bluuebunny/crossref_metadata_2025 huggingface dataset:
Metastasizing malignant oncocytoma of the submandibular gland
Authors: Mahnke C. G. , Jänig U. , Werner J. A.
Published: November 2007

Malignant oncocytomas are extremely rare tumours of the salivary glands. Fewer than 50 cases have been reported in the world literature so far, 34 of which were located in the parotid gland. Only three of these tumours have been located in the submandibular gland. We report one further case of a malignant oncocytoma of the submandibular gland in a 47-year-old man. Since a definite histological diagnosis of malignant oncocytoma can rarely be made both clinical and histopathological findings are essential in establishing the diagnosis. Treatment consists of wide surgical excision, neck dissection and post-operative radiotherapy. The prognosis with regard to five-year survival is poor becauseof metastatic disease.
Solitary plasmacytoma of the epiglottis: a case report and review of the literature
Authors: Welsh James , Westra William H. , Eisele David , Hogan Robert , Lee Ding-Jen
Published: November 2007

A 59-year-old white male presented with a two-month history of dry cough and shortness of breath. At bronchoscopy, a 1 cm mass on the laryngeal surface of the epiglottis was found. Immunohistochemical stain of the biopsy specimen revealed a monoclonal proliferation of plasma cells. Serological tests revealed normal serum immunoglobulin levels, and a bone marrow aspirate and biopsy was also normal; no abnormalities were found on serum or urine electrophoresis. He received radiotherapy (50 Gy), and was doing well three years following therapy without evidence of disease.
Multiple malignancies in a patient with bilateral retinoblastoma
Authors: Eha H. M. , Balm A. J. M. , de Jong D. , Van't Veer L. J.
Published: November 2007

A case is presented of a patient with bilateral retinoblastoma, treated at infancy with surgery, chemotherapy and radiotherapy, who subsequently developed at least four additional histologically distinct malignancies: a Ewing sarcoma of the left fibula, two extraskeletal osteosarcomas of the left lower extremity, a mucoepidermoid carcinoma of the right parotid gland and a squamous cell carcinoma of the left paranasal cavity.

In addition to retinoblastoma, patients with a germline RB-1 mutation are at high risk of second primary malignancies. An additive carcinogenic effect of cytotoxic therapy in these patients has been assumed. Patients with hereditary retinoblastoma should be under life-long follow-up programmes including a regular head and neck examination for detection of new primaries, especially in the radiation field of the presenting retinoblastoma.
An unusual cause of acute labyrinthine failure
Authors: Mehta J. S. , Sharr M. M.
Published: November 2007

We report a case of a 40-year-old man presenting with acute vertigo and deafness. Computed tomography (CT) scanning at initial presentation was normal. However, one year later he developed numbness on the right side of his face and examination revealed fifth, seventh and eighth cranial nerve palsies as well as cerebellar dysfunction. Magnetic resonance imaging (MRI) demonstrated a cerebellopontine angle lesion. He underwent near total excision followed by neuro-axis irradiation. The main mass of the tumour projected into the cerebellopontine angle. Histology showed this to be a medulloblastoma. All features of this case are unusual; hence we discuss the pathogenesis and management of this very rare tumour.
The usefulness of computed tomography in the diagnosis of impacted fish bones in the oesophagus
Authors: Watanabe Ken-ichi , Kikuchi Toshihiko , Katori Yukio , Fujiwara Hiroko , Sugita Reiji , Takasaka Tomonori , Hashimoto Sho
Published: November 2007

The usefulness of computed tomography (CT) in the diagnosis of fish bone impaction in the oesophagus was evaluated. Thirty-two patients were examined by plain X-ray followed by direct oesophagoscopy for suspected fish bone impaction. Among 25 cases in which fish bones were actually removed, foreign bodies were not clearly demonstrated by plain X-ray in 14 cases (56 per cent). Eleven cases underwent CT prior to the oesophagoscopic examination. Fish bones were clearly demonstrated by CT in all patients. CT also clearly visualized secondarily-induced inflammatory changes in the neighbouring structures. In order to confirm this result, we made a simulation model of oesophageal fish bone impaction, using fish bones of three different species surrounded by a water bag. In comparison with plain X-ray, CT depicted a superior image of fine fish bones and provides extremely useful information for the management of impacted fish bones in the oesophagus.
Ortner's syndrome revisited
Authors: Sengupta A. , Dubey S. P. , Chaudhuri D. , Sinha A. K. , Chakravarti P.
Published: November 2007

Hoarseness of voice due to paralysis of the left recurrent laryngeal nerve caused by a dilated left atrium in mitral stenosis as discussed by Ortner, is a subject of controversy. Different authors have cited different mechanisms as explanation. A variety of cardiac problems such as primary pulmonary hypertension, ischaemic heart disease, various congenital heart disorders can all lead to paralysis of the left recurrent laryngeal nerve. Most authors believe that pressure in the pulmonary artery causes the nerve compression. In Papua New Guinea cor pulmonale and rheumatic heart disease are the commonest cardiac disorders seen. Ortner's syndrome is a rarity and has never been reported from here before. Here three different case reports are presented with mitral stenosis, primary pulmonary hypertension and combined mitral stenosis and regurgitation and the pathogenesis of hoarseness is discussed.
Cochlear implantation under local anaesthesia, the Belfast experience
Authors: Toner J. G. , John G. , McNaboe E. J.
Published: November 2007

