bluuebunny/crossref_metadata_2025 huggingface dataset:
Accessory nerve schwannoma extending extracranially to the second cervical level of vertebra
Authors: Nakashima T. , Tomita K. , Uemura Takuya , Matsushima Toshio , Fukui Masashi
Published: November 2007

We described a 67-year-old man who had a right jugular foramen tumour expanding extracranially to the level of C2 cervical body. Paralysis of the glossopharyngeal, vagal, accessory, hypoglossal nerves and sensorineural hearing disturbance were found. The tumour originated from the accessory nerve and the histological examination revealed it was schwannoma. Accessory nerve as an origin of the jugular foramen neurinoma and its pre-operative neurological signs are reviewed.
Aetiology of bilateral sensorineural deafness in children
Authors: Das V. K.
Published: November 2007

The study was carried out in children born during the four year period 1981–1984 in the Greater Manchester County. The children were investigated for possible congenital infections. Perinatal assessment was carried out for adverse aetiological factors. Family histories were obtained and parents and siblings were examined for any hearing impairment. A total of 164 cases were investigated. Various aetiological groups were formed which showed the following distribution: cause unknown 36.5 per cent; genetic group 20.1 per cent; adverse perinatal factors 14.6 per cent; congenital infections 9.8 per cent; meningitis 6.1 per cent; chromosomal abnormalities 3.7 per cent; syndromal group 3.7 per cent; and miscellaneous 5.5 per cent. The findings are discussed in the light of previous studies.
Grommets and cholesteatoma in children
Authors: Herdman R. , Wright J. L. W.
Published: November 2007

Cholesteatoma in children may be a sequel to chronic exudative otitis media with tympanic membrane retraction but he the role of grommets in the possible facilitation of squamous epithelial invasion into the middle ear is not yet clear. A retrospective study was made of the history and prior treatment in 25 children who underwent mastoidectomy for cholesteatoma at St. Mary's Hospital between 1975 and 1986. Thirteen patients had undergone previous middle ear aeration procedures which included myringotomy, cortical mastoidectomy and grommets. There was no difference in the site or severity of cholesteatoma in the operated and non-operated cases. Of the seven patients with a history of multiple grommets three had primarily attic, and three had primarily mesotympanic disease. The latter had greater ossicular erosion. One patient with an intact tympanic membrane had grommet insertion subsequently developed a cholesteatoma. While cholesteatoma due directly to the presence of grommets is rare, it appears that children who require multiple grommet insertions constitute a high risk group and should be very closely monitored.
Down's syndrome with lingual tonsil hypertrophy producing sleep apnoea
Authors: Phillips D. E. , Rogers J. H.
Published: November 2007

A 12-year-old girl is presented with Down's syndrome and lingual tonsillitis causing sleep apnoea. In order to overcome her sleep apnoea she adopted a functional sleeping posture. The sleep apnoea was successfully treated by a single staged lingual tonsillectomy without preliminary tracheostomy. A return to a normal sleeping posture occurred spontaneously in the early post-operative period.
Toothbrush: an unusual foreign body in ENT practice
Authors: Shirali G. N. , Savant R. A. , Uppal P. K. , Bhargava K. B.
Published: November 2007

The toothbrush is an unusual foreign body in ENT practice. Three cases of toothbrushes are presented.
Local iatrogenic complications in nasopharyngeal rhinoscleroma
Authors: Dawlatly E. E. , Anim J. T. , Baraka M. E.
Published: November 2007

The possible role of surgical manipulation in inducing local spread and cicatricial complications in rhinoscleroma is illustrated by the three cases discussed in this paper. This is especially so where is occasional presentation as polypoid lesions of the lower respiratory tract may mimic other more sinister lesions and lead to unwarranted invasive procedures by the unsuspecting clinician. The infective nature of the lesions must be appreciated and confirmed microbiologically for appropriate drug treatment to be used. The benefits of minimal surgical intervention are illustrated in the third case.
Induction cytotoxic chemotherapy: The significance of apparent complete clinical regression after using the Price Hill Schedule A protocol for squamous carcinoma of the head and neck
Authors: Shaw H. J.
Published: November 2007

A small group of 46 previously untreated patients out of about 260 in all who have received Price Hill schedule A cytotoxic chemotherapy, achieved apparent complete clinical regression (ACCR) of their disease before local treatment. Forty patients were classified T3 or T4, over half having clinically positive nodes at the start of treatment.

A determine survival rate of 70 per cent disease free at three years was obtained and 74 per cent achieved quality of all symptoms. Two patients declined local treatment and survived three years disease free after chemotherapy alone. No recurrence has occurred to date in seven patients achieving apparent complete histological regression (ACHAR) in their surgical specimens.

Although ACCR does not automatically improve prognosis it is likely that it does enhance the complete remission rate, especially for those also achieving ACHR.

