bluuebunny/crossref_metadata_2025 huggingface dataset:
Lateral approaches to the median skull base through the petrous bone: the system of the modified transcochlear approach
Authors: Sanna Mario , Mazzoni Antonio , Saleh Essam A. , Taibah Abdel K. , Russo Alessandra
Published: November 2007

Twenty-three patients with intradural lesions of the petroclival region and prepontine cistern were managed in our centres by the modified transcochlear approach. Total tumour removal was accomplished in 17 patients, while a second stage was planned for the remaining six patients. Two cases died in the immediate postoperative period. All the remaining cases showed a good outcome and returned to work. The basic approach type A is further classified according to its anterior, superior and inferior extension into types B, C and D respectively. The surgical procedure, classification, illustrative case reports and patients' summaries are presented.
The distribution of nasal airflow sensitivity in normal subjects
Authors: Clarke R. W. , Jones A. S.
Published: November 2007

Nasal airflow modifies the pattern of ventilation presumably due in part to nervous signals arising in the nose and transmitted along the trigeminal nerve to the respiratory centre. Nasal receptor tissue must also be important in determining the sensation of airflow at a conscious level but little attention has been paid to the distribution and function of these receptors.

An experimental model to deliver a pulse of air at different velocities to various nasal test sites is described. In this way nasal sensitivity to an air jet can be mapped out. Sensitivity of the nose to an air jet is greatest at the entrance to the nose – the region of the nasal vestibule.
The role of transcanine surgery in antrochoanal polyps
Authors: El-Guindy A. , Mansour M. H.
Published: November 2007

During a period of two years, 24 cases of antrochoanal polyps were diagnosed by clinical examination, nasal endoscopy and computerized tomography. Surgery started with endoscopic transnasal removal of the polyp. Every attempt was made to remove the antral portion of the polyp through the wide ostium. Then transcanine sinuscopy was performed. Remnants of the polyp were detected and removed in five cases. One or more other cysts were found and extirpated in 11 cases. Endoscopic follow-up for 18 months to three years revealed no recurrence.

It is recommended that endoscopic middle meatal surgery should be combined with transcanine sinuscopy to ensure complete removal of antrochoanal polyps.
Expectorated tissue leading to diagnosis of renal adenocarcinoma
Authors: Ziyada W. F. , Brookes J. D. , Penman H. G.
Published: November 2007

Metastatic tumour to the tongue is extremely rare. We report a case of renal adenocarcinoma metastasis involving the right side of the base of the tongue with extension to the right vallecula in a 59-year-old man in which a piece of the metastatic lesion in the tongue was expectorated and was the first evidence of the primary tumour in the right kidney. Previously reported cases are reviewed.
MR imaging features of an intracochlear acoustic schwannoma
Authors: Donnelly Martin J. , Daly Carmel A. , Briggs Robert J. S.
Published: November 2007

We present a very unusual case of an acoustic neuroma involving the left cochlea and internal auditory canal of a 24-year-old man. Clinical suspicion was aroused when the patient presented with a left total sensorineural hearing loss and continuing vertigo. The diagnosis was made pre-operatively with MRI after initial CT scanning was normal. The tumour was removed via a transotic approach. This case report demonstrates the MRI features of an intracochlear schwannoma and emphasizes the importance of MRI in patients with significant auditory and clinical abnormalities with normal CT scans of the relevant region.
The Emperor who smoked a pipe
Authors: Laurenson Rae Duncan
Published: November 2007

Since 1946 authoritative reports have identified smoking as a cause of cancer of the lung and a probable cause of cancer of the larynx. Crown Prince Frederick (later Emperor Frederick III of Prussia and the German Kaiser) was a pipe smoker for at least 30 years before he died of cancer of the larynx in 1888 at the age of 57 years. The evidence is so overwhelming that this author proposes that the Emperor's laryngeal cancer was induced by tobacco.
Submandibular salivary disease: a proposed allergic aetiology
Authors: Harkness P.
Published: November 2007

Two cases of submandibular gland swelling are documented. In one patient examination of the excised submandibular gland revealed a dense eosinophilia: the other patient had a peripheral blood eosinophilia. Both patients demonstrated a marked decrease in the swelling of the salivary glands after a course of oral antihistamine. Although allergy has been implicated as a cause of recurrent parotid gland swelling, there are no previous reports of such a phenomenon occurring in the submandibular gland.
Occupational rhinitis — possible mechanisms of pathogenesis
Authors: Welch A. R. , Birchall J. P. , Stafford F. W.
Published: November 2007

Occupational rhinitis has been a prescribed industrial disease in the UK since 1907. It has only relatively recently received significant attention from otorhinolaryngologists although numerous studies have been performed in the past by occupational and industrial health physicians. At the present time the precise mechanisms of pathogenesis are unclear and would appear to be multiple.

