bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum antibodies against respiratory tract viruses: A prospective three-year follow-up from birth
Authors: Harsten G. , Prellner K. , Löfgren B. , Heldrup J. , Kalm O. , Kornfält R.
Published: November 2007

Acute otitis media (AOM) has been epidemiologically related to viral respiratory tract infections, and viral antigens have also been detected in middle ear secretion in some AOM episodes. Successive serum samples from children followed prospectively for three years from birth were analysed for IgG antibodies against respiratory syncytial virus (RSV), adenoviruses and influenza A virus.

Values from serum antibody activity gradually decreased during the first six months of life, followed by a gradual increase. Various relationships were found to obtain between age and the increases of antibody activity against the different viruses. Thus, three quarters of those tested had manifested increased antibody activity against RSV by 18 months of age, and against adenoviruses by 30 months of age. No increase of antibody activity against influenza A was noted before 12 months of age, and then only seen in two thirds of those tested during the entire three-year observation period. With regard to age, however, the proportion of children with increased antibody activity to RSV, adenoviruses or influenza A virus did not differ between otitis-prone and non-otitis-prone children. Thus, as compared to non-otitis-prone children, development of the ability to produce antibodies against these viruses was not found to be delayed in otitis-prone children.
Subglottic haemangioma in the infant: contribution by CO2laser
Authors: Remacle M. , Declaye X. , Mayne A.
Published: November 2007

The availability of the low intensity CO2laser beam, and the possibility of defocalization that is associated with control of subglottic high frequency jet ventilation, requires a more interventionist attitude regarding dyspnoea caused by a subglottic haemangioma in the infant. It is indeed possible reliably to reduce the size of the subglottic haemangioma, and thus to avoid a lengthy period of intensive care, as well as the problems of prolonged intubation or tracheostomy for drainage, while also avoiding long term steroid therapy. This approach in no way affects the spontaneous evolution of subglottic haemangioma in the infant; there is a tendency for the haemangioma to regress after the age of one year. The treatment does, however, permit a considerable improvement in the comfort of the infant's life during this difficult period between 3 and 12 months.

We illustrate this new attitude by presenting a report on four cases.
An evaluation of myringoplasty in war injured people
Authors: Makki Haitham Taha
Published: November 2007

Perforation of the tympanic membrane is a common war injury, especially after explosions. Such perforations will normally heal spontaneously under favourable conditions. A small number in whom the defect persists will benefit from closure by myringoplasty. Thirty-four such cases underwent operative repair and were compared with an equal number due to other causes.
Presence ofBranhamella catarrhalisalters the survival ofStreptococcus pneumoniaeandHaemophilus influenzaein middle ear effusion: Anin vitrostudy
Authors: Stenfors Lars-Eric , Räisänen Simo
Published: November 2007

Viable and non-viableB. catarrhaliswere mixed together withS. pneumoniaeandH. influenzaeand injected into non-bacterial mucoid effusion material collected from the middle ear of patients with a present secretory otitis media. The samples were incubated at 37°C. Presence of viableB. catarrhaliscould evidently prolong the survival of bothS. pneumoniaeandH. influenzae. Presence of non-viableB. catarrhaliscould also enhance the growth ofS. pneumoniae, but notH. influenzae. In contrast bothS. pneumoniaeandH. influenzaesuppressed the growth ofB. catarrhalis.
Has the increasing use of grommets influenced the frequency of surgery for cholesteatoma?
Authors: Padgham N. , Mills R. , Christmas H.
Published: November 2007

The number of operations for cholesteatoma, together with the number of cases undergoing insertion of ventilation tubes in the Tayside region of Scotland between 1966 and 1986 have been studied. During this period there has been a sixty fold increase in the use of ventilation tubes, but the incidence of cholesteatoma surgery has only varied between 0.94 and 1.88 operations per 10000 of population per year. The mean annual incidence of cholesteatoma during this period was 1.32 cases per 10 000 of population. The results indicate that there has been neither a rise nor a fall in the incidence of cholesteatoma in Tayside despite a considerable increase in the use of ventilation tubes.
Adenocarcinoma of the ethmoid sinuses in High Wycombe 1986
Authors: Capper J. W. R. , Radstone D. J.
Published: November 2007

Abstract Adenocarcinoma of the ethmoid sinus is a rare cancer in this country but relatively common in High Wycombe because of the concentration of furniture factories in this area. The management of five cases occurring recently in the High Wycombe area is described and changes in management since 1960 discussed.
Bacterial tracheitis
Authors: Rabie Ibi , McShane Donald , Warde Declan
Published: November 2007

Bacterial tracheitis is the term used to describe a severe infraglottic infection characterized by toxicity, brassy cough, inspiratory stridor, subglottic oedema and the presence of copious mucopurulent secretions in the trachea. It is an uncommon condition that requires prompt diagnosis and intensive medical therapy if significant morbidity and mortality are to be avoided.