Benefits to patients obtaining ACCR with this minimally toxic chemotherapy schedule and listed.
Odontogenic keratocyst involving the maxillary antrum
Authors: Shenoy P. , Paulose K. O. , Al Khalifa S. , Sharma R. K.
Published: November 2007

An unusual case of odontogenic keratocyst arising from the maxilla, involving the maxillary anturm has been reported. Presence of an ectopic canine tooth under the orbital floor was a noticeable feature of this case. The clinical presentation, radiological, and histological aspects and treatment have been reviewed.
Rhabdomyoma of the tongue
Authors: Boysen M. , Scott H. , Hovig T. , Wetteland J. , Kolbenstvedt A.
Published: November 2007

Adult rhabdomyoma is a benign neoplasm of skeletal muscle origin, which mainly occurs in the head and neck region. Because of its rarity the diagnosis may be missed, especially if cross-striations cannot be demonstrated by light microscopy. By applying supplementary diagnostic evaluation with immunohistochemistry and electron microscopy, the diagnosis is established. Positive staining with desmin unequivocally demonstrates that the tumour cells are derived from muscle tissue. The presence of myofibrils, Z-bands and numerous mitochondria by ultrastructural examination are characteristic features of this tumour.
Carcinoid tumour of the middle ear
Authors: Kodama H. , Takezawa H. , Suzuki T. , Kobayashi K. , Kataura A. , Wakabayashi J. , Satoh M.
Published: November 2007

Carcinoid tumours belong to the rarer neoplasms of the middle ear. In 1980, Murphy et al. described the first case of a carcinoid tumour of the middle ear. Only five cases could be traced in the literature. The light and electron microscope features of a primary atypical carcinoid tumour of the middle ear are presented and compared with those described in the literature. Primary carcinoid of the middle ear appears to be derived from the epithelial lining of the middle ear. Distant metastases have not been reported. The duration and nature of the symptoms are of little diagnostic value. An atypical carcinoid tumour in the left ear of a 33-year-old woman is described.
Primary cholesteatoma of the mastoid presenting as cervical abscess
Authors: El-Kholy A. A. , Cherry J. R.
Published: November 2007

Primary cholesteatoma has been described in a number of sites within the temporal bone. We report an unusual case of primary cholesteatoma, confined to the mastoid, presenting with a Bezold's abscess of the anterior cervical triangle, in an otherwise asymptomatic elderly man with normal hearing.
Temporal bone venous anomaly of surgical significance
Authors: Shotton J. C. , Ludman H. , Cox T.C.S.
Published: November 2007

Variability in the size of the dural sinuses and jugular bulb is not uncommon and usually manifests as a high jugular bulb encroaching upon the floor of the middle ear. A rarer entity is the superior and medial extension of the jugular bulb into the bone of the posterior wall of the internal auditory meatus. We report a case where this anomaly was encountered during acoustic neuroma surgery making exposure of the fundus of the internal auditory meatus technically impossible. The possibility of a communication with the superior petrosal sinus is discussed.
Tensa retraction cholesteatoma: treatment and long-term results
Authors: Lau T. , Tos M.
Published: November 2007

To obtain the best possible results of treatment of acquired cholesteatoma, we made a subdivision of cholesteatoma types into attic and pars tensa cholesteatomas, and subdivided the latter further into tensa retraction cholesteatoma and sinus cholesteatomas. Tensa retraction cholesteatoma is defined as arising from a retraction or perforation of the whole pars tensa, whereas sinus cholesteatoma is defined as arising from a retraction or perforation of the postero-superior part of the tensa. We present the long-term results obtained in tensa retraction cholesteatomas treated with one stage surgery from 1964 to 1980. Median observation time was 9 years, range 2 to 19 years. Sixty-one ears were treated without mastoidectomy, whereas 71 ears had canal wall-up mastoidectomy and 64 ears had canal wall-down mastoidectomy. The total recurrence rate was 13.3 per cent; 17 ears had residual cholesteatoma, and nine ears had recurrent cholesteatoma. The best results were obtained in ears with an intact ossicular chain where mastoidectomy was not performed. In 49 per cent of the cases, the cholesteatoma was confined to the tympanic cavity without reaching the aditus, antrum or mastoid process. About one-third to one-quarter of the ears had tympanoplasty only, with removal of the cholesteatoma through the ear canal.
Total parotidectomy—a routine treatment for parotid gland swellings?
Authors: Alajmo E. , Polli G. , De Meester W.
Published: November 2007

The results of 25 years of quasi-routine total parotidectomy performance are shown. At the Department of Otolaryngology of the University of Florence, 582 patients were treated as follows: on 527 occasions by total parotidectomy with facial never preservation; 24 occasions by lateral lobectomy; 27 occasions by total parotidectomy with removal of the whole facial nerve; four times by enucleo-resection of the disease. Benign tumours were 378; primary and metastatic malignant tumours—100; non tumoral lesions—104.

The benign tumours follow-up showed three recurrences only (two pleomorphic adenomas—one of them proved to be an adenoid-cystic carcinoma, and one monomorphic adenoma, which also proved to be an adenoid-cystic carcinoma), respectively 6, 6 and 8 years later. The malignant tumours were also treated by total parotidectomy with adequate management both of the facial nerve and the neck lymph nodes. The results thoroughly justify the nerve preservation, when preserved.
Haemangiopericytoma of the larynx
Authors: Bradley P. J. , Narula A. , Harvey L. , Holland I. , Morgan D.A. , MacLennan K.
Published: November 2007

Haemangiopericytoma is an uncommon vascular tumour which has rarely been recorded in the larynx. The diagnostic and histopathological difficulties are discussed. A total laryngectomy was performed because of the size and site of the tumour, the associated risk of local recurrence and the high metastatic rate.
Occasional stapes surgery—a Norwegian experience
Authors: Mair I. W. S.
Published: November 2007