Recently interest has arisen because of compensation claims. Diagnosis made on the basis of the clinical history is subject to two problems: firstly, there is difficulty in differentiating between occupational and nonoccupational rhinitis, and secondly, clinical histories can easily be feigned. Physical signs would be a more reliable indicator of occupational damage to the nasal mucosa if they differ from the signs normally found in allergic or vasomotor rhinitis. In a series of 100 shipyard workers dry atrophic nasal mucosa was found in 66and septal ulceration in two. From their clinical histories 78 individuals complained of nasal obstruction, 28 of epistaxis, 42 of hyposmia, 10 of anosmia and 90 of rhinorrhoea. Possible pathogenesis is described
Diagnostic imaging of the larynx: autofluorescence of laryngeal tumours using the helium-cadmium laser
Authors: Harries Meredydd Lloyd , Lam Stephen , MacAulay Calum , Qu Jianan , Palcic Branko
Published: November 2007

The use of tissue autofluorescence for the detection and localization of cancer of the larynx is described. In this pilot study, eight patients with probable carcinoma of the vocal folds underwent laryngoscopy in which the tissue autofluorescence spectra of normal and pathologically confirmed tumour tissue were acquiredin vivo. Fluorescence images of the suspect areas were also acquired using the LIFE system (Xillix Technologies Corp.). The results suggest that the autofluorescence properties of laryngeal tissue, under 442 nm illumination, are similar to those of bronchial tissue and that the LIFE system has the potential to increase the accuracy of staging of cancer of the larynx and also to allow earlier diagnosis of tumours and theirrecurrence
CO2-laser therapy for carcinoma of the larynx
Authors: Outzen Knud Erik , Illum Peter
Published: November 2007

A retrospective study was undertaken to assess the outcome of 19 consecutive patients, who underwent endolaryngeal resection with a CO2-laser for laryngeal carcinomas. Sixteen of these patients had recurrences after primary curative radiotherapy. Seventeen of the patients had a curative operation carried out. So far, four CO2-laser treatment failures have been observed (median observation time 35 months). None of the patients needed tracheostomy in connection with the operation. Voice quality was in all cases acceptable.

It is recommended, that small recurrences (after radiotherapy of laryngeal squamous cell carcinomas)should be considered for a partial laryngectomy with the aid of a laser.
The treatment of node negative squamous cell carcinoma of the postcricoid region
Authors: Jones A. S. , McRae R. D. , Phillips D. E. , Hamilton J. , Field J. K. , Husband D.
Published: November 2007

This study includes 155 patients with T1–4N0carcinoma of the postcricoid region seen between 1963 and 1993. Sixty-seven were treated by primary surgery, 50 by primary irradiation therapy, 36 were unsuitable for curative treatment and two patients were lost to follow-up. Reasons for deciding against curative therapy were: advanced age, poor general condition and advanced disease at the primary site. This study included only those patients who had no neck node metastases at presentation.

Patients receiving surgery tended to be in better general physical condition and tended to have more advanced disease than those treated by irradiation in this series. The tumour-specific five-year survival rate for those treated by surgery was 43 per cent (95 per cent confidence interval (CI) 23–60 per cent). For those patients treated by irradiation the five-year survival rate was 48 per cent (95 per cent CI 27–66 per cent) and for those receiving no treatment the median survival rate was three months (95 per cent CI two-six months). The observed survival for the surgery group was only 18 per cent and for the radiotherapy group 25 per cent at five years.

Multiple logistic regression showed no significant difference in proportions of host and tumour factors between the group receiving radiotherapy and the group receiving surgery. Recurrence at the primary site and the appearance of neck node metastases were not predicted by any host or tumour factor.

Twenty-one patients out of 67 receiving primary surgery had recurrence at the primary site compared with 26 patients out of 50 receiving primary irradiation. Neck node metastases occurred in 16 out of 67 patients receiving surgery and in eight out of 50 receiving radiotherapy. The difference was statistically significant for recurrence at the primary site (X21= 4.261; p = 0.039) but not significant for neck node metastases (X21= 0.661;p = 0.416). The data were further analysed using Cox's proportional hazards model for survival and no host or tumour factors were found to be predictive of eventual outcome apart from poorly differentiated histology. This adversely affected survival (X21= 6.4444; p = 0.011). If patients not treated were included in the model, treatment became a significant factor in improving the survival (X21= 4.4197; p = 0.034).

Radiotherapy appears to be at least as good as surgery for treating patients with an early carcinoma of the postcricoid region. We would recommend radiotherapy is used in patients with no detectable neck node metastases and in tumours <5 cm long. The complication rate from radiotherapy was reduced when compared with that of surgery.
Rhabdomyoma of the larynx: a review of the literature with a summary of previously described cases of rhabdomyoma of the larynx and a report of a new case
Authors: Johansen Eva Charlotte Jung , Illum Peter
Published: November 2007

A review of extracardial rhabdomyomas of the larynx reported in the literature is presented. A new case is added (the largest described yet). The diagnosis was based on routine histological and immunohistological staining, and electron microscopy. The extracardial rhabdomyomas were divided into three types according to histopathological findings: (i) adult; (ii) foetal cellular type; and (iii) foetal myxoid. There are 23 well-documented cases (including this case) of extracardial rhabdomyomas of the larynx; 15 of the adult type, four of the foetal myxoid type and four of the foetal cellular type. The differential diagnosis and the requisite diagnostic procedure is discussed. The tumour is benign. The treatment is surgical excision. Although rare, its existence should be kept in mind in the differential diagnosis of laryngeal tumours.
‘Ceruminoma’ – a defunct diagnosis
Authors: Mills Richard G. , Douglas-Jones Tony , Williams R. Gareth
Published: November 2007