Since the condition was first described in 1979 approximately one hundred cases have been reported. In this paper we present four children with bacterial tracheitis to add to the current literature. Interestingly, one child was admitted on two separate occasions with the disease, an event not previously recorded. All patients underwent endoscopy which revealed findings typical of bacterial tracheitis in each case. None required tracheostomy though three required nasotracheal intubation. Post-endoscopy all were managed in the Intensive Care Unit. There were no fatalities or significant morbidity. The average duration of hospitalization was seven days.
Congenital cholesteatoma presenting as a post-auricular mass
Authors: Reilly P. G.
Published: November 2007

Congenital cholesteatoma usually presents as either a conductive deafness or as a facial palsy. We report a case which presented as a post-auricular mass. It is important to recognize the possibility that the disease may present in this way when considering the management of such a mass.
Auditory and vestibular findings in Waardenburg's type II syndrome
Authors: Hildesheimer M. , Maayan Z. , Muchnik C. , Rubinstein M. , Goodman R. M.
Published: November 2007

A group of 33 patients with the autosomal dominant form of Waardenburg Type II syndrome underwent hearing and vestibular examination. A bilateral, symmetrical, sensorineural hearing loss was found in 51 per cent of the tested subjects. The severity of hearing loss varied from mild to severe. Strong evidence indicated the possible progressive nature of the hearing loss. Concerning the frequency of vestibular findings, the study highlights the frequent divergence between cochlear and vestibular involvement.
Evaluation for waterproof ear protectors in swimmers
Authors: Robinson A. C.
Published: November 2007

The middle ear cavity is exposed and vulnerable to waterborne infection in patients with grommets, perforated tympanic membranes and after radical mastoidectomy. Patients suffering from chronic otitis externa and those receiving radiotherapy to the head and neck also have an increased susceptibility to such infections. Many advocate the use of waterproof ear protectors in such patients when swimming. The choice of a suitable ear protector is complicated as many are now available commercially.

This study was therefore designed to evaluate the degree of protection afforded by seven different ear protectors in a group of six swimmers. A very sensitive, original method of water detection was devised incorporating a pH indicator strip.

The results showed conclusively that cotton wool coated in paraffin jelly BPC was the most effective method of ear protection and was found to be comfortable and easy to use. Other methods, including custom-made silicone rubber plugs, were not adequate in sealing the external auditory canal and are considerably more expensive.
Symptomatic mucosal cysts of the maxillary sinus: antroscopic treatment
Authors: Fisher E. W. , Whittet H. B. , Croft C. B.
Published: November 2007

Antroscopy has been shown to have a role in the diagnosis and treatment of antral disease. Four cases of ‘non-secreting’ benign antral cysts, each presenting with facial pain, were successfully treated using antroscopic techniques. The aetiology and management of these lesions is reviewed with the recommendation that antroscopic removal is the treatment of choice for all symptomatic cases, and for asymptomatic cases in which the diagnosis is in doubt.
Audit of blood transfusion policy in head and neck surgery
Authors: Wake M. , McCullough Sister D. E.
Published: November 2007

There is current concern about the possible adverse affects of blood transfusion on patient survival after cancer surgery. In addition, blood transfusion is associated with a low incidence of morbidity and mortality in any patient. 100 patient records have been examined retrospectively to outline the problems with blood transfusion policy in head and neck surgery. The current situation lacks standardization on a scientific basis and represents an area of resource over-utilization. A new approach to this subject in head and neck surgery is proposed and a recommended ‘new policy’ suggested.
Scintigraphic evaluation of glomus tumours
Authors: Rockall T. A. , Watkinson J. C. , Clark S. E. M. , Douek E. E.
Published: November 2007

The current investigations of choice for a suspected glomus tumour are either direct or indirect angiography to include digital subtraction followed by computerized tomography (CT) or magnetic resonance imaging (MRI) or, if available, CT and MRI with gadolinium alone. Although these modalities confirm the diagnosis and give anatomical information to facilitate accurate staging, they do not provide functional data. The use of radionuclide scintigraphy can add an extra physiological dimension to glomus tumour imaging.

Iodine-131/123 metaiodobenzylguanidine (MIBG) is a tumour imaging agent which has been used to diagnose head and neck neuroendocrine tumours to include paragangliomata and medullary carcinoma of the thyroid (MCT). However, it is expensive and the new head and neck tumour imaging agent technetium-99 m (Tc99m) (v) dimercaptosuccinic acid (DMSA) has superceded it as the imaging agent of choice to evaluate MCT. We report a patient with a glomus jugulare tumour which was evaluated with I131/I123-MIBG and Tc99m (v) DMSA. The tumour was functional and is the first reported case exhibiting positive accumulation of both I131-MIBG and Tc99m (v) DMSA. The patient was subsequently treated with a therapeutic dose of I131-MIBG. The significance of these results is discussed.
Critical evaluation of Per-Lee tubes in children
Authors: Bhatnagar R. K.
Published: November 2007

A retrospective view of 37 Per-Lee tubes inserted into 29 patients over a period of four years. At the time of review all the tubes were in situ but eleven had to be removed due to recurrent otorrhoea or perforations causing increasing deafness particularly in children. Per-Lee tubes are not suitable for long-term ventilation of the middle ear cavity in children.
Subdural empyema of otorhinological origin
Authors: Wackym P. A. , Canalis R. F. , Feuerman T.
Published: November 2007

