bluuebunny/crossref_metadata_2025 huggingface dataset:
Intraoperative herniation of a tracheostomy tube cuff
Authors: Bar-Lavie Yaron , Gatot Albert , Tovi Ferit
Published: November 2007

A case of intraoperative tracheostomy tube obstruction is reported. The clinical features and the chain of events leading to the diagnosis of cuff herniation are presented. The different mechanisms of herniation are discussed. In the present case we speculate that a manufacturing defect together with nitrous oxide diffusion into the cuff caused dilatation and herniation of the latter which led to obstruction of the distal tube lumen. We draw attention to this rare but life-threatening complication.
A simple technique to measure body sway in normal subjects and patients with dizziness
Authors: Roland N. J. , Smith C. A. , Miller I. W. , Jones A. S. , Lesser T. H.
Published: November 2007

For many years vestibular testing has relied on measurements of the vestibulo-ocular reflex (VOR). More recently quantified assessment of balance, using fixed or moving force platforms and magnetometry have been applied to clinical research. These are objective attempts to quantify the vestibulospinal reflex (VSR). This study evaluates whether SwayWeigh, a simple device which measures lateral body sway, can provide an objective assessment of balance dysfunction. Forty patients with a balance disorder and 31 subjects with normal balance were tested with eyes opened and eyes closed whilst they were standing on a flat surface and then on an air bed. The lateral sway in patients with a balance disorder was compared to that in the normal subjects and highly significant differences (p<0.0001) were observed. The results also confirmed the importance of vision and proprioception in the maintenance of posture.

The Sway Weigh balance platform is a simple and economical device which objectively measures balance dysfunction.
Airway obstruction with stridor due to nasal secretions
Authors: Dingle Ann F. , Douglas-Jones A. G.
Published: November 2007

Two cases of non-fatal airway obstruction by nasal secretions are described. The diagnosis was made after laryngoscopy and the features which suggested this previously undescribed aetiology were: depression of conscious level: poor oral hygiene; and irregular friable mass with mucoid areas obstructing the airway. The diagnosis was confirmed by histological examination of the obstructing material which was composed of laminated fragments of squamous epithelium, keratin debris and mucus. It is suggested that these masses form in the post-nasal space and then become dislodged descending into the larynx, where they cause partial laryngeal obstruction and stridor.

In patients whose conscious level is depressed and who have poor oral hygiene, nasal secretions should be considered as a cause of sudden unexplained airway obstruction and stridor.
Peak nasal inspiratory flow – the plateau effect
Authors: Clarke R. W. , Jones A. S. , Richardson H.
Published: November 2007

To study the efficacy of peak nasal inspiration flow (PNIF) as a means of recording change in nasal patency 20 subjects were given increasing doses of intranasal 5tometazo1ine. Nasal resistance (NR) and peak nasal inspiratory flow (PNIF) were measured in the resting stateand after each xylometazoline administration. Successive increases in dose caused a progressive decrease in nasal resistance and an increase in PNIF but the change in peak nasal inspiratory flow (PNIF) was much less. Peak nasal inspiratory flow shows a plateau effect as nasal resistance decreases. The reasons for this plateau are discussed in terms of respiratory flow mechanics
An evaluation of mucus glycoproteins in the larynges of victims of sudden infant death syndrome
Authors: Brock Christine A.
Published: November 2007

Larynges from 24 victims of Sudden Infant Death Syndrome (.S.I.D.S.) and 10 controls, with ages ranging from two days to 24 weeks in the controls and from two toN 16 weeks in theS.1.D.S. victims, were transversely, step-serially sectioned and then stained to show acid, neutral and mixed mucus glycoproteins

The proportion of sulphated mucus glycoprotein and sialylated mucus glycoprotein to total acid mucus glycoprotein was determined by the use of various staining techniques and a comparison was made for each type between S.I.D.S. and controls. The differences were significant with a mean of 27 per cent in the controls compared to 59 per cent in the S.I.D.S. for sulphomucin (difference 32 per cent; standard error of difference 6 per cent;p<0.01) and 73 per cent in the controls compared to 41 per cent in the S.I.D.S. larynges (difference 32 per cent; standard error of difference six per cent;p<0.01) for sialomucin. The results suggest that sulphated mucus glycoprotein is secreted in excess in some victims of Sudden Infant Death Syndrome.
Lingual thyroid: tongue-splitting incision for transoral excision
Authors: Atiyeh Bishara S. , Abdelnour Amir , Haddad Fadi F. , Ahmad Hussein
Published: November 2007

Two patients presenting to the Central Military Hospital of Beirut with symptomatic lingual thyroid are reported. I131 thyroid scanning revealed the lingual thyroid to be the only functional thyroid tissue present in each patient. Subsequent CT scanning demonstrated the large size of these ectopic thyroids causing significant mechanical obstruction. These were excised transorally using a posterior midline tonguesplitting incision and reimplanted in the rectus abdominis muscles.