The clinical and pathological features of glandular tumours of the external auditory meatus are presented. Their heterogenous clinical and pathological features make the collective term ‘ceruminoma’ ambiguous andmisleading. The spectrum of pathological behaviour and histological features demonstrated by these interesting tumours necessitate a broader classification system. In our hospital 32 patients presented with tumours of the external auditory meatus over a 30-year period, of which seven were glandular in origin. A review of the histology of these glandular tumours enabled us to reclassify them as adenoma, cylindroma, adenoid cystic carcinoma or ceruminous adenocarcinoma. Together with the less common mucoepidermoid carcinoma and pleomorphic adenoma this subdivision forms a basis for a more meaningful classification system with prognostic and therapeutic implications specific to each tumour type. The term ‘ceruminoma’ should no longer be used unqualified.
An unexpected cause of upper airway obstruction
Authors: Meulenbroeks A. A. W. M. , Vos G. D. , Van der Beek J. M. H. , Kirslaar P. J. E. H. M.
Published: November 2007

A three-year old bot wiht a swelling on the right side of his neck was suspected of having parapharyngeal abscess after clinical examination and CT scan(computed tomography scan) of this region. Later it became clear, that the swelling was caused by an aneurysm of the internal carotid artery. This case report describes the pitfalls and difficulties encountered in the diagnostic course and treatment planning.
Angiolymphoid hyperplasia with eosinophilia
Authors: Ingrams D. R. , Stafford N. D. , Creagh T. M.
Published: November 2007

Angiolympoid hyperplasia with cosinophilia is a rare benign condition that causes swellings in the head and neck. It is difficult to diagnose prior to biopsy and is frequently mistaken for a malignant tumoour. A case involving a 21-year-old man who presented with a 2 cm diameter fiborous lesion the subcutaneous tissue of the cheek is reported. The clinical and histological features are reviewed and the differences between this condition and the similar condition of Kimura's disease are discussed. Initial treatment with intralesional or sustemic steroids is suggested as this may avoid the need for excision.
Comparison between short-term and long-term post-operative evaluation of sleep apnoea after uvulopalatopharyngoplasty
Authors: Lu Shao-Jung , Chang Shyue-Yih , Shiao Guang-Ming
Published: November 2007

For a long time uvulopalatopharyngoplasty (UPPP) has been used to treat the obstructive sleep apnoea syndrome (OSAS). The diverse surgical effects, the inadequate understanding of operation effect consistency, the possibility of disease progression, and the few reported papers for long-term evaluation after UPPP aroused our interest in designing this study. Fifteen OSAS patients who had undergone UPPP with pre-operative, initial post-operative and long-term post-operative polysomnographic studies were included in this study. Long-term post-operative polysomnography was undertaken more than five years after surgery. The polysomnographic evaluations included respiratory disturbance index (RD I), duration of saturation SaO2 <85 per cent (DOS), and the lowest O2 saturation (LOS). Amongst them, 10 patients with initial post-operative RDI reduction > 50 per cent were considered responders. In these responders, the long-term follow-up results of all three parameters showed improvement compared to the preoperative data. In a comparison between the initial and long-term post-operative sleep study results, LOS and DOS showed no significant difference. However, the long-term post-operative RDI result became significantly worse. More than 80 per cent of all cases had subjective symptomatic improvement in the long-term post-operative evaluation. The subjective improvement after operation is not adequately correlated to the polysomnographic result. We suggest that long-term follow-up for patients after UPPP is necessary.
Treatment of Robin sequence with nasal CPAP
Authors: Deegan Paul C. , McGlone Brian , McNicholas Walter T.
Published: November 2007

A 12-year-old schoolgirl presented with severe obstructive sleep apnoea due to the Robin sequence. The sleep apnoea, together with the associated findings of daytime sleepiness, nocturia, right heart strain and growth retardation, were successfully reversed by nasal CPAP therapy. This therapy allows postponement of a decision concerning corrective surgery until after full growth has occurred.
Verbal auditory agnosia with focal EEG abnormality: an unusual case of a child presenting to an ENT surgeon with “deafness”
Authors: Kale Uday , El-Naggar Mohamed , Hawthorne Maurice
Published: November 2007

Verbal auditory agnosia implies the failure to recognize sounds in a patient who is nevertheless not deaf. We present a child referred to the ENT outpatients for suspected hearing loss investigation. At one point she had grommets inserted on the basis of a flat tympanogram but with no effect. All hearing tests, including electrocochleography and distraction tests, revealed normal hearing thresholds. At the age of three years and three months, and on direct questioning of the parents, we discovered that the child responded remarkably well to music. Paediatric neurologists made the diagnosis of verbal auditory agnosia. The condition is very similar to another acquired language disorder called Landau-Kleffner syndrome. It is unusual for such a case to present primarily to an ENT surgeon.
Valve section of the eustachian tube
Authors: Su Chih-Ying
Published: November 2007

