bluuebunny/crossref_metadata_2025 huggingface dataset:
An audit of the cochlear implant service in Manchester
Authors: Mawman D. J. , Edwards J. D. , Giles E. C. , Aplin D. Y. , O'Driscoll M. , Woolford T. J. , Ramsden R. T.
Published: November 2007

The adult cochlear implant programme in Manchester was established in 1988 and the evaluation of the cochlear implant service involved the first 58 implants users (mean age = 51.65 years, range 19–75 years). Questionnaires were sent to implant users and their partners to evaluate the service with regard to provision of information, clinical care during in-patient assessments, waiting times, operation for cochlear implant and postoperative rehabilitation. The results show that the majority of patients (78 per cent) felt that the implant gave them as much or more benefit than expected. Areas identified for improvements include provision of more written information about cochlear implants; reduction in waiting times for first appointments; more information about the surgical risks and more instruction about home auditory training exercises for family and friends.

As a consequence of the audit results the clinical practice and service provision for cochlear implantation in Manchester has been modified.
Hemifacial spasm associated with external carotid artery compression of the facial nerve
Authors: Rakover Yoseph , Dharan Muralee , Rosen Gabriel
Published: November 2007

We report a unique case of hemifacial spasm due to compression of the facial nerve by the main trunk of the external carotid artery within the parotid space. Decompression of the facial nerve as well as partial section of the proximal trunk of the nerve, caused the hemifacial spasm to disappear.

Our case gives support to the theory that hemifacial spasm can be caused by pressure on the facial nerve along all its course and not only in its intra-cranial portion.
Kimura's disease
Authors: Pamaraju Nalinikanth , Khalifa S. A. , Darwish Abdulla , Paulose K. O. , Ahmed Nissar , Yousif Hisham
Published: November 2007

Kimura's disease is a rare condition of unknown aetiology. It usually presents as a mass in the head and neck region. The diagnosis is confirmed by biopsy and usually treated by excision even though recurrence is common. This condition can be mistaken for a malignant tumour. In this case report Kimura's disease presented as a nonspecific lymphadenitis in an Arab patient.
An in vitro study of tracheostomy tube cuff herniation and inflation characteristics
Authors: Hollis L. J. , Almeyda J. S. , Mochloulis G. , Patel K. S.
Published: November 2007

Seven of the most commonly used tracheostomy tubes used in the UK were tested for cuff herniation and creasing in synthetic tracheas corresponding to the shapes and sizes found in vivo. Results demonstrated that only two tubes of one particular brand herniated and that creasing occured in tubes disproportionaltely large for the trachea used. A discussion of modern tracheostomy tube manufacture is included.
Speech and voice rehabilitation in selected patients fitted with a bone anchored hearing aid (BAHA)
Authors: Thomas Julie
Published: November 2007

Within the Birmingham osseointegrated implant programme there have been several patients with severe pre-lingual conductive hearing loss. The majority of these have been patients with Treacher Collins syndrome.

There are characteristic features of speech and voice in those with long-standing conductive hearing loss. In addition, the associated abnormalities of jaw, teeth and palate may amplify the problem. There may be spontaneous improvement in features such as voice pitch, quality and intensity following the fitting of a BAHA. However, in those with a pre-lingual hearing impairment, speech therapy may be necessary. Patients assessed as suitable for BAHA have a full assessment of communication skills including audio recording of speech and voice. Post-operative training improves auditory discrimination and perception and is followed by training in the production of the newly perceived speech sounds.
A cadaver larynx holder for teaching laryngomicrosurgery
Authors: Paczona Robert
Published: November 2007

Although many reports can be found in the literature about temporal bone holders for postgraduate temporal bone surgery courses, the author did not find any kind of suitable description of a larynx holder for laryngomicrosurgery courses. A cadaver larynx holder is presented, made by the author himself for individual and postgraduate teaching courses. This simple model has been proved already to be a unique and a very useful tool for a practising course on laryngomicrosurgery during two training courses and the instructional session of the IIIrd EUFOS Congress in Hungary in 1996.
Undifferentiated carcinoma of the nasopharynx and leukemoid reaction: report of case with literature review
Authors: Saussez Sven , Heimann P. , Vandevelde Luc , Bisscnop Pierre , Jortay Albert , Schandene Liliane , Cogan Elie
Published: November 2007

A case of undifferentiated carcinoma of the nasopharynx presenting as a cervical mass associated with a paraneoplastic neutrophilic leukemoid reaction is reported. The diagnosis of undifferentiated nasopharyngeal carcinoma of the Regaud type was established by the presence of aggregates of epithelial neoplastic cells separated by areas of reactive lymphoid cells; the epithelial nature being confirmed by the positivity for epithelial markers (AE1/AE3, EMA). Serum IL-la, GM-CSF and TNFα remained undetectable suggesting that these factors were not involved in the occurrence of the paraneoplastic leukemoid syndrome.
Microscopic rhinoscopy in lepromatous leprosy
Authors: Soni N. K.
Published: November 2007

Ten patients with lepromatous leprosy have been studied to detect intranasal pathology by conventional naked eye rhinoscopy and also by use of the surgical microscope. The comparison of both methods reveals that microscopic rhinoscopy is superior in providing more accurate details of intranasal lesions in leprosy and biopsy can be taken in a precise manner from accurate and representative sites. Use of the microscope with adequate exposure and bright illumination provides precise details of lesions and an opportunity for bimanual manipulation, photography, teaching and recording. Thus, it is worthwhile to perform microscopic rhinoscopy in such cases.
Angiosarcoma of the head and neck
Authors: El-Sharkawi Salah
Published: November 2007