The profoundly deaf, who gain little or no benefit from conventional hearing aids and meet various criteria are potential candidates for cochlear implantation. The last two decades have witnessed remarkable progress in this field, and it is now a routine clinical procedure. A few adult patients who are potential candidates for cochlear implantation have an unacceptably high risk for hypotensive general anaesthesia due to other systemic conditions. This group has been successfully implanted under local anaesthesia in our centre. The post-implantation progress of these patients was comparable to those carried out under hypotensive general anaesthesia. Data regarding patient selection criteria, examination, anaesthesia, surgery and the outcome are discussed. It was concluded that cochlear implantation under local anaesthesia is a safe and effective procedure for those patients who otherwise may be denied an implant.
The ‘swing-door’ technique for uncinectomy in endoscopic sinus surgery
Authors: Wormald P. J. , McDonogh Mike
Published: November 2007

Uncinectomy is an important step in endoscopic sinus surgery. The traditional method of performing uncinectomy has the risk of penetration of the lamina papyracea with orbital fat exposure. If the orbital penetration is not recognized, major complications may follow. In this study the authors used historical consecutive controls to compare the incidence of orbital penetration, identification of the natural ostium and lacrimal apparatus injury by the traditional surgical technique and a new technique of uncinectomy. Six hundred and thirty-six uncinectomies have been performed using the ‘swing-door’ technique. The 636 uncinectomies performed prior to changing techniques were used as historical controls. The incidence of orbital penetration (six compared to 0;p<0.05) and ostium non-identification (42 not identified as compared to 0;p<0.001) was significantly less with the new technique. One lacrimal injury occurred with the ‘swing-door’ technique compared to zero with the standard technique (p>0.05). The techniques are described and the complications discussed. The authors recommend this technique as it is easy to learn, allows removal of the uncinate flush with the lateral nasal wall and allows easy identification of the natural ostium of the maxillary sinus.
Serum antibodies to human herpesvirus 7, human herpesvirus 6 and cytomegalovirus in patients with idiopathic facial nerve palsy or sudden deafness
Authors: Takasaki Tomohiko , Higashikawa Masahiko , Motoyama Soichi , Sugita Kunihiro , Kurane Ichiro
Published: November 2007

The aetiology of idiopathic facial nerve palsy (Bell's palsy) and sudden deafness are not known, although viruses have been suspected as a cause of them. We investigated the relationship between Bell's palsy or sudden deafness, and reactivation of cytomegalovirus, human herpesvirus 6 (HHV-6) and 7 (HHV-7).

Paired sera were collected from 22 patients with Bell's palsy and 24 patients with sudden deafness. IgG antibody titres to HHV-7 were increased in one patient with Bell's palsy. IgG antibody titres to HHV-6 were increased in one patient with Bell's palsy and two with sudden deafness. IgG antibody titres to cytomegalovirus were increased in one patient with sudden deafness. Titres of the three viral antibodies were not increased simultaneously in any patients. These viruses may contribute to the development of Bell's palsy or sudden deafness in some cases. It is, however, unlikely that these viruses are the main cause of Bell's palsy and sudden deafness in the majority of patients.
Cochlear implant failure due to unexpected absence of the eighthnerve – a cautionary tale
Authors: Gray R. F. , Ray J. , Baguley D. M. , Vanat Z. , Begg J. , Phelps P. D.
Published: November 2007

We present a case of bilateral absence of the eighth cranial nerve in the internal auditory meatus (IAM). This caused total failure of responses after cochlear implantation in a six-year-old patient with congenital deafness. Pre-operative magnetic resonance (MR)imaging is important to show not only the anatomy of the middle and inner ears but also the structures in the IAM.
Middle ear mechanics in normal, diseased and reconstructed ears
Authors: Merchant Saumil N. , Ravicz Michael E. , Voss Susan E. , Peake William T. , Rosowski John J.
Published: November 2007

A review of the structure-function relationships in normal, diseased and reconstructed middle ears is presented. Variables used to describe the system are sound pressure, volume velocity and acoustic impedance. We discuss the following

(1) Sound can be transmitted from the ear canal to the cochlea via two mechanisms: the tympanoossicular system (ossicular coupling) and direct acoustic stimulation of the oval and round windows (acoustic coupling). In the normal ear, middle-ear pressure gain, which is the result of ossicular coupling, is frequency-dependent and smaller than generally believed. Acoustic coupling is negligibly small in normal ears, but can play a significant role in some diseased and reconstructed ears.

(2) The severity of conductive hearing loss due to middle-ear disease or after tympanoplasty surgery can be predicted by the degree to which ossicular coupling, acoustic coupling, and stapes-cochlear input impedance are compromised. Such analyses are used to explain the air-bone gaps associated with lesions such as ossicular interruption, ossicular fixation and tympanic membrane perforation.

(3) With type IV and V tympanoplasty, hearing is determined solely by acoustic coupling. A quantitative analysis of structure-function relationships can both explain the wide range of observed postoperative hearing results and suggest surgical guidelines in order to optimize the post-operative results.