Research on the eustachian tube (ET) and related paratubal structures was carried out by serial section of the temporal bone-ET specimens. In the cadaveric studies, the mid-cartilaginous section of the ET presented a curved slit-like lumen. It is believed that this section functions principally as a valve mechanism and acts like an active sphincter of the ET. This report illustrates the dynamic movement of the valve section in a living ET which can be observed by using a superfine fibreoptic videomicroendoscope. Disorders of the open-close mechanism of the valve section in a diseased ET due to different aetiologies are also discussed. This study indicated that transtympanic ET microendoscopy had considerable potential for exploring fascinating new aspects of the physiology, pathophysiology and anatomy dynamics of the ET.
Non-tuberculous mycobacterial infections presenting as salivary gland masses in children: investigation and conservative management
Authors: Cox H. J. , Brightwell A. P. , Riordan T.
Published: November 2007

Non-tuberculous mycobacterial (NTM) infections in children commonly present as cervicofacial masses. The importance of early diagnosis is in the exclusion of infection requiring treatment, particularly tuberculosis and the rare case of malignancy. Five children with NTM presenting with salivary gland masses illustrate the value of skin testing with new tuberculins and the place of fine-needle aspiration cytology in the investigation of these infections.

Four children who were skin tested reacted specifically to one of the new tuberculins, two indicating infection withMycobacterium malmoense, confirmed by culture, the others responding to tuberculins fromM. scrofulaceumandM. avium-intracellulare, neither having a positive culture. The one case not skin tested producedM. avium-intracellulareon culture.

All five patients were managed conservatively. The place for conservative management when the facial nerve is at risk and extensive skin excision is indicated are discussed.
Audit of the treatment of tonsillar and peritonsillar sepsis in an ear, nose and throat unit
Authors: MacDougall G. , Denholm S. W.
Published: November 2007

We became aware that a range of antibiotics were being used in our unit to treat patients suffering from tonsillitis or peritonsillar abscess (quinsy). There appeared to be no rationale to determine which antibiotics were used, and we felt that we were possibly using expensive antibiotics when cheaper equally effective ones were available. An audit project was therefore devised to establish the current practice in the ENT Unit at the City Hospital at Edinburgh. Following a six-month prospective pilot study, a protocol for the treatment of tonsillar and peritonsillar sepsis was drawn up and subsequent practice and outcome was then audited, thus completing the audit cycle. As a result substantial savings in the cost of prescribed antibiotics have been made without compromising patient care.
An unusual cause of cochlear implant failure
Authors: Thomas D. M. , Abramovich S. , Rakkar-Thomas S.
Published: November 2007

We present a cochlear implant failure previously unidentified and unreported. Following successful implantation and activation of a Cochlear Mini 22 system, a distressing barrage of crackling noises was heard by the patient despite repeated programming with threshold and comfort level adjustment. The implant soon became nonfunctional and integrity testing showed deficient electrical responses and abnormal surface measured wave forms. Investigation of the explant, following reimplantation with an identical system, showed a defective trim capacitor, an electric component of the internal circuit in the stimulator. Paired Student's t-test showed a marginally significant increase (p = 0.047) in effective threshold level and a highly significant decrease (p = 0.0002) in maximum comfort level for the second implant compared to the first implant.
An unusual complication following inferior turbinectomy
Authors: Ravikumar A. , Griffiths T. D. , Flood L. M. , McNeela B. J.
Published: November 2007

Neurological complications following turbinate surgery are relatively rare. We present here an unusual complication of unilateral partial oculomotor and trigeminal nerve palsy after bilateral inferior turbinectomies. The probable aetiological mechanism is discussed.
Dilemmas in auditory assessment of developmentally retarded children using behavioural observation audiometry and brain stem evoked response audiometry
Authors: Rupa V.
Published: November 2007

The records of 94 consecutive developmentally retarded children with speech retardation and suspected hearing loss who underwent auditory assessment by both conventional behavioural observation audiometry (BOA) and brain stem evoked response audiometry (BERA) were analysed. In 54 children (57.4 percent) there was good agreement between the results of both techniques leading to a clearcut diagnosis. In 22 children a diagnosis was possible only by the results of BERA as the results of BOA were inconclusive. Of the remaining 18 children, two groups could be identified whose results posed a dilemma. Group 1 (n = 7) consisted of children whose BOA test results differed considerably from their BERA results. Group 2 (n = 11) consisted of children in whom there was no discernible response by BERA while the response by BOA was either inconsistent (n = 5) or not elicitable (n = 6). The specific strategies to be adopted for hearing assessment in these situations are discussed.
The influence of race on the position of the jugular bulb
Authors: Low W. K. , Fenton J. E. , Fagan P. A. , Gibson W. P. R.
Published: November 2007

The position of the jugular bulb (JB) is of great clinical significance to the otologist. A high and laterally situated jugular bulb may pose difficulties when dealing with the middle ear while a high and medially sited jugular bulb can create problems in neuro-otological surgery. This paper aims to study possible racial differences in the position of the jugular bulb.

Fine-cut computed tomogram (CT) scans of temporal bones (in the axial plane) of 34 Caucasians and 34 Chinese were studied. The position of the jugular bulb was determined with reference to the midpoint of the lumen at the inferior limit of the cochlea (mpC).

