bluuebunny/crossref_metadata_2025 huggingface dataset:
Histopathology of the stapes in osteogenesis imperfecta
Authors: Pedersen Ulrik , Melsen Flemming , Elbrønd Ole , Charles Peder
Published: November 2007

Conventional histological studies of stapes footplates from patients with osteogenesis imperfecta revealed, in nine out of 15 stapes examined, an otospongiotic-like lesion. Although the morphology of the stapedial lesion was comparable to the early otosclerotic focus, a greater structural disorganization and larger resorption spaces in osteogenesis imperfecta distinguished the two conditions. The histopathology of the stapes was related to the morphology of cortical and trabecular bone from the iliac crest. Various degrees of immature, osteogenic bony tissue were found in the iliac crest, showing no resemblance to the otospongiotic-like focus in the footplate. Even though the histologic appearance of the stapes footplates differed from the findings in peripheral bone, the present study indicates that the stapedial lesion in osteogenesis imperfecta is most likely a manifestation of the generalized bone and connective tissue disorder. The study further supports the view that osteogenesis imperfecta and otosclerosis are of different aetiology.
Near-total laryngectomy with myo-mucosal valved neoglottis
Authors: Singh Waryam , Hardcastle P.
Published: November 2007

The entire larynx is usually sacrificed in the process of surgical treatment of T3 glottic carcinoma, trans-glottic carcinoma and pyriform sinus carcinoma, with consequent loss of speech. Most of the uninvolved, cancer-free part of the larynx is discarded for no good reason.

According to the surgical principles of oncology, a tumour should be removed with clear margins, but this does not necessarily mean that the whole organ has to be extirpated. In a recently applied surgical procedure, the small tumour-free part of the larynx is fashioned into an innervated myo-mucosal valved shunt joining trachea and pharynx. This neoglottis allows expiration into the pharynx in speech production but it also contracts during swallowing to avoid aspiration. The first four consecutive cases in which this procedure has been carried out with complete success are presented.
Transdermal scopolamine for peripheral vertigo (A double-blind study)
Authors: Rahko T. , Karma P.
Published: November 2007

Transdermal scopolamine medication has been evaluated in 30 cases of acute peripheral vertigo. The double blind study revealed favourable effects, e.g. in Menière's disease. The best compromise between effect and side-effects was one active medication patch. The side-effects were those described for scopolamine, such as blurred vision and dryness of the mouth. Transdermal scopolamine seems to offer an alternative form of medication in acute peripheral vertigo.
Fibre optic guided nasal intubation—shouldn'st we be the experts?
Authors: Gleeson M. J. , Stodlak M. Z. , Wengarf C. L.
Published: November 2007

Difficult intubations are more common in otolaryngological practice than any other branch of medicine or surgery. The majority of these are predictable. It is the unexpected intubational failure, usually in a patient undergoing treatment for an unrelated problem, that results in tragedy. In this paper the indications for fibre optic guided intubation are discussed, and the technique described and illustrated in a case of pharyngeal obstruction secondary to an epiglottic cyst. It is suggested that our expertise to operate within the upper airway should be exploited to the advantage of our patients, and of our anaesthetic and surgical colleagues.
The role of fibreoptic oesophagogastroscopy in E. N. T. Practice
Authors: Batch A. J. G.
Published: November 2007

Fibreoptic endoscopy has only recently become used as a diagnostic tool for the E.N.T. surgeon but it has not been widely used in the investigation of pharyngeal disease. During a two-year period at Warwick Hospital 53 patients have undergone flexible fibreoptic endoscopy using a gastroscope, with visualization of the pharynx. larynx and upper G.I. tract as far as the duodenum. This report describes the technique employed, details the endoscopic findings in 53 patients, and discusses the indications for the technique and the advantages that it holds for the E.N.T. surgeon in the diagnosis and management of pharyngeal disease.
Failure of intubation in acute inflammatory airway obstruction in childhood
Authors: Robb Peter J.
Published: November 2007

At the present time, viral laryngotracheobronchitis. (LTB), and bacterial epiglottitis account for the majority of cases of acute infectious upper airway obstruction in children. This airway obstruction may become life-threatening and require relief either by tracheotomy or by nasotracheal intubation. Recently the trend has been away from tracheotomy and towards intubation. Three cases are reported in this paper, in which intubation by experienced anaesthetists proved impossible, and a life-saving tracheotomy was immediately performed by the otolaryngologist in attondance.

It is recommended that an experienced otolaryngologist should always be present at the time of intubation, should it prove impossible, and the child require emergency tracheotomy to secure the airway.
Aspects of mandibular reconstruction
Authors: Hodge R. A. , Matthews R. N. , Eyre J. , Davies D. M. , Walsh-Waring G. P.
Published: November 2007

We present in this paper the indications for bony reconstruction following mandibular resection, together with evaluation of the reconstructive techniques available. Case reports illustrate methods we have found satisfactory and are followed by our recommendations for their specific use.
The use of dexamethasone in pediatric bronchoscopy
Authors: Ghorayeb Bechara Y. , Shikhani Alain H.
Published: November 2007

The beneficial effect of intravenous corticosteroids in preventing traumatic laryngeal edema is controversial. Between 1968 and 1971, a controlled clinical study was conducted, at the American University of Beirut Medical Center, of 70 children who underwent bronchoscopy for removal of foreign bodies from the tracheobronchial tree.