Angiosarcoma of the head and neck is a rare tumour of vascular origin that affects the elderly. A 74-year-old man who presented with bruise-like macules of the scalp and face is reported. He was treated for a few months with different antibiotics and anti-allergic medication by his own family doctor, and referred for specialist opinion when he failed to derive any benefits from the medications. A biopsy was obtained from the lesion and proved to be an angiosarcoma. A review of the literature indicates that the most important prognostic factor in this particular disease is the size of the lesion on presentation, hence the importance of early diagnosis. This case is reported, and the literature for similar cases is reviewed, to highlight the diagnostic and therapeutic aspects of this uncommon aggressive tumour in an attempt to help in the process of early diagnosis.
Benign necrotizing osteitis of the external auditory meatus
Authors: Kumar B. N. , Walsh R. M. , Sinha A. , Courteney-Harris R. G. , Carlin W. V.
Published: November 2007

Benign necrotizing osteitis of the external auditory meatus is a rare condition which occurs in non-diabetic healthy people. The aetiology of the necrotic process with the formation of sequestrum in the bony external meatus is unknown. It is important to differentiate this benign process from malignant otitis externa and radionecrosis of the temporal bone as the management of these conditions differs. We present two cases, one managed surgically and the other medically, and review the literature. Immediate surgical excision of the sequestrum is advocated instead of long-term medical therapy and waiting for it to separate spontaneously.
Sensorineural hearing loss in MELAS syndrome
Authors: Warrick P. D. , Wardrop P. , Sim D. W.
Published: November 2007

A case of sensorineural hearing loss (SNHL) in MELAS syndrome, a variety of mitochondrial cytopathy, is presented. Mitochondrial cytopathies have gone almost unreported in the otolaryngology literature, despite evidence from a recent review that about 60 per cent of such patients suffer from SNHL (Gold and Rapin, 1994). The same review revealed that only one of 117 case reports in the period 1984–1993 contained an audiogram (Swift and Singh, 1988), and none presented sequential audiograms. However, audiometry has since been published on 23 members of a family with a mitochondrial point mutation causing only sensorineural hearing loss with no other symptoms (Vernham et al., 1994). We present a case of mitochondrial cytopathy three years after diagnosis with two sequential audiograms.
Mucous membrane plasmacytosis of the upper aerodigestive tract. A case report with effective treatment
Authors: Khan N. A. , McKerrow W. S. , Palmer T. J.
Published: November 2007

We present a case of plasmacytosis of the mucous membrane of the upper aerodigestive tract. This is a rare benign condition characterized by plasma cell infiltration of the mucosa, with only nine cases described previously (Ferreiro et al., 1994). The lesions, which have a cobblestone appearance, cause throat discomfort, dysphonia and mild dyspnoea. All the cases described previously failedto respond to antibiotics, systemic steroids, or to surgical resection. The present case has however responded favourably to intensive andprolonged treatment with beclamethasone oral spray and Corsodyl mouthwashes.
Neonatal and paediatric fibre-optic laryngoscopy and bronchoscopy using the laryngeal mask airway
Authors: Hinton A. E. , O'Connell J. M. , Besouw J. P. Van , Wyatt M. E.
Published: November 2007

Endoscopy of the upper airways in neonates and infants has traditionally been accomplished using rigid laryngoscopes and bronchoscopes. The laryngeal mask may be used both to control the airway for anaesthetic ventilation and to guide a fibre-optic endoscope to the laryngeal inlet and beyond.

We report our experience with five neonatal and paediatric cases where fibre-optic laryngoscopy and bronchoscopy were performed through the laryngeal mask airway. All were cases in which standard rigid endoscopy had proved difficult with only a poor and restricted view of the laryngeal inlet being obtained due to the age of the infants, or abnormal anatomy of the upper airways.

No problems have been encountered with maintenance of the airway or with the endoscopic view obtained. In fact in neonatal patients, this technique has been found to be preferable with regard to safety and ease of use when compared to the ventilating bronchoscope. With the size 1 laryngeal mask airway it is not possible to simultaneously ventilate and endoscope the patient. Cases included, a vascular ring, Goldenhar's syndrome, laryngomalacia, supraglottis and vocal fold paresis.

This technique provides a secure method of maintaining anaesthetic ventilation during airway endoscopy, and also a means of easily locating the glottis.
Giuseppe Gradenigo and his contributions to Audiology
Authors: Stephens Dafydd , Orzan Eva , Di San Cataldo Ferdinanda Galleti
Published: November 2007

Giuseppe Gradenigo (1859–1926) was an important figure in the development of Otology. Within this paper the authors consider his background and his particularcontributions to the development of various aspects of audiology.
The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) as a consequence of neck dissection
Authors: Mesko Thomas W. , Garcia Orlando , Yee Lisa D. , Villar MaryJo , Chan Helen
Published: November 2007