The UCLA experience with subdural empyema (SDE) of otorhinological origin was reviewed. All cases of SDE with additional intracranial complications were excluded. Thirteen cases of SDE were identified with the prediposing factors being sinusitis (ten), mastoiditis (two), and otitis media (one). Based on data obtained from this review and from studies previously published in the literature, the keys to optimal outcome are rapid diagnosis, craniotomy with complete evacuation of the purulent collection followed by immediate surgical management of the otorhinological source of the SDE, and appropriate antibiotic therapy. Computed tomography is nearly always diagnostic but can be equivocal and magnetic resonance imaging may become the diagnostic study of choice. Of the five patients initially treated with craniotomy, 100 per cent improved as compared to 50 per cent of the eight patients initially treated with burr holes. None of the patients initially managed with craniotomy were worse or died, whereas of the four patients initially managed with burr holes, two were worse (25 per cent) and two died (25 per cent). Antibiotic therapy is guided by the organisms found in the empyema and the site of origin of the infection. The otolaryngologist must remain aware of the clinical features and management of SDE and work closely with his neurosurgical colleagues to provide early, decisive surgical treatment.
Osteochondroma of the tongue
Authors: Watson Carl , Crowther John A. , Stephen Mary R.
Published: November 2007

A case is described of osteochondroma of the tongue and the literature on osteomata, chondromata and osteochondromata of the tongue is reviewed. The tendency for these tumours to arise in the region of the foramen caecum has been noted in previous reports as has the female preponderance. It has been suggested that they arise from remnants of branchial arch cartilage. The variation in the duration and age at presentation of the lesion has not been explained and an alternative theory is suggested.
Dermoid cyst in the mouth: value of ultrasound
Authors: Thomas M. R. , Nofal F. , Cave A. P. D.
Published: November 2007

Teratomas including dermoid cysts occur in approximately 1:4000 births with the incidence in the head and neck varying according to different authors between 1.6 and 6.9 per cent.

The case presented is of a 28-year-old Caucasian male in whom a dermoid cyst occurred in the floor of the mouth where ultrasound was found useful in the pre-operative assessment.

The role of ultrasound in the pre-operative management of lesions in the head and neck is discussed.
Large retropharyngeal cold abscess in an adult with respiratory distress
Authors: Bhargava S. K. , Gupta Sanjay
Published: November 2007

A rare case of an adult with a large retropharyngeal cold abscess completely obstructing the airway and causing acute respiratory distress is presented. An urgent tracheostomy to safeguard the airway was required. The clinical features, surgical anatomy, aetiopathogenesis and management of a retropharyngeal abscess are discussed.
Titanium grommets: a trial to assess function and extrusion rates
Authors: Shone G. R. , Griffith I. P.
Published: November 2007

Titanium grommets have been promoted as having the advantage of a slower extrusion rate than other types of ventilation tube. A prospective trial was therefore designed to compare the function and extrusion rates of these grommets with those of the widely used Shepard design of Teflon grommet in a single group of patients. Thirty-one children had one type of grommet inserted in one ear and the other type in the opposite ear. After eight months there were significantly more Titanium grommets still functioning (p < 0.05) but after 12 and after 16 months there was no significant difference in the extrusion rates of the two types of grommet. There was a higher incidence of infection with granulation tissue formation around the Titanium grommet. Accordingly it is concluded that the extra expense of the Titanium grommet is not justified, particularly as the long-term effects of these grommets on the tympanic membrane are not known.
Cervical osteophytes: their significance in ENT practice (Ankylosing vertebral hyperostosis—Forestier's disease)
Authors: Jonathan D. , Baer S.
Published: November 2007

The condition known as ankylosing vertebral hyperostosis or Forestier's disease is described. Eight cases are reviewed where the radiological findings warranted this diagnosis. Their presenting symptoms are summarized as are their responses to treatment. The relevance of this diagnosis is discussed with emphasis being placed on the importance of thorough investigation of these patients. In those for whom no other cause has been found for their symptoms, the various therapeutic options are outlined with the possible complications.
Vallecula angioleiomyoma: unusual cause of acute adult airway obstruction
Authors: Evans K. L. , Lowe D. G. , Keene M. H.
Published: November 2007

A 44-year-old man presented with acute airway obstruction. A pedunculated lesion was found arising from the right vallecula. This was confirmed to be an angioleiomyoma, a type of hamartoma rarely found in the oropharynx.
Management of parotid metastases from cutaneous melanoma of the head and neck
Authors: Ball A. B. S. , Thomas J. Meirion
Published: November 2007

Parotid metastases from a cutaneous malignant melanoma are uncommon. Although the long-term prognosis is poor, loco-regional palliation is important. In a group of eight patients with parotid metastases, local control was obtained by superficial parotidectomy. Occult cervical lymph node metastases were identified in five cases in whom radical neck dissection provided regional control. Superficial parotidectomy with elective neck dissection is advocated for patients with parotid metastases from cutaneous melanoma to ensure optimal loco-regional palliation.
Management of radiation-induced otitis externa
Authors: Robinson Anthony C.
Published: November 2007

Four cases of otitis externa secondary to radiotherapy are described. This fairly common complication of irradiation to the head and neck, may impede a satisfactory completion of the therapy. Water precautions and regular otoscopic examination of the ears should be encouraged as prevention or early recognition of the condition is essential for the well being of the patient. The treatment of established otitis externa consists of frequent aural toilet and the application of weak antiseptic solutions. However, complete resolution will not occur until the cutaneous reaction has fully settled.
Bilateral choanal atresia: key to success with the transnasal approach
Authors: Singh Bharath
Published: November 2007

The intranasal approach is generally accepted as the route of choice in the correction of bilateral choanal atresia but unfortunately it is associated with a significant incidence of stenosis.