The patients were divided into two randomized groups; one group was given intravenous dexamethasone while the second was kept as a control. The length of hospitalization and the development of complications attributable to tracheobronchial edema were compared. Intravenous corticosteroids do not seem to reduce the incidence of post-bronchoscopy laryngeal edema.
Otorhinolaryngological manifestations of von Recklinghausen's disease in Nigerians
Authors: Ijaduola T. G. A. , Ademiluyi S. A.
Published: November 2007

Otorhinolaryngological manifestations of 13 patients with von Recklinghausen's disease appearing at Lagos University Teaching Hospital over a five-year period have been studied. Among patients with ENT manifestations of the disease, the most common general features exhibited were cutaneous neurofibromas (100 per cent), headache (69.23 per cent) and pruritus (46.15 per cent). But the head and neck findings included external meatal canal stenosis (30.77 per cent), conductive deafness (30.77 per cent), nasal discharge (30.77 per cent), cranial nerve involvement (30.77 per cent) and disfigurement of the soft tissues of the face (30.77 per cent). Involvement of pinna (23.31 per cent), rhinolalia aperta (15.38 per cent), mental retardation (15.38 per cent) and pharyngeal swelling (7.69 per cent) also featured. Clinically detectable bilateral acoustic neurofibromas in adults or astrocytomas in children were not found in this series. Involvement of the frontoparietal bone (7.65 per cent) presented with skull bossing which had to be differentiated from that due to sickle cell disease in the African. There was also a singular case of phrenic nerve involvement. However, malignancy occurred in one (7.69 per cent) of these patients. Thus, it is important always to follow-up these patients closely so as to detect malignant transformation in time.
Hualuronic acid in secretory otitis media
Authors: Laurent C. , Tengblad A. , Engströ-Laurent Anna
Published: November 2007

Middle-ear effusions of the mucoid type were collected from 14 children with secretory otitis media and analysed by a sensitive assay for hyaluronic acid. The concentration of the polysaccharide varied between three and 42 μg/g. in different patients but was in the same range in effusion material taken from the two ears of the same patient. As the hyaluronic acid concentrations were high compared to the serum levels, the results indicate that the effusion material contains a component derived from connective tissue.
Silastic foam dressing in pinnaplasty
Authors: Bandey S. A. , Atkins J. , Neil W. F.
Published: November 2007

Various forms of dressings, including proflavine wool, have been used traditionally for pinnaplasties.

We report the use of Silastic Foam as a dressing in seven of our pinnaplasty cases. The advantages of Silastic Foam dressing over conventional dressings are mainly:

1. Patient comfort.

2. No change of dressing is required.
Auditory brain stem evoked potentials in patients suffering from peripheral facial nerve palsy and diabetes mellitus
Authors: Ben-David J. , Gertner R. , Podoshin L. , Fradis M. , Pratt H. , Rabina A.
Published: November 2007

Forty-two patients affected by acute idiopathic peripheral facial palsy (AIPFP) underwent auditory brainstem evoked potential (ABEP) investigation in order to further our understanding of the nature of facial palsy. Twenty-two of these patients suffered from diabetes mellitus. Our results indicate that the AIPFP of the diabetic person may be considered as a preliminary sign of diabetic peripheral neuropathy.
Osteochondroma of the cervical spine
Authors: Nielsen O. G. , Gadegaard Lena , Fogh A.
Published: November 2007

Osteochondromas of the cervical spine are rare. Two cases are described, both originating from the second cervical vertebra, one localized to the spine and the other to the anterior aspect of the body of the vertebra. The examinations carried out and the treatment are reported.
Microfractures of the otic capsule
Authors: Proops D. W. , Hawke W. M. , Berger G.
Published: November 2007

Microfractures of the temporal bone have been recognized for more than seventy years and occur in certain well-defined areas of the otic capsule. The etiology and significance of these microfractures has been debated since their discovery. The most commonly held theory is that they result from stresses within the otic capsule that develop with growth. An alternative explanation might be that they result from masticatory stress placed upon the temporal bone.

Fifty serially-sectioned temporal bones from the Ontario Temporal Bone Bank were examined in this study for the presence of microfractures. Our findings as to the most common sites of microfractures agree with previous studies.

It is proposed that the constant stress placed upon the petrous temporal bone by the act of mastication is directed by the anatomy of the external, middle and inner ear through certain definite pathways, including the Fallopian canal, the bony semicircular canals and the cochlea. The most common sites of these fractures represent sites of weakness in the path of these directed forces within the otic capsule, and the statistically significant increase in the number of fractures with age lends support to the masticatory stress theory.
Possible implication of an efferent neuropathy in vestibular upset
Authors: Prescott C. A. J.
Published: November 2007

This essay examines two possible mechanisms whereby a neuropathy affecting the efferent vestibular innervation may cause incoordination of vestibular afferent input to the Vestibular Integrating Centres: firstly, by loss of the normal fine control of afferent impulses; secondly, by a disruption of the sodium-potassium pump mechanism that maintains the ionic stability of the inner ear fluids.
Median nasal dermoid fistulae
Authors: Baton R. P. E. , Shuttleworth D. , Graham-Brown R. A. C.
Published: November 2007

Two cases of median nasal dermoid fistulae are presented. This is an uncommon developmental abnormality which may present either to ENT Surgerys, Plastic Surgeons, or Dermatologists. Although the extent of the tract in our cases was small, careful pre-operative assessment is required as the tract may be ectensive.
A comparison of endotracheal intubation and tracheostomy in the management of acute epiglottitis in children in the tropics
Authors: Odetoyinbo Olujimi
Published: November 2007

In children, acute epiglottitis is rapidly fatal due to airway obstruction by swollen supraglottic structures, but the oedema is short-lived. Therefore, in many centres short-term endotracheal intubation has replaced tracheostomy as the method of choice for relieving the obstruction.

