bluuebunny/crossref_metadata_2025 huggingface dataset:
Language development in children with recurrent acute otitis media during the first three years of life. follow-up study from birth to seven years of age
Authors: Harsten Göran , Nettelbladt Ulrika , Schalén Lucyna , Kalm Olof , Prellner Karin
Published: November 2007

From a cohort of 113 children, followed prospectively from birth during the first three years of life regarding different aspects of acute otitis media (AOM), two study groups were selected for the present investigation: 13 children with recurrent AOM (rAOM, i.e. at least six episodes of AOM during a 12–month period), and 29 children without any AOM episode. The purpose of this study was to analyse the possible effects of early onset rAOM on language development as assessed at four and seven years of age at phoniatric and linguistic examinations performed blindly. There were no differences between the two groups on any of the linguistic analyses performed, although the rAOM group manifested a somewhat better performance on auditory discrimination tests at four years of age. The results of the present study show that rAOM during the first three years of life, in otherwise healthy children, does not cause a detectable delay of language development at four and seven years of age.
Uni- and multivariate analysis of eight indications for postoperative radiotherapy and their significance for local-regional cure in advanced head and neck cancer
Authors: Ravasz L. A. , Hordijk G. J. , Slootweg P. J. , Smit F. , Tweel I. V. D.
Published: November 2007

Eighty consecutive patients with advanced head and neck cancer were treated with combined therapy of radical surgery and post-operative radiotherapy. Indications for post-operative radiotherapy were pathological staging of the primary tumour (pT3 or pT4), poorly differentiated or undifferentiated carcinoma (G3, G4), tumour thickness, tumour invasion in the surrounding tissues with slender tumour strands and solitary tumour cells, perineural spread, lymphangio-invasive tumour growth, multiple positive neck nodes or extranodal spread, and microscopical irradicality of the surgical margins. The contribution for prognosis of these indications for post-operative radiotherapy were retrospectively calculated in an univariate and multivariateanalysis. Of all investigated parameters, the mode of tumour invasion and lymphangio-invasive growth were independent prognostic factors. If these unfavourable prognostic signs are present, post-operative radiotherapy has to be intensified to at least curative doses of 66 Gy or more to the areas at risk.
Large maxillary antral mucocele presenting with facial asymmetry
Authors: Salam M. A. , Whitehead E.
Published: November 2007

Maxillary antral mucoceles are extremely rare. We report a case of a large antral mucocele presenting with facial asymmetry. The CT scan was essential for delineating the extent of the lesion and aiding in the pre-operative diagnosis. The pathogenesis, clinical features and radiological aspects of this entity are reviewed.
Nasal T-cell lymphoma associated with Epstein-Barr virus infection
Authors: Dhaliwal J. , Rowlands D. C. , Niedobitek G. , Williams A. , Gupta A. Das , Jones E. L.
Published: November 2007

A case of nasal T-cell lymphoma in a Caucasian male is reported, in which the presence of Epstein-Barr virus within tumour cells was demonstrated by in situ hybridization to the Epstein-Barr virus encoded RNAs EBER-1 and EBER-2.
Risk factors involved in stomal recurrence following laryngectomy
Authors: Esteban F. , Moreno J. A. , Delgado-Rodriguez M. , Mochon A.
Published: November 2007

Stomal recurrence after surgery for laryngeal tumours is an extremely serious complication, with a dismal prognosis despite aggressive surgical therapy or high-dose irradiation. Data from 209 patients who underwent total laryngectomy for cancers of the larynx and hypopharynx were retrieved from the registry of the Department of Otorhinolaryngology at the Hospital ‘Virgen de las Nieves’ of Granada. Stomal recurrence developed in 8.1 per cent of them (17 cases). We analysed several parameters from each case: first, those parameters significantly associated with stomal recurrence were detected, and secondly, a logistic regression analysis was done. Three factors were found independently related to stomal recurrence: T-staging, site of the primary tumour and prior tracheostomy. Together with a review of the literature, we discuss our findings and a proposal for management of the high risk patient.
Temporal bone histopathology of open mastoidectomy cavities
Authors: Youngs Robin
Published: November 2007

Open cavity mastoidectomy remains the principle surgical treatment of middle ear cholesteatoma in the United Kingdom. A significant proportion of mastoid cavities are prone to intermittent or continuous discharge.

In this study the temporal bone histopathology of four patients who had undergone open cavity mastoidectomy is presented. Cavities were predominantly lined with stratified keratinizing squamous epithelium. Residual air cells were obliterated by fibrous tissue, with no evidence of persistent respiratory epithelium. Where inflammatory changes were found, these consisted of areas of granulation tissue in association with epithelial ulceration. Residual cholesteatoma pearls (epidermoids) were not associated with significant inflammatory changes.
Analysis of lectin receptors in normal nasal mucosa, nasal polyp, inverted papilloma and papillary adenocarcinoma
Authors: Huang Hai , Jing Desheng , Li Zhaoji , Zhou Shuimiao , Xiao Shizhi , Ma Dalie , Zhang Rongzhou
Published: November 2007