Over a five-year period, we have diagnosed bilateral choanal atresia in 30 neonates. Trans-nasal surgery was performed on 27 of them. All belonged to the Black race group. The incidence was 1:8,300 live births. There was a female predominance of 5:1. Four (13 per cent) had other associated anomalies. One was a twin.

Various factors were analysed to determine the cause of the stenosis. These were:

1. Drilling compared with curettage of the bony atretic plate. 2. Stenting versus non-stenting. 3. Soft versus hard Portex tube stenting. 4. Variation of stenting period—six, eight and twelve weeks. 5. The use of prophylactic broad spectrum antibiotic for the whole of the stenting period.

The conclusion derived from this study is that curettage of bony atresia, stenting with soft Portex tube for a period of six weeks and the use of broad spectrum antibiotic for the entire stenting period eliminates the problem of stenosis associated with the trans-nasal approach for the correction of bilateral choanal atresia.
Anterior nasal stenosis from joss stick burns
Authors: Lee Stephen T. S.
Published: November 2007

An unusual use of joss sticks leading to anterior nasal stenosis is presented.
Endolymphatic hydrops precipitated by haemodialysis
Authors: Moffat D. A. , Cumberworth V. L. , Baguley D. M.
Published: November 2007

We report a case of endolymphatic hydrops preceded by haemodialysis in the contralateral ear of a patient with known Menière's disease, and discuss the possible mechanism. It is suggested that the sudden decrease of plasma osmolality during haemodialysis acts as a reverse glycerol test. The audiometric and electrophysiological recordings pre- and post- dialysis and the induction of the Menière's triad of symptoms during dialysis, were strongly indicative of the presence of endolymphatic hydrops.
Rhinosporidiosis associated with squamous cell carcinoma in the tongue
Authors: Ahluwalia Karvita B. , Bahadur S.
Published: November 2007

The peritumoural region of a squamous cell carcinoma of the tongue when examined with light and electron microscope showed nodular bodies in the submucosa with all the distinctive features of ‘sporangium’ and ‘spores’ of rhinosporidiosis. The occurrence of rhinosporidiosis in the tongue along with malignancy has not been reported hitherto. Some interesting observations and causal relationships are discussed.
Malignant adenolymphoma of the parotid gland: report of carcinomatous transformation
Authors: Önder T. , Tiwari R. M. , van der Waal I. , Snow G. B.
Published: November 2007

Malignant transformation of an adenolymphoma (Warthin's tumour) is a rare event. This paper presents a case of carcinoma arising in an adenolymphoma of the parotid gland.
Tympanosclerosis of the middle ear: Late results of surgical treatment
Authors: Tos Mirko , Lau Torben , Arndal Helge , Plate Søren
Published: November 2007

The late results of one stage operation for middle ear tymanosclerosis in 73 patients during the period January 1965 to December 1980 are presented. Mean observation time was 11.2 years (range 3–20.2 years), with a follow-up rate 86 per cent. Among 64 patients with stapes fixation, 59 had removal of tympanosclerotic masses and stapes mobilization, and five cases underwent stapedectomy. The series was divided into six groups and the results analyzed. The best and most stable results occurred in the group with stapes mobilization and an intact ossicular chain followed by the group with stapes mobilization and Type II tympanoplasty with incus interposition. The poorest late results were obtained in ears with lacking stapes crura and stapes mobilization, and in ears subjected to stapedectomy. No case of post-operative sensorineural hearing loss occurred. We recommend that care is taken to preserve an intact ossicular chain at stapes mobilization performed at the same stage as myringoplasty. Also in ears with a defective ossicular chain but intact stapes with tympanosclerotic fixation we recommend stapes mobilization in one stage. In ears with fixation of the stapes footplate and defective crura, we recommend stapedectomy or stapedotomy in two stages.
Inter-arytenoid glottic bar following intubation
Authors: McCombe A. W. , Philips D. E. , Rogers J. H.
Published: November 2007

Inter-arytenoid glottic bar is a rare complication of prolonged endotracheal intubation. We present two such cases and their treatment.

The aetiology of this complication is multifactorial and involves local factors—local tauma, movement of the endotracheal tube within the larynx, infection, and anatomical influences–together with systemic factors such as in our two cases.

The relative importance of these factors is discussed.

A comment is also made on the use of a pre-operative topogram and the importance of an ENT assessment in patients with airway problems following prolonged intubation.
Primary intratemporal tumours of the facial nerve: Diagnosis and treatment
Authors: Sanna Mario , Zinia Carlo , Gamoletri Roberto , Pasanisi Enrico
Published: November 2007

Benign primary tumours of the facial nerve are uncommon. A slowly progressive facial palsy should be considered the result of a nerve tumour untilproven otherwise.