We have tried both methods in 15 children over a period of three years under conditions of limited material and human resources. Tracheostomy was found to be safer. It was concluded that it is better to have a live healthy child with a small scar in the neck than a dead child without a scar.
Malignant tumours of the tongue in young adults
Authors: Randall C. J. , Shaw H. J.
Published: November 2007

Twenty-three cases of malignant tongue tumours in patients aged 15 to 30 are reported. Treatment and prognosis in the 18 for which follow-up information is available are discussed. The disease appears to be very similar to that in older subjects except for a greater incidence of neck node metastases. Close follow-up after primary treatment is essential since there is a high possibility of recurrent disease but which may respond well to salvage surgery if identified early. A greater awareness of the occurrence of tongue cancer in young adults is also necessary.
A British experience of surgical voice restoration techniques as a secondary procedure following total laryngectomy
Authors: Perry Alison , Cheesman A. D. , McIvor J. , Chalton Rosemary
Published: November 2007

An earlier paper (Cheesman et al., 1985) described assessment procedures for ‘failed’ oesophageal speakers who were referred to Charing Cross Hospital for possible Surgical Voice Restoration in 1983–4.

This paper presents the results of surgical voice restoration in the first fifty laryngectomized patients referred and analyses the reasons for failure in those where surgical voice restoration was unsuccessful.

94 per cent of patients who underwent secondary voice restoration were successful at two weeks post-surgery, but this success rate dropped to 73 per cent at three months. Reasons for this are explained and the pre-requisites for a successful surgical voice restoration are indicated.
The diagnostic criteria of malignant external otitis
Authors: Cohen David , Friedman Peter
Published: November 2007

The diagnostic criteria of malignant external otitis (MEO) have been reviewed. They were divided into two categories: obligatory and occasional. The obligatory criteria are: pain, edema, exudate, granulations, microabscess (when operated), positive bone scan or failure of local treatment often more than 1 week, and possibly pseudomonas in culture. The occasional criteria are diabetes, cranial nerve involvement, positive radiograph, debilitating condition and old age.Allof the obligatory criteria must be present in order to establish the diagnosis. The presence of occasional criteria alone does not establish it. The importance of Tc99 scan in detecting osteomyelitis is stressed. When bone scan is not available, a trial of 1–3 weeks of local treatment is suggested. Failure to respond to such treatment may assist in making the diagnosis of MEO.
Surgical anatomy of the hypotympanum
Authors: SaviČ D. , Djerič D.
Published: November 2007

Anatomical characteristics of the hypotympanum were tested on 50 temporal bones. The hypotympanum has the shape of an irregular bony groove which is surrounded by five walls. The outer wall is formed by the tympanic part of the temporal bone. In 65 per cent of the cases the inner wall is formed by part of the petrous bone which extends under the promontory; in 25 per cent it is formed only by the lower part of the promontory; and in 10 per cent it corresponds to the juncture of the promontory and the petrous bone. The lower wall is clearly defined in 48.2 per cent of cases and corresponds to the juncture of its inner and outer walls. In 65 per cent of cases a recess of the inferior hypotympanic sinus is found on the floor of the hypotympanum. In 25.3 per cent of cases the jugular bulb protrudes into the tympanic cavity. In 73.4 per cent of cases the front wall is formed by part of the petrous bone which extends from its floor towards the tympanic opening of the protympanum, and in 26 per cent of the cases it is formed by the wall of the internal carotid artery. On the front wall, in 22.4 per cent of cases, a recess of the anterior hypotympanic sinus is found. The back wall is formed by elements of the styloid complex and in five per cent of the cases a recess or posterior hypotympanic sinus is found on it.
Maxillary sinus aspiration in children What are the indications?
Authors: Shone G. R.
Published: November 2007

The results of sinus aspiration in 100 children were analysed retrospectively. There was no correlation between a positive aspiration and the patients' symptoms, signs or previous radiograph.
Chronic tonsillitis, tonsillectomy and sickle cell crises
Authors: Ijaduola G. T. A. , Akinyanju O. O.
Published: November 2007

A study of the effect of tonsillectomy on the frequency of sickle cell pain crises was carried out on 15 patients with sickle cell disease (Hb SS) who presented with complaints of frequent pain crises and were found to have chronic tonsillitis. They comprised 9 females and 6 males and ranged in age from 6 to 35 years, with a mean of 15 years. Tonsillectomy was performed under general anaesthesia. The mean number of pain crises in the one-year period after tonsillectomy was 1.5 and was significantly less than the mean number 4.7 in the one year preceding the operation (p<0.001). Four patients failed to show a reduced number of crises and these were those whose tonsils at operation showed no pus in their tonsillar crypts. It is thus observed that chronic tonsillitis, symptoms of which may not be volunteered at examination, is a potent inductor of sickle cell pain crisis and that tonsillectomy is an effective mode of treatment, especially when the tonsillar crypts contain pus.
Chondrogenic neoplasms of the nasal cavity
Authors: El-Silimy O. E. , Harvey L. , Path M.R.C. , Bradley P. J.
Published: November 2007