In order to investigate the changes in glycoprotein structure in the process of cellular differentiation of the nasal mucosa, formalin-fixed, paraffin-embedded biopsy specimens of normal nasal mucosae, nasal polyps, inverted papillomas and papillary adenocarcinomas were analysed by the Avidin Biotin-Peroxidase Complex technique for the demonstration of peanut agglutinin (PNA) receptors, concanavalin ensifomis agglutinin (ConA) receptors, ulex europeaus agglutinin (UEA-I) receptors, wheat germ agglutinin (WGA) receptors, carcino-embryonic antigen (CEA) and keratin. The quantity and distribution of PNA receptors, ConA receptors, UEA-I receptors and CEA were different, in relation to the varying pathological changes. The results suggest that the glycoprotein structure in the cells of the nasal mucosa will change following their differentiation and malignant transformation, which may be helpful in establishing the diagnosis.
Cough and stridor: who should investigate the patient?
Authors: Hassan W. U. , Henderson A. F.
Published: November 2007

Stridor is usually produced by obstruction in the upper airways. We present a case of stridor referred to the ENT Department in whom an endoscopic examination as far as the lower trachea showed no abnormality. A subsequent bronchoscopy in the Chest Department revealed a tumour in the right main bronchus.
Emergency tracheostomy in a patient with Melnick-Needles Syndrome and sleep apnoea
Authors: Curran Aongus J. , O'Dwyer T. P. , Blayney Alexander
Published: November 2007

A six-year-old girl with a rare bone dysplasia (Melnick-Needles Syndrome) presented with a five month history of severe sleep apnoea, weight loss and failure of thrive. The syndrome is associated with craniofacial abnormalities, including micrognathia. Following a multi-disciplinary assessment an elective tracheostomy was considered the most appropriate treatment. The patient developed severe respiratory distress 10 days prior to the arranged date of surgery and required an emergency tracheostomy. This resulted in a dramatic return to health. The recognition of severe sleep apnoea in patients with craniofacial abnormalities and the role of initial tracheostomy are discussed.
Gentamicin ototoxicity in continuous ambulatory peritoneal dialysis
Authors: Gendeh B. S. , Said H. , Gibb A. G. , Aziz N. S. , Kong N. , Zahir Z. M.
Published: November 2007

Abstarct

A prospective study was undertaken of 10 chronic renal failure patients on Continuous Ambulatory Peritoneal Dialysis (CAPD) complicated by repeated bouts of peritonitis treated with gentamicin. Each 10-day treatment course consisted of a 120 mg loading dose, followed by 16 mg in 21 of peritoneal dialysate, given four times a day. Serum gentamicin analysed by enzyme immunoassay showed a mean level of 5.2 µg/ml, (range 3.7 to 6.6 µg/ml) four hours after the loading dose. Similar levels, well within the therapeutic range, were maintained on the 3rd, 5th, 7th and 9th days of intraperitoneal gentamicin therapy, suggesting no accumulation of gentamicin in the serum. Pure tone audiometry, electronystagmography and clinical assessment were performed during each course of treatment. Although no evidence of ototoxicity was found during the first two courses of gentamicin, but disequilibrium and bobbing oscillopsia were present during the third and fourth courses of gentamicin. These findings could be explained by cumulative injury to the vestibular apparatus caused by repeated therapeutic insults.
The use of cortical bone grafts in ossiculoplasty
Authors: Mills R. P. , Heaton J. M. , Gray I. G.
Published: November 2007

This paper describes the results of a comparative audit of the costs of using artificial prostheses and cortical bone. The costs of using a bone graft have been calculated by estimating the expenses incurred as a result of the additional time required for preparation of the grafts. The mean cost of preparing a graft was £29.10, while the mean cost of using a prosthesis was £65.01.
Same-day tonsillectomy
Authors: Tewary A. K. , Curry A. R.
Published: November 2007

Tonsillectomies have been performed on a same-day basis in Coventry for the past three years. We report our experience with this technique which has gradually evolved over the last ten years. The procedure is described in detail and the results of the first two years have been analysed. In common with the experience of others, it is possible to perform tonsillectomies safely on a same-day basis.
Synovial osteochondromatosis of the temporo-mandibular joint
Authors: Nomoto Minoru , Nagao Koichi , Numata Tsutomu , Konno Akiyoshi , Kaneko Toshio
Published: November 2007

Abstarct

A rare case of synovial osteochodromatosis of the temporo-mandibular joint is presented. Important diagnostic information can be obtained by CT, MRI, 99m Tc bone scan and aspiration biopsy. Observation using a light microscope showed mild cellular atypia, but the hallmarks characteristic of chondrosarcoma were not found. Observation using an electron microscope showed the mature chondrocytes contained a well-developed rough endoplasmic reticulum. Histological evaluation indicated that the present case was benign synovial osteochondromatosis in an early stage.
Informed consent: using a structured interview changes patients' attitudes towards informed consent
Authors: Dawes P. J. D. , O'Keefe L. , Adcock S.
Published: November 2007

Patients want to know more about their condition and its proposed treatment. Gaining patients' confidence before treatment reduces the chances of their seeking legal redress for an unexpected outcome. As part of a prospective study of informed consent for surgery we have assessed the attitudes of patients towards informed consent when different types of consent interview are used.

We found that most patients are happy to do as their doctor advises but think the informal consent interview is important because it gives them information; they also want to know about most, but not all, complications of the procedure. One quarter worried about the anaesthetic, about one eighth worried about ‘not waking up’ nd similar proportions worried about complications and other things such as pain and nausea. Most patients think that the consent form is a legal document.