Improvements in diagnostic imaging techniques of the temporal bone have increased the possibility of a correct pre-operative diagnosis but facial nerve tumours remain a frequently ignored or misdiagnosed entity as a consequence of their subtle and protean clinical manifestations.

A series of 12 cases of primary facial nerve tumours is presented. The clinical features, diagnostic modalities and treatment are discussed in relation to a review of the literature.
Auro-nasopharyngeal poiyp and cholesteatoma
Authors: Maw A. R. , Hawthorne M. R.
Published: November 2007

We report the association of an auronasopharyngeal poiyp arising in a congenitally abnormal middle ear and Eustachian tube. Subsequently, ten years after removal of the polyp and insertion of a ventilation tube, there was recurrence of the polyp in association with cholesteatoma of the middle ear.
Direct extension of laryngeal carcinoma to the skin of the neck
Authors: Rifai Mohamed , Mebed Hassan , Bassiouni Mahmoud
Published: November 2007

Invasion of the skin of the neck by laryngeal carcinoma is relatively uncommon. Twelve cases of cancer of the larynx fungating through the cervical skin are presented. They mostly followed initial treatment by deep X-ray therapy or partial laryngectomy. A high tracheostomy was also considered to be a contributing cause for the occurrence of such a mishap. The management and follow-up of these patients is described.
Late development of a squamous carcinoma in a reconstructed pharynx
Authors: Deans J. A. J. , Hill J. , Welch A. R. , Soames J. V.
Published: November 2007

We report a case in which a squamous cell carcinoma was found to have arisen from a delto-pectoral skin flap used in pharyngeal reconstruction. The flap had been forming a neo-pharynx for 24 years. No other signs of recurrent disease had developed in this period. This raises the possibility of tumour induction in heterotopic skin used for oropharyngeal reconstruction.
Tracheostomy closure in restrictive respiratory insufficiency
Authors: Hickey S. A. , Ford G. R. , Evans J. N. G. , Patrick J. A. , Spencer G. T.
Published: November 2007

A retrospective study is presented of 31 patients who required ventilatory support via a tracheostomy for periods of one month to 27 years whilst in a tertiary referral centre for the care of patients with restrictive respiratory insufficiency. All patients underwent closure of a long-standing tracheostomy. Post-operative follow-up periods of up to 16 years are documented. The indications for and the complications of tracheostomy closure in patients with severe chronic restrictive respiratory insufficiency requiring long-term respiratory support are discussed. It is concluded that the benefits of operative tracheostomy closure outweigh the disadvantages in this unusual type of patient.
Leiomyoma of the nasal septum
Authors: Barr G. D. , More I. A. R. , Path F.R.C. , McCallum H. M. , Path F.R.C.
Published: November 2007

A case of leiomyoma of the nasal septum is presented together with electron micrographs.
Marijuana smoking as a possible cause of tongue carcinoma in young patients
Authors: Almadori G. , Paludeeri G. , Cerullo M. , Orraviani F. , D'alatri L.
Published: November 2007

A case of T1N0M0carcinoma of the tongue in a male 23-year-old ‘regular’ marijuana smoker is described. Hemiglossectomy and complete bilateral neck dissection were carried out. No post-operative radiotherapy was given as the resection margins were histologically negative. The tumour recurred one year later in the left cervical region involving the mandible and surgery was again performed, but after three months, neck disease was still evident. The case described case implies the introduction of marijuana as a possible new risk factor in the development of oral cavity tumours. Resection of the primary lesion has to be as wide as possible even in T1cases, due to the aggressive biological behaviour of such tumours in young subjects.
Audiological findings following head trauma
Authors: Abd Al-Hady M. R. , Shehata O. , El-Mously M. , Sallam F. S.
Published: November 2007

Traumatic head injury is the principal cause of death and serious physical disability in adolescents and young adult. Hearing loss is a common sequela of head trauma. The results of pure tone and auditory brain-stem response (ABR) assessment of minor head injury revealed that 20 per cent of these cases showed impairment of hearing including both conductive and sensorineural heaing loss mostly in the high frequencies loss.

ABR findings showed a significant difference of absolute wave V latency and interwave (III-V) latencies at repetition rate 11.1 click/sec., and a highly significant difference at a repetition rate of 51.1 click/sec., compared with the control group.

In severe head injury, conductive hearing loss was found in only one case, in which a longitudinal fracture of the temporal bone was identified radiologically. No ABR could be recorded at a repetition rate of 11.1 click/sec. in either ear of this case; this patient died a few days later.

Three cases were found with a mixed sensorineural hearing loss; one of them showed a longitudinal fracture radiologically. ABR findings in two cases showed prolongation of wave V and I–V interwave latencies, and the third case showed absence of ABR recording.

In comatose patients, an ABR grading system is a more sensitive index of brainstem dysfunction than the simple division of normal versus abnormal ABR waves and interwave latencies. Presence or prolongation of wave V and interwave latency I–V even in one ear is of good prognostic value in the comatosed patient.
Angiolymphoid hyperplasia with eosinophilia
Authors: Sharp J. F. , Rodgers M. J. C. , Macgregor F. B. , Meehan C. J. , McLaren K.
Published: November 2007

Angiolymphoid hyperplasia with eosinophilia is a rare condition and is poorly recognized in the otolaryngological literature. The condition is characterized by the appearance of cutaneous nodules within the head and neck region especially around the external ear. Variable lymphadenopathy and peripheral eosinophilia can occur and the condition can mimic neoplasia. It is important to be aware of this disease entity in order to avoid overtreatment. Surgical removal is the treatment of choice; however, this often multilobulated and poorly delineated lesion often precludes initial wide excision and local recurrence is common.