Details of this modified tongue-splitting surgical approach are described. A brief review of the literature concerning lingual thyroid and its surgical treatment is also presented as well as three patients operated on for lingual thyroid at the American University of Beirut Medical Centre between 1975 and 1994 using an external neck incision.
Antrochonal polyp: a case report of treatment with intranasal steroids
Authors: Seshadri R.
Published: November 2007

The aetiology of antrochonal polyps is unknown. We report one case where treatment with topical intranasal cortico-steroids was successful. We are not aware of any previous reports of medical treatment.
Benign osteoblastoma of the mastoid part of the temporal bone: case report
Authors: Khashaba Ahmad , De Donato Giuseppe , Vassallo Gabriele , Landolfi Mauro , Russo Alessandra , Taibah Abdelkader , Sanna Mario
Published: November 2007

Osteoblastoma is a benign bone lesion that mainly affects the long bones and rarely the temporal bones. Very few cases have been reported in the literature. This paper reviews the literature, discusses the differential diagnosis, clinical presentation, and CT scan findings of such a condition and details our experience with a young patient who had a temporal bone (mastoid process) osteoblastoma.
Recurrent massive epistaxis due to traumatic intracavernous internal carotid artery aneurysm
Authors: Bhatoe H. S. , Suryanarayana K.V. , Gill H. S.
Published: November 2007

Traumatic internal carotid artery aneurysm presenting with epistaxis is rare. Epistaxis often occurs after a delay of weeks to months following head injury. The present case had bouts of recurrent massive epistaxis nearly four months after head injury. Diagnosis was made after carotid angiography. Epistaxis ceased after ipsilateral carotid ligation.
Malignant fibrous histiocytoma of the floor of the mouth: case report
Authors: Poli P. , Floretti G. , Tessitori G.
Published: November 2007

Malignant fibrous histiocytoma (MFH) is a common neoplasm of soft tissue. The floor of the mouth is an unusual site of origin and has not been described in the literature previously. Its rarity, aspecific clinical symptoms and complex histopathology combine to make the diagnosis difficult. The treatment of choice is wide surgical excision with adjunctive irradiation.
Eye protection during mastoid surgery
Authors: Mitchell T. E. , Courteney-Harris R. G. , Innes A. J.
Published: November 2007

A questionnaire was sent to all Full Members of the British Association of Otolaryngologists to ascertain whether and what type of eye protection surgeons and theatre nurses wear during mastoid surgery. Despite Department of Health recommendations only 58 per cent of surgeons and 19 percent of theatre nurses routinely wear any form of eye protection.
Cryotherapy in the treatment of nasal obstruction: indications in adults
Authors: Hartley C. , Willatt D. J.
Published: November 2007

Cryotherapy is an established method of treating hypertrophic obstructive inferior turbinates. The long-term effectiveness of the technique is assessed in this study, using the need for alternative nasal surgery as an objective way of distinguishing success from failure. Over 50 per cent of patients with obstructive symptoms, including those with minor septal deviation or allergy derived lasting benefit from the technique. Cryotherapy is an effective means of treating nasal obstruction due to mucosal hypertrophy of the turbinates and may replace the need for more radical surgery.
Early diagnosis and treatment of Ramsay Hunt syndrome: the role of magnetic resonance imaging
Authors: Kuo M. J. , Drago P. C. , Proops D. W. , Chavda S. V.
Published: November 2007

We present the case of a 47-year-old woman with left otalgia, rotatory vertigo, sensorineural hearing loss and acute facial nerve palsy. An enhanced magnetic resonance imaging (MRI) scan showed discrete enhancement of the facial and vestibulocochlear nerves in the left internal auditory canal as well as of the labyrinth. This appearance was compatible with that in Ramsay Hunt syndrome and acyclovir was started prior to the appearance of any vesicular eruption. The diagnosis was subsequently confirmed serologically. She regained full facial function but the sensorineural hearing loss persisted. The literature pertaining to the role of the MRI in acute facial palsies is reviewed.
Variation of expression of the gene for type 2 neurofibromatosis: absence of a gender effect on vestibular schwannomas, but confirmation of a preponderance of meningiomas in females
Authors: Evans D. G. R. , Blair V. , Strachan T. , Lye R. H. , Ramsden R. T.
Published: November 2007

Type 2 neurofibnormatosis is a dominantly inherited disorder in which the great majority of sufferes develop bilateral vestibular schwannomas. In a UK study of 183 individuals from 112 families we have previously shown a fairly similare disease course within families, but quite marked inter-familial variation. We have confirmed an increase in severity when the gene is inherited from an affected mother, but evidence that women are more severely affected than men is lacking. Age at onset of symptoms, of deafness and at diagnosis are idential for the entire dataset and for a comparison of 10 male/female sibling paries. Only three out of 42 pregnancies in symptomatic women were accompanied by reversible worsening in symptoms due to vistibular schwannomas. Of 328 consecutive cases of unilateral vesitibular schwannoma, there was no significant difference in the sex ratio or size. There now appears to be little evidence for a female hormonal effect on vestibular schwannomas. However, females with type 2 neurofibromatosis have significantly more meningfiomas.
Objective measurement of the benefit of walking sticks in peripheral vestibular balance disorders, using the Sway Weigh balance platform
Authors: Nandapalan V. , Smith C. A. , Jones A. S. , Lesser T. H. J.
Published: November 2007

Following a lesion in the vestibylar system visual, proprioceptive and residual vestibular information is integrated by the brain, to enable a patient ot attain equilibrium. The basis of vestibular rehabilitation is to encourage these adaptive and compensatory mechanisms. Another form of rehabilitation is to provide some form of mechanical aid, and walking sticks are often used for this purpose in patients with balance disorders.