The past history of, and current trend in, stapes surgery are reviewed, and experience from a personal series of 128 procedures over an 18 year period is presented. Results are frequently poorer than many surgeons and their patients anticipate, and more stringent pre-operative case selection and centralisation of surgical activity would appear desirable. Amplification has become a more acceptable management alternative for some patient categories.
Cephalometric analysis in patients with obstructive sleep apnoea syndrome.
Authors: Lyberg T. , Krogstad O. , Djupesland G.
Published: November 2007

Facial skeletal morphology was studied by cephalometric analysis in 25 patients with obstructive sleep apnoea syndrome (OSAS) and ten controls. The hyoid bone was more inferiorly positioned in patients (at the level of cervical vertebrae C4-C6) than in controls (C3-C4 level). The height and length of the nasal cavity was normal, while the length of the bony nasopharynx was moderately reduced. The mandibular plane inclination was slightly larger in patients as was the anterior face height. Mandibular retrognathia was demonstrated in six patients (24 per cent), but the angles of maxillary and mandibular prognathism was within normal limits when the group was considered as a unity. Cephalometric analysis is highly recommended as a diagnostic aid in OSAS patients, especially when surgical intervention is considered.
Role of masseter crossover flap in oropharyngeal reconstruction
Authors: Tiwari R. M. , Snow G. B.
Published: November 2007

Oropharyngeal reconstruction especially after surgery for medially located lesions of moderate dimensions presents a challenge. The risk of using well vascularized, but insensitive tissues close to the airway has led to the development of several measures to overcome the difficulties involved. The transposition of masseter muscle which has been put forward in recent years provides successful primary closure with preservation of function.
Tongue metastasis from carcinoma of the rectum
Authors: Davidson N. G. P. , Wilson A.
Published: November 2007

A case report of a patient with carcinoma of the rectum with metastasis to the tongue clinically mimicking a primary tongue neoplasm is described. The patient presented with an ulcer in the tongue three years after undergoing an anterior resection for a Dukes C carcinoma of the rectum. Other asymptomatic metastatic lesions were discovered only after the histology report suggested that the tongue ulcer biopsy was metastatic in origin. Metastatic tumour to the tongue is extremely rare and often occurs at a late stage, when there is disseminated disease. We are not aware of any reported case of tongue metastasis from carcinoma of the rectum.
Fractured tracheostomy tube in the tracheobronchial tree
Authors: Ming C. C. , Ghani S. A.
Published: November 2007

A fractured tracheostomy tube is a rare complication; cases have been reported in the past, usually associated with prolonged usage in patients with chronic airway obstruction. We present here a fracture occurring in a new tube, and also describe a method for retrieving the tube from the tracheobronchial tree.
Histopathology of the soft parts in 50 patients with malignant external otitis
Authors: Bernheim J. , Sade J.
Published: November 2007

Reports concerning the lesions of the skin coverage of the external ear canal in malignant external otitis (M.E.O.) are very few. To evaluate this problem, we studied the skin lesions of 45 skin biopsies from 40 M.E.O. patients, 23 from regions covering the osseous part of the ear structure, seven from the cartilaginous part of the external canal and 15 from both parts. The epidermis was normal in nine, thickened in 16, with acanthotic thickening and pseudoepitheliomatous hyperplasia in 20. In the dermis the amount of collagen was normal, but it was infiltrated by the inflammatory process. Acute inflammation was observed in 16 biopsies, subacute in 23, chronic in six. A mixture of acute and chronic changes was present in 18 biopsies. No major abnormalities of the vasculature could be detected. The distinguishing pathological feature of M.E.O. concerns the typical topographic distribution of the inflammation in the osseous part of the external ear canal.
Sensorineural deafness associated with IgA nephropathy
Authors: Ataya N. L.
Published: November 2007

IgA nephropathy is an immune complex glomerulonephritis in which examination of the renal biopsy by immu-nofluorescence reveals IgA as the predominant antibody deposited in the glomerular mesangium (Clarkson et al., 1984). It was first described by Berger in 1969. The disease is more common in males and occurs generally during the second or third decades of life (Emancipator et al., 1985). A case of established IgA nephropathy with subsequent onset of sensorineural deafness is described.
Verrucous carcinoma of the maxillary antrum
Authors: Bacon M. P. , Chevretton E. B. , Slack R. W. T. , MacLeod T. I. F.
Published: November 2007

Verrucous carcinoma is a rare type of squamous cell carcinoma which is most often seen in the oral cavity and larynx. This paper describes a case of verrucous carcinoma of the maxillary antrum, a site in which this tumour has been described on only two previous occasions in the English language literature.
Mucoepidermoid carcinoma of the larynx
Authors: Cumberworth V. L. , Narula A. , MacLennan K. A. , Bradley P. J.
Published: November 2007

We report two cases of poorly differentiated mucoepidermoid carcinoma of the larynx which both remain well after surgical management. The first underwent a radical neck dissection for recurrent disease following radiotherapy and the second a total laryngectomy with elective post-operative radiotherapy.

Although well differentiated (‘low grade’) mucoepidermoid tumours of the larynx may respond to radiotherapy surgical management is generally recommended for all grades of such tumours especially for poorly differentiated (‘high grade’) tumours. Elective post-operative radiotherapy is often advocated for high grade tumours; radical neck dissection is generally undertaken only in the presence of lymphadenopathy, although elective radical neck dissection has been proposed for high grade tumours. These cases emphasise the value of comprehensive surgical management for this condition.

