bluuebunny/crossref_metadata_2025 huggingface dataset:
The Foley catheter in epistaxis management – a scientific appraisal
Authors: Hartley C. , Axon P. R.
Published: November 2007

The Foley balloon catheter has been used in the management of posterior epistaxis for several decades. Despite a lack of uniformity in balloon use, it is frequently successful in arresting haemorrhage. A better understanding of the balloon's characteristics may further increase its effectiveness by more appropriate use in some individuals.

Inflation characteristics were assessed in vitro by measurement of balloon length and diameter at various inflation volumes. Deflation of air-filled balloons was found to be consistent for each balloon type. The deflation rate was unaffected when BIPP (bismuth-iodoform-paraffin paste) or liquid paraffin soaked gauze were applied to the catheter.

Recommendations for catheter use are made.
Importance of pre-operative recognition of the nonrecurrent laryngeal nerve
Authors: Nagayama Ikuo , Okabe Yozo , Katoh Hideaki , Furukawa Mitsuru
Published: November 2007

The nonrecurrent laryngeal nerve is vulnerable during thyroid surgery. Pre-operative recognition of this nerve allows surgeons to avoid injuring the nerve. This anomaly depends upon the aortic arch anomaly and, therefore, in some cases, surgeons are able to predict the presence of this nerve pre-operatively by chest X-ray or barium swallow. Two patients with nonrecurrent laryngeal nerve are reported, one of whom, a 48-year-old man, had an abnormal shadow of the aortic arch, which led to confirmation of a right aberrant subclavian artery. Barium swallow plays a decisive role in the diagnosis of nonrecurrent laryngeal nerve, and this test is mandatory in patients who complain of difficulty in swallowing.
Ear dysplasia after Mondini
Authors: Phelps Peter D.
Published: November 2007

An historical account of descriptions of malformation of the inner ear.
Post-laryngectomy neopharyngeal diverticulae
Authors: Hartley C. , Saeed S. R. , Farrington W. T.
Published: November 2007

Four cases with a neopharyngeal diverticulum following total laryngectomy are presented. Each patient required surgery for complications directly related to the pouch. The relevance of these diverticulae is discussed with reference to their aetiology, complications and management.
A unique congenital glossocervical fistula
Authors: Donnelly Martin J. , Timon Conard I. , Mooney Eoghan
Published: November 2007

Lateral cervical fistulae which communicate with the oropharynx are considered to result from incomplete obliteration of the second branchial cleft and pouch. Classically these fistulae have a well-defined pathway through the neck. We present a case, and discuss the aetiology, of a fistula extending from the lateral neck via a previously undescribed course through the neck structures and opening into the posterior aspect of the tongue at the level of the vallate papillae.
Perilymphatic fistula—the value of diagnostic tests
Authors: Podoshin Ludwig , Fradis Milo , Ben-David Jacob , Berger Steven I. , Feiglin Hava
Published: November 2007

Perilymphatic fistula (PLF) remains one of the most challenging problems in otological practice. Fifty-two consecutive patients (53 ears) who underwent explorative tympanotomy for suspected PLF between 1985–1992 were included in this study. The clinical picture, history, patients' complaints and laboratory tests were analysed and compared with the operative findings. The conclusions of our work are that the diagnosis of PLF is based mostly on the clinical picture and a battery of laboratory diagnostic tests, but no one test is truly diagnostic for PLF.
Sudden deafness and cerebellar tumour
Authors: Gálvez E. Merino , Meseguer D. Hellín , Ortega F. García , Mondejar J. Manuel
Published: November 2007

We report the case of a female patient who presented with sudden deafness as the first symptom of a cerebellar tumour which was not localized strictly in the cerebellopontine angle and did not show direct compression on the extrabulbar portion of the Vlllth cranial nerve. The clinical picture contained a number of signs and symptoms typical of cerebellar involvement.

Surgical intervention restored the hearing and caused the symptoms to disappear.

We also review the association between tumours and sudden deafness in the literature.
Severe chronic inflammation of the mucous membranes in the eyes and upper respiratory tract due to work-related exposure to hexavalent chromium
Authors: Johansen Morten , Overgaard Erik , Toft Arne
Published: November 2007

Chronic inflammation of the skin and mucous membranes following prolonged exposure to high doses of toxic hexavalent chromium is well known in the occupational medical literature. Perforation of the nasal septum is a cardinal clinical feature. Late development of cancer in the respiratory system is established. A recently diagnosed case with an unusually severe affect on the eyes is described. The industrial usage of chromium and its toxiological profile is reviewed.
A comparison of artificial saliva and pilocarpine in radiation induced xerostomia
Authors: Davies A. N. , Singer J.
Published: November 2007

Twenty patients with radiation-induced xerostomia were entered into a prospective randomized crossover study comparing a mucin-based artificial saliva (Saliva Orthana) and a mouthwash containing pilocarpine 5 mg three times a day. Overall the patients found that the pilocarpine mouthwash was more effective than the artificial saliva in relieving their symptoms (p = 0.04), and 47 per cent of the patients wanted to continue with this treatment after the study had finished.
A case report of facial nerve palsy associated with chickenpox
Authors: Watanabe Yoshiharu , Ikeda Minoru , Kukimoto Nobuo , Kuga Mutsumi , Tomita Hiroshi
Published: November 2007