Chondrogenic neoplasms of the nasal cavity are rare. Clinically, presentation is often late, with expansion and destruction of the middle facial skeleton. Local radical surgical excision is the preferred treatment, with regular life-long follow-up. Risk of local recurrence and distant metastases may Qccur many years after initial treatment. All chondrogenic tumours should be carefully followed up because the natural course of the disease may not match the histological differentiation.
Musculus uvulae and velopharyngeal status
Authors: Ijaduola G. T. A. , Williams O. O.
Published: November 2007

A study of velopharyngeal status after partial excision of musculus uvulae, as in total uvulectomy, has been carried out in 15 adults with normally formed soft palates. Fifteen volunteers matched for age and sex with normal palates, who had not had total uvulectomy, were used as controls. Four assessment techniques were used: (a) Air escape, with modified tongue anchor technique; (b) Production of speech sounds; (c) Transnasal nasopharyngoscopy; and (d) Radiological screening. Even though Azzam and Kuehn (1977) have stressed the importance of the musculus uvulae in velopharyngeal closure, all assessments showed that partial excision of the musculus uvulae, as in total uvulectomy, has no statistically significant effect on the velopharyngeal status in subjects with a normally formed soft palate.
Squamous cell hyperplasia of the larynx
Authors: Kalter P. Olde , Lubsen H. , Delemarre J. F. M. , Snow G. B.
Published: November 2007

According to Kleinsasser's classification 200 patients with squamous cell hyperplasia, seen between 1963–1981, were reviewed histologically. The untreated patients (47 per cent) have been analysed for the incidence of malignant change and the patients with Class III lesions (carcinoma in situ) who were treated, were analysed for response to treatment. The mean follow-up period was 8.4 years. Only two of the 38 initially untreated patients of Class I (simple squamous cell hyperplasia) developed an invasive carcinoma. In Class II (hyperplasia with atypia), of 62 patients who were not treated initially, 17 developed a laryngeal squamous cell carcinoma later. Only six patients of Class III did not receive any treatment initially, and one of these progressed to invasive carcinoma. Almost all other patients with carcinoma in situ (Class III) were irradiated. In these patients no evidence of local recurrence was found.
Pendred's syndrome with episodic vertigo, tinnitus and vomiting and normal bithermal caloric responses
Authors: Das V. K.
Published: November 2007

A case of early-onset bilateral sensori-neural deafness with episodic objective vertigo, tinnitus and vomiting, suggestive of Meniere's syndrome, was found to have a diffuse goitre. A Perchlorate discharge test was positive, indicating an organification defect diagnostic of Pendred's syndrome. The case was found to be euthyroid both clinically and on investigations. Tone decay was absent and recruitment was found, thus indicating a cochlear site of lesion. Bithermal caloric tests and clinical tests of vestibular function were within normal limits. X-rays, including petrous tomography, did not show any abnormalities.
Breast carcinoma metastatic to the nasopharynx
Authors: Saab Ghaleb A. , Abdul-Karim Fadi W. , Samara Milhem
Published: November 2007

A case report of a patient with adenocarcinoma of the breast with matastasis to the nasopharynx is described. The patient presented initially with pulmonary metastasis followed later by metastasis to the left jugulo-digastric lymph nodes. A prominent but asymptomatic nasopharyngeal mass was concomitantly discovered on head and neck examination. Three months later, symptoms of panhypopituitarism developed. Invasion of the base of the skull and pituitary were documented. Patients with adenocarcinoma of the breast and high cervical node metastasis should have a thorough otolaryngologic and head and neck evaluation.

Metastatic carcinoma to the nasopharynx is an extremely rare occurrence. Only two cases of bronchogenic carcinoma of the lung and two cases of hypernephroma metastatic to the nasopharynx have been reported in the literature (Bernstein et al., 1966). We present what we believe to be the first case of metastatic adenocarcinoma of the breast to the nasopharynx.
Silicone ear splints in the management of acute haematoma auris
Authors: Bingham B. J. G. , Chevretton E. B.
Published: November 2007

A discussion of the rationale of management of acute haematoma auris and a description of a simple, reliable method of management using Otoform K Silicone impression material to form ear splints.
The effect of tonsillectomy and adenoidectomy on the intra-tympanic pressure
Authors: Tuohimaa Pekka , Palva Tauno
Published: November 2007

A group of 67 children were studied (mean age 7 years, 2 months) who underwent adenoidectomy and/or tonsillectomy because of either recurrent otitis media or upper respiratory tract infection. The mean pre-operative intratympanic pressure was –67.3 mmH20 (SD 65.1); three months post-operatively it was –21.9 mmH20 (SD 32.4), a highly significant improvement (p<0.001). The size of the adenoids had a nearly significant effect on the pre-operative intratympanic pressure (p<0.05). In children with large vs small adenoids the difference was highly significant (p<0.001). In a group of five children, tonsillectomy along (adenoidectomy performed earlier) did not have any effect on the intratympanic pressure. No change in intratympanic pressure was seen in children with nasal allergy as compared with non-allergic children after adenoidectomy.
Anaplastic thyroid carcinoma metastatic to the tonsil
Authors: Hadar Tuvia , Mor Celia , Har-El Gady , Sidi Jack
Published: November 2007