Such laryngeal tumours are difficult to diagnose histologically from biopsy and are often initially reported as squamous cell carcinoma.
Right vocal cord paralysis after internal jugular vein cannulation
Authors: Sim D. W. , Robertson M. R. I.
Published: November 2007

Neurological complications are rare after central venous cannulation. We report a case of right vocal cord paralysis after internal jugular vein cannulation. The mechanism of neural injury is discussed.
Nontraumatic intracavernous carotid aneurysm presenting with epistaxis
Authors: Chandy M. J.
Published: November 2007

A patient with an intracavernous carotid aneurysm usually presents with symptoms and signs of a space occupying lesion, producing one of a variety of types of cavernous sinus syndromes (Jefferson, 1938). Epistaxis is an unusual feature in these patients and when present is nearly always associated with a traumatic aneurysm (Mahmoud, 1979). There are only two reported cases of non-traumatic intracavernous carotid aneurysms presenting with epistaxis and diagnosed during the lifetime of the patient (Troupp, 1962; Labayle and Legent, 1964). The authors present a third such case. The importance of considering aneurysms in the differential diagnosis of epistaxis is emphasised. The radiological investigations and management of these patients is discussed.
Influence of the mode of preparation on the distortion and consistency of homologous costal cartilage implants
Authors: Adlington P. , Anscombe A. J. , Joshi J. B.
Published: November 2007

Nasal implants of autologous costal cartilage have an undesirable tendency to distortion. This tendency may be reduced by the process of devitalization, which occurs in the preparation of homologous costal cartilage for storage in a tissue bank. Anin vitrostudy has been undertaken, utilizing five common methods of cartilage preparation (cialit, ethyl alcohol, formalin, glutaraldehyde and irradiation) to determine whether there is any significant variation in the degree of distortion which occurred and any variation in cartilage consistency. We conclude that all of the methods evaluated would produce banked homologous costal cartilage with an equally low incidence of distortion but implants are less readily carved from cartilage stored in cialit.
Metastasis to the temporal bone, secondary to carcinoma of the bladder
Authors: Saldanha C. B. R. , Bennett J. D. C. , Evans J. N. G. , Pambakian H.
Published: November 2007

An 80-year-old man was seen in the clinic with a two month history of pain, bleeding and deafness in his left ear; accompanied by a left facial palsy. Six months earlier, anaplastic carcinoma of the bladder had been diagnosed and treated with radiotherapy. On examination there was a mass in his left external auditory canal and VII, VIII, IX and X left cranial nerve palsies. Histology of a biopsy was identical with his original bladder tumour. He received a course of palliative radiotherapy but died shortly after. Post-mortem demonstrated the left temporal bone metastasis extending into the middle and posterior cranial fossae. There was no evidence of residual bladder tumour, or other primary tumour. Temporal bone metastases are probably more common than generally thought. Presentations like this may become more common as cancer therapy improves, with patients surviving longer and presenting later with metastatic disease.
Attitudes to tympanometry
Authors: Stoney P. J. , Rogers J. H.
Published: November 2007

A postal questionnaire revealed the widest possible spectrum of opinion regarding tympanometry. The reasons are discussed.
Ophthalmic considerations in fronto-ethmoidal mucocoeles
Authors: Lund Valerie J. , Rolfe Muriel E.
Published: November 2007

The pre-and post-operative ophthalmic consequences of fronto-ethmoidal mucocoeles are considered in a prospective series of 22 patients. Proptosis, lateral and inferior displacement, diplopia and restriction of ocular mobility were the commonest presenting problems. Following external fronto-ethmoidectomy, proptosis and displacement resolved completely in the majority of patients. One third of patients experienced a transient exacerbation of diplopia but this resolved in most patients. Persistent diplopia occurred in seven patients and required medical correction in four and surgery in one. This was due in all cases to underaction of the superior oblique muscle and probably to backward displacement of the trochlea which may be avoided by careful surgical re-attachment.
Second primary tumour following retinoblastoma
Authors: Berridge D. C. , Hitchcock A. , Bradley P. J. , Kapila L.
Published: November 2007

Reported is a child who at the age of 18 months had presented with a left retinoblastoma. The lesion had involved the optic nerve (Stage IV), and was successfully treated by enucleation and radiotherapy. The radiation field did not include the mandible or the submandibular triangle. He was followed up until he left the area aged 11 years. He represented aged 12 years with a progressive swelling of the left submandibular gland. Histology of the surgically excised submandibular gland revealed a mucoepidermoid carcinoma of the submandibular gland. This case highlights the need for continual surveillance in survivors of retinoblastoma, as second primary tumours occur both within and outside of previous radiation fields. The clinical association between retinoblastoma and mucoepidermoid carcinoma of the submandibular gland has not been previously reported.
Atypical thyroglossal duct cyst
Authors: Cumberworth V. L. , Bradley P. J.
Published: November 2007

Thyroglossal duct cysts most frequently present in childhood as a painless midline swelling of the neck. Uncommonly, these embryonal remnant cysts present clinically in adult life. The majority of adults with thyroglossal duct cysts present with a swelling at the level of the thyrohyoid membrane. On rare occasions, a thyroglossal duct cyst can present with more sinister symptoms, such as hoarseness, dysphagia and dyspnoea. On these occasions, the pre-operative clinical and investigative diagnosis remains in doubt until histology is available.
Synchronous extra-parotid Warthin's tumour
Authors: Nishikawa H. , Kirkham N. , Hogbin B. M.
Published: November 2007