We present three cases of this unusual condition and a brief resumé of the literature.
Long-term results of submandibular duct transposition for drooling
Authors: Burton M. J. , Leighton S. E. J. , Lund W. S.
Published: November 2007

This study examines the long-term results and morbidity of submandibular duct transposition in drooling children. Twenty-two patients, aged 3 to 18 years, with neurological dysfunction and excessive drooling underwent submandibular duct transposition between 1984 and 1987. In January 1990, 20 patients were reviewed. Their degree of drooling pre-operatively, immediately post-operatively and currently was assessed. The rate of improvement and the occurrence of complications were noted. Drooling was ‘much better’ in the early post-operative period in 17 of the 20 patients, and this improvement was invariably noted within three weeks. In the three other patients drooling was ‘better’. Deterioration occurred in only three patients over the entire follow-up period. Complications all occurred in the first 18 months following surgery; they consisted of salivary retention cysts in four and transient submandibular gland swelling in a fifth patient.
Unusual complication of an ingested foreign body
Authors: Gertner Rachel , Bar'el Esther , Fradis Milo , Podoshin Ludwig
Published: November 2007

Migration of a foreign body from the mouth and throat to the subcutaneous tissue of the neck is very rare. We present a case of a migrating foreign body (a piece of straw) from the floor of the mouth to the neck. To our knowledge, this is the second case reported in the English literature.
Combined study to assess the role of calcium alginate swabs and ligation of the inferior tonsillar pole in the control of intra-operative blood loss during tonsillectomy
Authors: Sharp J. F. , Rogers M. J. C. , Riad M. , Kerr A. I. G.
Published: November 2007

Bleeding is the major source of morbidity and mortality of tonsillectomy and most operative time is spent securing haemostasis. Calcium alginate reduces experimental wound blood loss. This study assessed the efficacy of alginate swabs during tonsillectomy and inferior tonsillar pole ligation in the control of blood loss during tonsillectomy.

Ninety-nine tonsillectomy patients were randomized to gauze or alginate swab use. A haemoglobinometer measured blood losses collected by suction during dissection and by swab until haemostasis was secured. Operative time, complications and healing were also assessed.

Mean total blood losses and operative times were similar for the two groups. Swab blood loss was significantly lower for surgeons who ligated the lower tonsillar pole, compared with surgeons who used a snare. This finding was independent of swab type. Independent assessment showed no difference in the healing rate.

Alginate swabs offer no advantage over gauze in terms of blood loss, operative time or complications of tonsillectomy. The results show that routine lower pole ligation significantly reduces post-dissection blood loss. We suggest that this technique should be more widely adopted.
Mucosal wound and cicatricial stricture formation in the dog trachea: an experimental study
Authors: Zhi Wang , Rucheng Chi , Wenxuan Chen , Wenzhong Liu
Published: November 2007

Complete healing of full-thickness tracheal mucosal wounds of different sizes was studied in three groups of dogs. No stricture was observed when the mucosal wounds were less than 20×15 mm. Obvious stricture, however, occurred when the wounds were 20×25 mm. Normal epithelium regenerated on the wounded areas in all of the three groups within seven weeks.
Sensorineural hearing loss and the Marinesco-Sjögren syndrome
Authors: Newton V. E.
Published: November 2007

Sensorineural hearing loss has not been previously reported in patients with the Marinesco-Sjögren Syndrome. Two siblings are described where hearing was initially normal but subsequently deteriorated.
Radiological study of primary spontaneous CSF rhinorrhoea
Authors: Tolley N. S. , Lloyd G. A. S. , Williams H. O. L.
Published: November 2007

A radiological study of skull base anatomy was performed in patients presenting with primary spontaneous CSF rhinorrhoea. Radiology correctly identified the fistula site in 90 per cent of cases. Contrast CT imaging was found to be the most suitable technique for identifying the presence and site of CSF fistulae. However, pre-contrast bony dehiscences were identified in all patients leaking from the cribriform plate region. More significantly, all of these patients showed deviation of their crista galli, a radiological sign hitherto unreported. These findings support the theory that congenital bony dehiscence is the aetiological basis for this condition. The importance of radiology in the management of this condition is emphasized.
Solitary keratoacanthoma of the nasal vestibule
Authors: McGlashan J. A. , Rees G. , Bowdler D. A.
Published: November 2007

Keratoacanthomas are lesions which rarely present to Otorhinolaryngologists; however they must be considered in the differential diagnosis of any rapidly growing lesion in the head and neck. We report a case of a keratoacanthoma of the nasal vestibule which caused clinical and histopathological difficulties in diagnosis. Keratoacanthomas and the treatment options are discussed.
Bacteriology of inadequately treated active chronic otitis media in paediatric age group
Authors: Amadasun J. E. O.
Published: November 2007