Of the 60 Caucasian and 58 Chinese temporal bones with identifiable jugular bulbs, 33 jugular bulbs of the Caucasian (55 percent) and 34 jugular bulbs of the Chinese (58.6 percent) were at the same height or higher than the mpC (p= 0.2; chi-squared test). The midpoint of the jugular bulb was 8.67 ± 1.73 and 8.61 ± 2.49 mm posterior to the mpC for the Caucasian and Chinese respectively (p= 0.2;t-test). However, the midpoint of the jugular bulb of eight Caucasian (24.2 percent) and 22 Chinese (64.7 percent) were medial to the mpC (p<0.001; chi-squared test).

Race does not influence the height of the jugular bulb nor its position in the sagittal plane but can influence whether a high jugular bulb is medially or laterally situated.
Day-case septal surgery under general anaesthesia and local anaesthesia with sedation
Authors: Srinivasan V. , Arasaratnam R. B. S. , Jankelowitz G. A.
Published: November 2007

Septal surgery (submucous resection and septoplasty) has been performed as a day-case procedure routinely under general anaesthesia and local anaesthesia with sedation at the Ipswich Hospitalsince 1992. The outcome of the day-case septal surgery over a period of 18 months has been audited. A total of 95 cases were operated on of which 48 were under general anaesthesia (GA) and 47 under local anaesthesia (LA) with sedation using midazolam intravenously. The bleeding rate and overnight admission rate were 10.5 and 11.4 percent respectively. The bleeding rate was the same in both GA and LA groups. The combination of local anaesthesia and sedation has been foundto be safe, effective and acceptable to patients. It is concluded that septal surgery is suitable as a day procedure and that local anaesthesia combined with sedation has a definite place ifcarried out properly.
A prospective randomized study to assess the efficacy of post-operative nasal medication after endonasal surgery
Authors: Spraggs Paul D. R. , Macnamara Marcelle , Joseph Theo
Published: November 2007

Post-operative nasal medications are commonly used following routine septal or turbinate surgery but their efficacy in removing blood clots, improving the sensation of a patent airway and promoting healing are unknown. This prospective randomized trial of patients undergoing septal and/or turbinate surgery assessed the efficacy of three commonly used nasal medicines, 0.5 per cent ephedrine hydrochloride nasal drops, betamethasone sodium phosphate (Betnosol®) nose drops and alkaline nasal douches, in producing the sensation of a patent airway in the 14 days following surgery. Ninety-seven patients were randomized into the three treatment groups and a control group who received no nasal medication. Patients assessed their nasal patency by means of a visual analogue scale (VAS) and any complications of treatment were recorded. Statistical analysis of the 76 complete sets of results using the Mann-Whitney U-test showed that there was a significant difference in the distribution of all of the treatments for each of the time intervals (p<0.05). Glass rank biserial correlation coefficients were all small (rg<0.085) but the most significant differences were between ephedrine and the control group at two hours, two, seven and 10 days (0.02, 0.054, 0.057, 0.085 respectively), alkaline nasal douches being most significant at four and 14 days (0.06 and 0.0722 respectively).
Spindle cell carcinoma of the parotid gland
Authors: Ishibashi Toshio , Hojo Hiroshi
Published: November 2007

Spindle cell carcinomas of the salivary gland are extremely rare, with only a few cases having been previously reported. We present a 55-year-old man with a rapidly enlarging mass in the left parotid gland. Despite radical surgery, the tumour recurred, and led to death 11 months later. Histopathologically, the tumour was composed of two components, a squamous cell carcinoma component and a spindle cell sarcomatoid component. A diagnosis of primary spindle cell carcinoma of the parotid gland was made. Immunohistochemical studies revealed keratin positivity and vimentin negativity in the squamous cell carcinoma component: the spindle cell sarcomatoid component was positive for vimentin and negative for keratin, but showed focal positivity for epithelial membrane antigen. The origin of the sarcomatoid component and the differential diagnosis from malignant mixed tumours are discussed.
Raised ABR threshold after suction aspiration of glue from the middle ear: three case studies
Authors: Mason J. D. T. , Mason S. M. , Gibbin K. P.
Published: November 2007

Between 1991 and 1993, 13 children (25 hearing ears) underwent recordings of the auditory brain stem response (ABR) under a general anaesthetic. The anaesthetic technique was similar for each child. Fourteen of these ears had fluid aspirated after myringotomy with insertion of grommets prior to the auditory brain stem response investigation. On subsequent hearing assessment six of these 14 ears (43 per cent) showed clear evidence of a threshold shift of 15 dB or greater. Eleven ears had either dry myringotomies or did not have a myringotomy prior to ABR and none of these showed evidence of a temporary threshold shift. Using Fisher's Exact probability test this difference is significant (p = 0.034). We feel it is important to report these observations so that unexpected high ABR thresholds following aspiration of glue are interpreted with caution.
Audiological findings in a Phase I protocol investigating the effect of WR 2721, high-dose cisplatin and radiation therapy in patients with locally advanced cervical carcinoma
Authors: Rubin John S. , Wadler Scott , Baitler Jonathan J. , Haynes Hilda , Rozenblet Alla , McGill Frances , Goldberg Gary , Runowicz Carolyn
Published: November 2007