In addition patients who had an informal interview felt obliged to sign the consent form and thought it had medicolegal implications. In contrast those who had a structured interview felt less obliged to sign the consent form and more involved in the decision to operate.
The management of lateral sinus thrombosis
Authors: Singh Bharath
Published: November 2007

The standard recommended treatment for lateral sinus thrombosis is intravenous antibiotics. For those that fail, some authors recommend anticoagulant therapy, others internal jugular vein ligation. Despite these recommendations, there is still a significant mortality in all reported large series and the main reason this is that the cause of the failure has not been found or investigated.

Over a six-year-period, from January 1985 to December 1990,36 patients were admitted with lateral sinus thrombosis. The initial treatment consisted of intravenous antibiotics and surgery. The surgery included cortical mastoidectomy for non-cholesteatomatous ears and modified radical mastoidectomy for cholesteatomatous ears and drainage of the intracranial collection of pus in patients with subdural empyema and brain abscess.

There were nine failures (25 per cent) with this treatment regimen. Blood cultures and pus swab of the ears were taken from these patients. The blood cultures were positive in four patients and the organisms isolated included (3-haemolyticStreptococcus sp.in two,Proteus mirabilis and Streptococcuspneumoniaein one each). From the ear swab mixed cultures were found in eight and a single organism in one.

Gram-negative organisms were isolated in nine (100 per cent),Proteus mirabilisin eight (89 per cent) andEnterobacter sp.in two. Both these organisms were resistant to ampicillin and penicillin but were sensitive to amikacin.

Amikacin was then added to the treatment regimen and a dramatic response with a fall in the temperature, and improvement in the patients' general condition was noted within 24 hours, in all patients. There was not a single death, despite the fact that 42 per cent of the patients had other associated intracranial complications. The conclusion is that the treatment of choice for patients refractory to the conventional antibiotic therapy and surgery is amikacin therapy and not internal jugular vein ligation, or anticoagulant therapy.
Sudden sensorineural hearing loss in haemoglobin SC disease
Authors: Tavin M. Ellis , Rubin John S. , Camacho Fernando J.
Published: November 2007

Presented herein is a case report of sudden sensorineural hearing loss in the setting of haemoglobin SC disease. The relationship of the two is rare; the authors have found that this is only the second report in the literature. In this instance, partial exchange transfusions were performed in an attempt to decrease viscosity and improve blood flow. Thereafter, hearing stabilized and then slowly improved. The evidence for the beneficial role of these transfusions in this setting is, at best, circumstantial, but it is theoretically sound and worthy of further study.
Acute visual loss in association with sinusitis
Authors: El-Sayed Yousry , Al-Muhaimeid Hamad
Published: November 2007

Acute visual loss may occur in association with sinusitis either as a complication of orbital cellulitis or, less frequently, as a part of the orbital apex syndrome. We describe two cases of temporary monocular visual loss caused by sinusitis. In one case the visual loss was due to orbital cellulitis; while in the other patient it was due to incompletely developed orbital apex syndrome. This later mode of presentation is called ‘partial orbital apex syndrome’ by some authors and ‘posterior orbital cellulitis’ by others.

The relationship between sinusitis and blindness is discussed.
Basal cell adenocarcinoma of the parotid gland: a case report and review of the literature
Authors: Atula Timo , Klemi Pekka-Juhani , Donath Karl , Happonen Risto-Pekka , Joensuu Heikki , Grenman Reidar
Published: November 2007

Basal cell adenocarcinoma is a rare salivary gland tumour. A DNA diploid parotid gland basal cell adenocarcinoma, with a low mitotic rate, in a 78-year-old female patient is described. Total removal of the affected salivary gland without sacrificing the facial nerve gave a good therapeutic result.
Sensorineural hearing loss caused by metastatic prostatic carcinoma: a case report
Authors: Pringle M. B. , Jefferis A. F. , Chir M. , Barrett G. S.
Published: November 2007

Abstract: Metastases to the temporal bone are a recognized, if rare, cause of otological symptoms including sudden sensorineural hearing loss. Carcinoma of the prostate is a common cancer which frequently metastasizes to bone but is only rarely reported in the temporal bone. We report a case of sudden sensorineural hearing loss due to metastatic prostatic carcinoma in the temporal bone.
Granular cell tumour of the larynx in an eight-year-old girl
Authors: Hamid Abdalla M. , Alshaikly Abduljabbar
Published: November 2007

Granular cell tumour is a rare benign neoplasm, that can affect many parts of the body, as single or multiple lesions. It is more common in black people and females. Typically it occurs between the fourth and fifth decades of life, with the median age for the laryngeal variety as 36 years. About 30 to 50 per cent occur in the tongue and 30 per cent in the skin.

A case of granular cell tumour of the larynx is reported in an eight-year-old girl, presenting with hoarseness of voice. She was successfully treated with local excision of the tumour. This tumour is rare in the larynx where it is more common in males than females although granular cell tumours are found more frequently in females generally.