There are no reported studies objectively assessing the use of walking sticks in patients with balance disorders. In this study we used the Sway Weigh balance patform (Raymar) to determine the efficacy of a walking stick in 25 patients with peripheral vistibular balance disorders. Patience were tested with their eyes opened and eyes closed whilst they were standing on a flat surface and on an air-filled bed (to alter limb proprioeption) on the Sway Weigh balance platform. All the tests were carried out with, and without, a walking stick. The results demonstrate that a walking stick significantly reduces lateral body sway in patients with peripheral vestibular balance disorders.
The value of radiological investigations in pre-endoscopic assessment of children with stridor
Authors: Tostevin P. M. J. , de Bruyn R. , Hosni A. , Evans J. N. G.
Published: November 2007

The differential diagnosis of stridor in an infant depends on a careful history and examination, followed by radiological and endoscopic investigations. Currently a chest, lateral neck and antero-posterior, high kilovolt (Cincinnatti) view radiographs in association with a diagnostic barium swallow are performed prior to the definitive diagnostic procedure of microlaryngobronchoscopy.

Our impression was that some of the routinely ordered radiological investigations were of limited value in the differential diagnosis. We undertook a retrospective audit study to determine the value of radiological investigations in the pre-endoscopic assessment of infants with stridor. The radiological and endoscopic information of 100 infants presenting over the three-year period 1991–1993 at Great Ormond Street Hospital, London (a tertiary referral centre) was collected.

It was found that only five out of 65 barium swallow investigations performed had consistent positive findings at diagnostic microlaryngobronchoscopy. The lateral neck and Cincinnatti views identified many of the more gross pathologies of the larynx and trachea e.g. the space occupying lesions, which occur infrequently. The more common diseases e.g. laryngomalacia or subglottic stenosis are rarely identified radiologically.

Our results confirmed that radiology had a limited screening role and that in a child presenting with stridor the initial radiological assessment should be a chest radiograph with further imaging and a barium swallow only if an abnormality is found at microlaryngobronchoscopy.
Plasma cell granuloma of the supraglottic larynx
Authors: Zbären Peter , Läng Hubert , Beer Karl , Becker Minerva
Published: November 2007

The occurrence of plasma cell granuloma of the larynx appears to be unusual. Review of the literature revealed only two previously reported cases. We present an additional case of plasma cell granuloma of the larynx. The diagnosis was made by histological and immunohistochemical examinations. The tumour was successfully treated by radiation therapy.
Unusual inflamed thyroglossal cyst
Authors: Zidar Nina , Gale Nina , Podboj Jernej
Published: November 2007

The authors report a case of an unusual inflammatory reaction in a thyroglossal cyst. It consisted of broad papillary intraluminal projections covered by histiocytes and occasional multinucleate giant cells. This benign process should not be confused with a true papillary neoplasm, a rare complication of a thyroglossal cyst.
Endoscopic anatomy of the sphenoid sinus and sella turcica
Authors: Sethi Dharambir S. , Stanley Ralph E. , Pillay Prem Kumar
Published: November 2007

An endoscopic study of the sphenoid sinus was carried out, on 30 cadavers, to understand the important anatomical relationships of the sphenoid sinus, and the sella turcica. The aim was to study the endoscopic anatomy and the variants, and to determine if endoscopic instrumentation and techniques, could play a beneficial role in endoscopic management of sellar lesions.

The results of this study are discussed, with particular reference to the important surgical anatomical features of the sphenoid sinus. A surgical technique for the endoscopic transsphenoid approach to the sella turcica was developed.

Anatomical variants can be identified endoscopically, and endoscopic techniques have the advantages of improved visualization, magnification, angled vision, and a panoramic perspective of the intrasphenoid anatomy, compared to currently employed methods of pituitary/sellar surgery, using the operating microscope/.
A combined approach excision of branchial fistula
Authors: De P. R. , Mikhail T.
Published: November 2007

Second branchial cleft and pouch anomalies are by far the commonest of the branchial anomalies. In most cases, however, there is a unilateral cleft sinus. A complete fistula with external and internal openings is rare. We present a case with a complete branchial fistula in which the tract was followed from the neck to the tonsillar fossa using a combined approach.
Schwannoma of the external auditory canal
Authors: Harcourt J. P. , Tungekar M. F.
Published: November 2007

Solitary schwannomas are relatively rare. There has been only one previously reported case, in the English literature, of a schwannoma arising in the external auditory canal. We present a case which was managed by local excision and was unassociated with cochlear or retrocochlear pathology.
Localization of active otosclerotic foci by tympano-cochlear scintigraphy (TCS) using correlative imaging
Authors: Ross Uwe H. , Reinhard M. J. , A. Berlis
Published: November 2007

High-resolution, tympano-cochlear scintigraphy (TCS) is a useful tool for visualizing changes in labyrinthine bone metabolism in active otosclerosisin vivo. But until now, the activity patterns have mostly been rather imprecisely ascribed to the labyrinthine structures; more exactly by means of high- resolution CT (HR-CT). Experimental studies on TCS using a human temporal bone model revealed that correlative imaging of X-ray photographs and the scintigrams or superimposition with masks of the temporal bone drawn from the X-rays can facilitate the localization of small foci of about 0.5–1 mm.