We examined a very unusual patient who developed peripheral facial palsy with chickenpox. A survey of the English literature revealed that eight such patients had been reported, but the period between the appearance of the vesicles of varicella and the facial nerve palsy ranged from five days before to 16 days after the eruption development. We presume that the route of infection was neurogenous in patients who had palsy after the appearance of the eruptions, but haematogenous in patients who had palsy before the appearance of vesicles. The two patients whose infection route was presumed to be haematogenous, had a poor prognosis.
Lipoma in the peri-tonsillar space
Authors: Tsunoda Atsunobu
Published: November 2007

Lipomas in the head and neck region usually occur in the immediate subcutaneous tissue, and only rarely in the upper aerodigestive tract. We report here a case of a 58-year-old female with a lipoma in the peri-tonsillar space. The tumour originated from the left peri-tonsillar space over the palate tonsil and partly protruded into the oral cavity. MRI (magnetic resonance imaging) showed not only the acccurate location of the tumour but also suggested its pathology. To our knowledge, a lipoma in the peri-tonsillar space is quite rare and MRI is useful in its diagnosis.
Parotid duct stone – removal by a dormia basket
Authors: Sharma R. K. , Al-Khalifa S. , Paulose K. O. , Ahmed N.
Published: November 2007

Removal of a parotid duct calculus using a Dormia basket is described and the literature reviewed. To our knowledge, this procedure has not previously been reported.
High-resolution computed tomography in evaluation of cochlear patency in implant candidates: a comparison with surgical findings
Authors: Frau Giuseppe N. , Luxford William M. , LO William W. M. , Berliner Karen I. , Telischi Fred F.
Published: November 2007

High-resolution computed tomography (HRCT) is important in the evaluation of cochlear implant candidates. This study examines the accuracy of radiological assessment of cochlear patency in relation to findings at the time of surgery. Older and newer HRCT methods and attending and senior radiologist interpretations are compared in a large series of cochlear implant patients.

Subjects were 50 adults (22 to 74 years) and 31 children (2.4 to 11.7 years) who received either a 3M/House or a Nucleus 22-channel cochlear implant. Attending radiologist reports were obtained by chart review and the scans were re-reviewed for this study by a senior radiologist. Accuracy in detecting cochlear ossification ranged from 86.4 per cent for attending radiologists, with all HRCT scans, to 94.7 per cent for the senior radiologist with newer HRCT scans. False positives were rare, but false negatives did occur. Overall, best results were obtained with newer HRCT scans and a senior radiologist.

Knowledge of the presence and extent of cochlear ossification is important to the implant surgeon and for patient counselling. Technical guidelines and a check list for interpretation of results are presented.
Solar recharging system for hearing aid cells
Authors: Estancona N. Gòmez , Tena A. G. , Torca J. , Urruticoechea L. , Muñiz L. , Aristimuño D. , Unanue J. M. , Torca J. , Urruticoechea A.
Published: November 2007

We present a solar recharging system for nickel-cadmium cells of interest in areas where batteries for hearing aids are difficult to obtain. The charger has sun cells at the top. Luminous energy is converted into electrical energy, during the day and also at night if there is moonlight. The cost of the charger and hearing aid is very low at 35 US$.

The use of solar recharging for hearing aids would be useful in alleviating the problems of deafness in parts of developing countries where there is no electricity.
The high jugular bulb in ear surgery: three case reports and a review of the literature
Authors: Moore Philip J.
Published: November 2007

Encounters with the jugular bulb in ear surgery are uncommon. This communication relates three cases where the author was confronted with the bulb in middle ear surgery – one in relation to the external auditory canal when raising a tympanomeatal flap and two in the hypotympanum when entering the middle ear. The anatomy of the jugular bulb is considered, particularly in regard to its quite variable placement within the temporal bone. The manner of clinical presentation of the high jugular bulb and previous cases in the literature where the jugular bulb has been discovered in juxtaposition to the surgical approach are discussed. Implications of surgical management are considered.
Two cases of lateral sinus thrombosis presenting with extracranial head and neck abscesses
Authors: Pearson C. R. , Riden D. K. , Garth R. J. N. , Thomas M. R.
Published: November 2007

Two cases of lateral sinus thrombosis in fit adults with no previous otological history are presented. One case occurred in association with Bezold's abscess and followed mastoiditis which was masked by previous antibiotic treatment. The other case occurred in association with an occipitoparietal scalp abscess and there was no obvious preceding middle ear infection. The causative bacteria were Streptococcus milleri and a variant Steptococcus intermedius. Lateral sinus thrombosis is discussed.
Management of parapharyngeal space cysts
Authors: Günerí Aataman , Günbay M.Ufuk , Günerí E. Alpin , Ceryan Kerim , Sütay Semih
Published: November 2007

Parapharyngeal space cysts, besides salivary gland origin may be derived from the first and dorsal portions of the second pharyngeal pouches. They are mucosal or epithelial lined structures with no external or visceral opening and always present on the lateral aspects of the nasopharyngeal wall.