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) canhave multiple causes. Surgical neck dissections may have an association with this syndrome and represent the basis for this study. A retrospective review of 50 patients undergoing neck dissections was performed to evaluate for the development of hyponatraemia as a consequence of SIADH. Based on the results of this review, a prospective study of 20 consecutive patients undergoing 22 neck dissections was performed to determine the incidence ofSIADH. A control group of 25 consecutive patients undergoing major non-neck dissection surgery was also studied. SIADH developed in nine of 50 patients (18 per cent) of our retrospective group with a high incidence of development in those who had jugular vein ligation (JVL) (22 per cent), pre-operative radiation therapy (25 per cent) or squamous cell cancers (32 per cent). SIADH developed in six patients undergoing 22 neck dissections (27 per cent) in our prospective group. A high incidence was also noted for those with JVL (42 per cent), pre-operative radiation therapy (67 per cent) or squamous cell cancer (40 per cent). No patients developed symptomatic hyponatraemia. No patients in the prospective control group developed SIADH. Neck dissection surgery is associated with a significant risk for the development of SIADH. Factors such as jugular vein ligation (JVL), pre-operative radiotherapy and squamous cell cancer appear to increase this risk.
Horner's syndrome: a rare presentation of cervical sympathetic chain schwannoma
Authors: Ganesan S. , Harar R. P. S. , Owen R. A. , Dawkins R. S. , Prior A. J.
Published: November 2007

We describe a cervical sympathetic chain schwannoma in a 77-year-old woman who presented with a neck mass and Horner's syndrome. Such schwannomas are rare and this is the first documented case of a Horner's syndrome at presentation. The mass was excised via a cervical approach and her post-operative course was uneventful. The prognosis is excellent, with recurrence being rare. A brief discussion of the pathology, presentation, diagnosis, and treatment of this condition is made in this paper. The relevance of the uncertainty in diagnosis is discussed with the message that a pre-operative Homer's syndrome may guide the surgeon in the care of the patient but we suggest that in all cases proper counselling of the possible neurological consequences of this surgery be conducted.
Reversible sensorineural hearing loss in Lyme disease
Authors: Quinn S. J. , Boucher B. J. , Booth J. B.
Published: November 2007

We report a case of bilateral sensorineural hearing loss of two years duration which appears to have been due to lateBorrelia burgdorferiinfection. The 39-year-old woman presented with bilateral deafness and multiple other neurological complaints some six months after developing a ‘target’ lesion on the lower leg after walking in the New Forest. Serology forBorrelia burgdorferibecame positive and the patient made a complete recovery from both her deafness and her other neurological problems after a five-week course of oral antibiotic therapy.
Trends in randomized controlled trials in ENT: a 30-year review
Authors: Ah-See K. W. , Molony N. C. , Maran A. G. D.
Published: November 2007

There is a growth in the demand for clinical practice to be evidence based. Recent years have seen a rise in the number of randomized controlled clinical trials (RCTS). Such trials while acknowledged as the gold standard for evidence can be difficult to perform in surgical specialities. We have recently identified a low proportion of RCTS in the otolaryngology literature. Our aim was to identify any trend in the number of published RCTS within the ENT literature over a 30-year period and to identify which areas of our speciality lend themselves to this form of study design. A Medline search of 10 prominent journals published between 1966 and 1995 was performed. Two hundred and ninety-six RCTS were identified. Only five were published before 1980. Two hundred (71 per cent) of RCTS were in the areas of otology and rhinology. An encouraging trend is seen in RCTS within ENT literature.
The evaluation of velopharyngeal function using flexible nasendoscopy
Authors: Ramamurthy L. , Wyatt R. A. , Whitby D. , Martin D. , Davenport P.
Published: November 2007

Nasendoscopy is an essential tool in assessing the dynamic function and structure of the velopharyngeal sphincter during speech and swallowing.

Flexible fibre-optic nasendoscopy has been used by the cleft palate team at Withington Hospital, Manchester since 1989. Seventy-six patients were referred between 1989 and 1994 for evaluation of velopharyngeal function during speech. Flexible nasendoscopic evaluation was attempted in 50 patients, and successfully carried out in 43 patients. The age range was four years to 77 years (mean 21 years). The patients were divided into two groups: Group 1 consisting of patients with cleft palate and Group 2 comprised of patients with non-overt cleft palate-related velopharyngeal dysfunction of various aetiologies; such as, submucous cleft, post-tonsillectomy, post-adenoidectomy, neurological and post-traumatic.

Based on the findings on nasendoscopy, videofluoroscopy and clinical speech/voice analysis the following treatment options were recommended: 17 (40 per cent) for pharyngoplasty, five (11 per cent) for revision pharyngoplasty, 15 (35 per cent) for speech therapy, four for an obturator and one for tonsillectomy. Two previously undetected submucous clefts were diagnosed.
Patient with primary tonsillar and gastric syphilis
Authors: Ishimaru Tadashi , Mizuno Yasutsugu , Shiga Hideaki , Nagayama Ikuo , Furukawa Mitsuru
Published: November 2007

A male patient with syphilitic lesions in the tonsil and stomach is presented. The patient was infected while practising oral sex with heterosexual friends. He complained of nausea and snoring; his left tonsil was enlarged. Spirochetes were detected in a smear preparation from the left tonsil. As a gastric lesion, initially believed to be cancer, appeared to result from spirochete ingestion, the case is considered to represent primary syphilis. After antibiotic therapy with ampicillin, the left tonsil returned to normal size and gastric changes were no longer evident endoscopically. Gastroscopy should be considered if syphilis of the tonsil is observed, particularly when gastrointestinal symptoms are present. Both the oral and the gastric lesion can be mistaken for malignant neoplasm.
Prophylaxis for venous thromboembolism in head and neck surgery: the practice of otolaryngologists
Authors: Ah-See K. W. , Kerr J. , Sim D. W.
Published: November 2007