Clinical applications of the visualization technique, combining functional with structural images, confirmed the benefit of this method, improving the accuracy in detection and localization of focal activity enrichment of the petrous bone in cases of active otosclerosis by means of TCS.
Flexible endoscopic tracheo-oesophageal puncture under local anaesthetic
Authors: Hong Ga Sze , John A. B. , Theobald David , Soo Khee Chee
Published: November 2007

Blom—Singer valve prosthesis is an increasingly popular technique for voice rehabilitation in alaryngeal patients. Although primary voice puncture is being practised, the creation of the tracheo-oesophageal fistula is performed in the majority of patients as a secondary procedure.

We describe a technique of secondary tracheo-oesophageal puncture using the flexible endoscope which can be performed under local anaesthetic and sedation. The technique overcomes the difficulty of passing a rigid oesophagoscope or forceps to the level of the tracheostome in a scarred and irradiated neck. The new technique also obviates the need for general anaesthesia.

We have successfully used the technique in three patients.
Osteogenic sarcoma of sphenoid bone: an extended lateral skull base approach
Authors: Hazarika P. , Nayak D. R. , Sahota J. S. , Rao D. , Kapadia R. D.
Published: November 2007

Osteogenic sarcoma involving the sphenoid bone is an extremely rare condition. The rarity of the disease and the close proximity of the sphenoid bone to the various important intracranial structures poses a real challenge in diagnosis and surgical management of these lesions. An extended lateral craniofacial resection by a multidisciplinary approach was carried out in one such case to attempt en bloc resection. This case is presented and also a review of the relevant literature.
Right vocal fold paralysis as a result of central venous catheterization
Authors: Martin-Hirsch D. P. , Newbegin C. J. R.
Published: November 2007

Invasive peri- and post-operative monitoring is being increasingly utilized, and a corresponding increase of concomitant complications are becoming apparent.

Two cases of complete right vocal fold paralysis are reported as a possible complication of right central venous catheterization. The underlying aetiology of this complication is presumed to be either direct trauma at the time of introduction of the central venous catheter, or by thrombosis and fibrosis around the recurrent laryngeal or vagus nerve. It is suggested that multiple attempts at cannulation and leaving the central line in situ for long periods increases the risk of this complication.

When the integrity of the left recurrent laryngeal nerve or vagus is jeopardized or must be sacrificed during surgery, it is suggested that ipsilateral central lines are inserted to minimize the risk of bilateral vocal fold paralysis.

Cases of vocal fold paralysis secondary to central line insertion should be followed expectantly and surgical intervention only be considered after 12 months review.
Acute sjögren-like syndrome as the first manifestation of a generalized cmv infection in a patient with aids
Authors: Van Vooren J. P. , Farber C. M. , Daelemans P. , Delforge M. L. , Liesnard C.
Published: November 2007

We report the first case of generalized cytomegalovirus (CMV) disease in an AIDS patient who presented with an acute Sjogren-like syndrome and was diagnosed by parotid gland biopsy. All symptoms disappeared after a few days of intravenous ganciclovir therapy.
Measurement of small tissue volumes using Holden's apparatus
Authors: Mason J. D. T. , Hehar S. S. , Holden M. , Jones N. S.
Published: November 2007

A reproducible method for the estimation of volumes of small tissue samples was needed to allow comparison of the biological activity of tissue explants and to relate symptom improvement to procedures such as adenoidectomy or polypectomy. Holdens apparatus, which utilizes fluid displacement between two chambers, was compared to displacement in a 20 ml syringe. Two observers made four readings each on 20 tissue samples (range 0.37 to 4.70 ml) using both methods for comparison.

A two-way analysis of variance for replicated data gave an F ratio of 0.6885 (df 19; p>0.8) for Holden's apparatus, and an F ratio of 1.4307 (df 19; p>0.1) for the 20 ml syringe. The standard error of the mean for repeated readings on the same sample by an observer was 0.001 ml for Holden's apparatus and 0.014 ml for the syringe method. For accurate estimation of small tissue volumes within 0.01 ml we recommend Holden's apparatus.
Removal of superglue from the external ear using acetone: case report and literature review
Authors: Abadir Wedad F. , Nakhla Venice , Chong Philomina
Published: November 2007

The ability of superglue preparations (cyanoacrylate) to bond instantly to skin as well as inanimate objects presents a special problem when instilled into the external ear canal. We present two cases of patients who had it successfully removed under the microscope with the help of acetone BP to debond it from the skin, without any damage to the meatus or the tympanic membrane. The third patient had the superglue removed without the help of acetone but sustained damage to the tympanic membrane. A literature review of similar cases is included.
Survival times of Provox™ valves
Authors: de Carpentier J. P. , Ryder W. D. J. , Saeed S. R. , Woolford T. J.
Published: November 2007

This study was performed to assess the survival times of the Provox™ valve in the Manchester area. Thirty-nine patients from four hospitals, representing 81 valve failures, were studied. The effects of the timing of the tracheo-oesophageal puncture, previous radiotherapy, and the presence and timing of cricopharyngeal myotomy on valve life were analysed. Regression analysis using an extension of the Cox model to allow strata showed that the lifetime of the first valve only is adversely affected by previous radiotherapy. The other covariates do not have a statistically significant effect on valve survival. The median valve survival is 4.5 months, (range one to 12 months). A small percentage of valve users with particularly frequent valve failures may require additional support and prolonged anti-fungal therapy.
Should nasopharyngeal biopsy be mandatory in adult unilateral glue ear?
Authors: Lee W. C. , Weiner G. M. , Campbell J. B.
Published: November 2007

