherapy for disseminated Kaposi's sarcoma. Laryngeal Kaposi's sarcoma did not contribute to patient mortality.
Posterior rhinoscopy revisited
Authors: Shadaba A. , Graham J. M.
Published: November 2007

Posterior rhinoscopy remains a valuable yet often difficult examination by conventional means. Fibreoptics, although providing an excellent alternative, may not always be available. We have combined a St. Clair Thomson's mirror with a Lack's metallic tongue depressor for ease of examination and patient cooperation. It is possible to examine the nasopharynx with 6 mm, 8 mm, 10 mm and 12 mm mirrors. The instrument may be boiled, is sturdy, economical and extremely useful in paediatric practice.
Laparoscopically assisted total laryngopharyngoesophagectomy with gastric transposition
Authors: Montgomery P. , Willson P. D. , Mochloulis G. , Tolley N. S. , Rosin R. D.
Published: November 2007

Pharyngolaryngoesophagectmy (PLO) for post-cricoid tumour offers opportunity for cure or reasonable paliation. However, it carries significant morbidity and mortality. We present two patients with post-cricoid carcinomas who underwent laparoscopically-assisted total PLO with gastric transposition without a laparotomy, thoracotomy or thoracoscopy. This technique appears promising for patients with post-cricoid or hypopharyngeal malignancy in reducing operative morbidity, and may represent improvement on conventional open and thoracoscopic techniques in selected patients.
Anaplastic thyroid carcinoma presenting as a pharyngeal mass with ball-valve type obstruction of the larynx
Authors: Lee W. C. , Walsh R. M.
Published: November 2007

Thyroid tumours can compromise the airway by extrinsic compression or invasion of the trachea or larynx and damage to the recurrent laryngeal nerve. In this report, the pedunculated extension of a large anaplastic thyroid carcinoma penetrated through the posterior hypopharyngeal wall causing a partial ball-valve type obstruction of the laryngeal inlet on inspiration. This unusual pattern of invasion has not been reported previously.
Adenoma of thyroid gland containing fat (thyrolipoma). Report of a case
Authors: Laforga Juan B. , Vierna Jaime
Published: November 2007

Thyroid adenomas containing adipose tissue are rare. Only scattered case reports have been recorded. We describe an additional case of an adenolipoma of the thyroid gland, incidentally found in residual gland subsequent to excision of a papillary carcinoma.
A clinical, genetic and audiological study of patients and families with unilateral vestibular schwannomas. II. Audiological findings in 93 patients with unilateral vestibular schwannomas
Authors: Neary W. J. , Newton V. E. , Laoide-Kemp S. N. , Ramsden R. T. , Hillier V. F. , Kan S. W.
Published: November 2007

Ninety-three patients with histolofically or radiolofically confiemd unilateral vestibular schwannomas were recruited. Audiological testing for retrocochelar pathology was undertaken. Patients' hospital records were examined for previous audiological and radiological results.

The audiometric configuration was designated as one of the following normal, sloping, low frequency, peak, through or falt. A sloping sensorneural audiometric configuration was present in 68 pec cent of cases. No significant correlation was found between tumour size and average pure tone threshold 500 HZ to 4000 HZ, optimum discrimination score or interaural differences for wave V. Ninety-one per cent of cases had abnoramalities on auditory evoked potential; 92 per cent of cases showed abnormalities on stapedial reflex testing.