Haphazardly treated active otitis media was investigated bacteriologically in 214 children. Analysis showed that Pseudomonas aeruginosa was more prevalent than other micro-organisms. Candida was also found in appreciable quantity. The author contends that this was due to inadequate self treatment before these children reported in his hospital. He advocates that decision regarding the chemotherapeutic agent to be used should be based on culture and in vitro sensitivity.
Squamous carcinoma of the temporal bone: a revised staging
Authors: Clark L. J. , Narula A. A. , Morgan D. A. L. , Bradley P. J.
Published: November 2007

Carcinoma of the middle ear is a difficult tumour to treat. We present ten cases and discuss staging of these tumours. Our results would suggest that a revised staging system may allow better identification of patients that would benefit from surgery whilst sparing some mutilating surgery that offers little to improve their quality or quantity of life.
Post-traumatic cholesteatoma
Authors: Bottrill L. D.
Published: November 2007

Post-traumatic cholesteatoma often presents many years after the original injury. This case occurred 24 years after a head injury which represents the longest recorded interval. A further interesting feature was that the patient presented with an infected skull prosthesis that was inserted at the time of the original injury.
Mastoid surgery at the Red Cross War Memorial Children's Hospital 1986–1988
Authors: Prescott C. A. J. , Malan J. F.
Published: November 2007

Eighty-three children between ages 0–12 years had mastoid surgery in the three year period 1986–88. The indications were acute mastoiditis (30 children), uncontrolled chronic suppurative otitis media (CSOM) (24 children), cholesteatoma (22 children) and a miscellaneous group (7 children). Forty-seven per cent of those with acute mastoiditis were under one year but the 27 per cent with cholesteatoma as the precipitating cause were 4–12 years. Twenty-three per cent had significant complications. Typmano-mastoid surgery was employed to resolve uncontrolled CSOM. Children were between 2–12 years and 62 per cent were below the 25th centile for weight. Seventy-nine per cent of the tympanic membrane grafts were successful. The children with cholesteatoma were between 3–12 years and 76 per cent were below the 25th centile for weight. Eight of them only presented after the onset of acute mastoiditis. One child had a definite congenital cholesteatoma. Only one had a pars flaccida origin of the cholesteatoma sac and only eight an origin from the postero-superior pars tensa. All had open cavity surgery. When the cavity was lined by temporalis fascia, healing was improved markedly.
Clinical evaluation of nasopharyngeal carcinoma in Jordan
Authors: Jamal Musa N.
Published: November 2007

Thirty-three cases of nasopharyngeal carcinoma are reported. This is the first report of this condition from Jordan. Age, sex, early presentation and metastases are discussed. Bimodal distribution of age showed two peaks between 16–20 and 41–45 years. The disease was more common in males. Lymph node enlargement was the most common presentation, and bone metastases were the most frequent.
Arytenoidectomy and posterior cordectomy for bilateral abductor paralysis
Authors: Chazly Mohamed El , Rifai Mohamed , El Ezz Ashraf Abou
Published: November 2007

Twelve patients with bilateral fixed vocal cords seeking decannulation of their tracheostomies were subjected to endoscopic correction of the compromised airway. They all had arytenoidectomy associated with posterior cordectomy whether as a primary or secondary stage procedure. Decannulation was achieved in all patients using the technique described.
Primary treatment of cancer of the larynx
Authors: Rockley T. R. , Robin P. E. , Powell J. , McConkey C. C.
Published: November 2007

Analysis of 3,445 cases of cancer of the larynx witha follow-up of 99.8 per cent shows that over a period in which the survival has improved neither the modality of the treatment nor the severity of the cancer has changed. Improved survival may be due to socioeconomic factors or an improvement in the quality of treatment.
Fatal human cyclical neutropenia with unresolving tonsillitis and bilateral cervical abscesses
Authors: Bandason C. , Lee R. J.
Published: November 2007

Human Cyclical Neutropenia is a rare haematological disorder, characterized by periodic oscillations in peripheral neutrophil levels from normal to neutropenic, during which patients experience ulcerative stomatitis, fever, malaise and occasional cutaneous and subcutaneous infections.

We present our experience with a fatal case of Human Cyclical Neutropenia together with a brief review of the literature and diagnostic criteria. The paper aims to heighten the clinical awareness of the otolaryngologist to the condition. Close co-operation with the haematologist is essential both for diagnosis and management.
Characterization of severely and profoundly hearing impaired adults attending an audiology clinic
Authors: McClymont L. G. , Browning G. G.
Published: November 2007

Despite the fact that around 12 per cent of adult patients attending an audiology department will be severely hearing impaired (pure tone averages of 0.5, 1, 2 and 4 kHz of 70 dB HL or worse in the better hearing ear), their clinical and audiometric characteristics have not been well documented.

These characteristics were collected prospectively in 132 adult patients attending a Severe Impairment Clinic, set up to manage their specific problems. The inability to provide sufficient masking makes audiometric assessment of the severity of the impairment uncertain in the poorer hearing ear in 52 per cent of these patients. In addition, the limited bone conduction output makes it almost invariably impossible to assess the masked bone conduction thresholds and hence the air-bone gap in the poorer ear. Hence, accurate characterization is only practical of the better hearing ear in such patients.