Deep venous thrombosis (DVT) and pulmonary embolism (PE) are an important cause of morbidity and mortality in the surgical patient. The first guideline produced by the Scottish Intercollegiate Guidelines Network was for the prophylaxis of venous thromboembolism. Patients undergoing major head and neck cancer surgery commonly exhibit risk factors for venous thromboembolism. Currently, however, there are no data on its incidence in these patients. A questionnaire survey was performed to assess the current practice of consultant otolaryngologists regarding DVT prophylaxis in patients undergoing head and neck cancer surgery. Of those respondents who managed these patients, 57 per cent did not use routine DVT prophylaxis while 43 per cent did. A wide variety of techniques were employed among those practising DVT prophylaxis.

A consensus is needed concerning the use of thromboembolism prophylaxis in head and neck surgery patients.
Acute otitis media and otitis media with effusion in children with bacterial meningitis
Authors: Richardson M. P. , Reid A. , Williamson T. J. , Tarlow M. J. , Rudd P. T.
Published: November 2007

Acute otitis media and otitis media with effusion (OME) have often been observed in children with bacterial meningitis. OME has also been proposed as the mechanism of reversible hearing loss after meningitis. In this controlled study, children with acute bacterial meningitis were studied using auditory brainstem responses (ABR), otoacousticemissions, tympanometry and otoscopy. An age- and sex- matched control was recruited for each patient and the incidence of acute otitis media and OME was compared between the twogroups. One hundred and twenty-four children with meningitis were studied. Ninety-two children (74 per cent) had meningococcal meningitis. Five patients (4 per cent) had conductive hearing loss (ABR threshold≥30 dB HL) at the time of discharge from hospital. None of the patients or controls had acute otitis media. Patients and controls were well matched for risk factors for OME and the prevalence of middle ear effusion in patients and controls was 7.2 per cent and 11.3 per cent respectively. The relative risk of OME in the children with meningitis was 0.64 (95 per cent confidence interval 0.29 to 1.42). After nine months, three of the five children with meningitis and conductive hearing loss had regained normal hearing.

In contrast to previous reports, there was no relationship between bacterial meningitis and acute otitis media or OME in this study. Nevertheless, coincidental conductive hearing defects were identified as the cause of reversible hearing loss in three patients.
Endoscopic orbital decompression for dysthyroid eye disease
Authors: Koay Boon , Bates Grant , Elston John
Published: November 2007

Orbital decompression for dysthyroid eye disease is traditionally performed either through an external approach or transantrally. The introduction of endoscopic sinus surgery over the last decade has led to a better understanding of the intranasal surgical landmarks of orbital walls and the development of endoscopic orbital decompression. We have adopted the endoscopic technique as the treatment of choice for orbital decompression in dysthyroid eye disease for the last two years. The surgical technique is described and illustrated, and the results of our first series of 15 patients (30 orbits) are presented.
Influence of phylogeny on jugular fossa shape and otological disorders
Authors: Tsunoda Atsunobu , Yamada Mari , Komatsuzaki Atsushi
Published: November 2007

We examined the shape of the jugular fossa and its protrusion into the tympanic cavity in 51 human skulls and in 355 various monkey skulls. All human specimens had a dome-shaped fossa, and the right fossa was larger than the left in 60 per cent of the specimens. Fossae protruded into the tympanic cavity in 20 per cent of these specimens.

In contrast, none of the monkey specimens had a dome-shaped fossa. Some monkeys had saucershaped jugular fossa; the frequency of such fossa became higher as phylogeny progressed. Furthermore, the jugular fossae in monkeys did not protrude into the tympanic cavity. The shapes of both the jugular fossa and sulcus of the transverse sinus were generally symmetrical.

The shape of the jugular fossa and its positional relationship to the tympanic cavity were considered from the viewpoint of the influence of phylogeny and the possible relationship to various otological problems.
Nasal septal surgery as an out-patient procedure
Authors: Nieminen Peter , Silvola Juha , Aust Rudolf , Stenfors Lars-Eric
Published: November 2007

Sixty consecutive patients (48 males, 12 females; age range 16 to 57, mean age 35 years) underwent nasal septal surgery at our out-patient department for symptoms of nasal obstruction. The operations were performed under local anaesthesia supplemented with 2.5–5 mg intravenous midazolam. Only one surgeon and one nurse were needed for the procedure. The total time spent at the hospital averaged three hours. The preliminary short-term results of surgery are comparable to those at our day-care unit. The complication rate was negligible. Ninety-five per cent of these patients regarded the arrangements for their operation as safe. Our results show that nasal septal surgery can be performed with good costeffectiveness, satisfactory quality and with good safety and patient satisfaction as an out-patient procedure.
Chlorine-induced anosmia. A case presentation
Authors: Benjamin E. , Pickles J.
Published: November 2007

Chlorine gas is known to be a potent irritant to the eyes, nose, throat and lungs with severe exposure resulting in pulmonary oedema and even death. There have been no case reports, however, of chlorine inducing anosmia. We present such a case, along with a review of the literature on the toxicology of chlorine and its effect on the nose.
Subcutaneous emphysema as a complication of tonsillectomy
Authors: Hampton S. M. , Cinnamond M. J.
Published: November 2007