Unilateral secretory otitis media is a recognized presenting feature of nasopharyngeal neoplasia. In the two cases presented, biopsy from the nasopharynx revealed an unsuspected underlying adenocarcinoma. The need to biopsy the normal looking post-nasal space is highlighted.
Unilateral vocal fold paralysis: a review of the current methods of surgical rehabilitation
Authors: Harries Meredydd Lloyd
Published: November 2007

Absteract

This review article discusses the surgical treatment of patients suffering from unilateral vocal fold paralysis who have already been assessed and considered appropriate candidates for surgery. There are currently three main methods of surgical rehabilitation; injection medialisation; laryngeal framework surgery; re-innervation procedures.
Laser-assisted uvulopalatoplasty: an assessment of a technique
Authors: Wareing Michael , Mitchell David
Published: November 2007

The Kamami technique of laser-assisted uvulopalatoplasty has recently been introduced into British practice as an office-based multistage procedure for the treatment of snoring and, in certain cases, for obstructive sleep apnoea. We have treated 50 patients with simple snoring, with a minimum follow-up of six months. Six-month telephone interview follow-up has assessed partner and patient satisfaction, as well as willingness to undergo the procedure again. We have found the procedure easy to perform with no serious intra-operative complications. Thirty-four (68 per cent) of patients' partners have been definitely satisfied with the results of treatment, with 11 (22 per cent) definitely unsatisfied. However, only 25 of these 34 satisfied patients (76 per cent) would be prepared to undergo the treatment again with postoperative pain and discomfort cited as the reason in those who would not. The failure rate doubled between one and six months post-operatively. There have been no serious complications but a 40 per cent minor side-effect rate is noted. These results are discussed in the context of previously reported results, with consideration of future strategies to improve outcome.
DNA indices of primary and recurrent squamous cell carcinomas of the tongue and tonsil using image cytometry
Authors: Sarker S. K. , Tierney P. , Patel K. S. , Fisher C. , Coleman D. V.
Published: November 2007

Ploidy status of squamous cell carcinomas of the head and neck (SCCHN) from primary and recurrent tonsillar and tongue lesions has not been compared using image cytometry. We have measured and compared the DNA indices in 41 cases. There were 29 tongue SCCHN, 20/29 were primary and 9/29 were recurrent. Mean DNA index (DI) was 1.19 (range 0.70–1.81) and 1.28 (range 0.79–1.94) respectively. There were 12 tonsillar cases, 10/12 primary and two out of 12 recurrent. Mean DI was 0.84 (range 0.57–1.09) and 1.00 (range 0.98–1.02) respectively. Mean DNA indices of both primary carcinomas were lower than the mean DNA indices of the recurrent carcinomas. This difference between the two groups may be a reflection of their tumour biology. However, since our study is small no definite conclusions can be made at this stage. We aim in the future to evaluate the prognostic role of DNA indices of patients with paired primary and recurrent SCCHN. This may be of clinical value and improve the treatment modalities available to this group.
Predictive value of flow cytometric analysis in DNA contents in patients with locally advanced head and neck carcinoma
Authors: Wong Gene , Stidley Christine , Dressler Lynn , Castillo Michael , Crooks Lida , Bartow Susan
Published: November 2007

A restrospective study was performed on 61 eligible patients with stage III and IV (AJC/UICC Staging System) squamous carcinomas of the head and neck region who were treated with definitive radiotherapy with, or without, surgery. DNA contents were measured by flow cytometric analysis of archival paraffin blocks and were correlated with clinicopathological findings, tumour response and patient survival. Comparison of variables including treatment modality was performed for identification of significant prognostic factors. There were 28 diploid, 27 aneuploid tumours and the remaining six were questionable. All patients were followed-up for at least two years or until death.

Aneuploid tumours had a significantly higher S-phase fraction (percentage S-phase) (p<0.001). Neither ploidy nor percentage S-phase were found to have predictive value in tumour response or patient survival within the power of a sample size of 61. Twenty of the 27 (74 per cent) aneuploid tumours had a complete response (CR) whereas 19 out of 28 (68 per cent) diploid tumours achieved CR. Five-year survival by the Kaplan-Meier method was 33 per cent for both aneuploid and diploid tumours. However, nodal stage (N stage) was found to have significant predictive value in both tumour response and patient survival. The complete response for stage N0 patients was 96 per cent, N1 patients 61 per cent, N2 patients 60 per cent and 43 per cent for N3 patients (p<0.002). Similarly, the five year survival for the N0 and N3 groups of patients was 53 per cent and 29 per cent respectively (p<0.05).
Schwannoma of the larynx: a case report
Authors: Ingels K. , Vermeersch H. , Verhoye C. , De Potter C.
Published: November 2007

A case of schwannoma of the larynx is presented. Clinical findings are presented together with magnetic resonance images. The literature is reviewed. The surgical technique is discussed and the histology is described.
A double-blind comparative study of ofloxacin otic drops versus neomycin-polymyxin B-hydrocortisone otic drops in the medical treatment of chronic suppurative otitis media
Authors: Tong Michael C. F. , Woo John K. S. , Andrew van Hasselt C.
Published: November 2007