(4) In tympanoplasty types I, II and III, the hearing result depends on the efficacy of the reconstructed tympanic membrane, the efficacy of the reconstructed ossicular chain and adequacy of middle-ear aeration. Currently, our knowledge of the mechanics of these three factors is incomplete. The mechanics of mastoidectomy and stapedectomy are also discussed.
Surgery for acquired cholesteatoma in children: long-term results and recurrence of cholesteatoma
Authors: Stangerup Sven-Eric , Drozdziewicz Dominika , Tos Mirko , Trabalzini Franco
Published: November 2007

The aim of the study was to evaluate the long-term results after surgery for acquired cholesteatoma in children and to contribute to the search for predictors of recurrence. During a 15-year period, 114 children underwent surgery. The patients were re-evaluated with a median observation time of 5.8 years. At the last re-evaluation 85 per cent of the ears were dry with an intact drum. Recurrence of cholesteatoma developed in 27 ears. The cumulated total recurrence rate was 24 per cent using the incidence rate calculation, applying Kaplan-Meier survival analysis the corresponding recurrence was 33 per cent. Recurrent disease occurred significantly more frequently in children younger than eight years, with a negative pre-operative Valsalva, with ossicular resorption and with large cholesteatomas. In conclusion, young children with poor Eustachian tube function and a large cholesteatoma with erosion of the ossicular chain, are at special risk of recurrence and should be observed for several years after surgery.
Aberrant jugular bulb vein obstructing approach to intracanalicular vestibular schwannoma
Authors: Tsutsumi Takeshi , Tsunoda Atsunobu , Shimamoto Kumiko , Komatsuzaki Atsushi
Published: November 2007

In cases of jugular bulb anomalies, such as a high jugular bulb, troublesome bleeding may occur during surgery. We report an unusual case with a vestibular schwannoma, in which we recognized an additional branch arising from the jugular bulb. Three-dimensional computed tomography (3-D CT) revealed this anomaly beforehand, enabling us to avert excessive bleeding upon resection of the tumour. The abnormal vein was thought to be a remnant of the petrosquamosal sinus in the embryonic stage.
Encephalocoele as a complication of intranasal sinus surgery: optimal evaluation with magnetic resonance imaging
Authors: Wolansky Leo J. , Chiang Peter K. , Zurlo John , Baredes Soly , Baker Stephen R.
Published: November 2007

We report a case of post-operative frontal basal encephalocoele evaluated using a new magnetic resonance imaging (MRI) sequence, fast inversion recovery for myelin suppression (FIRMS). FIRMS was developed to enhance the differentiation between grey and white matter. In this case, the sequence was beneficial in distinguishing the encephalocoele from adjacent nasal mucosa and secretions.
Power Doppler imaging findings in multilocular giant parathyroid adenoma which caused hypercalcaemic crisis
Authors: Wang Qian , Takashima Shodayu , Takayama Fumiyoshi , Kobayashi Shinya , Sone Shusuke
Published: November 2007

Radiological findings including ultrasonography, computed tomography (CT) and Tc-99m sestamibi scintigraphy of a patient with multilocular giant parathyroid adenoma which caused hypercalcaemic crisis are presented. The location of the tumour by grey scale sonography, CT and Tc-99m sestamibi scintigraphy was not certain because the tumour was uncommon in shape, location, size and internal structure. Whereas, increased flow in the solid portion of the mass was demonstrated on power Doppler sonography, which proved to reflect abundant vessels in the adenoma in pathological findings.
Diabetes and hearing impairment in Mexican American adults: a population-based study
Authors: Ma Fangchao , GóMez-Marín Orlando , Lee David J. , Balkany Thomas
Published: November 2007

Reports on the relationship between diabetes and hearing loss have been controversial. The present study examined this relationship in 1,740 Mexican American adults using data from the Hispanic Health and Nutrition Examination Survey. Hearing threshold levels were obtained for each participant at the following frequencies: 500,1000, 2000, and 4000 Hertz (Hz). The thresholds from the worse hearing ear were used in the analyses. Diabetes and insulin use were assessed by self-report. The mean crude hearing thresholds in diabetics were significantly higher than in non-diabetics at each of the four frequencies. However, after adjustment for age, gender, and socioeconomic status, diabetics had a significantly higher mean threshold than non-diabetics only at 500 Hz (mean difference ± SE: 2.8 ± 1.2, p = 0.04). Diabetics who were not using insulin had significantly higher thresholds than those who were using insulin at 2000 (mean difference ± SE: 5.6 ± 2.6, p = 0.03) and 4000 Hz (7.7 ± 3.3, p = 0.02). Also, at 4000 Hz, insulin users had a significantly lower mean threshold than non-diabetics (mean difference ± SE: –4.9 ± 1.6, p = 0.02). Our data suggest that associations between diabetes and decreased hearing acuity in the higher frequencies are present only amongst diabetic Mexican-Americans who do not use insulin.
On-line resources for otolaryngologists
Authors: Saada Ahmed A.
Published: November 2007

Advances in telecommunications technology in the last decade have fostered the development of computer networks that allow access to vast amounts of information and services. The most prominent is the Internet (Glowniak, 1995). Medical information is increasingly available on such computer networks. The purpose of the present article is to provide an update to previously published otolaryngology sites (Johns, 1996; Burton and Johns, 1996) available on the World Wide Web, and to provide the otolaryngologist with details of resources that are accessible via the Internet. However, the reader should also be aware that the uniform resource locator (URL) addresses of Web sites can change without warning.
Audit of regional screening guidelines for vestibular schwannoma
Authors: Dawes P. J. D. , Jeannon J.-P.
Published: November 2007

An audit of 334 patients who underwent magnetic resonance imaging (MRI) as investigation for a possible diagnosis of vestibular schwannoma was carried out to assess adherence to previously agreed screening guidelines. This represents one year's activity. A posterior fossa tumour was identified in 12 patients. Scan requests were judged to be inappropriate for 28 cases. The issues surrounding the screening for acoustic neuroma are discussed.
Pyoderma gangrenosum producing saddle nose deformity
Authors: Worley George A. , Wareing Michael J. , Sergeant Robert J.
Published: November 2007

Pyoderma gangrenosum affecting the nose is rare and this may lead to diagnostic confusion because of the large differential diagnosis. As diagnosis is made, largely, on the basis of exclusion the treatment of pyoderma gangrenosum may be unduly delayed. The condition is often disfiguring, particularly following inappropriate surgical intervention, and early diagnosis is therefore important.