Two consecutive cases of parapharyngeal space cysts totally excised by transoral and transparotid routes are presented.
Myxoma of the larynx: a case report and a review of literature
Authors: Hadley J. , Gardiner Q. , Dilkes M. , Boyle M.
Published: November 2007

Laryngeal myxomas are rare benign mesenchymal tumours in contrast to myxomatous degeneration in laryngeal polyps which occurs frequently. A correct diagnosis of myxoma is usually not difficult to reach if the possibility of myxomatous degeneration in laryngeal polyps is excluded and strict pathological criteria are adhered to. We report a myxoma arising from the left vocal fold in a 64-year-old male who presented with a four-year history of intermittent dysphonia. Although excision was microscopically incomplete, there is no evidence of recurrence macroscopically 18 months later and the patient remains asymptomatic.
A comparison of cellular proliferation markers in squamous cell carcinoma of the head and neck
Authors: Jones A. S. , Roland N. J. , Caslin A. W. , Cooke T. G. , Cooke L. D. , Forster G.
Published: November 2007

Head and neck squamous cell carcinoma has a relatively good prognosis but treatment may be at the expense of function and quality of life. Various host and tumour parameters have been studied in an attempt to predict the course of the disease but without success. It has been hoped that laboratory based methods, particularly those based on molecular biology, may prove more useful. Cell kinetic parameters are studied in this paper.

The present study includes 75 patients with a proven squamous cell carcinoma of the head and neck at various sites and undergoing various forms of treatment. The patient's mean age was 62 years and the median survival rate 45 months. Immunohistochemical techniques using Ki67 and PCNA were compared with flow cytometric analysis which included the BRDU labelling index, the duration of S phase, ploidy and potential doubling time.

The median PCNA index was 560 and the Ki67 index 298. These indices varied between 980 and 150 for PCNA and 808 and 110 for Ki67. The BRDU labelling index measured by flow cytometry was 8.9 with a range from 25 to 1.6 and the duration of S phase was 14.8 hours. The PCNA index failed to correlate with any host or tumour factors and this failure was also seen in Ki67 indices and also in the flow cytometric parameters. There was a strong correlation between PCNA and Ki67 expression (p<0.0001). Neither PCNA nor Ki67 values were significantly different between irradiated and nonirradiated tissues nor in sites or in patients who later developed lymph node metastases. Neither PCNA nor any other cell kinetics parameter correlated with survival and multivariate analysis confirmed this lack of correlation.

The PCNA labelling index like the Ki67 index and flow cytometric parameters does not appear to be of value in predicting the course of squamous cell carcinoma of the head and neck.
Pulmonary carcinoma metastatic to the larynx
Authors: Bernáldez Ricardo , Toledano Adolfo , Alvarez Javier , Gavilán Javier
Published: November 2007

Metastases to the larynx from distant primaries are rare. We report a case of a pulmonary epidermoid carcinoma metastatic to the larynx that simulated a primary cancer. A review of the literature showed nine previously reported cases of pulmonary metastases to the larynx—only two of them were epidermoid carcinomas.

Treatment of a secondary lesion in the larynx is justified only when other organs have not been affected. The diagnostic and therapeutic considerations of this condition are discussed.
Technique of tracheo-oesophageal puncture under local anaesthesia
Authors: Bath A. P. , Toynton S. C. , Innes A. J.
Published: November 2007

Various techniques for performing a secondary tracheo-oesophageal puncture to enable insertion of a speech prosthesis in laryngectomized patients have been described. We describe a modification that allows a safe secondary tracheooesophageal puncture under local anaesthesia using standard equipment available in an ENT department.
False positive MRI in the diagnosis of small intracanalicular vestibular schwannomas
Authors: Donnelly Martin J. , Cass Anne D. , Ryan Laurie
Published: November 2007

The current gold standard for diagnosing vestibular schwannomas is MRI with gadolinium-DTPA enhancement. This imaging modality is particularly useful in the detection of small intracanalicular tumours which can be missed by CT scanning. We present a case where MRI with enhancement suggested the presence of a 4 mm intracanalicular vestibular schwannoma. Surgical exploration of the internal auditory canal via a retrosigmoid approach, revealed no tumour, but inflammatory arachnoid matter around the vestibular nerve was found. A review of the audiological test results uncovered some results which did not correlate with the interpretation of the MRI scan. We would therefore caution against immediate surgical intervention in patients where the diagnosis of a small intracanalicular vestibular schwannoma is not totally supported by the audiological findings. In such cases rescanning with gadolinium enhancement after a suitable interval is recommended.
Unilateral nasal obstruction: an unusual presentation of a complication of nasotracheal intubation
Authors: Kuo M. J. , Reid A. P. , Smith J. E.
Published: November 2007

Partial avulsion of the middle turbinate is an unusual complication of nasotracheal intubation while minor nasal mucosal trauma is not uncommon. Nasal turbinate avulsion often presents with persistent epistaxis but in the case reported, unilateral nasal obstruction with minimal epistaxis was the presenting feature. Unilateral nasal obstruction following nasotracheal intubation should raise suspicion of significant disruption of the intranasal architecture.
kikuchi–Fujimoto disease: a report of two cases and an overview
Authors: Louis N. , Hanley M. , Davidson N. McD.
Published: November 2007