Warthin's tumour (also known as adenolymphoma or papillary cystadenoma lymphomatosum) is benign and accounts for 12 per cent of all neoplasms of the parotid gland. A case of extra-parotid Warthin's tumour occurring synchronously in a peri-parotid lymph node is described. This is not a metastatic phenomenon and occurs as a result of salivary gland inclusions of local lymph nodes during the embryological development of the parotid. Extra-parotid Warthin's tumour should be regarded as a benign incidental finding and the prognosis is excellent.
Contralateral auditory brainstem response abnormalities in acoustic neuroma
Authors: Moffat D. A. , Baguley D. M. , Hardy D. G. , Tsui Y. N.
Published: November 2007

Contralateral Auditory Brainstem Response (ABR) findings in a series of 79 patients with unilateral acoustic neuroma are presented. Sixty-four patients (81 per cent) had a normal contralateral ABR, thirteen (16.4 per cent) had latency abnormalities contralaterally and in two patients (206 per cent) no consistent responses could be recorded despite good hearing. Abnormalities in the contralateral ABR were analysed and five patients had abnormal III-V interwave intervals, in seven patients the I-III intervals were abnormal and in one patient, only the fifth wave was present and of abnormal latency. The tumour size was assessed by computed axial tomography (CT) and the relationship between tumour size and contralateral ABR findings established. Large tumours (>2.5 cm.) were associated with contralateral ABR abnormalities in 25.6 per cent of the patients, medium tumours (1.0-2.5 cm.) with ABR abnormalities in 14 per cent and there were no abnormalities in the small group (intracanalicular). The implications for interpretation of ABR recordings contralateral to an acoustic neuroma are discussed in relation to brainstem compression and its effect on the wave generator sites.
Clofazimin in the treatment of scleroma
Authors: Shehata M. A. , Salama A. M.
Published: November 2007

Scleroma is a chronic progressive granulomatous disease predominantly affecting the mucous membrane of the upper respiratory tract, endemic in temperate and tropical zone countries including Egypt. Many patients in early stages respond to medical treatment while others do not. In these patients an antileprotic agent Clofazimin (Lamprene®) was tried in 76 patients and the therapeutic results are very promising, especially for the early stages of the disease.
Traumatic middle ear lesions. Fracture of the malleus handle, aetiology, diagnosis and treatment
Authors: Pedersen C. Brahe
Published: November 2007

Traumatic middle ear lesions are quite common but only seldom mentioned in the literature; an isolated fracture of the handle of the malleus seems to be extremely rare. The appearance of two patients with an isolated fracture of the haddle of the malleus within one year might indicate that this type of lesion should be considered more frequently. The traumatic aetiology, symtoms, diagnosis and treatment of this lesion is described and is illustrated by two cases.
Total glossectomy: reconstruction and rehabilitation
Authors: Tiwari R. M. , Greven A. J. , Karim A. B. M. F. , Snow G. B.
Published: November 2007

Patients with carcinoma of the tongue including the base of the tongue who underwent total glossectomy in a period of just over ten years since January 1979 have been reviewed. Total glossectomy may be indicated as salvage surgery or as a primary procedure. The larynx may be preserved or may have to be sacrificed depending upon the site of the lesion. When the larynx is preserved the use of laryngeal suspension facilitates early rehabilitation and preserves the quality of life to a large extent. Cricopharyngeal myotomy seems unnecessary.
Alveolar soft part sarcoma of the tongue
Authors: Cetik F. , Ozsahinoglu C. , Kivanc F. , Secinti E.
Published: November 2007

In this report a 13-year-old girl with characteristic clinical and pathological features of alveolar soft part sarcoma of the tongue is presented. Alveolar soft part sarcoma is a rare malignant tumor of unknown origin. Forty eight cases of alveolar soft part sarcoma have so far been reported in the head and neck region. Median survival reported for all sites of the body is 79 months following various modes of therapy. In this case, the treatment was surgical excision of the mass combined with radiotherapy and chemotherapy. The patient has been asymptomatic for the past 12 months.
Facial schwannoma without facial paralysis
Authors: Sharp J. F. , Kerr A. I. G. , Carder Pauline , Sellar R. J.
Published: November 2007

A 64-year-old man with right aural discharge presented complaining of progressive deafness. Other otological symptoms were absent and specifically there was no seventh nerve paresis. A right aural polyp was identified and biopsied. Histology showed the polyp to be a schwannoma.

Subsequent temporal bone computed tomography showed expansion of the distal facial canal. At operation, the schwannoma filled the middle ear cleft and extended from the genu to the region of the stylomastoid foramen. The floor of the middle ear had been eroded, exposing the jugular bulb.

Facial paresis is the usual presenting feature of a facial schwannoma, while deafness, ageusia and reduced lacrimation are variable, dependent upon the site of the lesion. The absence of facial palsy as a presenting feature is very rare and this case illustrates the need for histological examination of all abnormal aural material.
Congenital subglottic fibromatosis
Authors: O'Connell Janet E. , Raafat Faro , Proops David
Published: November 2007

Benign tracheal tumours are uncommon in adults and rare in children. According to several extensive reviews, fibromas are the second most common benign tumour to occur in the trachea. (Gilbert et al., 1949, 1953).