The limitations of audiologica testing in the investigation of patients with suspected unilateral vestibular schwannomas are discussed. A protocol for the investigation of such patients is presented.
An unusual foreign body in the larynx: a case report
Authors: Bhat N. A. , Oates J.
Published: November 2007

Inhalation of a foreign body is a serious event. A small proportion of foreign bodies become impacted in the larynx, when urgent recognition is required to prevent disaster. The case of an 18-month-old baby with an impacted artificial finger nail in the larynx is described along with a brief review of the literature
Atypically located submandibular gland diagnosed by Doppler ultrasound
Authors: Carney A. S. , Sharp J. F. , Cozens N. J. A.
Published: November 2007

The anatomical location and relationships of the submandibular gland are well-known to most otolaryngologists and gross variations from the norm are rare. We report a case of an atypical submandibular gland located 2 cm below the mandible which presented as a painful neck swelling with non-diagnostic fine needle aspiration cytology. Using Doppler ultrasound the mass was noted to be closely located to the facial artery and vein and following the administration of oral lemon juice, the peak systolic velocity of a small artery within the mass rose from 8.5 cm/s to 16.4 cm/s, confirming the tissue's salivary nature. We review the literature on using Doppler ultrasound in this area of the neck and discuss realistic practical applications of the technique.
Primitive neuroectodermal tumour of the masseter muscle
Authors: Hollis L. J. , Poole S. , Hern J. , Patel K. S.
Published: November 2007

Masseter muscle enlargement is one of the differential diagnoses of swelling of the cheek. We discuss a uniquecase of a malignant tumour of the masseter which was found to be a peripheral primitive neuroectodermaltumour (PNET). A review of tumours of the masseter is presented.
Medical examiner variability
Authors: Hinchcliffe R.
Published: November 2007

There are undoubtedly many factors that contribute to inter-examiner variability relevant to the use of medical practitioners in justiciable matters. One source of variability with regard to claims relating to hearing disorders could well be the training and ‘calibration’ of medical examiners. A tentative analysis of the examination papers and of the declared roles of the specialties that provide these examiners lends support to such a thesis. One solution would be to train special specialists for medicolegal work, as envisaged by Boyarsky for forensic urology (Boyarsky, 1996). At the same time there is the need to change the role-perception of many examiners. There is also the need for medical examiners to express honest, unbiased opinions. There are also problems inherent in the litigation process which does not promote the interactive and adaptive processes between experts that characterise scientific discussions and enquiry.
Effect of drinking water fluoridation on the prevalence of otosclerosis
Authors: Vartiainen Eero , Vartiainen Terttu
Published: November 2007

The effect of drinking water fluoridation on the prevalence of clinical otoscierosis was investigated in an area where the natural waters have a very low fluoride content. The methods included a retrospective chart review and a residential history questionnaire. Only subjects born between 1948 and 1962 were included. In this age group, the prevalence of clinical otosclerosis was found to be 0.35 per cent of persons exposed to fluoridated tap water and 0.32 per cent of those consuming fluoride-poor water. It seems that a sodium fluoride intake of 1 to 3 mg daily cannot prevent the development of clinical otosclerosis in a lowfluoride area.
Superficial siderosis of the central nervous system: an underestimated cause of hearing loss
Authors: Castelli M. L. , Husband A.
Published: November 2007

Superficial siderosis of the central nervous system (CNS) is a rare disease resulting in the accumulation of haemosiderin in the meninges, the brain surface, the spinal cord and the cranial nerves. The pigment is deposited as a result of chronic bleeding in the subarachnoid space. This produces a clinical picture of deafness, ataxia, cranial nerve deficits and in the latest stages dementia. In some cases the source of bleeding can be identified, whilst in others it can not. Despite its rarity the disease should be considered in the differential diagnosis of sensorineural deafness, particularly as it is a progressive and in some cases curable disease which is easily diagnosed by magnetic resonance imaging (MRI). In this case report the haemosiderin was derived from an ependymoma of the fourth ventricle with extension into the cerebello-pontine angle. The first symptom was a worsening sensorineural hearing loss.
Infectious pseudomonas subglottic stenosis occurring in a patient with acquired immunodeficiency syndrome
Authors: Ghufoor K. , Almeyda J. , Mochloulis G. , Montgomery P. Q. , Tolley N. S.
Published: November 2007