We describe a 65-year-old woman who presented with a left tonsillar tumour. Biopsy revealed metastatic anaplastic cell carcinoma of the thyroid. Metastatic tumours are rare in the tonsils. This case, to the best of our knowledge, is the first in which the thyroid was the primary site.
A method for preparation of fibrin glue
Authors: Durham L. H. , Willatt D. J. , Yung M. W. , Jones I. , Stevenson P. A. , Ramadan M. F.
Published: November 2007

Otorhinolaryngological operations would be facilitated by the use of a safe, cheap, surgical adhesive. Though commercial fibrin glue is effective, it is both relatively expensive and, because it is prepared from pooled human blood, there has been concern that it carries the risk of transmitting viral disease, in particular hepatitis and acquired immune deficiency syndrome. We describe a rapid, cheap method of preparing sufficient fibrin glue, of adequate bonding power, from a small quantity of the patient's own blood, and therefore with no risk of contracting viral disease. Our method of preparation of fibrin glue promises to provide a valuable adjunct to otorhinolaryngological surgical practice.
Chemical burns of the oesophagus
Authors: Sellars S. L. , Spence R. A. J.
Published: November 2007

Chemical burns of the oesophagus caused by ingestion of corrosives present a difficult and potentially dangerous problem of management. Initial failure to recognize the seriousness of the injury and inexperience in the handling of the severer burn may result in consequences which are both life-threatening and life-long.

Analysis of 95 patients who had ingested caustic substances is presented. Ninty-one sustained burns of the mouth, 39 of the hypopharynx or oesophagus, and 31 had laryngeal burns. Sixty-three were children of 15 years and under. Caustic soda, especially in children, was the most common substance ingested. Severe oesophageal strictures developed early in 17 patients and in a further 21 oesophageal stricturing occurred late.

A protocol for the management of these patients is discussed.
Occurrence and recurrence of basal cell carcinoma of the head and neck in negroid and albinoid africans
Authors: Ademiluyi S. A. , Ijaduola G. T. A.
Published: November 2007

A study of sixty patients with basal cell carcinoma of the head and neck region carried out over a six-year period (1979–1985) is hereby presented. Sixteen (26.72 percent) were albinos and 44 (73.28 per cent) negroids. Forty-eight (80 per cent) were outdoor workers. The negroid patients presented between the 3rd and 4th decades while the albinos presented a decade earlier. The commonest site involved in the head and neck was the forehead. The midface showed the highest recurrence rate in both groups, even after adequate excision. The frequency of recurrence in tumours presenting with a size of 2–5 cm. diameter was significantly higher in the albinos than in the negroid (P<0.05), whereas, with tumours of a size larger than 5 cm., there was no statistically significant difference between the albino and the negroid. However, the overall recurrence rate was significantly higher in the albinos (P<0.005). The mortality among the albinos was 25 per cent while there were no deaths in the negroid Africans.
Revision stapes surgery
Authors: Bhardwaj B. K. , Kacker S. K.
Published: November 2007

The records of 120 patients who had undergone revision stapedectomy were analyzed to determine: (i) the causes of failure; (ii) how to prevent failure by taking precautions during primary surgery; (iii) hearing results; and (iv) possible identifying factors which might pinpoint those patients with a high risk of sensorineural deafness.

A review of these cases demonstrates that the results of revision stapedectomy are different from those of primary stapedectomy. The commonest cause of failure was prosthetic dislocation (30.8 per cent), followed by fibrous adhesions (18.3 per cent) and otosclerotic regrowth (14.1 per cent). First revision operations resulted in post-operative bone-air gaps of 15 dB. or less in 46.5 per cent of cases, much better than 25 per cent for second revisions. Primary stapedectomy resulted in successful closure of the air-bone gap to 15 dB. or less in 89.5 per cent of cases.

The sensorineural loss occurred in 11.3 per cent or first revisions and in 16.6 per cent of second revisions, as compared to 1.3 per cent after primary surgery. “Dead ears” were encountered in 2.2 per cent of first revisions, as compared to nil in the primary group.
Rationalization of peritonsillar abscess as an indication for tonsillectomy
Authors: Curley Jane W. A. , Bates G. J.
Published: November 2007

It has been widely held that peritonsillar abscess is a strong, if not absolute, indication for tonsillectomy, performed either immediately or after an interval of some weeks. A retrospective study of 48 patients is presented. It appears that age and the incidence of previous throat infections can be related to the likelihood of further problems and the need for operation.
Reconstruction of the pharynx after laryngectomy and partial pharyngectomy
Authors: Stafford N. D. , Matthews R. N.
Published: November 2007

Stricture formation may occur after pharyngolaryngectomy it less than one half of the circumference of the pharynx is available for primary closure. However, the alternative of total pharyngectomy with skin flap or visceral replacement carries with it a high mortality and morbidity rate. In an attempt to overcome these problems, a policy of patch grafting the paryngeal defect with a myocutaneous flap or segment of free vascularised jejunum has been adopted whenever a strip of pharyngeal mucosa greater than one centimetre in width remains after excision of the tumour. A good post-operative smallow has been achieved in all cases.
Is vidian neurectomy worthwhile?
Authors: Ogale S. B. , Shah Ajay , Rao S. C. , Shah K. I.
Published: November 2007

Vasomotor rhinitis is a frustrating experience both for the consultant and for the patient. The purpose of vidian neurectomy is to destroy the secretomotor nerve supply to the nasal mucosa, the main indication being severe intractable non-atopic casomotor rhinitis.