WR 2721 (ethiofos) protects against the toxic effects of the heavy metal compound cisplatin. which is used in the treatment of solid tumours. In a Phase I protocol designed to determine the maximum dose of WR 2721 which could be tolerated when administered in combination with cisplatin and radiation therapy to patients with cervical carcinoma. 11 patients were evaluated by audiologic testing before and after cisplatin WR 2721 administration in an attempt to identify the degree of ototoxicity. Forty-five per cent were noted to have significant hearing threshold changes. predominantly in the high frequencies. There were no significant changes in the speech frequencies in this series. This contrasts with the greater degrees of ototoxicity observed in controls treated in the same way who received cisplatin without WR 2721 protection.
Non-cholesteatomatous suppurative otitis media: facial nerve palsy in an immunocompromised patient
Authors: Hartley C. , Saeed S. R. , Lyons T. J.
Published: November 2007

A 47-year-old man developed a complete facial nerve palsy secondary to non-cholesteatomatous suppurative otitis media. At operation, this was seen to be due to destruction of the nerve from halfway along the horizontal segment to a point just distal to the second genu. The history of recent renal transplantation and subsequent immunosuppression was judged to be significant in the pathogenesis of the palsy.
Salivary megalith with a sialo-cutaneous and a sialo-oral fistula: a case report
Authors: Paul D. , Chauhan S. R.
Published: November 2007

A rare case of a salivary megalith with a sialo-cutaneous and a sialo-oral fistula in an elderly man is presented. A brief review of the literature is made.
Deep lobe parotid lipoma: a case report
Authors: Weiner Graeme M. , Pahor A. L.
Published: November 2007

We present a patient with a lipoma of the deep lobe of the parotid gland. Despite the common occurrence of this tumour in other regions of the body, we believe that this is only the second report in the literature of a lipoma in this location. We believe that these tumours are easily dealt with by simple enucleation, and that superficial parotidectomy should be reserved for tumours deep to the facial nerve.
Fine-needle aspiration cytology of submandibular gland lesions
Authors: Atula Timo , Grénman Reidar , Laippala Pekka , Klemi Pekka-Juhani
Published: November 2007

The usefulness of fine-needle aspiration cytology (FNAC) in the diagnosis and treatment of submandibular gland lesions is not well known. The 210 FNACs taken from submandibular gland lesions at Turku University Central Hospital between 1984 and 1991 were reviewed. Of these FNACs, 78 samples from primary lesions were confirmed histologically. Within this subset 10 FNACs were taken from benign neoplasms, all of which were correctly classified (sensitivity 100 per cent; specificity 88 percent). Only four of the 14 FNACs from malignant lesions were cytologically considered malignant (sensitivity 29 per cent). On the other hand, four FNACs raised a false suspicion of malignancy (specificity 6 per cent). Out of 54 FNACs from non-neoplastic lesions 43 were correct (sensitivity 80 per cent; specificity 63 per cent). There were 104 patients (123 FNACs), who had not been operated on: the follow-up of these patients shows that in this subset of FNACs there were no false malignant but probably one false benign finding (1 per cent). We conclude that FNAC can offer valuable information about the type of the submandibular gland lesion, but the decision of operative and other treatment should not be based solely on the result of FNAC.
The modified Valsalva manoeuvre to improve visualization of the hypopharynx during flexible nasopharyngoscopy
Authors: Spraggs Paul D.R. , Harries Meredydd Lloyd
Published: November 2007

A simple, safe and effective procedure of improving the diagnostic accuracy of nasopharyngoscopy is described. It is most useful for the exposure of the hypopharynx, especially in the elderly patient.
Cisplatin in children: hearing loss correlates with iris and skin pigmentation
Authors: Todd N. Wendell , Alvarado Carlos S. , Brewer Debra B.
Published: November 2007

Pigmentation is reported to affect cisplatin-induced ototoxicity in adult humans. The hearing loss is worse in people with brown irises, than in those with blue irises. We assessed the hypothesis that cisplatintreated children with dark irises suffer more deterioration in auditory thresholds than do those with less pigmentation. For the 19 children whose data met the requirements of this observational retrospective study, we found a weak correlation (Spearman's r = 0.50; p>0.05) of high frequency hearing loss (at 4000 Hz) and pigmentation. Blue or hazel-eyed children averaged 2.9 dB worsening at 4000 Hz, in contrast to 14.2 dB worsening for brown or black-eyed children.

Pigmentation may account for some of the individual susceptibility to cisplatin ototoxicity. We suggest that iris colour be included in future reports of cisplatin-related hearing loss
Is a community-based mastoid microsuction service feasible: the audit of a pilot project
Authors: Lewis Charles , Resouly Adel
Published: November 2007

Patients who have had a mastoidectomy form a considerable long-term follow-up commitment to their local ENT Department. A community-based mastoid aural toilet pilot project run by a GP is described using an operating microscope and suction apparatus in his surgery. To obtain the necessary information about community treatment, an audit was performed of all mastoidectomy patients from a large general practice in Portsmouth: 57 mastoidectomy patients were reviewed. During the project it was possible to transfer to the community microsuction project the long-term care of most of their mastoidectomy patients who were attending the hospital ENT outpatient clinic.
Atlanto-axial subluxation (Grisel's syndrome) following otolaryngological diseases and procedures
Authors: Samuel D. , Thomas D. M. , Tierney P. A. , Patel K. S.
Published: November 2007