For these reasons the authors suspect that their case, of a laryngeal granular cell tumour occurring in an eight-year-old girl might be the youngest to be reported.
Facial palsy after glomus tumour embolization
Authors: Herdman Rory C. D. , Gillespie James E. , Ramsden Richard T.
Published: November 2007

A case is presented of a patient undergoing pre-operative embolization of a glomus tumour who developed a facial palsy one hour after embolization. At the time of surgery it was found to be due to the embolization material (polyvinyl alcohol foam) blocking the stylomastoid artery. The blood supply of glomus tumours and the variations in the blood supply of the facial nerve are discussed.
Type II collagen autoimmunity and Ménière's disease
Authors: Herdman R. C. D. , Morgan K. , Holt P. J. L. , Ramsden R. T.
Published: November 2007

Antibodies to type II collagen have been reported by some authors to be raised in patients with Ménière's disease. In this study the antibody levels to type I and II collagen have been measured in 37 patients with Ménière's disease and 20 controls, using a solid-phase, double-antibody, enzyme-linked, immunoassay. No significant difference in antibody levels between the two groups was found. These findings do not support previously reported work which suggests that some cases of Ménière's disease are due to type II collagen autoimmunity.
Sinus computerized tomography in primary hypogammaglobulinaemia
Authors: Snow D. G. , Hansel T. T. , Williams P. E. , Drake-Lee A. B. , Thompson R. A.
Published: November 2007

Thirteen patients suffering from primary hypogammaglobulinaemia receiving intravenous immunoglobulin replacement therapy underwent computerized tomography of the paranasal sinuses. The CT scans were evaluated and related to clinical data from the patients, who were selected for study on the basis of having symptoms of rhinosinusitis. The scans varied from normal to demonstrating widespread sinus abnormality. Th.ere was no relationship between the scan findings and duration of ENT symptoms, range of current symptoms, or the interval between the onset of ENT symptoms and the start of intravenous immunoglobulin replacement therapy. It is nevertheless possible that prompt institution of replacement therapy, after correct diagnosis early in the course of the disease, may prevent the development of sinus disease refractory to such treatment.
Foley catheter fixation in posterior epistaxis
Authors: Wareing M. J. , Gray R. F.
Published: November 2007

An improved technique for fixation of a Foley catheter in posterior epistaxis is presented. It has the advantage of rigidity combined with a narrow diameter.
Ligation of the internal jugular vein in venous hum tinnitus
Authors: Nehru Vikas Indernath , Al-Khaboori M. J. J. , Kishore K.
Published: November 2007

Vascular anomalies, extracranial and intracranial arteriovenous malformations as well as glomus jugulare tumour are well known causes of pulsatile tinnitus. Of late, benign intracranial hypertension has been stated to be a more common cause. However, tinnitus arising from and within the internal jugular vein has been reported only infrequently. Previously known as cephalic bruit and essential objective tinnitus, the venous hum tinnitus presents as pulse synchronous unilateral objective tinnitus. Ligation of the internal jugular vein appears to be a successful treatment. Two cases are presented.
Extramedullary plasmacytoma of the larynx
Authors: Mochimatsu Izumi , Tsukuda Mamoru , Sawaki Shuji , Nakatani Yukio
Published: November 2007

A case of IgD myeloma in a 54-year-old male with a long-standing history of extramedullary plasmacytoma involving the larynx is reported.

The patient was treated with radiation therapy and laryngectomy. Twelve years later, he complained of nasal bleeding. On examination he was found to have large masses in the left nasal cavity and in the left supraclavicular region. Histological examination of both lesions showed plasmacytoma. Serum immunoglobulin studies revealed an IgD monoclonal spike of the lambda type. Bence-Jones protein was present. Using the immunoperoxidase staining technique, cytoplasmic monoclonal IgD was detected.
Unusual cerebello-pontine angle tumours
Authors: Moffat David A. , Saunders James E. , McElveen John T. , McFerran Donald J. , Hardy David G.
Published: November 2007

Fifty-nine unusual cerebello-pontine angle tumours have been studied. These lesions represent 19.3 per cent or 1 in 5 of a series of 305 cerebello-pontine angle tumours of which the rest, 246 (80.7 per cent), were acoustic neuromas. An analysis of the relative incidence, histology and presenting clinical features has been carried out. The various radiographical features and imaging techniques used to diagnose these fascinating tumours have been described and also the otoneurosurgical procedures necessary to excise them.
Concho-antropexy or total inferior turbinectomy for hypertrophy of the inferior turbinates? a prospective randomized study
Authors: Salam M. A. , Wengraf C.
Published: November 2007

Twenty-five patients with bilateral nasal obstruction due to hypertrophy of the inferior turbinates were entered into a prospective study to compare the efficacy and the associated complications of total inferior turbinectomy and concho-antropexy. We found no significant statistical difference in the efficacy of these procedures in relieving nasal obstruction and discharge (>0.5). Total inferior turbinectomy was associated with more postoperative pain (p<0.05) and with long-term dryness and crusting (p<0.05) which were statistically significant. This is the first trial where concho-antropexy and total inferior turbinectomy are compared.
An unusual cause of benign paroxysmal positional vertigo
Authors: Andaz C. , Whittet H. B. , Ludman H.
Published: November 2007

Benign paroxysmal positional vertigo (BPPV) is a self-limiting condition characterized by vertigo and nystagmus induced by certain head positions. The most common causes of BPPV are post-traumatic following head injury and post-viral labyrinthitis. We present an interesting case of BPPV following an otherwise uneventful neurosurgical removal of a parietal osteoma using hammer and chisel. Caution should be exercised during such procedures as disabling vertigo can result for a considerable period of time.
Preparation of a temporal bone exhibit
Authors: Natarajan B. , Baxter A.
Published: November 2007

Temporal bone dissection forms an important aspect in the training of an otolaryngologist. The more dissection one does the more confident one is in the operating room. The aim of this paper is to advise in the preparation of temporal bones for the purpose of display, exhibition or competition. The practical aspects of dissection are deliberately avoided concentrating on the selection of bones pre- and post-dissection, preparation of the bones, fixing and display of vessels and nerves and also mounting and lighting for exhibition purposes.