Kikuchi-Fujimoto disease (KFD) has been widely reported from Japan and sporadically from many parts of the world including Saudi Arabia, since its original description in 1972 but the disease remains poorly known by clinicians. In this paper we report two Saudi patients seen in Tabuk. Saudi Arabia. One was a 36-year-old Saudi man and the other a 16-yearold Saudi girl. Both presented with cervical lymphadenopathy and pyrexia. Histological examination of biospy material from both showed classical features of KFD. Other laboratory findings were unremarkable except for leucopenia. Following excision biopsy both patients recovered without sequelae. KFD is a self-limiting process of uncertain aetiology that predominantly affects young women aged 20–-30 years. We review the pathology, clinical featuers and possible aetiology of this interesting disease, which may well be underdiagnosed. Increased awareness of KFD will minimize the risk of confusing this entity with malignant lymphoma or other serious conditions.
Surface morphology of middle ear epithelium in chronic ear disease
Authors: Agius A. M. , Wake M. , Pahor A. L. , Smallman L. A.
Published: November 2007

The ultrastructural details of normal middle ear mucosa have been reported in detail in the literature. This study was aimed at investigating the superficial structure of middle ear epithelium with the scanning electron microscope in patients with persistent otitis media with effusion (OME) and chronic suppurative otitis media (CSOM), especially in the light of the authors' recent findings regarding decreased ciliary beat frequency (CBF) in patients exposed to tobacco smoke.

Mucosal biopsies were taken from the anterior mesotympanum in four patients with OME and another four patients with CSOM. There was no significant abnormality of cellular surface structure in patients with chronic middle ear disease. Furthermore, no significant difference was observed between smoke exposed and nonsmoke exposed patients. It is concluded that the effect of tobacco smoke on CBF is functional and not related to any anatomical abnormality observed by scanning electron microscopy (SEM).
A one-stage surgical procedure for placement of percutaneous implants for the bone-anchored hearing aid
Authors: Mylanus E. A. M. , Cremers C. W. R. J.
Published: November 2007

The bone-anchored hearing aid (BAHA) is an alternative to the conventional bone conduction hearing aid. The transducer is coupled to a percutaneous titanium implant which is traditionally inserted into the temporal bone in two stages. This study focusses on a one-stage surgical technique for the implantation of percutaneous implants. The preliminary clinical results of 33 one-stage implants in 33 patients are presented.

Post-operative necrosis of the skin grafts did not occur. After a follow-up which varied from nine to 25 months, 31 out of the 33 fixtures (94 per cent) were anchored firmly in the skull. Twenty-six out of the 33 implants (79 per cent) remained free from potentially dangerous skin reactions. The results were statistically comparable to those obtained with two-stage implants at the same clinic. Although longer follow-up is needed before a general statement can be made about replacing the two-stage technique, the preliminary one-stage results are promising.
Suspension microlaryngoscopic surgery and indirect microlaryngostroboscopic surgery for benign lesions of the vocal folds
Authors: Dikkers F. G. , Sulter A. M.
Published: November 2007

A prospective study was designed to compare the effects on voice capacities after either suspension microlaryngoscopic surgery or indirect microlaryngostroboscopic surgery. Patients where the clinical diagnosis 'dysphonia due to a benign lesion of the vocal fold' was made, and who could be operated in either way, entered the study. Post-operative voice evaluation was performed on 21 patients after suspension microlaryngoscopic or indirect microlaryngostroboscopic surgery. The long-term voice results following indirect microlaryngostroboscopic surgery and suspension microlaryngoscopic surgery demonstrate a statistically significant improvement for the maximum intensity, maximum dynamic intensity range, dynamic intensity range at habitual speaking pitch, and melodic pitch range. In selected cases indirect microlaryngostroboscopic surgery offers a very good functional result.
Temporal bone chondroblastoma: big and small
Authors: Leong H. K. , Chong P. Y. , Sinniah R.
Published: November 2007

Chondroblastoma represents approximately one per cent of all primary bone tumours. It is even rarer in the temporal bone and so far only 34 cases have been reported. We report here two cases with chondroblastoma of the temporal bone. The first case was discovered as a small lesion of the attic and root of zygoma. It was removed via mastoidectomy and reconstruction of the bony defect achieved normal external ear canal anatomy and hearing post-operatively. The second case presented as an advanced tumour involving the infratemporal fossa and parapharyngeal space. It was treated surgically via the infratemporal fossa approach. As clear surgical margins were not obtained, post-operative radiotherapy was also given to minimize the chance of recurrence.
Endoscopic fenestration of choanal atresia
Authors: Cumberworth V. L. , Djazaeri B. , Mackay I. S.
Published: November 2007

We report two cases of unilateral choanal atresia and one of choanal stenosis treated successfully by endoscopic fenestration, with no recurrence at a mean follow-up of 18 months. Rigid endoscopy and axial CT scanning confirm the clinical diagnosis and this technique avoids the need for stenting or prolonged postoperative stay.
Salvage brachytherapy and salvage surgery for recurrent oropharyngeal carcinoma following radiotherapy
Authors: Regueiro Carlos A. , de la Torre Alejandro , Valcárcel Francisco J. , MagallóN Rosa , Aragón Gregorio
Published: November 2007

We reviewed 21 patients who underwent salvage treatment after a biopsy of proven locally recurrent carcinoma of the oropharynx. Two of these patients underwent a second salvage treatment after failure of the first. Treatment was performed with Ir192 interstitial implant in 17 cases (13 rT1 and 4 rT2); by surgery in five cases (3 rT1, 1 rT2, 1 rTx), including two patients who had relapsed after salvage treatment with Ir192 implant; and by hyperfractionated external beam irradiation plus concomitant Tegafur chemotherapy in one case (rT3).

