bluuebunny/crossref_metadata_2025 huggingface dataset:
Cystic hygroma presenting in adulthood
Authors: Baer S. , Davis J.
Published: November 2007

We report a typical case of cystic hygroma presenting in an elderly female patient. A review of the literature on this condition reveals that although rare in adults, it should form part of the differential diagnosis of a cystic swelling in the neck in this group of patients as well as in the more commonly observed juvenile population. The embryology and pathogenesis of lymphangiomata are discussed as well as the recommended management of a cystic hygroma in an older patient.
Some observations on submucous diathermy
Authors: Woodhead C. J. , Wickham M. H. , Smelt G. J. C. , Macdonald A. W.
Published: November 2007

Submucosal diathermy (SMD) of the inferior turbinates is widely used, although its effect histologically has not been well shown. We attempted to demonstrate the acute histological changes of SMD by performing it immediately prior to inferior turbinectomy. The results found help to explain the unpredictability of producing a clinical response.
Incidence of abnormality in routine ‘vocal cord checks’
Authors: Curley J. W. A. , Timms M. S.
Published: November 2007

Where elective surgery carries a risk of damage to the recurrent laryngeal nerve, pre-operative examination of the larynx is routine. The incidence of positive findings at such examination has been determined by retrospective review of 1,947 clinic records. Only 31 vocal cord palsies were found. The possible causes and relevance of such findings are discussed.
Anterior neck lipoma masquerading as an external laryngocoele
Authors: Ramakantan R. , Shah P.
Published: November 2007

Lipomas of the anterior neck are rare lesions with about 40 cases reported so far in the world literature. Though lipomas are known to change shape depending upon adjacent compressive forces, our case is unique in that the change in shape clinically mimicked an external laryngocoele. A possible explanation for the unusual behaviour of this lipoma is offered.
Effect of acoustic overstimulation on the glycocalyx and the ciliary interconnections in the organ of Corti: High resolution scanning electron microscopic investigation
Authors: Takumida M. , Fredelius L. , Bagger-Sjöbäck D. , Harada Y. , Wersäll J.
Published: November 2007

Changes in ciliary interconnections in the organ of Corti are described after acoustic overstimulation using a special high resolution scanning electron microscope and tannic acid-osmium staining technique, giving an almost three dimensional view. Guinea pigs were exposed to a 3.85 kHz pure tone at an intensity of 120 dB for 22.5 minutes. The first detectable change was a disarrangement of the cilia with a loosening of the interconnections. The ciliary plasma membrane presented with an abnormally smooth appearance. The tip links connecting the tips of the stereocilia to their taller neighbours were also affected showing elongation or even disappearance. The fine granules which cover the tips of the tallest stereocilia of the outer hair cells were decreased. These findings suggest that acoustic overstimulation may affect the carbohydrate metabolism exceding to degeneration of ciliary interconnections resulting in a disarrangement and detachment of cilia. The tip links, which may participate in sensory cell transduction, seem also to be affected by acoustic overstimulation.
Wegener's granulomatosis, subglottic stenosis and antineutrophil cytoplasm antibodies.
Authors: Hoare T. J. , Jayne D. , Evans P. Rhys , Croft C. B. , Howard D. J.
Published: November 2007

Wegener's granulomatosis is difficult to diagnose, especially when the presentation is unusual, restricted to an isolated region. We report four cases of recurrent subglottic stenosis posing difficulty in diagnosis. In each case the finding of anti-neutrophil cytoplasm antibodies (ANCA) strongly suggested an underlying vasculitic pathology, Wegener's granulomatosis. We discuss reasons for the difficulty in diagnosis in the past, the possible role of the ANCA assay in such patients, and suggest it should be more widely used in the future.
DNA content and proliferative activity of myoepitheliomas
Authors: El-Naggar A. , Batsakis J. G. , Luna M. A. , Goepfert H. , Tortoledo M. E.
Published: November 2007