Subcutaneous emphysema occurs when air is introduced into the tissues. This can happen as a complication during, or immediately after surgery. It has rarely been described after tonsillectomy. Definitive treatment will depend on the cause. We report two cases of subcutaneous emphysema following tonsillectomy.
Parapharyngeal abscess secondary to an external auditory meatus foreign body
Authors: Jones R. L. , Chavda S. V. , Pahor A. L.
Published: November 2007

Parapharyngeal abscess is not an uncommon condition and may be due to spread of infection from acute tonsillitis or dental or secondary to perforating injury of the pharynx. We present a case report of a patient with an external auditory meatus foreign body who developed a parapharyngeal abscess.
Patterns of hearing loss in non-explosive blast injury of the ear
Authors: Berger Gilead , Finkelstein Yehuda , Avraham Shabtai , Himmelfarb Mordehai
Published: November 2007

A prospective study of hearing loss in 120 cases with non-explosive blast injury of the ear, gathered over a six-year period, is presented. Thirty-three (27.5 per cent) patients had normal hearing, 57 (47.5 per cent) conductive hearing loss, 29 (24.2 per cent) mixed loss and one (0.8 per cent) had pure sensorineural loss. The severity of conductive hearing loss correlated with the size of the eardrum perforation; only a marginal difference was found between water and air pressure injuries, with respect to this type of hearing loss. Of all locations, perforations involving the posterior-inferior quadrant of the eardrum were associated with the largest air-bone gap. Audiometric assessment revealed that none of the patients suffered ossicular chain damage. Three patterns of sensorineural hearing loss were identified: a dip at a single frequency, two separate dips, and abnormality of bone conduction in several adjacent high frequencies. Involvement of several frequencies was associated with a more severe hearing loss than a dip in a single frequency. Healing of the perforation was always accompanied by closure of the air-bone gap, while the recovery of the sensorineural hearing loss was less favourable.
An unusual case of presumed perilymph fistula
Authors: Fish B. M.
Published: November 2007

Perilymph fistulae have been described for over 30 years and yet there are no universally accepted diagnostic criteria or treatment regimes for them. This paper describes an unusual case of a presumed traumatic perilymph fistula and discusses its treatment and prognosis in relation to previous studies.
Congenital dermoid cyst of the tongue
Authors: Miles L. P. , Naidoo L. C. D. , Reddy J.
Published: November 2007

True dermoid cysts of the oral cavity are rare, usually presenting as midline swellings in the floor of the mouth and occasionally elsewhere in the oral cavity. This report describes the diagnosis and management of a congenital dermoid cyst of the lateral aspect of the body of the tongue in a 10-year-old girl. The theories of the pathogenesis of this cyst during embryogenesis of the tongue are also reviewed.
Cholesterol granuloma of the maxillary sinus: six cases from the same region
Authors: Kunt Tanfer , Ozturkcan Sedat , Egilmez Reyhan
Published: November 2007

It is common to find cholesterol granuloma in the mastoid antrum and air cells of the temporal bone, but it is very rare in paranasal sinuses. In the development of this pathology, the key factor is the presence of a closed cavity containing exudate and blood. Six cases of cholesterol granuloma of the maxillary sinus are presented from six years' study in our hospital. According to the main symptoms, clinical findings, and radiological appearance (except the destruction of the antrum wall in some patients), the pathology was similar to chronic maxillary sinusitis. All the patients were treated with radical operative techniques.

In this study, we reviewed the literature and our cases, and could not detect any findings to explain why this pathology had occurred frequently in our district. We strongly recommend that investigations should be carried out on all specimens obtained from paranasal sinus surgery, because the cholesterol granuloma in the maxillary antrum could be mistaken for chronic sinusitis.
Laryngeal paralysis in organophosphorous poisoning
Authors: Indudharan R. , Win M. N. , Noor A. R.
Published: November 2007

Organophosphorous poisoning causing isolated laryngeal paralysis has only been rarely reported before. We describe a case of difficult extubation in a patient with organophosphorous poisoning, the cause of which was found to be bilateral vocal fold palsy. This is a type of intermediate paralysis that recovers with time. Such a condition should be thought of as a cause of dyspnoea or difficult extubation in patients with organophosphorous poisoning.
Granular cell tumour of the larynx
Authors: Kamal Syed Akhtar , Othman Eyas Osama
Published: November 2007

Granular cell tumour (GCT) of the larynx is an uncommon laryngeal tumour. It is always benign and commonly located in the posterior part of the larynx. Care must be taken to differentiate this lesion from others due to the presence of pseudo-epitheliomatous hyperplasia which overlies the GCT and may occasionally mimic squamous cell carcinoma. Therefore, histological differentiation is important because these tumours are normally managed conservatively. The origin of this tumour is a matter of debate, but most authors believe it to be neural in origin. The rarity of this tumour in the male population prompted reporting this case in the literature.
Leiomyosarcoma of the auricle: case report and literature review
Authors: Karasen R. Murat , Sutbeyaz Yavuz , Gundogdu Cemal , Aktan Bulent
Published: November 2007