We present a case of pyoderma gangrenosum managed initially in the community with minor surgery and resulting in the rare complication of saddle nose deformity.
Cavernous haemangioma in the infraorbital nerve canal – an unusual expansion in the maxillary sinus
Authors: Walch C. , Anderhuber W. , Luxenberger W. , Humer-Fuchsi U.
Published: November 2007

A patient with a four-week history of hypaesthesia and recurrent swelling of the cheek in the left infraorbital region presented with a computed tomography (CT) scan demonstrating an expansion in the infraorbital nerve canal, thought to be a neuroma. The tumour was surgically removed without complications and no bleeding. Histopathological investigation showed a partially thrombosed cavernous haemangioma. To our knowledge, after reviewing the literature, this is the first report of a cavernous haemangioma in the infraorbital nerve canal.
Bronchogenic cyst: an unusual cause of lump in the neck
Authors: Rapado F. , Bennett J. D. C. , Stringfellow J. M.
Published: November 2007

Bronchogenic cysts are rare congenital benign lesions that are usually detected in the paediatric patient with symptoms of infection or compression on vital structures. They are rarely diagnosed in the adult population. We present a case of bronchogenic cyst presenting as a lump in the neck in an adult patient. Radiological imaging helped to diagnose this lesion accurately before any form of intervention. Complete surgical excision is the treatment of choice.
The epiglottis and obstructive sleep apnoea syndrome
Authors: Catalfumo Frank J. , Golz Avishay , Westerman S. Thomas , Gilbert Liane M. , Joachims Henry Z. , Goldenberg David
Published: November 2007

Obstructive sleep apnoea syndrome (OSAS) is caused by obstruction or narrowing of the airway at various levels. The repair of one site only will not alleviate the syndrome if there are obstructions in other sites. Epiglottis prolapse during inspiration is an unusual cause of airway obstruction and a rare cause of OSA.

Twelve cases of OSAS due to an abnormal epiglottis are presented. We present our approach to the diagnosis using fibre-optic examination of the hypopharynx, and our treatment using endoscopic carbon dioxide laser partial epiglottidectomy.

We found in our series that in 11.5 per cent of patients who failed the uvulopalatopharyngoplasty procedure, the reason was a narrow airway at the hypopharyngeal level caused by an abnormal epiglottis. It is our suggestion that in these cases a laser partial epiglottidectomy should be performed. The results of this study show that partial epiglottidectomy can increase the cure rate of patients with obstructive sleep apnoea syndrome by 10–15 per cent.
The Scheibe cochlea deformity with macrocephaly: a case for single channal implantation
Authors: Ray J. , Gay R. F. , Vanat Z. H. , Begg J. A.
Published: November 2007

An 11-year-old congenitally deaf child with bilateral primitive common cavity (Scheibe type) cochleosaccular dysplasia and benign familial macrocephaly was implanted with an extracochlear single channel device with an ear level speech processor. This paper describes the assessment, findings, dilemmas in decision making, surgical procedure and the favourable outcome after implanting. The relevant literature has been reviewed and our case is presented for the unusual combination of features.
Brainstem pathology of infantile Gaucher's disease with only wave I and II of auditory brainstem response
Authors: Kaga Kimitaka , Ono Masae , Yakumaru Kazuhiro , Owada Masao , Mizutani Toshlo
Published: November 2007

We studied the auditory brainstem response (ABR) and neuropathology in a female infant who died at six months of age because of typical infantile Gaucher's disease. The patient was hospitalized for hepatosplenomegaly and failure to thrive. Her ABR showed only waves I and II.

The neuropathological study disclosed that: (1) Gaucher's cells were found in the perivascular region of the cerebrum and anterior ventral nucleus of the thalamus. (2) Gliosis was found in the dorsal part of the brainstem rather than the ventral part. (3) Neuronal cells in the superior olivary nucleus were lost, and marked gliosis was found in the cochlear nucleus. The disappearance of wave III and later waves of ABR could be supported by these pathological findings.
Metastatic testicular teratoma of the nasal cavity: a rare cause of severe intractable epistaxis
Authors: Tariq M. , Gluckman P. , Thebe P.
Published: November 2007

Malignant neoplasms of the nasal cavity and paranasal sinuses are uncommon. Choriocarcinoma is a highly malignant germ cell tumour occurring in the reproductive organs. Metastasis may be principally by the lymphatic route as in other germ cell tumours but choriocarcinoma is also known to spread haematogenously. We present a rare case of metastatic choriocarcinoma to the nasal cavity from testicular teratoma presenting with intractable epistaxis in a 32-year-old Caucasian male, who ultimately succumbed to this disease.
Functional neck dissection: cure and functional results
Authors: Güney Ercihan , Yigitbaşi O. Gazi , Canöz Kürşat , ÖZtürk Mustafa , Ersoy Ali
Published: November 2007