The primary tumour was controlled in four of the 17 cases (23 percent) treated with Ir192 implant. Of these four patients, two remained disease-free 42 and 59 months after treatment, one died of nodal metastases eight months after treatment and another of distant metastases 19 months after treatment. Four of the five cases (80 per cent) treated with surgery, including two patients who relapsed after salvage brachytherapy, remained free from local, regional and distant relapse 21, 25, 31 and 56 months after treatment.
An alternative to regular dressings for otitis externa and chronic supperative otitis media?
Authors: Wilde A. D. , England J. , Jones A. S.
Published: November 2007

Otitis externa and chronic otitis media often present to the otolaryngologist with a discharging ear. The conventional method of treatment is to perform regular aural toilet and insert medicated dressings into the external auditory canal. This treatment is either performed by trained nurses or medical staff, but in either case is time consuming.

This study compares the efficacy of the above standard regimen with a novel treatment where a single aural toilet is carried out and medicated ointment instilled into the ear. Both regimens were evaluated at three weeks.

Our results shows that there was no significant difference between the two treatment regimens with regard to the resolution of either of the conditions studied or the improvement in the symptom status of the patients. On the basis of this it would seem that a single aural toilet and instillation of medicated ointment is a valid treatment option, cuts down hospital attendance and could be performed in the community by general medical practitioners or trained practice nurses.
Soft tissue sarcomas of the head and neck associated with surgical trauma
Authors: Dijkstra M. D. , Balm A. J. M. , Gregor R. T. , Hilgers F. J. M. , Lofrus B. M.
Published: November 2007

Soft tissue sarcomas in the head and neck are rare. Aetiological factors relating to these tumours have not yet been identified. The association with von Recklinghausen's disease andwith irradiation is however well recognized. In the literature it has been speculated that trauma may also play a role in the development of soft tissue sarcomas. In this article we present five patients with a history of surgical trauma at the site where a sarcoma later developed. Although we cannot prove a causal relationship, the relatively high incidence of possibly trauma-related soft tissue sarcomas in a series of 60 patients we have seen over a 30-year period, suggests that such a relationship could exist.
Branchial cyst of the nasopharynx: resection via the endonasal approach
Authors: Tamagawa Yuya , Kitamura Ken , Miyata Mamoru
Published: November 2007

We present a rare branchial cyst of the nasopharynx in a 57-year-old man. The cyst was located at the higher level between the roof and the left lateral band of the nasopharynx, and was removed by the endonasal approach following a preparatory septoplasty. While several cases of nasopharyngeal cysts have previously been reported, this appears to be the first case of the resection of such a cyst via the endonasal approach, and is a useful, and potentially less injurious, alternative to the transpalatal approach.
Actinomycosis of the vallecula: report of a case and review of the literature
Authors: Thomas Ratna , Kameswaran Mohan , Ahmed Shamim , Khurana Praful , Morad Nader
Published: November 2007

A rare case of actinomycosis presenting primarily as a mass in the vallecula is described. The patient was a healthy, 65-year-old Saudi, lady who was not immunocompromised and had no other primary pathology in the oral cavity. The clinical presentation and management of the case are discussed and the relevant literature reviewed.
Successful management of tracheo-innominate artery fistula using interposition of a thymus pedicle flap
Authors: Nakanishi Ryoichi , Shimazu Akira , Mitsudomi Tetsuya , Masuda Takehiro , Osaki Toshihiro , Onimura Shutaro , Shigematsu Akio , Sata Takeyoshi , Urano Hajime , Yasumoto Kosei
Published: November 2007

Tracheo-innominate artery fistual is usually fatal complication of tracheostomy. The trachea and innominate artery were successfully reconstructed in an 11-year-old girl who presented with this complication. The thymus was interposed betweenn these two structres in order to prevent further long-term complications.
Post-operative morbidity in electrodissection tonsillectomy
Authors: Tay H. L.
Published: November 2007

A prospective randomized study was carried out to assess the post-tonsillectomy morbidity of the electrodissection technique as opposed to the blunt dissection and ligation technique. One hundred and four patients, each serving as his or her own control, were randomized to have either the right or left tonsil removed by electrodissection. There was significantly less pharyngeal pain on the electrodissection side in the first postoperative day in adult patients. This, however, was transient as there was increased pharyngeal discomfort and otalgia, both in severity and duration, on the electrodissection side by the end of first week. There was no difference in the incidence of haemorrhage between the two techniques.
A simple method for retaining the aural speculum
Authors: Soo G. , Nunez D. A.
Published: November 2007

In middle ear surgery via the permeatal approach, aural specula are frequently used to improve visualization of the operative field. Mechanical holders designed for retaining the aural speculum, are expensive and require sterilization for reuse. A simple technique for retaining the speculum which overcomes the drawbacks of a mechanical holder is described.
A long-term review of the Shah Permavent tube
Authors: Hern J. D. , Hasnie A. , Shah N. S.
Published: November 2007

A retrospective study of 74 Shah Permavent tube insertions is presented. These were inserted into 74 ears of 55 patients during the period between 1985 and 1988. At the time of review, 35 tubes had extruded spontaneously, 11 tubes had been removed for recurrent infections, 10 tubes had been removed electively and 10 tubes were still insitu. On examination of the ears approximately 12 months after the tubes had extruded, the overall rate of tympanic membrane perforation was 18.2 per cent. In ears in which the Permavent tube extruded spontaneously the perforation rate was 22.2 per cent. In ears in which the tube was removed because of infection the perforation rate was 20.0 per cent. However in ears in which the tube was removed electively the perforation rate was zero. This finding has implications in the use and management of long-term ventilation tubes.
The management of sinogenic orbital complications
Authors: Singh Bharath
Published: November 2007

The place of conservative treatment in sinogenic orbital complications has not been fully explained in the literature. The question that remains unresolved is – at which stage of the disease is surgery indicated?