Leiomyosarcoma is a malignant tumour of smooth muscle origin. These tumours are rarely encountered in the head and neck region. A case of leiomyosarcoma of the auricle is presented. There are two cases of external auditory canal leiomyosarcoma in the literature. To our knowledge the present case is the first example of leiomyosarcoma of the auricle.
Verrucous squamous carcinoma of the nasal septum
Authors: Pothula V. B. , Jones H. Savage
Published: November 2007

We document only the second reported case of verrucous squamous carcinoma of the nasal septum. In both cases previous surgical treatment for assumed squamous papillomata had resulted in multiple recurrences necessitating formal surgical resection. Our patient has remained tumour-free during long-term follow-up.
B-cell lymphoma with extensive cutaneous involvement presenting to the ENT surgeon
Authors: Hughes Richard G. M. , Morgan David W.
Published: November 2007

This paper reports an unusual case of B-cell non-Hodgkin's lymphoma presenting with extensive cutaneous involvement of the head and neck region.
Nothing new under the sun: the management of epistaxis
Authors: Pothula Vijay , Alderson David
Published: November 2007

The management of epistaxis is reviewed from ancient times onwards. Many curious methods have been employed and indeed epistaxis has been encouraged at times. Although current management is based on sound principles folklore remedies still predominate amongst some of our patients. The basis of contemporary treatments was known and practised by our ancient forebears.
A prospective evaluation of the feasibility of day-case microlaryngeal surgery
Authors: Ah-See K. W. , Kelly G. , Todd J. G. , MacKenzie K.
Published: November 2007

An increasing number of surgical procedures are being performed on a day-case basis. In the UK otolaryngologists have been reluctant to introduce same day discharge in microlaryngeal surgery (MLS). The reason for this is the perceived risk to the airway from bleeding and oedema after MLS. The aim of this study was to investigate the feasibility of establishing a same day discharge service for MLS patients. One hundred consecutive patients under the care of one consultant otolaryngologist were recruited. A clinical street-fit assessment and objective measures of peak expiratory flow rate (PEFR) and oxygen saturation (SaO2) were recorded pre- and post-operatively. Results indicate that the PEFR and SaO2 did not change significantly during the course of the study. The street-fit criteria for discharge were satisfied in 80 per cent of patients following surgery. By combining the ASA score (American Society of Anaesthesiologists) with street-fitness 63 per cent of our patients were eligible for same day discharge.
Pull-through oropharyngectomy in advanced stage malignant tumours
Authors: Basterra J. , Bagán J. V. , Zapater E. , Armengot M.
Published: November 2007

Surgery is the first therapeutic option in extensive oropharyngeal carcinomas. An operation to treat these tumours is described, based on the hemiglossopelvectomy without mandibulectomy technique. Tumours located in the oropharynx are resected downwards by a modified pull-through approach, performing the resection of the oropharyngeal tumour in monoblock with the ipsilateral neck dissection, avoiding any action upon the mandible. The operation has been performed in 14 consecutive patients. By avoiding either mandibulotomy or mandibulectomy, morbidity and post-operative recovery are improved.
Successful treatment of rhinocerebral mucormycosis by a combination of aggressive surgical debridement and the use of systemic liposomal amphotericin B and local therapy with nebulized amphotericin – a case report
Authors: Raj P. , Vella E. J. , Bickerton R.C.
Published: November 2007

A case of mucormycosis involving the nose and paranasalsinuses in a 55-year-old man with recently diagnosed acute promyelocytic leukaemia is reported. It was successfully treated with a combination of aggressive surgical debridement and systemic amphotericin B. In addition, local nebulized amphotericin B was used as an adjunct totherapy. We believe this is only the second documented use of nebulized amphotericin in the management of sinonasal mucormycosis. The needfor a high index of suspicion and early aggressive management is emphasized.
Internal jugular vein thrombosis in association with the factor V Leiden mutation
Authors: Arullendran P. , Jani P. , Baglin T. , Moffat D. A.
Published: November 2007

We report an unusual case of internal jugular vein thrombosis in a 57-year-old female, with the recently discovered factor V Leiden (FVR506Q) mutation. The molecular basis of this mutation is described, and the importance of screening for hereditary venous thrombotic states is emphasized.
Multidirectional observations of the larynx using transurethral rigid endoscopes during direct laryngoscopy
Authors: Kawaida Masahiro , Fukuda Hiroyuki , Kohno Naoyuki
Published: November 2007

Microscopic direct laryngoscopy (microlaryngoscopy) under general anaesthesia is the optimal method of observing the larynx. However, as microlaryngoscopy does not allow precise observations of the ventricle, inferior surface of the vocal fold and subglottis, multidirectional observations of the larynx using transurethral rigid endoscopes were performed during direct laryngoscopy. This endoscopic technique has been shown to be clinically useful in the diagnosis and treatment of laryngeal lesions. The equipment and methods are introduced herein, and a representative case is presented.
Hearing preservation despite labyrinthectomy for resection of giant cholesteatoma with middle fossa extension
Authors: Rapado F. , Fergie N. , Ramsden R. T.
Published: November 2007

A case is described of an extensive acquired cholesteatoma of the middle ear cleft which had invaded the middle cranial fossa and produced a mass effect on the temporal lobe. It had also extended into the labyrinth without causing elevation in the bone conduction threshold. Furthermore, even after total bony labyrinthectomy, there was very little elevation in these thresholds. The literature relating to hearing preservation after labyrinthectomy is reviewed.
Traumatic laryngocoele
Authors: Mitchell T. E. , Pickles J. M.
Published: November 2007