In this study, the cure and functional results of 133 functional neck dissections performed between 1992–1997 in Erciyes University Medical Faculty were evaluated. The overall recurrence rate was three per cent. This rate was 1.4 per cent for elective functional neck dissections and five per cent for curative functional neck dissections. Electromyographic studies showed that there was severe neurogenic deficit in the trapezius muscle of seven patients (12.5 per cent), and in the sternocleidomastoid muscle of 12 patients (21.4 per cent) among 56 randomly selected patients. In all cases, the flow rate and diameter of the internal jugular vein was found to be normal by Doppler ultrasonography. The results of this study showed that functional neck dissection is a reliable technique for obtaining a high cure rate and functional results.
Neonatal stridor in association with herpes simplex infection of the larynx
Authors: Sharp H. R. , Blaney S. P. A. , Morrison G. A. J.
Published: November 2007

Herpes simplex virus (HSV) infection in the neonatal period may be confined to the eyes, skin and upper aerodigestive tract or may be widely disseminated to other organs, with particular recognition of involvement of the central nervous system (CNS) causing herpes encephalitis (Whitleyet al., 1980a, b; Andersen, 1987).

Primary laryngeal HSV infection is extremely uncommon. We present a case of acute neonatal stridor secondary to such localized disease and discuss its management.
Corrosion of a silver Negus tracheostomy tube
Authors: Ayshford C. A. , Walsh R. M. , Proops D. W.
Published: November 2007

Corrosion of silver tracheostomy tubes has previously been reported. In all of these reports, it occurred at the junction between the neck plate and the outer tube where an alloy of inferior corrosion resistance, compared to silver, has been used in the brazed joint. We present, to our knowledge, a previously unreported case of corrosion of the main body of the outer tube of a silver Negus tracheostomy tube where no such alloy is present.
Verruciform xanthoma of the nose
Authors: Than T. , Birch P. J. , Dawes P. J. D.
Published: November 2007

We report a case of verruciform xanthoma of the nasal skin. The case is unique because the lesion both bled and has shown evidence of multicentricity.
Kikuchi-Fujimoto's syndrome masquerading as tuberculosis
Authors: Jayaraj Samuel M. , Lloyd Josephine , Frosh Adam C. , Patel Kalpesh S.
Published: November 2007

We report a case of a 27-year-old Asian man presenting with the typical features of tuberculous cervical lymphadenitis who was commenced on anti-tuberculous therapy on the strength of the clinical presentation. Histological examination of an excised cervical lymph node however, revealed the diagnosis of Kikuchi's syndrome; a histiocytic necrotizing lymphadenitis which is usually self-limiting.
Endoscopic anatomy of the sphenoid sinus
Authors: Elwany Samy , Elsaeid Ibraheim , Thabet Hossam
Published: November 2007

The anatomy of the sphenoid sinus, as it relates to endoscopic sinus surgery, was studied in 93 cadaver heads (186 sphenoid sinuses) using endoscopic dissections as well as sagittal sections. The relationship of the sphenoid sinuses to the carotid artery, optic nerve, floor of sella turcica, as well as other important structures, were verified and discussed. The recesses of the sinus as well as its ostium and accessory septa and crests were described and their clinical importance was discussed. Pertinent measurements were included wherever appropriate.
Otological findings in idiopathic hyperphosphatasia
Authors: Sennaroǧlu Levent , Sozeri Bulent , Sungur Arzu
Published: November 2007

A 17-year-old male patient was admitted because of progressive hearing loss since the age of six. His former blood and radiology investigation had revealed idiopathic hyperphosphatasia. On ENT examination bilateral thickened tympanic membranes with severe mixed-type hearing loss was diagnosed. Computerized tomography (CT) demonstrated expansion of the calvarial bones, including the temporal bones, except for the otic capsule. Middle-ear exploration revealed thickened middle-ear mucosa and a stone hard, immobile bony mass instead of the normal ossicular chain at the posterior superior part of the mesotympanum. No ossicular reconstruction could be attempted and the patient was rehabilitated with a hearing aid.
Goitre presenting as an oropharyngeal mass: an unusual finding in the elderly
Authors: Berenholz Leonard P. , Segal Samuel , Kessler Alex
Published: November 2007

Thyroid goitre presentation in the neck with extension inferiorly to the mediastinum is well-known. Extension superiorly into the retropharyngeal space is very rare and may be accompanied by change in voice and/or airway compromise.

A case is described of a patient with change in voice and mild airway compromise secondary to a goitre presenting in the oropharynx. Computed tomography (CT) and physical findings are discussed with the need to recognize this rare entity.
Nasal haemangiopericytoma: report of two cases with literature review
Authors: Marianowski Rémi , Wassef Michel , Herman Philippe , Huy Partice Tran Ba
Published: November 2007

Haemangiopericytoma (HPC) is a rare vascular tumour produced by proliferation of pericytes. One hundred and thirty-three cases of HPC have been reported in the nose and the paranasal sinuses. We present two more cases. Wide surgical excision via lateral rhinotomy, midfacial degloving, or endonasal removal is the treatment of choice. Radiotherapy has been used post-operatively in cases of incomplete removal. Life-long follow-up is required to evaluate local recurrence and late metastases.
Transtympanic dexamethasone application in Ménière's disease: an alternative treatment for intractable vertigo
Authors: Sennaroğlu Levent , Mottaghian Dini Farzin , Sennaroğlu Gonca , Gursel Bulent , Ozkan Soner
Published: November 2007