Active chronic suppurative otitis media poses a management problem when patients are being considered for surgical treatment. Topical antibiotics have demonstrated varying degrees of success in the management of discharging ears. The introduction of quinolones has revived interest in these topical agents. This double-blind study compares two antibiotics, namely ofloxacin and neomycin-polymyxin B, with similar in vitro sensitivities to Gram positive and Gram negative organisms. Fifty-two patients were selected randomly and the results show that ofloxacin eardrops have marginal benefits in symptomatic improvement (89 per cent versus 79 per cent, p = 0.27) and bacterial eradication (81 per cent versus 75 per cent, p = 0.81) in active chronic suppurative otitis media. Significantly fewer patients (seven per cent versus 29 per cent, p = 0.04) in the ofloxacin group had active disease at the end of the two-week treatment. We recommend the use of ofloxacin eardrops in managing active chronic suppurative otitis media since it has high clinical efficacy, contains no steroid component and has no demonstrated risk of ototoxicity.
Speech assessment of patients using three types of indwelling tracheo-oesophageal voice prostheses
Authors: Heaton J. M. , Sanderson D. , Dunsmore I. R. , Parker A. J.
Published: November 2007

A multidisciplinary prospective study compared speech acceptability between three types of indwelling tracheo-oesophageal voice prostheses. Twenty male laryngectomees took part over five years, using 42 prostheses. Speech was assessed on a discrete scale by trained and untrained personnel. The majority scored in the mid-range for each assessor. The kappa coefficient was used to test similarity between assessors, and for all pairings agreement was significant (p<0.05). The speech and language therapist tended to give higher scores and the patient lower. A relationship was found between patients' ages categorized by decade and the surgeon's score alone. This relationship held for Groningen high resistance and Provox prostheses individually too (p<0.05). The untrained assessed similarly to the professionals – humans are all voice listeners. The analysis suggests surgeons find tracheo-oesophageal speech in older patients better than in younger ones; or make more allowances for the elderly. There was a trend for Provox prostheses to produce the best scores.
Value of lymph node biopsy in the diagnosis of acquired toxoplasmosis
Authors: Tuzuner Nukhet , Doǧusoy Gülen , Demirkesen Cuyan , Ozkana Ferda , Altas Kemal
Published: November 2007

Toxoplasmic lymphadenitis generally involves a solitary lymph node in the head and neck regions, without systemic symptoms. In order to determine the frequency of toxoplasmic lymphadenitis, we reviewed the histological sections of 731 consecutive patients with reactive lymph node hyperplasia. Amongst 731 patients, 112 had histological features supporting a diagnosis of toxoplasmic lymphadenitis (15.3 per cent). In 80 of these patients (71 per cent), either Indirect Haemaglutination test (IHA), in 37 cases, or the Enzyme-Linked Immunosorbent Assay (ELISA) for detecting toxoplasmic IgG or IgM antibodies, in 43 cases, were performed. In 76 out of 80 patients (95 per cent), histological features correlated well with serological studies. The IHA test was positive in 30 patients with a titre of 1/64 or higher. The IgG-ELISA test was positive in 11 whereas the IgM-ELISA test was positive in 28 patients. These results provide further evidence of the distinctive nature of the histological changes in toxoplasmic lymphadenitis, which should enable the clinician to make a confident diagnosis of acute acquired toxoplasmosis.
An improvement in hearing sensitivity following hearing-aid fitting in a child with an apparent sensorineural hearing impairment
Authors: Munro K. J. , Cafarelli Dees D.
Published: November 2007

This case describes an apparent improvement in hearing sensitivity in a young girl over a period of 12 months, after she was fitted with binaural hearing-aids. Discrepancies between objective and subjective test results are highlighted. Even if the underlying reason for the conflicting test results was due to poor listening skills or test error, this child behaved like a hearing-impaired child and her performance improved after hearing-aid use. The case also illustrates the application of earphone testing from six months of age. The importance of closely monitoring all children who are fitted with hearing-aids is highlighted.
Post-tonsillectomy pain with selective diathermy haemostasis
Authors: Tay H. L.
Published: November 2007

A prospective randomized study was carried out to assess the post-tonsillectomy morbidity of the selective diathermy technique as opposed to the ligation technique. One hundred and five patients had one tonsillar fossa haemostasis secured by unipolar diathermy and the opposite side by ligation technique. There was significantly less pharyngeal pain on the diathermy side in the first post-operative day. However, there was no significant difference between the two sides, both in pharyngeal discomfort and otalgia for the rest of the post-operative period. There was no difference in the incidence of haemorrhage between the two techniques.
Meatoplasty in Marfan syndrome
Authors: Fenton J. E. , Fagan P. A.
Published: November 2007

Marfan syndrome (MS) is a rare connective tissue disorder, uncommon in otological practice. Ear surgery in MS has not been previously reported. An identical complication of meatoplasty developed in two patients with MS after modified radical mastoidectomy and meatoplasty for chronic otitis media. Both cases presented postoperatively with an external auditory canal narrowing when the walls of the initial meatoplasty in both cases collapsed. It is proposed that this occurred because of the inherent structural abnormality of the cartilage in Marfan syndrome. A simple technique of revision meatoplasty is described that resulted in successful management of these cases.
Parapharyngeal vagal neurilemmoma extending to the jugular foramen
Authors: Yumoto Eiji , Nakamura Koshiro , Mori Toshihiro , Yanagihara Naoaki
Published: November 2007