A review of 208 cases which have undergone transnasal vidian neurectomy by diathermy coagulation in the last five years is presented.

The operation has proved worthwhile, the patients remaining symptom-free in 92 per cent of cases (longest follow-up 5 years). There have been on complications
Bilateral chylothorax following left radical neck dissection (Case report)
Authors: Pace-Balzan A. , Moriarty B.
Published: November 2007

Bilateral chylothorax is a rare complication of radical neck dissection and was first described in 1907. Stuart (1907) reviewed a number of patients with injuries to the thoracic duct in the neck and reported on three patients with bilateral chylothotax, all of whom died. The condition was not reported again until 1951 when the first of the five single case reported published to date appeared. The rarity with with which this complication is reported makes it difficult for clinicians to be familiar with it. A further case is reported and the relevant literture, and certain aspects of the aetiology and management are discussed.
An ingenious mucus trap
Authors: Harrop-griffiths Katherine , McLean Neil R.
Published: November 2007

This brief report describes how, with commendable insight, a patient recently treated in our Unit adopted a very simple device to collect the excess mucus issuing from his tracheostomy tube.
The surface morphology of the endolymphatic sac of the Mongolian gerbil (Meriones unguiculatus) (A scanning electron microscopic study)
Authors: Barbara Maurizio , Rask-Andersen Helge , Bagger-Sjöbäck Dan
Published: November 2007

A scanning electron microscopic study of the endolymphatic sac of the mongolian gerbil is presented. As described in other animal species and in man. three rather distinct regions on the epithelial surface can also be recognized in this rodent. Light and dark cells are seen to line the sac epithelium throughout. At the level of the intermediate portion, however, a different cell-type—the granular cell—is present, with its luminal surface covered by large amounts of solid material.

On the basis of light and transmission electron microscopic studies presented elsewhere, a higher degree of functional specialization in this portion of the gerbilline sac is proposed.
Intratemporal Vascular Tumours
Authors: Mazzonial A , Pareschial R , Calabresea V
Published: November 2007

Hemangiomas of the temporal bone are uncommon benign tumours, occurring most frequently at two sites: the internal auditory meatus (IAM) and the geniculate ganglion.

In this paper the authors discuss the pathology, clinical onset and features, and the therapeutic management of two of these lesions. A review of the literature is also presented, paying attention to the controversy regarding the origin, pathogenesis and histologic classification of this rare lesion of the temporal bone
Facial cutaneous fistula due to a foreign body in Wharton's duct
Authors: Shem Tov Y. , Talmi Y. , Zohar Y. , Laurian N.
Published: November 2007

An extremely rare case of a cutaneous fistula of the submandibular salivary gland is presented. The etiology of the fistula was a foreign body in Wharton's duct.

We describe the clinical course, management and histo-pathological findings.
Scrofula revisited
Authors: Talmi Y. P. , Finkelstein Y , Shem Tov Y , Zohar Y , Laurian N
Published: November 2007

Mycobacterial cervical lymphadenitis, or scrofula, is a disease dating back thousands of years.

In spite of modern treatment and public health measures, scrofula persists but is infrequently seen.

Five patients with cervical tuberculous lymphadenitis as a sole presentation have been seen in our department in the last 10 years.

The clinical presentation and current methods of diagnosis and treatment are described.

A short historical review is given.
Traumatic perilymphatic fistulae of the lateral semicircular canal
Authors: Yaniv Eitan , Traub Phillip
Published: November 2007

Fifteen patients with perilymphatic fistulae were evaluated. Of these patients, three had CSF leaks in addition to the perilymphatic fistulae. Eight patients had fistulae of one or both windows; two had fistulae confined to the lateral semicircular canal; and two had combined fistulae of both round window and lateral semicircular canals. All improved dramatically following surgical repair.

In the following study, we have shown that perilymphatic fistulae can occur in the lateral semicircular canal, and we suggest exploration of this area when indicated.
An inverted papilloma with intracranial extension
Authors: van Olphen A. F. , Lubsen H. , van 'T Verlaat J. W.
Published: November 2007

Inverted papilloma can be found in the lateral wall of the nose, the ethmoidal sinus, the maxillary sinus, the sphenoidal sinus and the frontal sinus. To our knowledge there are no reports of papillomas with intracranial extension. This case report describes the history of a patient with long-standing inverted papillomas, which eventually grew intracranially. The treatment of this patient and the treatment of inverted papilloma in general are discussed.
A symptomatic venous anomaly of the parotid gland: Case report and review of the literature
Authors: Manni Johannes J. , Merx Johannes L. , van den Broek Paul , Thussen Henk O. M.
Published: November 2007

Abstract A rare case of a symptomatic venous anomaly of the parotid gland is described in a 14-year-old female patient who presented with Turkey Wattle sign. A definitive diagnosis of this disorder requires venographic studies. Surgical treatment was successful, with a follow-up of four years.
Wax plugs and cotton buds
Authors: Sim David W.
Published: November 2007

Three hundred and ten patients were examined by otoscopy. Age, sex, social class and use of cotton buds for-aural toilet were recorded. The incidence of visually occlusive wax plugs in the external auditory canals was not significantly different between users and non-users of cotton buds, either in children or in adults.
Septoplasty and/or submucous resection?
Authors: Fjermedal O. , Saunte C. , Pedersen S.
Published: November 2007