Grisel's syndrome is a rare condition of uncertain aetiology characterized by atlanto-axial subluxation following an infection in the head and neck region. The condition most frequently affects children and characteristically presents in the post-operative period with cervical pain and torticollis. We describe three cases and discuss the aetiology and pathogenesis. A high index of suspicion may lead to early diagnosis in its natural history thereby preventing potentially serious complications.
VIIIth cranial nerve involvement in sarcoidosis
Authors: O'Reilly B. J. , Burrows E. H.
Published: November 2007

Hearing loss and vertigo are uncommon but well-recognized complications of neurosarcoidosis. Until recently the site of the lesion has been debatable and the efficacy of steroids commonly prescribed for this type of hearing loss has been said to be doubtful. A case is presented of sarcoidosis-induced hearing loss in which bilateral VIIIth nerve lesions were demonstrable by MRI with gadolinium enhancement. Treatment with high- dose steroids and azathioprine produced a symptomatic improvement and virtual resolution of the lesions.
Comparison of the proteins of middle ear effusion with human mast cell proteins
Authors: Rakover Yoseph , Shneyour Amir , Rosen Gabriel , Lensky Yaacov
Published: November 2007

In order to clarify the role of mast cells in the aetiology of secretory otitis media (SOM), we compared the protein components of middle ear effusion (MEE) with human mast cells using acrylamide gradient gel electrophoresis and electrofocusing methods. This first direct comparison between the proteins of MEE and human mast cells has been made possible by a method developed in our laboratory for cultivation of human mast cells in tissue culture.

On electrophoresis, we found that out of 12 bands of MEE proteins that were different from the serum, seven (58 per cent) had a similar electrophoretic migration rate (Rx) to mast cells. On electrofocusing, three of the four bands of MEE had a similar Rxto the mast cells. We have shown that proteins of mast cells and MEE had similar Rxs. Therefore, our study supports previous studies which suggests that mast cells play an important role in the aetiology of SOM.
Management of carotid artery exposure with pectoralis major myofascial flap transfer and split-thickness skin coverage
Authors: Leemans C. R. , Balm A. J. M. , Gregor R. T. , Hilgers F. J. M.
Published: November 2007

The risk for post-operative exposure of the carotid artery due to skin flap necrosis after major head and neck surgery is increased after previous radiation and in severely malnourished patients. Eight patients are described who presented with an (imminent) carotid exposure one to eight weeks after surgery. Pectoralis major myofascial flap transfer with split thickness skin graft coverage was used for protection of the carotid artery. All cases were managed successfully and healed primarily in two to four weeks with acceptable cosmesis. We advocate immediate treatment in the event of an exposed carotid (or imminent exposure) by a pectoralis major myofascial flap with split-thickness skin grafting.
Endobronchial tuberculosis masquerading as foreign body aspiration
Authors: Weiner Graeme M. , Batch A. J. G.
Published: November 2007

Endobronchial tuberculosis is a rare manifestation of pulmonary mycobacterial disease. We present a case in which an endobronchial tuberculous granuloma resulted in acute respiratory distress simulating foreign body aspiration.
Stridor in patients with HIV infection
Authors: Laing R. B. S. , Wardrop P. J. C. , Welsby P. D. , Brettle R. P.
Published: November 2007

The immunodeficiency which results from HIV infection is associated with a range of opportunistic infections and tumours which may present with the symptoms of upper airways disease. This paper presents three cases of stridor from different causes in patients with HIV infection, all of whom recovered following treatment. The management of this problem requires consideration of the likely aetiology which, in those with advanced immunodeficiency, includes bacterial and fungal laryngitis and epiglottitis as well as rapidly growing laryngeal tumours. Recommendations for the treatment of those with HIV infection who present with severe or rapidonset stridor should include a combination of aggressive airway intervention and broad-spectrum antibacterial and antifungal agents. Laryngeal biopsy for histology and culture is particularly important for those patients who fail to respond to the aforementioned treatment.
Occult thyroid carcinoma presenting as a parapharyngeal mass
Authors: Ferrario Fulvio , Roselli Raffaele , Macchi Alberto
Published: November 2007

This report describes a 47-year-old male who had an occult papillary carcinoma of the thyroid present as a nodal involvement of the parapharyngeal space, in the retrostyloid compartment. To the best of our knowledge, this is an extremely rare condition.
Abnormalities of the paranasal sinuses in patients with nasopharyngeal carcinoma: a computed tomographic study
Authors: Porter M. J. , Cheung H. S. , Ambrose R. , Leung S. F. , van Hasselt C. A.
Published: November 2007

A retrospective study of computed tomography scans of the paranasal sinuses of 131 control subjects in Hong Kong revealed minor mucosal abnormalities in more than half of the ethmoid sinuses. Major abnormalities were present in seven per cent of maxillary, five per cent of anterior ethmoid and four per cent of posterior ethmoid sinus. In 85 patients with nasopharyngeal carcinoma the prevalence of minor mucosal abnormalities in the sinuses was similar to that of the control group but major mucosal abnormalities were significantly more common in the anterior and posterior ethmoids at 15 per cent and 21 per cent of the respective sinuses (p<0.001).
Ultrasound versus physical examination in staging carcinoma of the mobile tongue
Authors: Narayana Harindra M. , Panda Naresh K. , Mann S. B. S. , Katariya Sudha , Vasishta R. K.
Published: November 2007