A large vagal neurilemmoma in a 33-year-old man is reported. He complained of slowly progressive palsy of the tongue on the left side. Weakness of soft palate movement was also noted. Magnetic resonance imaging (MRI) revealed a tumour in the left parapharyngeal space with partial extension to the posterior cranial fossa through the jugular foramen. Carotid angiography revealed avascularity of the tumour and anterior shift of the left internal carotid artery. The venous phase showed no blood flow in the internal jugular vein. The tumour was successfully extirpated via a transmandibular transpterygoid approach. Although vagus nerve dysfunction was not observed pre-operatively, the tumour was identified as a neurilemmoma arising from the vagus nerve. The surgical approach should be selected according to the lesion in individual patients. Since neurilemmoma is benign in nature, minimal post-operative sequelae should be expected.
Metastatic papillary thyroid carcinoma presenting as a typical branchial cyst
Authors: McDermott I. D. , Watters G. W. R.
Published: November 2007

Two cases of papillary thyroid carcinoma presenting as a cystic lateral neck mass are reported. This tumour characteristically presents in patients under 40-years-old and in the presence of an occult primary tumour may mimic a branchial cyst. In such cases simple aspiration of the cyst will produce a chocolate-brown serous fluid which excludes the diagnosis of a branchial cyst and is characteristic of papillary thyroid carcinoma. Cytological examination of the fluid has a high degree of sensitivity and specificity in the diagnosis of thyroid malignancy and should avoid delay in diagnosis and unneccessary surgical exploration prior to definitive treatment.
Laryngeal paraganglioma. A review and report of a single case
Authors: Özünlü Adnan , Dündar Ahmet , Satar Bülent , Günhan Ömer
Published: November 2007

Laryngeal paraganglioma originates in the neural crest cells in the laryngeal paraganglia. Two distinct types may be cited on the basis of clinical features, but biopsy is essential for diagnosis. By light microscopy, the Zellballen pattern appears pathognomonic. The treatment consists of surgical excision.

In this article, due to the rareness of the tumour, one case of laryngeal paraganglioma is presented. The general knowledge and the available literature are reviewed. The difficulties in the differential diagnosis are stressed and treatment principles are discussed.
Severe acute pancreatitis as a first symptom of primary hyperparathyroid adenoma: a case report
Authors: Shimizu Hironori , Kodama Akira
Published: November 2007

We present a case of severe acute pancreatitis in a 14-year-old boy that may have been caused by hyperparathyroidism. The clue to finding the parathyroid adenoma was the hypercalcaemia. Although the patient did have acute pancreatitis, no therapy had been effective until the discovery of the parathyroid adenoma. After the excision of the parathyroid adenoma, the function of the pancreas and serum calcium returned to normal. This result suggests a certain cause and effect relationship between hyperparathyroidism and acute pancreatitis.
Cryoglobulinaemia and septal perforation: a rare but logical cause
Authors: Smith I. , Smith M. , Mathias D. , Wallis J.
Published: November 2007

A case of nasal septal perforation secondary to cryoglobulinaemia is reported. In this instance the cryoglobulinaemia was due to Waldenstrom's macroglobulinaemia (lymphoplasmocytic lymphoma with IgM paraprotein) in which the paraprotein was a potent cryoglobulin.
Abductor vocal fold palsy in the Shy-Drager syndrome presenting with snoring and sleep apnoea
Authors: McBrien Fergus , Spraggs Paul D. R. , Harcourt John P. , Croft Charles B.
Published: November 2007

The case of an elderly male with Shy-Drager syndrome is presented. His presentation to the Sleep Clinic for assessment of snoring illustrates bilateral abductor vocal fold palsy as a rare presentation of the syndrome. This case emphasizes the need for thorough investigation of all patients with sleep-related breathing disorders with video and sound recordings prior to anaesthesia and surgery.
Spontaneous closure of acquired tracheo-oesophageal fistula
Authors: Senthilkumaran G. , Crankson S. , Yousef M.
Published: November 2007

Acquired tracheo-oesophageal fistulae are uncommon in the paediatric age group. A case of such a fistula secondary to impaction of a button battery is reported below. Prompt management is essential to reduce morbidity and mortality in these cases.
Wegener's granulomatosis presenting as major salivary gland enlargement
Authors: Ah-See K. W. , McLaren K. , Maran A. G. D.
Published: November 2007

Salivary gland involvement is rare in Wegener's granulomatosis. We report the first case of widespread major salivary gland enlargement as part of the presentation of this disease. A review of the few reported cases in the literature suggests that salivary gland involvement may be associated with a limited form of the disease and an improved prognosis. The anti-neutrophil cytoplasmic antibody (c-ANCA) assay remains the gold standard of diagnosis but care should be exercised in the interpretation of results. This patient responded well to current immunosuppressive therapy.
Reconstruction with composite nasal septal cartilage and auricular cartilage in extended partial laryngectomy
Authors: Şekercioğlu Nihat , Cansiz Harun , Güneş Muammer
Published: November 2007

Several reconstruction techniques have been employed following partial laryngectomy in order to improve laryngeal function. We report 12 cases in which composite nasal septal cartilage and auricular cartilage were used. We decannulated the patients in an average of 19 days. Following the reconstruction we obtained a satisfactory phonatory function and swallowing. Six patients completed a follow-up period of three years without presenting any recurrences or mortality. Our experience with reconstruction using composite nasal septal and auricular cartilage following partial laryngectomy proved effective.
An unusual cause of facial pain
Authors: de Carpentier J. P. , Flanagan P. , Hargreaves S. P. , Timms M. S.
Published: November 2007