Information obtained from the case-records and completed questionnaires from 478 patients operated in the 5-year-period 1980 through 1984 with either septoplasty or submucous resection (SMR), has been analysed on an average 31 months after surgery. Two hundred (42 per cent) underwent SMR and 278 (58 per cent) septoplasty. Twenty per cent presented for a clinical follow-up examination. Of the 478 patients, 63 per cent were satisfied. More patients were satisfied with the functional results after septoplasty, which also resulted in fewer and smaller perforations than SMR. Septoplasty ought to replace the latter as the routine procedure. 10 per cent had troublesome crusting independent of the technique used. Change in the external shape of the nose is a minor problem for the patients, and was not regarded as an indication for re-operation. Patients with allergic rhinitis may undergo septal surgery on general lines.
Benign metastatic mixed tumours or unrecognized salivary carcinomas?
Authors: El-Naggar A. , Batsakis J. G. , Kessler S.
Published: November 2007

‘Benign metastasizing mixed tumours’ are enigmatic lesions of the parotid gland. The authors, through the illustrations of a case and review of the literature, conclude that the tumours are unrecognized and currently unclassified malignancies.
Melanoma metastatic to the head and neck
Authors: Harries M. L. L.
Published: November 2007

A 42-year-old man presented with a two-week history of right-sided otalgia, deafness and nocturnal tinnitus. Examination revealed a black mass on the posterior meatal wall. Two years before presentation, he had a malignant melanoma removed from the left hip region. Biopsy of the lesion in the posterior canal wall and another which had developed within two weeks on the anterior wall, confirmed metastatic disease. Treatment with radiotherapy and later chemotherapy were unsuccessful and the patient died 15 months later.
Prognostic factors in otitis media with effusion
Authors: Robinson P. M.
Published: November 2007

To determine which factors were associated recurrence of ottitis media with effusion following grommet insertion, the casenotes of 323 who had a total of 485 operations for grommet insertion were reviewed. The incidence of repeat surgery was higher in those aged between four and six years, in those having grommet insertion between the months of July and October and in those cases in which the grommet was extruded within six months. Recurrence was not related to sex of patient, month of listing for surgery, adenoidectomy, tonsillectomy, length of time on the waiting list or past history of previous grommet insertion.
Acute epiglottitis in adults
Authors: Stanley R. E. , Liang T. S.
Published: November 2007

Acute epiglottitis in adults is a potentially fatal but self-limiting disease of increasing incidence world-wide.

Forty-two patients, seen consecutively over a four year period at the ENT Department, Singapore General Hospital were reviewed retrospectively.

A strong male predominance with a peak age incidence in the sixth decade was noted. A severe sore throat and dysphagia with disproportionate signs of oropharyngeal inflammation was the main presenting picture. Only three patients had stridor on presentation. Vigilant monitoring of the airway with empirical high-dosh intravenous amicillin, cloxacillin and steroids resulted in a dramatic clinical improvement in most patients and none developed stridor after admission. The yield from throat swabs and blood cultures were low. Two patients developed complications, a Ludwigs angina and an epiglottic abscess. Recurrent epiglottistis was a problem in one patient.

There was low morbidity and no mortality on the management regime outlined.
Osteopetrosis (marble bone disease)—agenesis of paranasal sinuses
Authors: Paulose K. O. , Al Khalifa Salman , Shenoy P. K. , Harris S. , Sharma R. K.
Published: November 2007

A case of Osteopertrosis (Marble Bone Disease) in a child is presented. Agenesis (non-pneumatization) of all paranasal sinuses has been one of the salient features in this case.
Tumefactive fibroinflammatory lesion of the head and neck
Authors: Said H. , Razi hadi A. , Akmal S. Noor , Lokman S.
Published: November 2007

The term tumefactive fibroinflammatory lesion is used to describe an unusual fibrosclersing disorder that behaves in a malignant way clinically but is histologically benign. Lesions in the head and neck are believed to be part of the broader fibrosclerosing syndrome which include pseudotumour of the orbit, Reidel's thyroiditis, sclerosing cholangitis and mediastinal fibrosis. Clinical diagnosis is often difficult and relies heavily on histopathology. Steroid is suggested as the first line of management, while surgery or radiation therapy is reserved for failures.
Primary hyperparathyroidism presenting with a maxillary tumour and hydrocephalus
Authors: Robinson P. J. , Woodhead P.
Published: November 2007

Primary hyperparathyroidism presenting with advanced bone disease is an important differential diagnosis of ‘tumours’ affecting the craniofacial skeleton. We describe a case of primary hyperparathyroidism presenting with a brown tumour of the maxilla causing local symptoms.

Differentiation from other giant cell lesions of the maxilla is necessary. The histological and radiological features of brown tumour, non-ossifying fibroma and reparative granuloma are all similar. Differentiation relies on plasma calcium estimation and the diagnosis of hyperparathyroidism is confirmed by serum parathyroid hormone assay.
Clinical role of informal tests of hearing
Authors: Browning G. G. , Swan I. R. C. , Chew K. K.
Published: November 2007

Clinical tests of hearing are regularly used in adults but their role, now that pure-tone audiometry is almost universally available, has not been evaluated by modern methods of analysis including sensitivity and specificity.