In our review of the literature, 197 adult cases of fibromas have been reported and 23 in children. However only one previous report of a congenital subglottic fibroma exists. (Tsui and Lore 1975). No previous case with a late onset vocal cord palsy has been reported.
Management of the inflammatory aural polyp
Authors: Williams S. Rhys , Robinson P. J. , Brightwell A. P.
Published: November 2007

Investigation into the underlying disease causing an aural polyp is often hampered when the polyp itself obscures the tympanic membrane. This retrospective analysis of 65 patients undergoing aural polypectomy was carried out to identify and predictive factors for underlying cholesteatoma and to determine a correct management stratergy for aural polyps. The duration of symptoms, size of polyp, size of conductive component of hearing loss and bacteriology of otorrhoea were unhelpful as predictors of the underlying disease. Radiological evidence of bony erosion of the mastoid is a useful sign of cholesteatoma when present.

Aural polypectomy resulted in 58.3 per cent of ears becoming inactive. It is proposed that aural polypectomy and histological assessment should be employed as initial treatment with mastoid exploration reserved for those ears thus identified as high risk for cholesteatoma.
Sudden sensorineural hearing loss as a presentation of HIV infection
Authors: Timon C. I. , Walsh M. A.
Published: November 2007

Two case reports of HIV positive patients presenting with sudden sensorineural hearing loss are described. The importance of CT scanning and cerebrospinal fluid examination are stressed. The possible aetiology and pathology of the condition are also discussed.
Treatment of combined subglottic and critically low tracheal stenoses secondary to burn inhalation injury
Authors: Timon C. I. , McShane D. , McGovern E. , Walsh M.
Published: November 2007

We report a case of combined severe subglottic and lower tracheobronchial stenoses after an inhalation burn injury. The patient was successfully treated by the insertion of a bifurcated silicone rubber stent. The proximal limb of the silicone tube was used to stent the subglottic stenosis after it had been resected, a treatment option not previously reported. It is speculated that the diffuse airway damage resulted from a combination of thermal injury, mechanical trauma and infection. The relatively late symptomatic presentation of the lower tracheal stricture is stressed and the treatment options discussed.
Sialadenoma papilliferum of the parotid gland
Authors: Kronenberg J. , Horowitz A. , Leventon G.
Published: November 2007

Sialadenoma papilliferum is a rare, benign exophytic tumour of salivary glands. The preferred site of this tumour is usually the hard palate. A case of sialadenoma papilliferum occurring in the parotid gland of a 49-year-old man is presented; only one such case has been previously described.
Spiral prominence epithelium
Authors: Sim D. W.
Published: November 2007

Recent studies have shown neuroendocrine-type cells in human spiral prominence epithelium. A light microscopic and ultrastructural study was made on the guinea pig spiral prominence epithelium to try and identify neuroendocrine cells. The study showed that such cells were not present in the guinea pig spiral prominence epithelium. The spiral prominence epithelium was characterized by uniformity of cellular staining with Toluidine blue and the ultrastructural appearance. The morphology of the spiral prominence epithelium was similar to that previously described. The absence of neuroendocrine cells in spiral prominence epithelium in the guinea pig is discussed in relation to species differences.
Pneumatic otoscopy: Study of inter-observer variability
Authors: Mains B. T. , Toner J. G.
Published: November 2007

The degree of inter-observer variability in the results of pneumatic otoscopy, used to predict the presence or absence of middle ear effusion was assessed. A group of 114 patients with 209 suitable ears had pneumatic otoscopy using a Seigle's speculum performed independently by two observers. The results were compared to the findings at myringotomy, on the basis that mobility of the tympanic membrane was indicative of a dry middle ear. The observers agreed in 187 ears, a concordance rate of 91 per cent, and in 174 of these (93 per cent) the observers' prediction of middle ear state was correct. The overall predictive accuracy of observer A was 89 per cent and of observer B 84 per cent, this difference is not statistically significant, p> 0.05.
Treatment of auricular haematoma by silicone rubber splints
Authors: Nahl S. S. , Kent S. E. , Curry A. R.
Published: November 2007

A modification of existing techniques for the treatment of auricular haematoma is described. This method employs incision, drainage and the application of silicone rubber splints (SilasticR). Existing methods of treatment are reviewed and discussed. A retrospective review of 16 cases using this technique showed a satisfactory cosmetic result in all cases.
Role and results of cortical mastoidectomy and endolymphatic sac surgery in Menière's disease
Authors: Kerr A. G. , Toner J. G. , McKee G. J. , Smyth G. D. L.
Published: November 2007

It is almost impossible to establish the natural history of Menière's disease and, by the same token, it is difficult to confirm the efficacy of endolymphatic sac surgery. The authors doubt the logic of sac operations. Only two controlled trials of sac surgery have been found and both cast doubt upon its value. There do not appear to be any controlled trials indicating that it works.

In 14 cases of incapacitating Menière's disease, where vestibular nerve section was indicated, cortical mastoidectomy was offered and accepted in the expectation that two-thirds might be spared the more major procedure. In the event, the vertigo was controlled in eight out of 14 (57 per cent), the remaining six (43 per cent) requiring more major surgery.