The temporal bone laboratory should be well equipped with a microscope, a power drill with a range of cutting and polishing burrs, a range of fine instruments, a suction machine with different sizes of suction tips, water source, a place to store the bones etc., thus creating an ideal environment for temporal bone dissection.
The influence of medical audit on the management of epistaxis in three District General Hospitals
Authors: Murthy P. , Christodoulou C. , Yatigammana N. , Datoo M.
Published: November 2007

The implementation of audit in most hospital departments in the UK has been instigated by the guidelines set out by the Royal Colleges. This paper aims to demonstrate the results of regular subregional audit meetings in the ENT departments involving three District Hospitals in East Anglia. We report the effects of audit meetings in improving the management of epistaxis, whereby a protocol for treatment and discharge was established, the duration of the nasal pack left in situ was reduced, and the material of the pack was changed.
Temporal bone fibrous dysplasia and cholesteatoma leading to the development of a parapharyngeal abscess
Authors: Yagoda Michelle R. , Selesnick Samuel H.
Published: November 2007

Monostotic fibrous dysplasia of the temporal bone is a rare disease entity that may lead to progressive stenosis of the external auditory canal with resultant trapping of skin and the development of cholesteatoma. The cholesteatoma may extend widely into the temporal bone. Once cholesteatoma occupies the petrous apex, erosion out of the temporal bone can occur superiorly into the middle fossa, posteriorly into the posterior fossa, inferiorly into the neck, and infero-medially into the parapharyngeal space. We present a case in which minimal symptoms were present despite a massive temporal bone fibrous dysplasia and cholesteatoma. Eventually, cholesteatoma eroded into the parapharyngeal space, leading to airway compromise. Late presentation occurred because the otic capsule was spared, there was no external skull deformity and there was slow inferior and medial growth that was well tolerated, until the development of a parapharyngeal space abscess.
Effect of hearing loss in electrocochleographic investigation of endolymphatic hydrops using tone-pip and click stimuli
Authors: Koyuncu M. , Mason S. M. , Shinkwin C.
Published: November 2007

Extratympanic electrocochleography (ECochG) was performed on 37 patients referred to the Evoked Potential Clinic with suspected Ménière's disease. The patients were classified according to their hearing impairment and audiometric configuration. Click and tone-pip stimuli with tone frequencies of 1 and 4 kHz were presented at a rate of 10 per second. Amplitude, latency and general waveform characteristics of the summation potential (SP) and action potential (AP) were analysed for each averaged response with respect to the level and configuration of the hearing loss. The highest incidence of abnormal percentage SP was in patients with average hearing loss in the range of 40–64 dB HL using the click stimulus. In low tone hearing loss, hydrops was identified from an enhanced SP in significantly more patients using the click and 4 kHz tone-pip than the 1 kHz stimulus. Measurement of the width of the 1 kHz tone-pip response waveform was abnormal in some patients even though the click and 4 kHz responses were normal. The optimum stimulus for identification of hydrops from an enhanced SP is dependent on the level and configuration of the hearing loss.
The role of Chlamydia pneumoniae in severe acute tonsillitis
Authors: Hone S. W. , Moore J. , Fenton J. , Gormley P. K. , Hone R.
Published: November 2007

Chlamydia pneumoniae has been implicated as a cause of tonsillitis and pharyngitis, but the incidence has varied from one to 19 per cent in various studies. We investigated 51 patients admitted to University College Hospital, Galway, with severe tonsillitis. Throat swabs were examined for evidence of Chlamydia pneumoniae using a direct monoclonal antibody test. Blood was taken for serology from 45 patients. A further specimen was taken at six weeks. A control group of 32 blood bank sera was used. Mean hospital stay was three days (one to eight). Five patients (10 per cent) were monospot positive. Chlamydia pneumoniae was identified by direct immunofluorescence on a tonsillar swab from one patient who did not seroconvert. IgG antibody was identified in 13 cases (29 per cent) and in seven of the control group (22 per cent). No serological evidence of recent infection was found. Chlamydia pneumoniae was not found to be a cause of severe acute tonsillitis in our study group.
Deep neck abscesses – changing trends
Authors: Sethi Dharambir S. , Stanley Ralph E.
Published: November 2007

A retrospective review was conducted of 64 patients with deep neck abscesses. Based on clinical and operative findings, these abscesses were categorized as retropharyngeal abscess (29 patients), parapharyngeal abscess (10 patients), Ludwig's angina (19 patients), or necrotizing cervical fasciitis (six patients). Regional trauma from an ingested foreign body was the cause for 59 per cent of the patients with a retropharyngeal abscess. In 90 per cent of subjects with Ludwig's angina, an odontogenic cause was established; however, in the majority of cases of parapharyngeal abscess (80 per cent) and necrotizing fasciitis of the neck (85 per cent), aetiology was unknown.