A case of chronic facial pain and headache is presented. This was found to be due to two pieces of windscreen-glass lodged in the superior meatus of the patient's nose since a road-traffic-accident 14 years earlier. Despite being reported as normal, review of previous X-rays of her sinuses showed that the glass was visible. The importance of carefully assessing the intranasal area on sinus-views is illustrated.
Intestinal-type sinonasal adenocarcinoma: a sporadic case
Authors: Böör Andrej , Jurkovič Ivan , Dudríková Katarína , Kavečanský Vojtech , Friedmann Imrich
Published: November 2007

A sporadic case of the intestinal-type sinonasal adenocarcinoma is described. The patient was a comparatively young 33-year-old woman employed as a senior biochemical scientific technologist for several years. The light microscopical pattern was that of a papillary-tubular adenocarcinoma with areas of more solid mucinous elements in the deeper parts of the neoplasm. The neoplasm had invaded the nasal septum and reached the left orbit invading the left ethmoidal sinus. The glands were lined by columnar cells with elongated spindle-shaped nuclei and the cells expressed cytokeratin, carcinoembryonic antigen (CEA), Chromogranin A, gastrin and serotonin but not neurone-specific enolase (NSE) nor synaptophysin. Neurosecretory granules were present. There was no history of wood dust inhalation and her exposure to chemicals is of some interest but had probably little or no role in the causation of this neoplasm.
Treatment of rhinophyma with carbon dioxide laser
Authors: Simo R. , Sharma V. L.
Published: November 2007

Rhinophyma is a slowly progressive, disfiguring disorder of the nose which represents the end stage of acne rosacea. The cosmetic deformity is often the reason for patients to seek medical attention. Over the years many treatment modalities, including dermabrasion, electrocautery, excision and grafting, decortication and cryosurgery amongst others, have been described to treat this condition, but none of them are very satisfactory. Special concern about the droplet dispersion of blood in dermabrasion have made this method less acceptable as it poses a potential risk to health workers.

We describe a technique in which this proliferative disorder can be treated, using carbon dioxide laser excision and vaporization. This method provides a very dry surgical field which allows the sculpting of the hypertrophic areas to be very effective, giving a very satisfactory cosmetic result.
Middle ear infection and sixth nerve palsy
Authors: Homer J. J. , Johnson I. J. M. , Jones N. S.
Published: November 2007

Three cases of patients with acute middle ear infections complicated by a sixth nerve palsy are described. The possible causes of sixth nerve palsy in such cases are discussed. We propose that where there is a sixth nerve palsy without petrositis and without raised intracranial pressure, it can arise as a result of spreading phlebitis along the inferior petrosal sinus from the lateral sinus.
Torsion of the palatine tonsil
Authors: Prikas Konstantinos G. , Bingham Brian J. G.
Published: November 2007

Torsion of a pedunculated part of the palatine tonsil is extremely rare. This paper discusses the clinical presentation, differential diagnosis, treatment of such a case and reviews the existing literature.
Occult pharyngeal perforation secondary to ‘pencil injury’
Authors: Smyth David A. , Fenton John , Timon Conrad , McShane Donald P.
Published: November 2007

Palatopharyngeal injuries due to impaction of rigid objects held in the mouth are common. Most are essentially innocuous injuries requiring no specific treatment. However, there is the potential for perforation of the pharyngeal wall with the subsequent development of serious infection such as retropharyngeal abscess or mediastinitis. This possibility is more likely to be suspected in the presence of a visible laceration or puncture wound at the site of impact in the mouth or pharynx. We report three cases in which occult pharyngeal perforation occurred without any clinical signs of breech of the pharyngeal wall. In all cases a lateral soft tissue neck X-ray was diagnostic of perforation, showing the presence of retropharyngeal air. We, therefore, advocate the routine performance of soft tissue neck X-rays in all patients who present with a history of falling on a rigid object held in the mouth.
Do antral washouts have a place in the current management of chronic sinusitis?
Authors: Pang Y. T. , Willatt D. J.
Published: November 2007

Antral washouts have been widely used in the management of chronic sinusitis. With the advent of modern antibiotics and powerful topical nasal steroids, we sought to establish if a role remains for this procedure.

One hundred and fourteen patients with chronic sinusitis were randomised into two groups. Patients in Group A received antral washouts followed by antibiotics and topical nasal steroids. Patients in the Group B received antibiotics and topical nasal steroids alone. In each group 51.6 percent and 50 per cent of patients respectively improved with treatment. The outcome of treatment is also not influenced by endoscopic abnormality. The difference was not statistically significant (p= 0.86). The study indicates that half of patients with chronic sinusitis will improve with medical treatment but the addition of antral washout confers no additional benefits.
Hydatid cyst of the pterygopalatine-infratemporal fossa
Authors: Gangopadhyay K. , Abuzeid M. O. , Kfoury H.
Published: November 2007

Hydatid disease is caused by the parasitic tapewormEchinococcus. This parasite in larval stage can thrive in many parts of the body, most commonly in the liver and the lung. Hydatid disease in the head and neck region is rare. An unusual location for hydatid disease in the pterygopalatine fossa-infratemporal fossa is presented. The patient did not have evidence of any other cyst on a ten-year follow-up.