Pseudomonas aeruginosa is emerging as an increasingly common opportunistic infective agent in the immunocompromised human immunodeficiency virus (HIV) positive patient (Kielhofner et al., 1992). Improvements in the prevention and treatment of opportunistic infections in HIV and acquired immunodeficiency syndrome (AIDS) has led to longer life expectancy (Graham et al., 1992), and this has changed the incidence of Pseudomonas aeruginosa infection in this population (Baron and Hollander, 1993). We present a case of a patient with AIDS who developed a fulminant Pseudomonas aeruginosa stenosing subglottic infection. We are unaware of any previous reports of this particular manifestation of Pseudomonas aeruginosa infection.
Facial nerve palsy in mastoid surgery
Authors: Nilssen E. L. K. , Wormald P. J.
Published: November 2007

The risk of facial nerve injury during mastoid surgery has decreased substantially since the advent of the microscope and the otological drill. However, the facial nerve remains at risk during mastoid surgery with the present day incidence suggested to be one per cent. Despite the severity of this complication there are no recent studies that accurately quantify the incidence or discuss its management. The aims of this study were to identify the risk of facial nerve injury for both the specialist as well as the trainee specialist and to review a management protocol for this complication. During the 10-year period from 1985 to 1994, 1024 consecutive mastoidectomies were reviewed. A total of 17 palsies was identified, seven were complete and 10 were incomplete. Of the seven complete palsies, four patients had decompression only and recovered to House Brackmann Grade 2 or better while three patients had decompression and grafting, of these, two were available for follow-up and recovered to House Brackmann Grade 4 only. All the partial palsies, barring one lost to follow-up, who were treated conservatively with pack removal, toilet and topical therapy recovered to House Brackmann Grade 2 or better. A management protocol followed for the above patients is presented and the results analysed. Specific operations and manoeuvres which may put the facial nerve at risk intra-operatively are also discussed.
The endoscopic treatment of cerebrospinal fluid rhinorrhoea: the Nottingham experience
Authors: Hughes R. G. M. , Jones N. S. , Robertson I. J. A.
Published: November 2007

The conventional neurosurgical management of cerebrospinal fluid (CSF) rhinorrhoea has been by intracranial access. Otorhinolaryngologists have undertaken extracranial approaches where access has been possible, and more recently an endoscopic approach has been advocated. We report 17 patients with confirmed CSF rhinorrhoea treated with endoscopic techniques between 1993 and 1996. Follow-up ranged from four to 32 months and showed an overall closure rate of 16 out of 17 patients with no complications. No patient undergoing primary endoscopic repair developed anosmia. The use of fluorescein helped localize the site of the CSF leak in four patients in whom the computed tomography (CT) scan had not identified the site of the defect.

We conclude that the endoscope is a valuable tool in the evaluation and subsequent treatment of CSF rhinorrhoea. Where the skull base defect is accessible to the endoscope, we propose that an endoscopic approach should be considered as the preferred method.
Mean nuclear area and chromosomal DNA content of squamous cell carcinomas of the oral cavity using computerized image analysis
Authors: Sarker S. K. , Patel K. S.
Published: November 2007

Morphometric measurements of nuclei may be of prognostic value in some cancers. In this present study we have evaluated the mean nuclear area (MNA) of 50 squamous cell carcinomas of the oral cavity (SCCOC) using computerized image analysis. Since chromosomal DNA content is a reflection of the DNA content in the nucleus, we have evaluated the relationship between MNA and chromosomal DNA. Thirteen tumours had a MNA greater than 49.9 μm2 and 37 had a MNA less than this. Six tumours were classified as hypodiploid, 29 as diploid and 15 as aneuploid. There were 44 node-negative patients and six node-positive. When comparing MNA in these groups, 50 per cent of node-positive patients had a larger MNA whilst only 20 per cent of the node-negative group had a large MNA. The correlation coefficient between MNA and DNA indices was r = 0.75. The greater nuclear size is possibly a reflection of a more aggressive tumour biology in the node-positive patients. We conclude that a large MNA may be a marker of aggressive tumour biology in this group. In the future, we aim to evaluate the prognostic significance of MNA in patients with SCCOC.
Extracranial meningioma presenting as a tumour of the external auditory meatus: a case report
Authors: Tsunoda Reiko , Fukaya Takashi
Published: November 2007