The aetiology of Ménière's disease still remains unknown and its therapy is therefore empirical. As a result of immunological abnormalities demonstrated, steroids are commonly used in Ménière's disease. The place of topical steroids is still controversial. In this investigation topical dexamethasone is applied for three months through a ventilation tube in patients with intractable vertigo. The results showed that this treatment controls vertigo in 72 per cent of cases. No patient was worse than before treatment. Only in 17 per cent of the patients was there an increase in hearing level. When compared to the reports which used only tympanostomy tubes, this procedure seems to have a placebo effect with minimal harmful effects. It appears that transtympanic dexamethasone application is a good alternative to vestibular nerve section. Topical treatment may be sufficient in most patients. Systemic treatment may be used in patients where topical treatment fails.
Comparison of the endoscopic stapling technique with more established procedures for pharyngeal pouches: results and patient satisfaction survey
Authors: Van Eeden S. , Lloyd R. V. , Tranter R. M.
Published: November 2007

Pharyngeal pouch surgery by the external approach has been shown to be effective but has a relatively high complication rate. We compared the outcome of 17 patients who had cricopharyngeal myotomy alone or combined with excision/inversion/suspension, simple pouch excision and Dohlman's procedure with 17 patients who had the relatively new Endo GIA-30 endoscopic stapling technique. Results were obtained retrospectively by postal questionnaire and medical records. We conclude that endoscopic stapling shortens the return to normal diet and in-patient stay. These patients also experience better swallowing and are generally more satisfied with the procedure. We have accepted endoscopic stapling as the method of choice for the treatment of pharyngeal pouches.
Complications resulting from treatment of severe posterior epistaxis
Authors: Bent John P. , Wood Brennan P.
Published: November 2007

Recent advances in nasal endoscopy and arterial embolization have improved the treatment of severe posterior epistaxis. This report reviews the therapeutic options, including a case of epistaxis that did not respond to nasal packing but was successfully controlled with superselective arterial embolization. The discussion includes an outline of potential complications of epistaxis treatment, including a case of nasal septal perforation.
Eustachian tube teratoma and its terminological correctness
Authors: Ruah Carlos B. , Cohen David , Sadé Jacob
Published: November 2007

Teratomas are germ cell tumours usually found in the young and are characteristically composed of tissue foreign to the place where they arise. Two teratomas of the middle ear were first described in 1866 and since then, and to the best of our knowledge, 19 additional cases have been reported in the literature under different terms such as hairy congenital polyps, epidermoid cysts, dermoid cysts, hamartoma, cutaneous teratoma and teratomas. The difficulty in classifying germ cell tumours may explain the different terminologies encountered in the literature. The authors describe a case of teratoma of the eustachian tube presenting as a mass in the middle and external ear of a 10-week-old girl. Using this case, a review of the literature is performed in light of the new classification of germ cell tumours proposed by the World Health Organization (WHO). It is of note that most of the teratomas that present in the middle ear arise from, or involve, the eustachian tube.
Psychological morbidity following laryngectomy: a pilot study
Authors: Gibson A. R. , McCombe A. W.
Published: November 2007

This study evaluated the nature and extent of problems faced by patients following discharge from hospital following laryngectomy. Semi-structured interviews investigated the practical and psychological concerns of a cohort of laryngectomy patients in a district general hospital. A number of simple practical measures can be employed to reduce early hospital re-admission following laryngectomy. Psychological morbidity is an important cause of low quality of life following laryngectomy. Formal psychological treatment could be of benefit in the management of these patients.
An unusual complication of augmentation rhinoplasty: late displacement of dorsal nasal splint
Authors: Owa A. O. , Zaman A. , Farrell R. W. R. , Bull T. R.
Published: November 2007

Silastic® (Dow-Corning) implants are used for augmentation rhinoplasty. Complications following their use usually occur within the first 24 months. We report a case in which the dorsal splint became displaced spontaneously five years after surgery.
Extracranial internal carotid artery aneurysm in a child: a diagnostic and surgical challenge
Authors: James A. L. , O'Malley S. , Milford C. A.
Published: November 2007

This paper reports the presentation and management of an extra-cranial internal carotid artery aneurysm in a 15-year-old male. To our knowledge there is no previous report of a similar case in childhood.
Laryngeal preservation by treatment with induction chemotherapy and radiotherapy protocol for stage III & IV carcinoma larynx – results of a pilot study
Authors: Thakar A. , Bahadur S. , Tandon D. A. , Ranganathan A. , Rath G. K.
Published: November 2007

Total laryngectomy for advanced carcinoma of the larynx is effective but functionally disabling. In an effort at laryngeal preservation, 33 patients of stage III/IV carcinoma larynx were treated between 1987 and 1991 with induction chemotherapy followed by definitive radiation. Two chemotherapy protocols were administered. Group I patients received one to three cycles of cisplatin 100 mg/m2(day 1), bleomycin 15 U/m2(day 1), and 5-fluorouracil 1000 mg/m2/day (day 2 to 5) at three weekly intervals. This was then followed by radiotherapy. Group II received one to six weekly injections of single agent methotrexate 50 mg/m2with or without leucocovorin rescue followed by radiotherapy. Any recurrence was salvaged by surgery.