This is the first reported case of a laryngocoele developing after laryngeal trauma. A 26-year-old man sustained a shotgun injury to his larynx. A large number of shotgun pellets was removed from his left vestibular fold. He subsequently developed a left-sided laryngocoele, probably due to fibrosis around the neck of the saccule.The laryngocoele was removed by an external approach.
Sudden parotid swelling due to spontaneous haemorrhage
Authors: Cerovac Sonja S. , Vowles Richard H. , Bleach Nigel R.
Published: November 2007

This paper presents an interesting case of a severe spontaneous haemorrhagewithin the parotid gland in an adult. A rapidly enlarging parotid mass with absence of causative trauma, inflammation or vascular abnormality, raised the suspicion of a neoplasm. Ultrasound, computed tomography (CT) and tissue biopsy, however, have shown only changes suggestive of previous haemorrhage and no evidence of malignancy. A 30-year review of theliterature revealed no similar case reported previously.
Immunoglobulin- and complement-coated bacteria in pus from peritonsillar abscesses
Authors: Lilja Markus , Räisänen Simo , Stenfors Lars-Eric
Published: November 2007

Fifty-five samples of pus were collected from 51 acute, non-perforated, two spontaneously ruptured and two recurrent peritonsillar abscesses (35 males and 18 females; median age 18 years) and analysed regarding (i) aerobic and anaerobic bacteria (standard culturing), (ii) morphology of bacteria and inflammatory cells (direct microscopy of acridine orange-stained material), and (iii) the percentage of bacteria coated with immunoglobulins IgG, secretory IgA (SIgA) andIgM and complement cleavage product C3b (immunofluorescence assay). Seventy-one per cent of the abscesses harboured a mixed bacterial flora of various aerobes and anaerobes. In none of the cases with a single bacterial species (27 per cent) could immunoglobulin- or complement-coated bacteria be found. In abscesses with a mixed flora, 18 per cent harboured IgG-coated, 15 per cent SIgA-coated, five per cent IgM-coated and five per cent C3b-coated bacteria, respectively. All pus samples contained inflammatory cells in abundance but they were mostly deformed and only occasionally could intracellular bacteria be recognized. Insufficient immunoglobulin-coating of bacteria might be an important aetiopathogenic factor in the development of a peritonsillar abscess. Bactericide in the abscesses is accomplished chiefly by protective mechanisms not dependent on antigen recognition by antibodies.
Simple model for teaching myringotomy and aural ventilation tubeinsertion
Authors: Owa A. O. , Farrell R. W. R.
Published: November 2007

Aural ventilation tube insertion is the most common otological operation and is usually the first operation learnt by trainees. The limited supply of temporal bones as well as expensive commercial models hampers training in the procedure. This paper describes a simple solution making a model of the ear canal and drum out of materials available on an ENT ward.
Idiopathic CSF rhinorrhoea presenting with tension pneumocephalus and hemiparesis
Authors: Hogg R. P. , Pillay H. , Mitchell R. , Johnson A. P.
Published: November 2007

A case of non-traumatic/non-iatrogenic CSF rhinorrhoea, presenting with tension pneumocephalus and hemiparesis is described. The possible pathological processes involved in this rare case are discussed. Cases in the literature of idiopathic CSF rhinorrhoea and also those of spontaneous pneumocephalus are reviewed.
Wegener's granulomatosis. First case report in Bahrain
Authors: Jamal Ahmed , Ebrahim Reda Ali , Tammam Nabeel , Kanekar Sungam
Published: November 2007

Formerly a fatal condition, Wegener's granulomatosis is now treated with good results. Although the annual incidence of Wegener's granulomatosis in the general population is not known, most European and American studies revealed an incidence in the range of one for every 250,000 of the population. The estimated total population of Bahrain as of June 1997 is 586,110; here we report the first diagnosed case of Wegener's granulomatosis in Bahrain.

Our patient presented with epistaxis, and from the clinical features, the very high ESR, the operative, histopathological and the radiological findings, and a high index of suspicion we could confirm the diagnosis along with the appropriate immunological test (positive cANCA). Standard treatment with cytotoxic agents and corticosteroids has been used. On follow-up the patient has shown a progressive improvement in her clinical and laboratory parameters.
Endoscopic resection of inverted papilloma of the nose and paranasal sinuses
Authors: Sham Cheuk Lun , Woo John Kong Sang , van Hasselt Charles Andrew
Published: November 2007

The results of a retrospective study of 22 patients with inverted papillomas resected by the endoscopic approach are presented with a follow-up of 33 to 96 months. Twenty-one patients had unilateral disease and one patient had bilateral involvement. None of the patients had orbital or cranial extension. One patient had synchronous carcinoma in situ. Eight patients had undergone previous surgical procedures. Following endoscopic surgery, six patients had residual disease requiring further revisions. Three of these six patients eventually required excision via limited external approaches. No patient required lateral rhinotomy or mid-facial degloving procedures. No complication occurredin any of the patients. The advantages of endoscopic surgery include precise determination of tumour extent, preservation of normal mucosa and bony structures and avoidance of external scars. Close endoscopic follow-up is mandatory to ensure early recognition and treatment of recurrent disease. Although the endoscopic approach is gaining popularity for the treatment of inverted papilloma, indiscriminate application may result in a high recurrence rate. The endoscopic approach should be performed by experienced surgeons and restricted to carefully selected patients with nasal, ethmoidal and limited maxillary disease. More extensive disease should be managed by radical external approaches or by combining endoscopic with limited external approaches.
A Le Fort I osteotomy approach to lateral sphenoid sinus encephalocoeles
Authors: Reynolds J. M. , Tomkinson A. , Grigg R. G. , Perry C. F.
Published: November 2007