A surgical model illustrates that, of themselves, these results are essentially meaningless in assessing the efficacy of cortical mastoidectomy in Menière's disease. Until all cases in a community are considered and followed-up, we shall be in doubt about the value of sac surgery and most other treatments of Menière's disease.
Pilonidal sinus of the nose
Authors: Paulose K. O. , Khalifa S. Al , Raj S. Sunder , Saeed T.
Published: November 2007

We report an unusual case of a pilonidal sinus appearing on the nose. From the clinical and pathological findings, we find it difficult to believe that it is an acquired condition. En bloc excision by an external rhinoplasty approach was performed with no evidence of any recurrence.
Radio-opacity of fishbones
Authors: Ell S. R.
Published: November 2007

Bones are the largest group of foreign bodies found in the air and food passages. Fishbones which lodge in the tonsil can be easily seen and removed relatively easily. Those lodging in the pyriform fossa are well localized by the patient and can usually be seen on mirror examination.

It would be useful to know which types of fishbones are radio-opaque and therefore likely to be shown by radiographs when mirror examination is difficult or fails to reveal a foreign body. Therefore a study was undertaken to ascertain the radio-opacity of the bones of ten different species of fish eaten in the British Isles.
St Cadoc and the healing of the deaf
Authors: Stephens S. D. G.
Published: November 2007

This manuscript traces the traditions of the healing of the deaf associated with St Cadoc. While Saint Cadoc was Welsh, the traditions associated with him are found in Brittany. It seems likely that they originated there as pre-Christian healing traditions which were subsequently incorporated into those associated with the Church. The centre of these traditions was (and is) St Cado in the South of Brittany, near Carnac.
Surgical treatment of glossopharyngeal neuralgia via the pharyngeal approach
Authors: Mairs A. P. , Stewart T. J.
Published: November 2007

Idiopathic glossopharyngeal neuralgia is an uncommon disorder which often fails to respond to medical treatment. Surgical treatment most commonly consists of intracranial section of the glossopharyngeal nerve and upper vagal rootlets. We present three cases treated by the much simpler pharyngeal approach and argue that in appropriately selected patients this approach should receive more serious consideration.
Effect of nasogastric tubes on Eustachian tube function
Authors: Wake M. , McCullough D. E. , Binnington J. D.
Published: November 2007

The Eustachian tube acts as pressure equalizing tube between the nasopharynx and the middle ear. It also functions as a conduit for removal of secretions from the middle ear and mastoid air cell system into the post nasal space. Eustachian tube function may be assessed objectively using tympanometric measurements. (Brooks, 1968, Lutman, 1987).

The post-operative use of nasogastric Ryles tubes is associated with reduced peak middle ear pressure (mmH2O) and reduced peak compliance volumes (ml) as assessed by tympanometry. In addition changes in the appearance of the tympanic membrane may occur with the protracted use of Ryles tubes. This phenomenon is a transient one.

Nasogastric tube-induced Eustachian tube dysfunction is a previously unreported entity.
New technique for treating pseudocyst of the auricle
Authors: Li-Xiang Zhu , Xiu-Yun Wang
Published: November 2007

Although pseudocyst of the auricle is a common disease in China, its cause and mechanism are still not clear. Several methods of treatment have been advocated: repeated aspirations combined with physiotherapy, and incision and drainage with contour pressure dressing, magnetotherapy etc. In recent years, a new technique with a drainage tube inserted into the pseudocyst using a guide needle has been used in our hospital in the treatment of this condition. We report 45 cases treated by this method, none of whom had the condition previously.
Ovarian carcinoma metastatic to the larynx
Authors: Cullen J. R.
Published: November 2007

The second case of ovarian carcinoma metastatic to the larynx is presented. The sites of the primaries and metastases of previously reported cases are reviewed, and possible methods of spread discussed.
Adenoidal hypertrophy as the presenting feature of HIV infection
Authors: Hickey S. A. , Buckley J. G. , Macartney J. C.
Published: November 2007

A case of symptomatic recurrent adenoidal hypertrophy, as the presenting feature of HIV infection in a haemophiliac child, is reported. The incidence of non-malignant nasopharyngeal lymphoid hyperplasia in HIV infection is examined and the relevance of the histological appearance is discussed in relation to progression of disease.
Pars flaccida perforation in tissue culture: morphological study
Authors: Stenfors L.-E. , Olsen E. G. , Henriksen A. Ö.
Published: November 2007

Subtotal pars flaccida perforation was effected in vitro in rat tympanic membranes. The drums were subsequently kept in tissue culture and after various intervals studied by means of light and scanning electron microscopy. No complete covering of the perforation was seen, though a marked thickening and hyperplasia of the outer, keratinizing, squamous epithelium (OE) was evident. The inner, tympanal epithelium (IE) appeared swollen, containing rounded structures in the cytoplasm especially close to the contact area with the OE. Ingrowth of OE onto the tympanal side of the drum was seen particularly in the areas where the IE was sparse and completely lacking. Complete covering of a drum perforation seems to be dependent on the formation of supporting granulation tissue, probably resulting from an inflammatory reaction in the healing area.
Treatment of earache among the Lappish people
Authors: Stenfors L.-E. , Henriksen A. Ö.
Published: November 2007

The traditional ways of treating earache among the Lappish people have been charted. Generally speaking, the Lapps have treated earache by applying a compress to the ear, dropping various ear-drops into the external auditory canal, breathing into the ear, massaging the ear, and inserting impregnated wool into the ear canal. The Lappish treatment principles for earache are discussed in relation to modern knowledge of pain relief.
Prophylactic antibiotics and post laryngectomy pharyngocutaneous fistulae
Authors: Violaris N. , Bridger M.
Published: November 2007

Pharyngo-cutaneous fistula following laryngectomy is a serious complication. The incidence worldwide varies from 7.6 to 50 per cent. The value of prophylactic antibiotics in preventing fistulae is well recognized but the type of antibiotics and the length of administration of the antibiotics is variable depending on the individual surgeon.