A study was undertaken in 240 patients with sinogenic orbital complications, to determine this. The patients were divided into three groups according to the stage of the disease as determined clinically: Group 1 (52 patients) with early stage disease, as detected by cellulitis only; Group 2 (76 patients) with intermediate stage, as detected by periorbital cellulitis and proptosis, but with full range of eye movement and unaltered vision: Group 3 (122 patients) with late stage disease, as detected by periorbital cellulitis and gross proptosis. with limitation of eye movement and altered vision.

Group I and Group 2 patients were treated conservatively, with intravenous antibiotics and antral lavage. Group 3 patients were treated with intravenous antibiotics and surgery. External frontoethmoidectomy was performed in 31 (bilateral in two), ethmoidectomy in 91 (bilateral in five), sphenoidectomy in 15 and bilateral antral washout in all (122 patients). There was 100 per cent success with conservative treatment in Group 1 patients, whilst in Group 2 there was 98.6 per cent failure. The 75 patients in whom conservative treatment failed were successfully treated with surgery: frontoethmoidectomy was performed in 66 and ethmoidectomy in nine. In Group 3 patients, 100 per cent success was achieved with intravenous antibiotics and surgery.

Sinogenic orbital complications can be treated conservatively and surgically, depending on the stage of the disease on presentation. Conservative treatment is only suitable for early complications, i.e. patients with periorbital cellulitis only. For disease beyond this stage i.e. intermediate and late stage disease, surgery is the treatment of choice.
Supraglottic transection: results of repair and functional outcome
Authors: Williamson Peter A. , Weir Jenny , Baldwin David L.
Published: November 2007

We present two cases of supraglottic transection, with concomitant neurotemesis of the superior laryngeal nerve. Both cases were repaired primarily and a temporary tracheostomy was used to protect the airway. In both cases subsequent decannulation was achieved within four weeks, following the initial injury. No long-term swallowing or voice disturbance was noted in either case. We recommend that in such cases it is unnecessary to repair the nerves directly, but that careful repair of the wound itself will achieve a functional result.
Radiation-induced tumours of the head and neck
Authors: van der Laan B. F. A. M. , BARIS G. , Gregor R. Th. , Hilgers F. J. M. , Balm A. J. M.
Published: November 2007

In order to study the induction of malignancy in normal tissues due to ionizing radiation, we reviewed the files of 2500 patients with a tumour of the head and neck treated at the Netherlands Cancer Institute (Antoni van Leeuwenhoek Ziekenhuis), Amsterdam, from 1977 to 1993. We then checked whether or not these patients had been previously irradiated. Patients with a thyroid carcinoma or skin cancer were excluded from the study, since it is generally known that previous irradiation is a risk factor in these tumours. Eighteen patients were found to have a malignancy within a previously irradiated area (0.70 per cent). The mean interval between radiation and diagnosis of the head and neck tumour was 36.5 years. There were five soft tissue sarcomas, nine squamous cell carcinomas and four salivary gland tumours. Fourteen patients were operated upon whereas four received palliative treatment only. The median survival of the total group was 3.5 years. Particularly. in young patients because of the better cancer therapy and prolonged survival one must be aware of the increased risk of radiation-induced tumours.
The restoration of hearing in neurofibromatosis type 2
Authors: Laszig R. , Sollmann W. P. , Marangos N.
Published: November 2007

Central electrical stimulation of the auditory pathway can allow hearing in patients sufferingfrom deafness localized in the auditory nerve. Developments in a multi-channel auditory brainstem implant based on the Nucleus Mini 22 Cochlear implant with transcutaneous signal transmission is discussed. The devices have been implanted in nine European patients suffering from Neurofibromatosis Type 2. Preliminary speech perception results and patient satisfaction are encouraging, and the data presented include some limited open speech recognition.
Role of magnetic resonance imaging in predicting late facial motor function after removal of vestibular schwannomas by the translabyrinthine approach
Authors: Moulin Guy , Dessi Patrick , André Philippe , Cannoni Maurice , Pellet William , Zanaret Michel , Emram Bruno , Chagnaud Christophe , Giusano Bernard , Bartoli Jean-Michel
Published: November 2007

Facial motor function was assessed in 61 patients 18 months after surgical resection, by the translabyrinthine approach, of vestibular schwannoma involving both the cerebellopontine angle (CPA) and the auditory canal.

Pre-operative magnetic resonance imaging (MRI) was performed to measure the maximum extracanalicular diameter of the tumour between the porus and the farthest extension in the CPA on tranverse slices and to calculate extracanalicular tumour volume. Post-operative facial motor function was graded according to the House and Brackmann system.