In 67 per cent of the better hearing ears, there was a mixed hearing impairment, the air-bone gap being 20 dB or greater. The aetiology of the conductive component was almost equally otosclerosis and chronic otitis media. In only 19 per cent was the impairment of a pure sensorineural type, broken down as 6 per cent congenitally acquired, 5 per cent due to meningitis and 9 per cent being adult in onset. In the remaining 14 per cent of patients the type of impairment could not be classified as the bone conductive thresholds were off scale.

Having had experience of managing these patients at a special clinic and knowing the workload involved, it is argued that consideration be given to setting up such clinics in most departments.
The microbiology of peritonsillar sepsis
Authors: Snow D. G. , Campbell J. B. , Morgan D. W.
Published: November 2007

Pus obtained by needle aspiration of 91 peritonsillar abscesses was examined microbiologically. A positive culture was obtained in 55 patients (60 per cent). Sixty-four bacteriological isolates were grown. Forty patients had a pure growth of a single organism, of which 21 (53 per cent) were beta Haemolytic streptococci. Pure growths of Staphylococcus aureus were found in only three patients. Fifteen patients had mixed organisms, including anaerobes, in their pus and the resistance to penicillin was low. Only the bacteroides species were generally penicillin resistant. The vast majority of patients made a good recovery following needle drainage of the abscess and treatment with parenteral penicillin. The patients with a mixture of penicillin sensitive and penicillin resistant organisms also made a good clinical recovery following needle drainage and administration of parenteral penicillin. The relevance of these findings in the pathogenesis and management of peritonsillar sepsis is discussed.
Rhinocerebral mucormycosis: Use of liposomal amphotericin B
Authors: Fisher Edward W. , Toma Abbad , Fisher Phillip H. , Cheesman Anthony D.
Published: November 2007

Rhinocerebral mucormycosis is a rare but often fatal condition characterized by an aggressive necrotizing infection spreading from the nose to the paranasal sinuses, orbit and hence to the central nervous system. A case is reported in which a diabetic male with advanced mucormycosis was successfully treated by a combination of surgery, supportive therapy and liposomal amphotericin B. Liposomal delivery allows the drug to be both less toxic and more effective, and this is the first reported case of its use in rhinocerebral mucormycosis.
Parapharyngeal space melioidosis in a diabetic
Authors: Elango S. , Sivakumaran S.
Published: November 2007

Pseudomonas pseudomallei, a gram negative organism causing melioidosis, is found in tropical and subtropical regions. It may manifest as a pulmonary lesion, osteomyelitis, soft tissue abscesses, abscesses in various organs or in septicaemic form. Melioidosis of the parapharyngeal space has not been reported so far. A case of melioidosis of the parapharyngeal space which was successfully treated by drainage and prolonged antibiotic therapy is reported here. Melioidosis should be suspected in severe forms of deep neck space infection, especially if the patient comes from an endemic area.
The implementation of audit in an ENT unit
Authors: Dingle Ann F. , Flood Liam M.
Published: November 2007

FNT Departments in the united kingdom are faced with increasing, managementand the colleges responsible for surgical training to intrtoduce formal medical self audit. The plethora of guidelines and publi-cations on the subject rarely address the differences in clinical pratice medicine or surgery and that of otoaryngology. Clearly the lead in the introduction of medical audit will come from the appropriate specilaist associations; however. this paper aims to share the experienceof the implementation of audit otoaryngology, head and neck surgery unit and offer suggestions for a programme elsewhere.
Development of tympanosclerosis in children with otitis media with effusion and ventilation tubes
Authors: Maw A. R.
Published: November 2007

Ventilation tube (VT) insertion is an accepted treatment for chronic otitismedia with effusion (OME) in children. One hundred and eighty five children with bilateral OME were treated by unilateral myringotomy and VT insertion with no treatment to the contralateral ear. During a 5 year follow-up 95 of the children required only one VT but the remainer required more than one but always treatment was carried out to the same ear. The rate of development of tympanosclerosis was measured and scored. After 2–3 yearsthe extent of the sclerotic changes stabilised and the rate of development reached 37–39 per cent in ears receiving only one VT, compared with 47–49 per cent in ears treated by more than one tube. The extent of the changes was no different whether or not one or more than one tube had been inserted. There was no overall evidence of resolution of sclerotic change with time.
Carcinoma of the lip: Observations on its frequency in females
Authors: Shpitzer T. , Stern Y. , Segai K. , Levy R.
Published: November 2007

Seventy-three patients with lip carcinoma were treated from 1970 to 1988 inthe Otolaryngology Department of the Beilinson Medical Center. The most common histological type was squamous cell carcinoma which occurred in 68 patients; four tumours were basal cell carcinoma and one acinic cell carcinoma. Carcinoma of the lip is more frequent in males. Nevertheless, the frequency of carcinoma in females in our series was substantially higher than the average reported in the literature. Forty-nine patients were treated surgically and 24 patients were treated by irradiation. Analysis of the results among thosetreated by surgery and those treated by irradiation shows a difference in tumour local control which was statistically significant (p = 0.025). Surgical treatment is recommended because of the advantage of tumour margin assessment, avoidance of radiotherapy complications and rapid rehabilitation. Two rare cases of carcinoma of the lip in young patients (age under 20 years) are presented.