Midway through the study, Group II protocol was discontinued as the initial results were not comparable with Group I or standard treatment. The Group I protocol, however, yielded an initial locoregional control rate of 83.3 per cent With the addition of surgical salvage the locoregional control rate was 94.4 per cent and the control rate with laryngeal preservation was 88.8 per cent. The Kaplan-Meier probability of two years and five years disease-free survival was 81.9 per cent and 61.4 per cent respectively. For disease-free survival with laryngeal preservation the corresponding figures for two years and five years were 58.3 per cent and 41.7 per cent.

The control group of 51 patients treated with radical surgery followed by radiotherapy yielded survival figures at two years and five years of 64.3 per cent and 57.2 per cent. The difference in the survival of Group I and the control group was not statistically significant (pvalue = 0.280). These initial results indicate that for stage III and for surgically resectable stage IV laryngeal carcinomas, a protocol of induction combination chemotherapy consisting of cisplatin, bleomycin and 5-fluorouracil followed by radiotherapy and combined with surgical salvage whenever required, can lead to comparable cure rates. In addition, a large proportion of patients are spared the morbidity of a total laryngectomy.
Adult presentation of a tracheoesophageal fistula with co-existing laryngeal cleft
Authors: Lancaster J. L. , Hanafi Z. , Jackson S. R.
Published: November 2007

Congenital posterior laryngeal clefts are rare anomalies, being first described by Richter in 1792, and first operated upon successfully by Pettersson in 1955. Most clefts present within the first few months of life, with only a few cases being documented as presenting in adulthood. We present the case of a 50-year-old lady presenting with a previously undiagnosed posterior laryngeal cleft with an associated tracheoesophageal fistula. The defect was graded as 2 on the Benjamin and Inglis classification system of posterior laryngeal clefts. Following a literature review, we believe that our patient is the oldest to present with this congenital defect.
Plummer-Vinson syndrome – a rare presentation in a child
Authors: Mansell N. J. , Jani P. , Bailey C. M.
Published: November 2007

Plummer-Vinson (Paterson, Brown-Kelly) syndrome refers to the association of iron-deficiency anaemia with dysphagia secondary to a post-cricoid web. Only seven cases of Plummer-Vinson syndrome in children and adolescents between the ages of 14 and 19 have been reported in the world literature. We report a case of the syndrome occurring in a child of 14 years and provide a short review of the present knowledge concerning the symptom complex.
Obliterative otosclerosis
Authors: Ayache Denis , Sleiman Joseph , Plouin-Gaudon Isabelle , Klap Patrick , Elbaz Pierre
Published: November 2007

From January 1990 to December 1996, 293 primary stapedectomies for otosclerosis were performed, among which 14 had obliterative otosclerosis (4.7 per cent). Probability of bilateral obliterative disease was 50 per cent. With this particular condition, a drill-out procedure was used to perform either a stapedectomy or a stapedotomy. In two patients with bilateral ‘far-advanced otosclerosis’, surgery was effective in enabling the patient to benefit from hearing-aids. In patients with a measurable hearing-loss, an air-bone gap closure to within 10 dB was achieved in 62.5 per cent of the cases and to within 10–20 dB in 37.5 per cent of the cases, with no deterioration of air-conduction thresholds at 8 kHz. A mild sensorineural hearing loss at 4 kHz was observed in 25 per cent of the cases. There was no statistical difference between stapedectomy and stapedotomy. According to these results, the drill-out technique is a safe and effective procedure in cases of obliterative otosclerosis.
Laser-turbinectomy: long-term results
Authors: Lagerholm Sven , Harsten Göran , Emgård Per , Olsson Bengt
Published: November 2007

Hypertrophy of the inferior turbinates is a common cause of nasal obstruction. Many cases respond to medical treatment with topical steroids or antihistamines. In some patients, however, this therapy is not sufficient and through the years many surgical procedures have been used to reduce the size of the inferior turbinates, but without any satisfactory long-term results. Furthermore, these procedures have often been painful to the patient and post-operative complications such as bleeding and crusting have not been uncommon. However, instead of conventional surgery of the turbinates, laser-surgery can be used to reduce their size. In order to investigate the long-term effect of such gross reduction of the turbinates we investigated the post-operative condition of 78 patients who had undergone CO2-laser-turbinectomy due to symptoms of nasal obstruction. Twenty-four to 36 months post-operatively three quarters of all the patients reported a marked decrease in nasal obstruction as well as a reduced frequency of nasal and sinus infections. No complications were reported and the procedure was without any discomfort to the patient. Thus, laser-turbinectomy seems to be an effective, simple and painless method for treatment of nasal obstruction due to hypertrophy of the inferior turbinates.
The effect of uvulopalatopharyngoplasty without tonsillectomy using local anaesthesia: a prospective long-term follow-up
Authors: Hultcrantz Elisabeth , Johansson Kaarina , Bengtson Harriet
Published: November 2007

This paper presents the long-term effect of restricted surgery for snoring and sleep apnoea. Patients with obstructive sleep apnoea (OSAS) (19) or heavy snoring (HS) (36) were studied prospectively for five to seven years after uvulopalatopharyngoplasty without tonsillectomy performed by regular surgical technique using local anaesthesia (LUPP). Five years after surgery, 90 per cent answered a questionnaire. All OSAS patients were offered a polysomnography, and the HS patients were offered a sleep study. Eighty per cent still showed a positive effect on daytime somnolence, and 77 per cent on snoring. Sideeffects were reported by 40 per cent; most common was choking (20 per cent) the first year. Eighteen per cent had local problems such as globus sensation. The polysomnography showed that 80 per cent were still ‘responders’ with an apnoea index (AI) reduction of >50 per cent. None of the HS patients had developed OSAS. In conclusion, LUPP in selected patients with OSAS or HS has a good long-term effect. Sideeffects are common, but diminish with time.
The diagnostic value of positron emission tomography (PET) with radiolabelled fluorodeoxyglucose (18F-FDG) in head and neck cancer
Authors: Slevin N. J. , Collins C. D. , Hastings D. L. , Waller M. L. , Johnson R. J. , Cowan R. A. , Birzgalis A. R. , Farrington W. T. , Swindell R.
Published: November 2007