Surgical therapy for early lesions of the tongue should have the potential to be both oncologically sound and easy to rehabilitate. Obviously, the amount of tongue left behind after surgery is proportional to the post-operative function. Hence accurate mapping of the diseased tongue is of paramount importance in order to limit or extend the resection margins. We have evaluated the use of ultrasound in carcinoma of the tongue, and also compared its relative accuracy with physical examination for determining the extent of growth, keeping the histopathological size as a gold standard. We found that ultrasound is more accurate in detecting T2 and T3 tumours than T1 lesions. Intraoral sonographic mappng may be the answer for such small lesions. In addition, ultrasonography is beneficial in showing spread to contiguous areas of the tongue. However, post-radiation fibrosis and frank residual disease were not differentiated accurately by ultrasound. Thus ultrasonography can be an effective investigative tool and together with physical examination it can increase diagnostic accuracy leading to precise surgery for carcinoma of the tongue.
Cervical lymphadenopathy secondary to atypical mycobacteria in children
Authors: Benson-Mitchell R. , Buchanan G.
Published: November 2007

Non-tuberculous mycobacterial (NTM) infections usually present as an enlarged lymph node in the neck of a non-immunocompromised child. The differential diagnosis includes bacterial adenitis, malignant disease and tuberculosis. The definitive diagnosis relies upon isolating the organisms in culture. The treatment is complete surgical excision with, or without, anti-tuberculous chemotherapy

Ten cases of NTM infections are presented with a discussion of the aetiology and treatment of this condition.
Acute suppurative parotitis and facial paralysis
Authors: Pang Y. T. , Raine C. H.
Published: November 2007

A case of facial nerve paralysis secondary to acute suppurative parotitis is described. This is a rare complication in the absence of malignant processes in the parotid.
Hairy polyp of the tonsil
Authors: Mitchell T. E. , Girling A. C.
Published: November 2007

Hairy polyps or dermoids of the oro- and naso-pharynx are benign lesions containing elements of both ectodermal and mesodermal origin. We report a case of a hairy polyp arising from the tonsil in a three-week-old infant. This presented as an intermittent swelling in the mouth, which was successfully removed under general anaesthesia. To our knowledge this is only the third case of a hairy polyp arising at this site to be reported. We discuss the terminology applied to these lesions and review the literature.
Hearing disability before and after radiotherapy for nasopharyngeal carcinoma
Authors: Low W. K. , Fong K. W.
Published: November 2007

This paper evaluates post-irradiation hearing changes in patients with nasopharyngeal carcinoma (NPC) from a disability orientated approach, which takes into account binaural hearing. Newly diagnosed patients with NPC were studied before radiotherapy, and at four to 12 months (mean 9.2 months) after radiotherapy, provided they remained disease-free. Each patient was examined clinically and with pure tone audiograms. Tympanometry was used to confirm middle ear effusion. Averaged hearing thresholds over 0.5,1 and 2 kHz were evaluated. If abnormal (>30 dB), the resultant hearing disability was illustrated by a modified Glasgow Plot. Twenty-three males and 10 females completed the study. Middle ear effusions resulted in 39.3 per cent (binaural in two patients) and 33.3 per cent (binaural in five patients) of patients having hearing disability pre- and post-irradiation respectively. No patient had hearing disability as a result of a sensorineural loss. It is recommended that future reporting of post-irradiation hearing changes in patients with NPC, as in middle ear surgery, be considered from a disability-orientated approach.
The treatment of hyposmia with intranasal steroids
Authors: Golding-Wood David G. , Holmstrom Mats , Darby Yvonne , Scadding Glenis K. , Lund Valerie J.
Published: November 2007

Hyposmia is a neglected symptom in patients with rhinitis. We studied 25 patients presenting with perennial rhinitis. Fifteen patients expressed hyposmia as a significant symptom. University of Pennsylvania smell identification test (UPSIT) and visual analogue scales (VAS) were used to score the symptoms of hyposmia, nasal obstruction and nasal discharge before and after six weeks treatment with betamethasone sodium phosphate drops. Those patients with initial symptoms of hyposia significantly improved their UPSIT scores (p= 0.00009) and their VAS scores for hyposmia (p= 0.00133). Despite a significant decrease in the sensation of nasal obstruction, the non-hyposmics showed no increase in UPSIT scores after betamethasone therapy. There was no clear correlation between UPSIT results and other symptom scores. The judicious use of betamethasone drops in the treatment of rhinogenic hyposmia can be recommended.
The management of dysphagia in jugular foramen surgery
Authors: Fenton J. E. , Brake H. , Shirazi A. , Mendelsohn M. S. , Atlas M. D. , Fagan P. A.
Published: November 2007

From 1985–1994, the Skull Base Unit at St. Vincent's Hospital, Sydney, operated on 61 patients with tumours involving the jugular foramen. Pre-operative assessment by a Speech Pathologist and the institution of swallowing techniques prior to surgery have improved post-operative morbidity. Ancillary procedures at the time of surgery were not required in the majority of cases. An individual assessment of each patient early in the postoperative period was found to be more important with regard to the benefits of supplementary surgery. The majority of patients with dysphagia settled with conservative management and only a few underwent ancillary surgery. It is perceived that the cortical and subcortical control of swallowing is a major factor in the rehabilitation of these patients.