Fifty-five patients (86 per cent) required open neck drainage. In the remaining nine (14 per cent) endoscopic drainage of the abscess was possible. Eight patients (12 per cent) needed a tracheotomy for airway control. The overall mortality was eight per cent despite aggressive anti-microbial therapy and early surgical intervention. Thirty-four cultures grew aerobic organisms. Seventy-six per cent of these were gram-negative microorganisms. The bacteriological pattern of deep neck abscesses is changing and may be responsible for the considerable mortality rate with which the abscesses are still associated despite anti-microbial therapy.
Neurofibroma of the supraglottic larynx in childhood
Authors: Czigner Jenö , Fekete-Szabó Gabriella
Published: November 2007

The case of a male child with a benign neurogenic laryngeal tumour caused by von Recklinghausen's disease is presented. At the age of eight years, tracheostomy was necessary. The tumour, deforming the right half of the larynx and extending into the right half of the neck, was removed three years later. Following this procedure, decannulation was possible, and the patient has been free of laryngological complaints for six years.

Attention is drawn to the fact that autosomal dominantly inherited neurofibromatosis is a generalized benign tumour with a special form. If it involves any vital structure or forms a functional obstacle, meticulous surgical removal is necessary, and this provides good prospects over a long period.
Acute pharyngitis, an unusual complication of intravenous hyperalimentation
Authors: Sakaguchi Masanori , Taguchi Kiichiro , Ishiyama Tetsuya
Published: November 2007

While the numerous complications of intravenous hyperalimentation (IVH) are well recognized, we encountered a unique one. A 60-year-old man developed a sore throat, neck pain and fever seven days after catheterization of the subclavian vein to provide post-operative nutrition. Marked swelling was visible at the right posterior wall of his oropharynx and hypopharynx. X-ray of the neck revealed that the tip of the catheter was positioned in the internal jugular vein, not the subclavian vein as intended. The acute pharyngitis, diagnosed as due to phlebitis of the internal jugular vein due to the malpositioned catheter, subsided within two days of catheter removal.
Ossified thyroglossal cyst – is it of embryological significance?
Authors: Davis J. P. , Toma A. G. , Robinson P. J. , Friedmann I.
Published: November 2007

We report a case of a partly ossified thyroglossal cyst in close proximity to the hyoid bone and discuss the possible embryological significance of this. Thyroglossal cysts occurring within the hyoid bone or deep to the hyoid periosteum support previous suggestions that the thyroglossal tract can sometimes be trapped within the developing hyoid bone.
Massive epistaxis following sphenoid sinus exploration
Authors: Hollis L. J. , McGlashan J. A. , Walsh R. M. , Bowdler D. A.
Published: November 2007

Internal carotid artery trauma is a rare but potentially disastrous complication of surgery to the sphenoid sinus and pituitary gland. Emergency and elective procedures to establish haemostasis are discussed.
Closure of the petrous apex of the temporal bone with ionomeric cement following translabyrinthine removal of an acoustic neuroma
Authors: Helms J. , Geyer G.
Published: November 2007

When performing translabyrinthine surgery for acoustic neuroma, the surgeon opens the cerebrospinal fluid space. To prevent the development of post-operative meningitis, the surgical defect should be closed reliably in a watertight fashion. To date, this has been done with success in 12 patients altogether using a self-curing bone cement (ionomeric cement). During follow-up for a maximum of three years there has been no evidence of cerebrospinal fluid leaks.
Vocal process granulomata
Authors: McFerran D. J. , Abdullah V. , Gallimore A. P. , Pringle M. B. , Croft C. B.
Published: November 2007

Thecase records and histology of 34 patients with vocal process granulomata were reviewed. The five patients presenting most recently with idiopathic vocal process granulomata were investigated by axial computerized tomography (CT). Increased density of the arytenoid cartilage on the side of the lesion was found in all five cases. It is suggested that this indicates cartilage ossification, secondary to periochondritis. This perichondritis, playing either a primary or a secondary role in granuloma development, may explain the annoying tendency of vocal fold granulomata to recur after excision.
Isolated laryngeal leishmaniasis in an immunocompetent patient: successful treatment with surgery
Authors: Cunchillos M. Navarro , Marcos J. L. Villanueva , Torre-Cisneros J. , Aumente P. Ostos , López-Rubio F. , Villarejo P. López
Published: November 2007

The localization of Leishmania spp. in the larynx is rare but it has recently been described in patients infected by humanimmunodeficiency virus (HIV). The normal treatment given is antimonials. We describe a case of isolated leishmaniasis inthe larynx which was cured by surgery. Our patient was a 47-year-old man who had suffered visceral leishmaniasis in hischildhood with no immunosuppression.
Aggressive (malignant?) epithelial odontogenic ghost cell tumour of the maxilla
Authors: Siar C. H. , NG K. H.
Published: November 2007

A case is described of ameloblastoma of the mandible presenting with multiple recurrences and subsequent extension to the maxilla with resultant transformation into an aggressive (malignant?) epithelial odontogenic ghost cell tumour. The latter is a rare, biologically virulent entity that affects mainly males, exhibits a preference for the maxilla and is histologically characterized by atypical malignant odontogenic epithelium associated with areas of ghost cell formation and varying amounts of dentinoid
Single grade specialist training in otolaryngology – a survey of attitudes among present and recent trainees
Authors: Collins Melanie , Ryan Rowena
Published: November 2007

The authors present the results of a postal questionnaire about possible advantages, disadvantages, and logistics of a single grade training scheme. Replies were received from 13 recently appointed consultants and 42 otolaryngologists in training. The majority (43) were in favour of a single grade training scheme, although it was felt that certain potential problems would need to be carefully addressed, particularly the potential for narrow clinical exposure and the difficulties inherent in early selection for higher surgical training. It was also felt that for such schemes to work, considerable extra consultant time would need to be set aside purely for teaching. The respondents' ideal training scheme is outlined.
The use of rigid endoscopes in cholesteatoma surgery
Authors: Yung Matthew Man Wah
Published: November 2007

The existence of blind pockets in the middle ear during cholesteatoma surgery could compromise complete removal of the disease, e.g. from the sinus tympanum. The use of side-viewing rigid endoscopes in conjunction with the operating microscope to control and facilitate cholesteatoma removal during mastoid operation studied.