Positron emission tomography (PET) scanning has recently been introduced into clinical practice but its usefulness in the management of head and neck cancer is not well defined. The aim of this prospective preliminary study was to examine the clinical value of fluorodeoxyglucose (FDG) – PET in patients with head and neck cancer treated by radiotherapy with surgery in reserve by (i) relating quantitative uptake of isotope to tumour type and histological grade and (ii) comparing the imaging findings of PET and magnetic resonance imaging (MRI) in post-radiotherapy assessment of tumour response. Twenty-one patients had pre-treatment PET and MRI scans and these were repeated four and eight months after treatment if there was no clinical relapse. Pre-treatment uptake of FDG using tumour to cerebellar ratio parameters was significantly related to the histological grade of squamous cancer (p = 0.04) but not to tumour type. Discordance of post-treatment PET/MRI findings in one case indicates a possible role for PET in the early detection of tumour recurrence. Other potential uses of PET scanning in the management of head and neck cancer are discussed.
Paediatric tympanoplasty
Authors: Lancaster J. L. , Makura Z. G. G. , Porter G. , McCormick M.
Published: November 2007

Much debate exists over the management of mucosal chronic suppurative otitis media in children, with the majority of it centred around the correct timing to perform either a myringoplasty (an operative repair of the tympanic membrane) or type I tympanoplasty (reconstruction of the tympanic membrane when there is an intact and mobile ossicular chain). Further discussion will use the term tympanoplasty to mean both of the above definitions. We present the findings of a recent survey of UK ENT consultants questioning their opinions on various management aspects of mucosal CSOM in the paediatric population. We also present an extensive review of the literature to provide us with published evidence in order to analyse the results of the questionnaire.
Limitations of imaging for foreign bodies in parapharyngeal abscess and the importance of surgical exploration
Authors: Coales U. F. , Tandon P. , Hinton A. E.
Published: November 2007

A rare cause of parapharyngeal abscess in association with a wooden skewer is presented. Despite the use of both ultrasound and computed tomography (CT) scanning as diagnostic tools, the foreign body could not be identified. Only through a meticulous exploration of the neck was the foreign body located. The importance of surgical exploration even with negative imaging is discussed.
Parotid duct carcinoma arising in bilateral chronic sialadenitis
Authors: Hogg R. P. , Ayshford C. , Watkinson J. C.
Published: November 2007

It is well recognized that, in general, chronic inflammation can predispose to malignant change. There is however, to our knowledge, no previously reported association between chronic obstructive sialadenitis and salivary gland epithelial malignancy. We describe here the first reported example in the English literature of a salivary duct carcinoma arising in a parotid gland with a long history of chronic obstructive sialadenitis. It is possible that a causal relationship exists between the two conditions. If this were the case then non-surgically treated chronic obstructive sialadenitis patients may well warrent careful clinical follow-up.
Radical revision mastoidectomy for chronic otitis media without cholesteatoma: the relevance of excenteration of all rest cells
Authors: Rombout Jan , Pauw Bernard K. H.
Published: November 2007

Patients who, despite treatment, suffer persistent chronic otitis media (COM), a radical cavity and a hearing loss of more than 55 decibels for more than five years, can be classified as having an ‘endstage’ COM. It is generally agreed that retained infected residual cell tracts or a too small meatus are common causes for failure of surgery for COM. Radical revision mastoidectomy (RRM) aims to remove all residual cell tracts in the mastoid, in the middle-ear cleft, around the labyrinth and around the Eustachian tube. The mastoid cavity is obliterated with a pedicled muscle flap. Thus the mastoid cavity is reduced and selfcleansing is improved. The first 16 consecutive patients who underwent a RRM for ‘endstage’ COM were included in this study. In about 80 per cent the treatment resulted in a dry ear. We, therefore, conclude that RRM is an effective and safe method for treating ‘endstage’ COM.
Useful residual hearing despite radiological findings suggestive of anacusis
Authors: Bamiou Doris Eva , Mahoney Cliodna O , Sirimanna Tony
Published: November 2007

A severe malformation of the inner ear, often referred to as severe labyrinthine dysplasia or common cavity deformity, consists of an absent or dilated cochlear basal coil, wide communication with the vestibule and a tapered internal acoustic meatus and can be associated with absent hearing. We discuss two children with severe labyringthine dysplasia as shown by computed tomography (CT) scans and, in the first case, an absent VIIIth nerve bilaterally shown by magnetic resonance imaging (MRI). In 1995, both cases were precluded from cochlear implantation, on the basis of the absent VIIIth nerve (first case) and increased risk of CSF leak during operation (second case). However, audiometric results and vocalization patterns of both children suggested the presence of some residual hearing function, while recently reported specific surgical techniques have been found to be safe and effective in the cochlear implantation of the common cavity deformity. The management of such cases should be decided on the grounds of a full audiological assessment in conjunction with the radiological features, in the light of current surgical trends shown to be safe and effective.