There was a statistically significant relationship between late facial motor function and extracanalicular diameter. The best cut-off point for good and poor results was 20mm. There was no relationship between the tumour volume and the late post-operative facial motor function grade.

In this study the best pre-operative radiological predictor of the late facial motor function in patients operated on by the translabyrinthine approach was the maximum diameter measured byMRI.
Inherited degenerative chondropathy – an autosomal dominant new clinical entity: report two cases and follow-up of four cases
Authors: Kurien Mary , Seshadri M. S. , Zachariah Anand
Published: November 2007

Four cases of the rare disorder, inherited degenerative chondropathy have been previously reported (Kurien et al., 1989). A five-year follow-up of these patients and two additional cases are presented in this report. The progress of this disease appears to be arrested after regulardapsone therapy and there was no other organ involvement noted during the follow-up period.
The use of leeches in a case of post-operative life-threatening macroglossia
Authors: Smeets I. M. G. , Engelberts I.
Published: November 2007

A case of severe macroglossia. following intraoral surgery, causing respiratory distress is described. Because conventional therapy appeared inadequate, leeches were used and proved an efficient method of reducing this life-threatening swelling of the tongue.
The value of radiographic assessment for oropharyngeal foreign bodies
Authors: Marais J. , Mitchell R. , Wightman A. J. A.
Published: November 2007

A double-blind, controlled study to assess the accuracy of interpretation of lateral soft tissue radiographs of 60 patients with suspected foreign body impaction in the oro/hypopharynx was carried out by 18 respondents from three different specialities. All the patients had endoscopy carried out and foreign bodies were present in 25. Of these, foreign bodies were diagnosed on the radiograph in only 38.3 per cent. False-positive diagnoses were made in a mean of 26.3 per cent of those patients who did not have a foreign body.
Scanning electron microscopy findings of human respiratory cilia in chronic sinusitis and in recurrent respiratory infections
Authors: Toskala Elina , Nuutinen Juhani , Rautiainen Markus
Published: November 2007

Acute and chronic infections cause morphological changes in the respiratory mucosa. The ultrastructure of human respiratory mucosa was studied by scanning electron microscopy from the maxillary sinuses of 28 patients, with chronic sinusitis, from middle turbinates of 60 patients, with recurrent respiratory infections, and from healthy sphenoidal sinuses of 31 patients. A loss of ciliated cells and an increasing number of nonciliated columnar cells with microvilli were seen in 62 per cent of the maxillary sinus mucosa. Ciliary disorientation was seen in 81 per cent of the chronically infected sinus mucosa and eight per cent in the healthy sphenoidal sinuses. Also metaplasia and extrusion of epithelial cells were prominent in chronic infections. Compound cilia were seen in 52 per cent of the samples from patients with chronic sinusitis and in 31 per cent of the healthy sphenoidal sinuses. Short cilia were often seen in infected mucosa indicating ciliogenesis.
Giant cell reparative granuloma of the concha bullosa
Authors: Koay C. B. , Whittet H. B. , Ryan R. M. , Lewis C. E.
Published: November 2007

Giant cell reparative granuloma is a benign lesion occurring most commonly in the bones of the jaw and rarely in the paranasal sinuses. We present an unusual case of giant cell reparative granuloma arising within a concha bullosa. Complete excision was achieved using an endoscopic transnasal approach.
Factors associated with recurrence of cholesteatoma
Authors: Vartiainen Eero
Published: November 2007

After a mean follow-up period of 7.3 years, a recurrence was found in 43 (12.3 percent) out of 349 consecutive patients undergoing surgical treatment for acquired cholesteatoma. The great majority of residual cholesteatomas detected in the ‘second-look’ operations arose from the oval window area.Chronic otorrhoea and a reperforation were the most common signs of late recurrences. In eight ears a recurrent cholesteatoma developed from a retraction pocket. The recurrence rate was higher in children than in adults. The type of surgical technique had no significant effect on recurrence rate. Recurrences were more frequent in pre-operatively discharging ears than in dry ears. Some suggestions have been made to improve the results of surgery for cholesteatoma.
Amylase activity in tracheobronchial secretions of laryngectomized patients
Authors: Nandapalan V. , McIlwain J. C. , England J.
Published: November 2007

The alpha-amylase activity in tracheobronchial secretions of 16 consecutive patients with a total laryngectomy was studied. None of these patients had a tracheopharyngeal fistula or pulmonary disorder which might affect the amylase activity. This study proves the presence of amylase in tracheobronchial secretions of laryngectomized patients with a normal lung at a level between x and y and the quantitative analysis of the amylase activity is discussed. The relevance of investigating laryngectomy patients is because of the nature of the surgery the lower respiratory tract is permanently and physically isolated from any other source of salivary amylase. No similar study of the analysis of amylase in normal lung tissue had been reported before.

This information may be of value in order to detect salivary aspiration in patients with a tracheostomy or endotracheal intubation if the level in the aspirate is in the order of a-b times greater than that found in normal tracheobronchial secretions, (x = 35 and y = 1125 i.u./l; a = 31.8 and b = 628.6 i.u./l).
How I do it: an improved temporal bone holder
Authors: Gendeh B. S. , Gibb A. G. , Khalid B. A. K.
Published: November 2007

Although some form of temporal bone holder is in use in virtually all ENT postgraduate teaching departments, a paucity of information in the literature may cause problems in selecting the most appropriate model to those responsible for equipping temporal bone laboratories.