Ninety-two primary operations for cholesteatoma over a four-year period were examined. Over one-third (35.9 per cent) of these cases had cholesteatoma extended into the sinus tympanum. Sixty-four operations were small cavity mastoidectomy. The others were either canal wall reconstruction or primary obliteration following open cavity mastoidectomy.

Although residual cholesteatoma was found in three patients, only one was in the middle ear. It is concluded from this study that side-viewing endoscopes could be very useful in cholesteatoma surgery.
Human papilloma viruses: a study of their prevalence in the normal larynx
Authors: Nunez Desmond A. , Astley Siân M. , Lewis Fraser A. , Wells Michael
Published: November 2007

The association of human papilloma viruses (HPV) with laryngopharyngeal squamous cell carcinoma is under investigation. The suitability of control tissue in the reported series, invariably obtained from histologically normal tissue adjacent to a squamous cell carcinoma or from patients with benign laryngopharyngeal disease, is questionable. The present study determined the prevalence of HPV in a series of normal larynges.

Twelve autopsy larynges were collected. DNA was obtained by SDS proteinase K digestion. Evidence of HPV infection was documented by the polymerase chain reaction using oligonulceotide primers complementary to sequences in the E6 region of HPV types 11, 16 and 18.

Four female and eight male larynges, mean age 65 years (sd=16 years) were collected 72 hours postmortem (median value). HPV type 11 was isolated from three specimens. A 25 per cent prevalence rate for HPV 11 was found. No other HPV types were isolated.
Primary amyloidosis of the larynx
Authors: Bennett J. D. C. , Chowdhury C. R.
Published: November 2007

The history, examination and operative findings of primary amyloidosis of the larynx are very suggestive of carcinoma, indicating the need for careful histological examination. Staining with Congo red shows a characteristic birefringence. Systemic amyloidosis may be present
A potential hazard for night denture wearers
Authors: Zeitoun H. , Robinson P.
Published: November 2007

A rare complication of denture use is presented. The clinical and radiological findings are documented and the optimum method of treatment discussed.
Ewing's sarcoma of the retropharynx
Authors: O'Connell Janet E. , Calder Caroline , Raafat Faro , Proops David
Published: November 2007

Ewing's sarcoma arising in the head and neck region is very rare. A case arising from C2 in a young child is presented. The unusual presentation, differential diagnosis and pathological features are discussed.
Management of middle ear myoclonus
Authors: Badia Lydis , Parikh Abhi , Brookes Gerald B.
Published: November 2007

Tinnitus produced by synchronous repetitive contraction of the middle ear muscles (middle ear myoclonus) is a rare condition.

We present six cases of middle ear myoclonus in whom different management regimes were successful. In two patients, the tinnitus was controlled by conservative measures. In one patient, whose tinnitus was associated with blepharospasm, significant improvement occurred following botulinum toxin injection into the ipsilateral orbicularis oculi. Three patients were cured by tympanotomy with stapedial and tensor tympani tendon section.

The aetiology of this type of myoclonus remains unclear. The diagnosis is based on the history of involuntary and rhythmic clicking or buzzing tinnitus which is invariably unilateral. The primary differential diagnosis is palatal myoclonus whilst other local aural pathologies must be excluded by careful clinical assessment. Surgical section of these muscles via tympanotomy brings guaranteed relief when conservative measures fail.
Negative ANCA in Wegener's granulomatosis
Authors: Carrie S. , Hughes K. B. , Watson M. G.
Published: November 2007

Wegener's granulomatosis is a systemic vasculitis characterized by necrotizing granulomata and without treatment is associated with a poor prognosis. Antineutrophil cytoplasmic antibodies (ANCA) have proved to be a useful serological marker allowing for early diagnosis and treatment of this condition. We report two cases of patients who were ANCA-negative on presentation despite clinical suspicion of Wegener's granulomatosis. In both cases the patients developed a positive ANCA titre as the disease progressed.
Cervical necrotizing fasciitis and tonsillitis
Authors: Scott P. M. J. , Dhillion R. S. , McDonald P. J.
Published: November 2007

We present a case of cervical necrotizing fasciitis following quinsy in a previously fit and healthy man. This is a potentially fatal condition with few specific clinical signs that requires early diagnosis and surgical debridement. Other features of the disease are discussed.
A transethmoid transorbital foreign body
Authors: Udwadia Reshma A. , Maniar Dipti , Acharya Mukul
Published: November 2007

A case of an unusual foreign body, the bristle end of a broken toothbrush which was removed for the ethmoid sinus complex is presented.
Post-irradiation carcinosarcoma of the parotid gland
Authors: Spraggs P. D. R. , Rose D. S. C. , Grant H. R. , Gallimore A. P.
Published: November 2007

Carcinosarcoma of the salivary glands are rare tumours, often associated with a history of pleomorphic adenoma. A case of carcinosarcoma of the parotid arising following irradiation to the resection site of a pleomorphic adenoma is presented. The clinical and histological features are discussed and the literature reviewed.
Pleomorphic adenoma of parotid gland with cystic degeneration
Authors: Nishimura Toshiro , Furukawa Mitsuru , Kawahara Ei
Published: November 2007