This report adds 16 myoepitheliomas of salivary glands to the 47 already recorded in the literature. It includes, for the first time, a flow cytometric analysis of their ploidy (DNA content) and proliferative capacity (S-phase fraction). Thirteen myoepitheliomas were diploid; three were aneuploid in their DNA content. A high proliferative capacity was always associated with an abnormal DNA content. Only one diploid myoepithelioma had a high S-phase fraction. Both flow-cytometric parameters are good predictors of an aggressive biological behaviour. Recurrences, however, were all the outcome of incomplete primary removal of the myoepitheliomas. Four of the twelve (33 per cent) diploid myoepitheliomas recurred and one, with high S-phase fraction, led to the death of the patient. Two of the three (67 per cent) aneuploid myoepitheliomas recurred. Extensive loco-regional invasion by one killed the patient. The other has clinical evidence of distant metastasis.
Carcinoma of the nasal vestibule: Report of 12 cases
Authors: Barzan L. , Franchin G. , Frustaci S. , De Paoli A. , Comoretto R.
Published: November 2007

Carcinoma of the nasal vestibule has an individual clinical character; in this retrospective analysis the data of 12 consecutive patients are reported. Small lesions were treated by surgical resection and larger tumours by intra-arterial chemotherapy (IAC) followed by external beam radiotherapy. One patient had a recurrence which was successfully treated surgically; six had previous or subsequent malignancies. The results of the most recent series reported in the literature are reviewed and the rationale of the IAC approach is discussed. The reported treatment policy seems effective in achieving the highest cure rate with the best functional results.
Nasopharyngeal carcinoma with secondaries at the porta hepatis presenting as obstructive jaundice
Authors: Elango S. , Jayakumar C. R.
Published: November 2007

Recent reports have dispelled the previously held concept that head and neck cancer rarely metastases beyond the cervical lymph nodes. Nasopharyngeal cancer has been reported to have a higher incidence of distant metastases compared to other head and neck cancers, the common sites being bone, lung and liver. A case of nasopharyngeal carcinoma presenting as obstructive jaundice because of secondaries at the porta hepatis is presented here.
Metastatic salivary pleomorphic adenoma
Authors: Sim David W. , Maran Arnold G. D. , Harris Douglas
Published: November 2007

Pleomorphic adenomas of the salivary gland are usually regarded as benign tumours. We report a case in which a solitary pulmonary metastasis arose from a pleomorphic adenoma of the right parotid gland. The mechanism of metastasis is discussed.
Value of middle ear inflation as a diagnostic indicator of eustachian tube patency
Authors: Luntz M. , Sadé J.
Published: November 2007

The value of tubal inflation as a diagnostic procedure for Eustachian tube patency and function is controversial. In an attempt to assess the diagnostic value of air douche in atelectatic ears, 49 such ears of 40 patients were politzerized. The procedure was successful in 45 ears. However, of the four unsuccessful cases, two of the patients were able to autoinflate their ears. These results show that air douches pass regularly through the Eustachian tube into the tympanic cavity even in atelectatic ears, which by definition suffer from aeration deficiency, which is often considered to be secondary to ‘Eustachian tube obstruction’, or alternatively ‘Eustachian tube dysfunction’. Thus, the ability to force air through the Eustachian tube by politzerization is of no diagnostic value as an indicator of normal or abnormal tubal patency or functioning in atelectatic ears and most probably in allied conditions.
Laryngeal amyloidosis
Authors: Talbot A. R.
Published: November 2007

Laryngeal amyloidosis is a rare disease. Surgery has been the mainstay of treatment either endoscopically or by an external neck approach. In more recent years, surgery with the carbon dioxide laser has been advocated for this condition. Four cases of laryngeal amyloidosis are presented. The application and the advantages of the carbon dioxide laser for the treatment of laryngeal amyloidosis are discussed.
Neuro-axonal recruitment: A result of selective compression
Authors: Lehnhardt Ernst
Published: November 2007

Many acoustic neurinomas and CPA tumours present an audiometric picture of positive-recruitment hearing impairment although often the CMs are not significantly impaired (according to ECochG) and because, even in the case of a small acoustic neuroma, the interpeak latency between wave I and V (ERA) is increased in the majority of cases. Recruitment cannot be explained, in these cases, as an expression of an accompanying vascular inner ear lesion. Therefore, we attempt to interpret the differential audiometric picture to the various patterns of damage of the auditory nerve. The finding of tone decay is seen as an expression of myelin damage corresponding to the hearing loss in multiple sclerosis.