A rare case of extracranial meningioma presenting as a tumour of the external auditory meatus is reported. Biopsy indicated a diagnosis of meningioma, but the radiological appearance was unusual. For example, computed tomography (CT) scans showed an unenhanced tumour mainly located in the squamous part of the temporal bone which expanded into the external meatus destroying the temporal bone. Magnetic resonance imaging (MRI) revealed that the tumour did not extend into the intradural space.

This meningioma, had an obvious tendency for extracranial development. According to the operative findings, the tumour arose from the middle cranial fossa dura and extended through the air cells of the temporal bone into the external meatus, instead of growing intracranially.

Secondary extracranial meningiomas of the temporal bone usually have a large intracranial component and cause neurological symptoms. However, this was a very rare case of a small meningioma causing no symptoms except for conductive hearing loss.
Glass in the frontal sinus: report of three cases
Authors: Önerci Metin , Öǧretmenoǧlu Oğuz , Yilmaz Taner
Published: November 2007

Patients with paranasal sinus foreign body are not commonly seen in otolaryngological practice; glass in the frontal sinus as a complication of maxillofacial trauma should be very rare, and papers dealing with this issue appear to be rare in the English literature. To elucidate the diagnostic pitfalls and the treatment aspects we present three cases of glass in the frontal sinus which occurred as a result of road traffic accidents.
Actinomycosis presenting as a nasopharyngeal tumour: a case report
Authors: Scott A. , Stansbie J. M.
Published: November 2007

A case of head and meck actinomycosis presenting clinically and radiologically as a nasopharyngeal tumour is described.
Actinomycosis of the thyroid gland masquerading as a neoplasm
Authors: Yiotakis J. , Tzounakos P. , Manolopoulos L. , Tzagaroulakis A. , Adamopoulos G.
Published: November 2007

Actinomycetal infections involving the head and neck often pose a diagnostic puzzle to the otolaryngologist. A rare case of unilateral thyroid swelling due to actinomycosis is described. Although the clinical, laboratory and imaging studies strongly suggested a thyroid neoplasm, the histological examination revealed the presence ofActinomycessp. in the excised lesion. The manifestations of actinomycosis of the head and neck, its pathogenesis and the difficulties encountered in the diagnosis and treatment of the disease are hereby reviewed.
Co-existing pleomorphic and tubular basal cell adenomas of the parotid gland
Authors: Chow Louis T. C. , Chow W. H.
Published: November 2007

We report a hitherto undescribed case of co-existence of a pleomorphic adenoma and a tubular basal cell adenoma affecting the superficial lobe of the left parotid gland of a 53-year-old man. The histology of the pleomorphic adenoma is also of interest in that the prominent adipose metaplasia of its myxoid stroma yielded an appearance reminiscent of myxoid lipoma. The tubular basal cell adenoma showed gross cystic change, and its solid portion consisted of closely packed tubules lined by double layers of cuboidal cells with little intervening stroma. Unlike Warthin's tumour and membranous basal cell adenoma, both pleomorphic and tubular basal cell adenomas exhibit no propensity towards multicentricity or bilaterality. We, therefore, believe that their co-existence in the superficial lobe of the parotid gland of our patient is a mere concidence rather than association.
Audiological findings in glomus tumours
Authors: Qiu William W. , Yin Shengguang S. , Stucker Fred J. , Hardjasudarma Mardjohan
Published: November 2007

Glomus tumours involving the middle ear and the cerebellopontine angle are reported with emphasis on audiological findings. Magnetic resonance imaging (MRI), angiographic and pathological results are presented. Audiological tests, including impedance audiometry, evoked otoacoustic emissions and auditory brainstem responses, are valuable in evaluation of the effect of glomus tumours on the auditory system as well as their pathological extent.
Surgical aspects of paediatric cochlear implantation
Authors: Papsin B. C. , Bailey C. M. , Albert D. M. , Bellman S. C.
Published: November 2007