Meningo-encephalocoeles of the skull base may present as spontaneous cerebrospinal fluid rhinorrhoea or acute meningitis. Previous approaches to midline skull base lesions have been either intracranial, via a craniotomy, or by transfacial or endoscopic extracranial approaches. This paper presents an alternative approach to lateral sphenoid sinus encephalocoeles through a Le Fort I osteotomy approach.
Replacing the combitube by an endotracheal tube using a fibre-optic bronchoscope during spontaneous ventilation
Authors: Gaitini Luis A. , Vaida Sonia J. , Fradis Milo , Somri Mustafa , Yanovski Boris , Kalderon Noam
Published: November 2007

We present a case of microlaryngoscopy in a patient with an unexpectedly difficult airway. The airway was managed by using an oesophageal-tracheal Combitube (Kendall-Sheridan, Argyle, NY) (ETC)and a fibre-optic bronchoscope (Pentax-Japan-5mm).
Have we got the full picture?
Authors: Demajumdar R. , Rajesh P. B.
Published: November 2007

A 59-year-old man with long-standing chronic obstructive airways disease (COPD), became progressively dyspnoeic, and repeatedly blacked-out during forced expiration. Spirometry suggested the possibility of large airways obstruction, and failing to respond to aggressive bronchodilator and steroid therapy, the patient was labelled as being non-compliant. Finally, he was assessed by an otolaryngologist and a cause for upper airway obstruction was suspected. Bronchoscopy and computed tomography (CT) scanning demonstrated tracheomalacia and the patient underwent resection of this segment of abnormal trachea.

Tracheomalacia, although rare, results from the substitution of cartilage with fibrous tissue, leading to severe airway compromise.

This case emphasizes the fact that although many conditions are uncommon, the total incidence of rare conditions is surprisingly high, and that care needs to be taken at all times in the management of ‘labelled’ patients with chronic illness, in order not to overlook such life-threatening diagnoses.
Hydralazine-induced lupus and vocal fold paralysis
Authors: Hari C. K. , Raza S. Ali , Clayton M. I.
Published: November 2007

Systemic lupus erythematosus (SLE) is a multi-system autoimmune disorder that can affect the upper airway. Hydralazine has been known to cause a lupus-like syndrome that can produce the clinical manifestations of SLE. We discuss a case of hydralazine-induced lupus, presenting with acute laryngeal oedema and right vocal fold paralysis. Cessation of hydralazine therapy resulted in reversal of paralysis.
A ten year audit of the management of cancers of the larynx and pharynx
Authors: Bulman C. H.
Published: November 2007

The Chief Medical Officers' expert advisory group (The Calman Hine report) (1994) for the commissioning of cancer services suggested that services in the district general hospitals (DGH) should be called ‘cancer units’ and that such units should be closely linked to ‘cancer centres’. The objective of these proposals would be to improve the quality of care to cancer patients. The report also acknowledges that these proposals are based on an inadequate understanding of the epidemiology of cancer within England and Wales and the way in which current configuration of services affects outcome. The authors make a plea for better documentation and recording of treatment and outcomes (i.e. audit) to fill this gap. Registration in cancer registries is of limited value in assessment of outcomes of care owing to lack of detail. This paper describes an audit of head and neck cancer in one department and attempts to define which patients might benefit from referral from the cancer units to the ‘centres’, and conversely, which patients would be better managed in the cancer units. If all patients with cancer of the head and neck were referred, the service in the cancer centres would be overwhelmed. Some system of triage will therefore be essential.
The answer is blowing in the wind: a pedunculated tumour with saw tooth flow-volume loop
Authors: Rendleman Neal , Quinn Stephen F.
Published: November 2007

Obstructing tumours of the upper airways have been demonstrated to alter the flow volume loop of pulmonary function testing. These alterations could be clues to the nature and location of the obstruction. This report describes a case of a pedunculated squamous cell carcinoma arising in the pharynx whose flow volume loop showed a saw tooth pattern which reflected the location and structure of the tumour.
Symptomatic heterotopic gastric mucosa in the upper oesophagus
Authors: Cuddihy P. J. , Maheshwar A. , Griffith H.
Published: November 2007

The presence of heterotopic gastric mucosa in the upper oesophagus has been reported to occur in up to 10 percent of individuals but it is usually asymptomatic. We present two pateints with symptomatic oesophageal heterotopic gastric mucosa and discuss the aetiology, pathogenesis, and management of the condition.
A rare case of intramuscular haemangioma in a six-year-old boy - a diagnostic dilemma
Authors: Chatrath P. , Pfleiderer A. G. , Blundell J. W.
Published: November 2007

Intramuscular haemangiomas are uncommon tumours of the head and neck, occurring mainly in adults and usually located in the region of the masseter muscle and parotid gland. We report the case of a child with an intramuscular haemangioma over the left maxilla, which caused some diagnostic confusion in view of its atypical location combined with the unusual age and inflammatory mode of presentation.