Pleomorphic adenoma is the most common tumour to arise in the parotid gland. Diagnosis becomes difficult when such a tumour undergoes degeneration and presents with unusual findings. This can lead to erroneous decisions concerning treatment. We present two patients with pleomorphic adenoma of the parotid gland with cystic degeneration, describe the pathological findings and discuss some pitfalls in diagnosis and treatment. Both patients recovered uneventfully after surgery.
Day-case adenoidectomy, parental opinions and concerns
Authors: Callanan Vincent , Capper Ruth , Gurr Paul , Baldwin David L.
Published: November 2007

Day-case surgery has been urged on the National Health Service by the Audit Commission in the last decade despite concerns about safety. A questionnaire was posted to the parents of 109 children who had recently undergone day-case adenoidectomy, addressing parental concerns and opinions. Eighty per cent of the questionnaires were returned. A high level of satisfaction with day-case adenoidectomy was expressed by the parents. All the children were observed for six hours after surgery prior to discharge. One child was visited at home by his general practitioner in the first 24 hours of discharge but there were no serious post-operative complications and none of the children required re-admission to hospital. Day-case adenoidectomy is safe, very acceptable to parents and does not result in a greatly increased workload for general practitioners.
Surgical emphysema: a novel complication of aural exostosis surgery
Authors: von Bluementhal Hubertus , Fisher Edward W. , Adlam David M. , Moffat David A.
Published: November 2007

We present the case of a 40-year-old male Caucasian patient who developed surgical emphysema of the neck five weeks after surgery for exostoses of the external auditory canal. Imaging of the temporal bone demonstrated that the surgery had resulted in entry into the temporomandibular joint. A mechanism is proposed for this novel complication.
Pseudosarcoma of the larynx: the value of ploidy analysis
Authors: Cassidy Michael , Maher Michael , Keogh Peader , Leader Mary
Published: November 2007

An 82-year-old male presented with a two-month history of hoarseness. A 2 cm pedunculated lesion was removed from the base of his epiglottis. Microscopy showed a polypoid atypical spindle cell lesion. Multiple levels failed to reveal an invasive squamous cell carcinoma. On the basis of haematozylin and eosin stained sections the main differential diagnosis was a pseudosarcoma with an overlying dysplastic squamous mucosa or infiltrating spindle cell carcinoma. Immunohistochemistry showed positive staining for vimentin but no convincing staining with antibodies to cytokeratin and EMA. Ultrastructural analysis also failed to reveal epithelial characteristics. Ploidy analysis by static cytophotometry of the spindle cell proliferation revealed an aneuploid stem line with a DNA index of 1.67. On the basis of this the process was felt unlikely to be reactive and a diagnosis of a spindle cell squamous carcinoma was made. This diagnosis was subsequently supported by a clinical recurrence of the nodule at a six-month follow-up.
Facial nerve monitoring in skull base surgery
Authors: Magliulo Giuseppe , Petti Roberto , Vingolo Gianluca Maria , Cristofari Piera , Ronzoni Roberta
Published: November 2007

The purpose of this work was to compare pre- and post-operative facial nerve function between unmonitored and monitored cases of skull base lesions. The study involved 32 patients suffering from lateral skull base tumours (10 unmonitored and 22 monitored). Facial nerve function was monitored intraoperatively by an acoustic facial electromyographic system (NIM-2). Post-operative facial function was graded according to the House-Brackmann scale. In the group of monitored cases, facial nerve function was normal (Grade 1 or 2) in 79 per cent of the patients, while the unmonitored patients showed normal function in only 50 per cent of the cases.

These results confirm previous observations that audible evoked electromyographic monitoring significantly reduces permanent facial nerve dysfunction.
A case of vascular leiomyoma of the larynx
Authors: Hirakawa K. , Harada Y. , Tatsukawa T. , Nagasawa A. , Fujii M.
Published: November 2007

We present a 68-year-old woman with a vascular leiomyoma of the larynx, a benign tumour that rarely involves that organ. Chief complaints were a feeling of a narrowing of the pharynx and difficulty in breathing in the supine position. A spherical tumour measuring 1.5 cm and covered with normal mucosa was found avthe margin of her epiglottis. The patient was administered a general anaesthetic and the tumour was successfully removed via direct laryngoscopy. Histological examination revealed that the tumour lay beneath a layer of stratified squamous epithelium and was encased in a welldefined fibrous capsule. The tumour parenchyma was composed of proliferated fibres that consisted of elongated cells, surrounded by an abundance of blood vessels. Its complete removal is the treatment of choice with care taken to avoid profuse bleeding. Recurrence is rare.
Glomus tympanicum chemodectoma: unusual radiological findings
Authors: Alshaikhly Abduljabbar , Hamid Abdalla M. , Azadeh Bahram
Published: November 2007

A 64-year-old Qatari female, with a one-year history of right otorrhoea and deafness, had a reddish-white mass projecting into the right ear canal, through the tympanic membrane, that proved histopathologically to be a paraganglioma. Computerized tomography (CT) of the temporal bones showed extensive destruction of the right mastoid bone, the posterior ear canal wall, and the sinus plate, with total disruption of the ossicles, simulating a malignant tumour, which is unusual for a middle ear paraganglioma.