Below we present the Plymouth Head and Neck Unit experience where, in the last five years, 33 patients underwent laryngectomy (30 total, three vertical hemi-laryngectomies).The prophylactic antibiotics used in all patients was parenteral cefotaxime 1G or cefuroxime 750 mg, given at eight hours pre-operatively, with the premedication and at eight, 16 and 24 hours post-operatively. Only two patients developed pharyngo-cutaneous fistulae, both after total laryngectomy (six per cent of total). Three patients developed skin cellulitis and five patients developed chest infection which required further treatment with antibiotics.
Paraganglioma of the maxillary sinus
Authors: Talbot A. R.
Published: November 2007

Non-chromaffin paragangliomas are unusual tumours arising in specialized tissue, probably of neural crest origin. A primary non-chromaffin paraganglioma of the paranasal sinuses is a very rare tumour with only a handful of such cases documented in the literature. The presence of such a tumour raises interesting questions as to the origin of such specialized tissue within the nose and paranasal sinuses.
Salivary gland involvement in Wegener's granulomatosis
Authors: Murty G. E. , Mains B. T. , Bennett M. K.
Published: November 2007

When salivary gland enlargement occurs in association with other ENT symptoms, Wegener's granulomatosis should be considered in the differential diagnosis. An early anti-neutrophil cytoplasmic antibody (ANCA) test may aid diagnosis. Effective medical treatment exists and, once the diagnosis has been made, therapeutic excision of the affected gland may be unnecessary. The fourth and fifth cases in the literature of salivary gland involvement in Wegener's granulomatosis are reported.
Management of acquired tracheo-oesophageal fistula following intubation
Authors: Camilleri A. E.
Published: November 2007

The management of acquired tracheo-oesophageal fistula due to tracheal intubation is reviewed and a case complicated by left vocal cord palsy and subglottic stenosis is presented. Permanent cricothyroidostomy was used in the management of this original triad of complications.
Pathological features of the facial nerve in patients with facial palsy of varying aetiology Light and electron microscopic study
Authors: Ylikoski Jukka
Published: November 2007

Facial nerve specimens obtained during reinnervation surgery from 31 patients with facial palsy of varying aetiology were studied. In patients who had a facial palsy after attenuation during acoustic schwannoma removal the facial nerve had normal populations of myelinated nerve fibres in the sensory zone but their numbers and sizes were severely reduced and fibrosis was increased in the motor zone. The latter also had large numbers of endoneurial tubes with thin unmyelinated axons.

When the facial nerve had been severed in tumour removal, it had practically no remaining nerve fibres. In three out of four patients with middle ear cholesteatoma, the distal facial nerve stump showed severe fibrosis. In patients with iatrogenic trauma and skull fracture, the distal stump usually showed few myelinated nerve fibres, endoneurial tubes with thin unmyelinated fibres and increased fibrosis.

The pathological changes observed indicate that in all cases the motor fibres distal to the lesion have undergone Wallerian degeneration and demyelination and in most a subsequent partial regeneration. However, the regeneration remained incomplete. The distal stump of the facial nerve with numerous endoneurial tubes in most cases of the material presented appear to provide favourable structural preconditions for reinnervation surgery.
Ear, nose and throat manifestations of Lyme disease
Authors: Lesser T. H. J. , Dort J. C. , Simmen D. P. B.
Published: November 2007

The manifestations of Lyme disease as they may present to the ENT surgeon are discussed. The most important ENT symptom is facial palsy. Particularly when combined with other cranial palsies, systemic illness or signs of meningeal irritation, the diagnosis must be considered. Three case reports are used to illustrate the presentation and diagnosis and treatment of Lyme disease. The characteristics of the disease are reviewed and the limitations of serological testing outlined. The literature has concentrated on bilateral or relapsing facial palsy. A review of palsies in Zurich that presented to the ENT clinic found only unilateral and partial palsies. The diagnosis should be considered in every case of facial palsy of unknown aetiology especially in children.
Surgical treatment of Zenker's diverticulum
Authors: Aggerholm K. , Illum P.
Published: November 2007

One-hundred-and-fifty patients with Zenker's diverticulum were reviewed; twelve patients received no treatment; 26 patients were treated endoscopically by dilatation, five of these had a diverticulectomy performed at a later stage.

One-hundred-and-ten patients had a diverticulectomy performed (a total of 115 primary operations were performed). Eighteen of the patients operated upon had a recurrence and six underwent re-operation.

Local complications occurred in 24 patients. Seven patients had a fistula and two had mediastinitis. Ten patients had recurrent nerve palsy, of which five were permanent. Thirteen patients had other complications, usually infection. One death occurred.

Post-operative prophylactic treatment with antibiotics was found to significantly reduce the number of local infectious complications and a correlation was found between the occurrence of local, infectious complications and later recurrence of the pouch.