Cochlear implantation in the paediatric population is now an accepted method of rehabilitating profoundly or totally deaf children. The problems of cochlear implantation in children with other significant medical problems are examined. A retrospective review of the records of the first 45 children implanted at our centre was carried out. The review focused on surgical factors and outcome in addition to variations in technique which have occurred since the programme began. Congenital hearing loss was the most common indication for implantation. Fifteen children (33 per cent) had other medical problems. Three cases of flap breakdown (two occurring after direct trauma to the package bed) and one case of a misplaced electrode requiring re-implantation accounted for the only major complications to date. Minor complications included hypertrophic scar formation and post-operativewound infection. All children were using their implants at the time of this review, but two have subsequently been explanted. Cochlear implantation of children with multiple medical problems requires acceptance of a slightly higher risk of complications.
A practical approach to ultrasound of cervical lymph nodes
Authors: Ahuja A. , Ying M. , King W. , Metreweli C.
Published: November 2007

Although the role of high resolution ultrasound (US) in evaluating cervical nodes is well established, it is often combined with fine needle aspiration cytology (FNAC). As a result, US appearances that help in distinguishing the various causes of cervical adenopathy are often overlooked and not emphasized. The aim of this study is to re-emphasize to the sonologist the US clues that may help in differentiating the aetiology of abnormal cervical nodes.

We, therefore, present the spectrum of US appearances of lymph nodes. One hundred and forty patients (702 abnormal nodes) with known pathology were compared with 100 normal subjects (1211 nodes).

After identifying an abnormal node, US features that further help in distinguishing between the various pathologies are the distribution of lymphadenopathy, echogenicity, calcification, distal enhancement, intranodal cystic necrosis, matting and soft tissue oedema.
Myringotomy and ventilation tube insertion: a ten-year follow-up
Authors: Riley D. N. , Herberger S. , McBride G. , Law K.
Published: November 2007

Eighty children who had myringotomy performed for otitis media with effusion in 1984 were reviewed in 1994. This had involved surgery on 158 ears. Three aspects of ear condition were studied: hearing loss, tympanic membrane perforation, and tympanosclerosis. Hearing losses were present in 13 ears (8.2 per cent), involving 10 children (12.5 per cent), although losses were under 20 dB in seven of these ears (five patients).

Of the six ears with losses more than 20 dB (3.8 per cent), in five patients bilateral losses of 30 dB were due to a recurrence of effusions, a large dry posterior perforation was the cause of a 30 dB loss, an infected anterior perforation had caused a 30 dB loss, an ear which had a cholesteatoma, and had a mastoidectomy and ossiculoplasty in 1987, had a 30–40 dB loss, and one ear which had a Type I tympanoplasty in 1994 had a 50 dB loss. Therefore in only three ears (1.9 per cent) could hearing loss be associated directly with myringotomy and ventilation tube insertion.

Perforations had persisted unilaterally in seven patients, three having had tympanoplasties. Of the remaining perforated tympanic membranes, two were free of symptoms, one had only a slight hearing loss, and one had a more significant loss with recurrent infection.

Tympanosclerosis was only found in those ears which had ventilation tubes inserted (and not those which had myringotomy only), occurring in 48 ears (31 per cent, or 39 per cent of those which had a ventilation tube inserted).