Free-field voice testing was carried out in 101 patients and the Rinne tuning-fork test in a different group of 127 patients prior to clinical or audiometric evaluation. The results were subsequently compared to air and bone conduction pure-tone thresholds assessed using rigorous standards.

Depending on the audiometric definition as to what constitutes a hearing impairment, the sensitivity of free-field voice testing to identify such an impairment because of an inability to hear a whispered voice at two feet (60 cm.) was 86 per cent or better with the specificity being in the region of 90 per cent.

In the Rinne test the 256 Hz fork was superior to the 512 Hz fork (p<0.05) and the loudness comparison method superior to the threshold decay method (p<0.01) in detecting an air-bone gap. Combining the responses to the two forks did not improve the results. The Rinne test with the 256 Hz fork will identify correctly 48 per cent of individuals with a 15 dB, 69 per cent with a 20 dB, 87 per cent with a 25 dB, and 95 per cent with a 30 dB conductive impairment. In all instances the specificity is greater than 90 per cent.
Genetic counselling for isolated hearing loss
Authors: Newton V. E.
Published: November 2007

An investigation into the causes of sensorineural hearing loss in young children has been used as a basis for determining risk factors for parents of children with a hearing loss of unknown origin having a further affected child and for the defect to be passed on to a subsequent generation. The degree of hearing loss likely to be found if further children are affected, is examined.
Does severe water deprivation affect the inner ear?
Authors: Barbara M. , Bagger-Sjöbäck D. , Rask-Andersen H. , Filipo R.
Published: November 2007

Through an ultrastructural study of the endolymphatic duct (ED) and sac (ES) system, the effects of an impaired body fluid metabolism on the inner ear fluid environment in the mongolian gerbil has been evaluated. A dehydrative state has been determined depriving of water for both five and twelve days this desert animal, which is known to withstand long periods of water abstinence. The morphological changes of the ED and ES under these circumstances have been compared with those induced by ethacrynic acid intoxication. Although the cochlear partition did not show signs of damage, the ED and ES system seems to be negatively influenced by the dehydrative state and displays a marked imbibition of the subepithelial tissue, which at places shows accumulation of an organic matrix.

A regulating role for the antidiuretic hormone on the inner ear fluids of the mongolian gerbil is also proposed and discussed.
Mycotic infection of the ear (otomycosis): A prospective study
Authors: Paulose K. O. , Khalifa S. Al , Shenoy P. , Sharma R. K.
Published: November 2007

Otomycosis (fungal infection of the ear) is a not uncommon clinical problem encountered in our ENT practice. It makes up to 6 per cent of all patients with symptoms of ear disease seen in the Outpatient Clinic. Of the 193 patients with a clinical diagnosis of otomycosis, 171 cases produced positive fungal isolates. In this study Aspergillus species (niger and fumigatus) have been the most common fungal pathogens. Various aetiopathological factors have been examined in detail, and the available literature reviewed. The results of the treatment by nine antifungal agents currently available in Bahrain have been analysed.
Validity of tympanometry in cases of confirmed otosclerosis
Authors: Muchnik C. , Hildesheimer M. , Rubinstein M. , Gleitman Y.
Published: November 2007

The otoadmittence or impedance measurements are common procedures in the diagnosis of middle ear pathologies. The present study was undertaken for the purpose of studying the clinical validity of static admittance values in 42 confirmed otosclerotic ears. For both 220 Hz and 660 Hz probe tones only one third of the otosclerotic ears had low admittance values, as expected. The remainder showed admittance values in the normal or high ranges. No significant correlation was found between air bone gap (ABG) and the admittance values.
Bone pâté repair of the eroded incus
Authors: Solomons N. B. , Robinson J. M.
Published: November 2007

The authors report on a series of 25 patients who, in the process of undergoing tympanoplasty, were noted to have erosion of the long process of the incus. This was rapaired with bone pâté in an attempt to restore ossicular continuity. The methods and results are presented and the prospects for the future are discussed.
Evaluation of recent experience in hypoglossal-facial nerve anastomosis in the treatment of facial palsy
Authors: Clayton M. I. , Rivron R. P. , Hanson D. R. , Fenwick J. D.
Published: November 2007

This evaluation of recent experience of hypoglossal-facial nerve anastomosis in ten patients who had undergone acoustic neuroma resection, indicates that this procedure may have a role to play in the treatment of this disfiguring condition. Facial symmetry at rest is satisfactory in the majority of patients, who suffered little long term deficit from the loss of their hypoglossal nerve. This procedure is ideally suited to otolaryngological practice.
Recurrent meningitis associated with meningioma of the mastoid cavity
Authors: Kelleher R. J. , Murray J. A. M. , Welsby P. D.
Published: November 2007

A 53-year-old female patient who presented with recurrent meningitis as a result of a meningioma, is reported. The meningioma was found to be wholly contained within the left mastoid antrum. To our knowledge this is the first reported case of a meningioma localised to the mastoid antrum. The patient had been assessed in the ENT department on two separate occasions, 17 years and 19 years previously for nebulous symptoms related to the left ear which had cleared spontaneously. Following a second episode of pyogenic meningitis, both of which were associated with aural symptoms, radiological examination suggested an intramastoid pathology which prompted mastoid exploration. Histological examination of the mass confined to the mastoid antum provided the diagnosis of meningioma. There was no clinical or radiological evidence of extratemporal spread of tumour.