The bone holder which we describe is based on existing designs but incorporates a built-in irrigation system which offers considerable advantages to the unassisted operator.
Paediatric tonsillectomy: bipolar electrodissection and dissection/snare compared
Authors: Pang Y. T.
Published: November 2007

Tonsillectomy is a common operation in children performed by a variety of techniques. Recently we have introduced a modified form of electrodissection tonsillectomy using bipolar diathermy. A prospective study was designed to evaluate this technique against the conventional dissection/snare technique. Sixty children were entered into each section of the study (total 120 children). There is a statistically significant shorter operating time (mean 11.2 minutes) and lower intraoperative blood loss (mean 5 ml) using the bipolar diathermy technique. Post-operatively, the children who had bipolar diathermy tonsillectomy were found to be able to drink and eat significantly earlier than the cold dissection group. There was no measurable difference in analgesia requirements before discharge and the time of discharge between the two methods. Post-operative haemorrhage occurred in two out of 60 (3.4 per cent) and one out of 60 (1.7 per cent children) in the conventional and bipolar diathermy dissection, respectively, but this was not statistically significant.
Life-size photograph transparencies: a method for the photographic detection and documentation of recovery from facial paralysis
Authors: El-Naggar Mohamed , Rice Brian , Oswal Vasant
Published: November 2007

We describe a simple and objective practical method for the detection of recovery from facial paralysis by multiple photographic assessments. The photographs are printed as life-size transparencies representing maximal effort. Each time the patient attends for review the new transparency is overlapped on the previous one and the difference can be detected easily. The prints are filed with the patient's notes for future reference. To achieve this system a specific photographic protocol is mandatory in order to avoid technical artefacts. We believe that this system avoids many of the complexities of other grading systems and is very suitable for use at outpatient follow-up.
Adult floppy epiglottis: a simple surgical remedy
Authors: Harries P. G. , Randall C. J.
Published: November 2007

Epiglottis prolapse during inspiration is an unusual cause of upper airway obstruction. We present a case of a previously fit. 73-year-old, male with upper airway obstruction secondary to a floppy epiglottis. We describe a simple method of treatment without the need for partial or total excision of the epiglottis or trecheostomy.
Endoscopic balloon dilatation of subglottic stenosis
Authors: Axon P. R. , Hartley C. , Rothera M. P.
Published: November 2007

Children with subglottic stenosis present a challenging problem to otolaryngologists. In many cases, a tracheostomy is necessary to safeguard the airway, but morbidity and mortality in the tracheostomized child may be significant. Therefore attempts to improve the airway by endoscopic means are often made; unfortunately, these have a variable success rate. Recent encouraging results in the use of balloon dilatation for subglottic stenosis led us to the successful use of this technique in a child whose stenosis had not responded to conventional endoscopic techniques. The reasons for the success are discussed.
Schwannoma of the posterior pharyngeal wall
Authors: Singh Bharath , Ramjettan Shanil , Maharaj Tej Prakash J. , Ramsaroop Reena
Published: November 2007

Schwannoma of the posterior pharyngeal wall, in a 36-year-old male patient is presented demonstrating the asymptomatic nature of the tumour (which is peculiar to schwannomas). The tumour gradually increased in size, destroyed the body of the third cervical vertebra but remained asymptomatic. The patient only presented to hospital when the tumour obstructed the airway, because of its large size.
The management of benign thyroid goitre causing tracheo-oesophageal embarrassment
Authors: Martin-Hirsch D. P. , Lannigan F. J.
Published: November 2007

The case of a massive benign thyroid goitre extending from the arch of aorta to the nasopharynx presenting with acute aerodigestive obstruction is reported. The management of the case is discussed and also a review of the relevant literature.
Ingested foreign bodies – a contemporary management approach
Authors: Tong Michael Chi Fai , Sang Woo John Kong , Sham Cheuk Lun , Van Hasselt Charles Andrew
Published: November 2007

A prospective study of all foreign body complaints presenting through our Accident and Emergency Department was conducted in a population where the condition is endemic. All patients were managed by otolaryngologists. Six hundred and eight patients were attended to yielding 179 foreign bodies. Making use of modern equipment and a practical approach, the requirement for examination under general anaesthesia was 6.3 per cent. In this series there was a complication rate of 0.5 per cent.
Complicated suppurative otitis media in a Greek diver due to a marine halophilicvibriosp.
Authors: Tsakris A. , Psifidis A. , Douboyas J.
Published: November 2007

Halophilic vibrios are distinct from non-cholera vibrios and have been recognized increasingly as potentially pathogenic bacteria in extraintestinal infections. A case of suppurative chronic otitis media in a Greek diver withVibrio alginolyticusrecovered from an ear drainage culture, is reported. The patient received appropriate antimicrobial therapy and her hearing improved significantly after a tympanoplasty type I was performed.

The association of halophilicVibriospp. infections with prolonged seawater contact, particularly in subtropical climates, is discussed. In swimmers with extensive exposure to salt water, individual preventive measures and aetiological treatment of ear infections seems to be required in order to reduce the severity of possibleVibriospp. ear infections.