There was no link between tympanosclerosis and hearing loss. The site of tympanosclerosis was not restricted to the site of myringotomy, and in many cases was present only in other areas of the tympanic membrane. There was a tendency for more extensive tympanosclerosis to occur in those ears which had more ventilation tube insertions. The risk of perforation in particular lends support to a policy of ‘watchful waiting’.
Cricothyroidotomy and the anatomy of the cricothyroid space. An autopsy study
Authors: Goumas P. , Kokkinis K. , Petrocheilos J. , Naxakis S. , Mochloulis G.
Published: November 2007

Airway management is one of the main dictums in anaesthesia, emergency medicine and critical care. Endotracheal intubation, tracheostomy and cricothyroidotomy are all approved methods to secure a patient's airway. Cricothyroidotomy is performed in the space between the anterior inferior border of the thyroid cartilage and the anterior superior border of the cricoid cartilage. We studied 107 autopsies with special interest in the anatomy of the cricothyroid space.
Malignant melanoma arising in the frontal sinuses
Authors: Jayaraj Samuel M. , Hern Jonathan D. , Mochloulis George , Porter Graham C.
Published: November 2007

Sinonasal malignant melanoma is rare and usually occurs in the nasal cavity. Presentation is often varied and occurs late in the natural history of the disease, resulting in a poor prognosis. A case is reported of a patient with malignant melanoma arising from the frontal sinus who presented with a forehead swelling and progressive confusion. A review of the literature on malignant melanoma in the nasal cavity and paranasal sinuses regarding its presentation, site of origin and principles of management is discussed.
Different glycoconjugates in the submucosal glands of the supraglottis and subglottis. Lectin histochemistry study in the hamster
Authors: Melgarejo-Moreno Pablo , Hellin-Meseguer Diego
Published: November 2007

A lectin histochemistry study was performed in the supraglottic and subglottic regions of 10 hamsters. The submucosal glands were observed by light microscopy. The supraglottic submucosal glands presented numerous mucous tubules but on the other hand, the subglottic submucosal glands had serous tubules which finished at the distal portion in serous acini. The results suggest that the distribution of fucosylatedmucin and serum-type glycloproteins between the supra- and subglottic submucosal glands suggest a different viscosity and function of the mucus.
Acquired subglottic cysts in the low birth weight, pre-term infant
Authors: Tierney P. A. , Francis I. , Morrison G. A. J.
Published: November 2007

Although subglottic cysts have previously been reported as a cause of airway obstruction in the neonate, they have previously been considered to be a relatively rare cause. Cystic narrowing of the subglottis has been associated with endotracheal intuhation. With improving survival of pre-term infants the incidence of the condition could be expected to rise. Prior to 1996, only 58 cases had been reported in the literature. We believe that the true incidence of the condition has been considerably under-reported. Over a six-month period our unit diagnosed five cases of compressible cysts in the subglottis in low birth weight, pre-term infants. All patients underwent diagnostic microlaryngobronchoscopy and vaporization of the cysts by CO2laser. Three children required more than one procedure. In all cases a satisfactory airway was achieved. The pathogenesis, diagnosis and treatment of the condition is discussed.
Ectopic pituitary adenoma in the sphenoid causing Nelson's syndrome
Authors: Esteban Francisco , Ruiz-Avila Isabel , Vilchez Ricardo , Gamero Carolina , Gomez Mercedes , Mochon Antonio
Published: November 2007

An ectopic functioning pituitary in the sphenoid is an extremely rare occurrence, and even rarer is pituitary adenoma causing symptoms of Nelson's syndrome. A case is presented of a young female diagnosed and treated in our clinic. The only functioning hypophyseal tissue was detected inside the sphenoid, as the pituitary gland had been radiated because of Cushing's syndrome 10 years before and imaging studies revealed an empty sella.
Laryngeal inflammation mimicking laryngeal carcinoma
Authors: Manohar M. Babu , Saleem M. , McArthur P. , Tulbah A.
Published: November 2007

A case of severe inflammation with an exuberant granulation lesion of the larynx that mimicked laryngeal tumour is presented. A patient who was a chronic smoker, with a history of hoarse voice underwent multiple endoscopies and biopsies, confirmed histopathologically as acute and, subsequently, as chronic inflammation. The tumour-like tissue in the larynx responded dramatically to prolonged antibiotic treatment. We emphasize the importance of histological confirmation before embarking on removal of an essential organ or part of the body which could lead to physical or emotional scarring.