The absence of any degree of tone decay excludes an isolated damage of the myelin sheaths; hearing loss then results from a disturbance also of the associated axons. At such a stage, where there is a functional loss to part of the neural fibres but with intact myelinated residual fibres, the result could be the phenomenon of recruitment for suprathreshold stimulation. This theory of selective compression is compared to an isolated efferent lesion theory as the cause for recruitment in AN and CPA tumours.
Stapes surgery: implications for training
Authors: Moriarty B. G.
Published: November 2007

The worldwide decline in surgery for otosclerosis had been reflected by a similar pattern here in Great Britain. Unless we are prepared to accept poorer results than have formerly been achieved, we will have to adopt measures to ensure that the skills of stapes surgery are transferred to the next generation of surgeons. Using the results of our experience, at the Queen Elizabeth Hospital, over the past 18 years, I have examined the implications for surgical training and for the management of future patients with otosclerosis.
Inferior turbinectomy: Comparison of four techniques
Authors: Elwany Samy , Harrison Robert
Published: November 2007

As yet, there is no totally satisfactory means for treating hypertrophied turbinates and the proper management of turbinate dysfunction remains in question. In the present series, four of the widely practiced surgical procedures for the reduction of the size of the inferior turbinates were evaluated and compared. In all cases turbinectomy was performed as an isolated procedure. Eighty patients with chronic non-allergic rhinitis and hypertrophied inferior turbinates were selected, randomly divided into four groups, and followed up post-operatively for one year. Study of the results indicated that the beneficial effect of the operation is mainly mechanical by reduction of the resistance to nasal airflow. The post-operative improvement in smell acuity correlated positively with the increased patency of the nasal airway. None of the procedures had a deleterious effect on olfactory acuity. In contrast, the operation failed to enhance the mucociliary clearance rate or significantly decrease nasal drainage. Partial inferior turbinectomy and laser turbinectomy improved nasal breathing in 77 per cent of patients, and enhanced olfactory acuity in 78 per cent of patients who had pre-operative hyposmia. The results of turbinoplasty and cryoturbinectomy were less favourable. The surgical technique, advantages, and drawbacks of each of these procedures are discussed.
Premalignant changes in nasal and sinus polyps: a retrospective 10 year study (1979–1988)
Authors: de la Cruzc Mera A. , Sánchez López M. J. , Royo E. Merino , Requena L.
Published: November 2007

One hundred and seventy cases of nasal and/or sinus polyps diagnosed in the Pathology Service of the Hospital Militar Central GOMEZ/ULLA of Madrid (Spain) between 1.9.79 and 1.9.88 are reviewed. In two cases areas of ‘carcinoma in situ’ in the epithelium covering the polyps were demonstrated. The literature is reviewed for reports of malignant transformation and dysplastic changes in nasal and sinusal polyps. We suggest that precancerous changes may ocassionally be noted in inflammatory lesions, a fact that pathologists should keep in mind.
Duro-cutaneous fistula caused by a ‘congenital’ cholesteatoma
Authors: Viani L. , McCormick M. S.
Published: November 2007

A cervical fistula from a ‘congenital’ cholesteatoma is described in a 70-year-old man. This was found to communicate with an extradural temporal lobe abscess. The presentation and management is described. No previous report of such a case has been found in a review of the literature.
Tuberculosis of the upper respiratory tract misdiagnosed as Wegener's granulomatosis—an important distinction
Authors: Couldery A. D.
Published: November 2007

Four cases, two personal, of mis-diagnosis of tuberculosis of the upper respiratory tract as Wegener's granulomatosis have been presented. Greater awareness of this possibility of mis-diagnosis may diminish the possibility of mistreatment. It is suggested that fresh specimens should be sent for bacteriological examination and culture in all relevant upper respiratory tract lesions.
Rare cavernous haemangioma of the hypopharynx with numerous phleboliths
Authors: Li Xue
Published: November 2007

Cavernous haemangiomata occur quite commonly, but one situated in the hypopharynx which contains as many as 240 phleboliths, as reported here, is a rare curiosity. The clinical manifestations, angiographic findings and the operative procedure of this case are described with a brief review of the formation of phleboliths in cavernous haemangiomas.
Tracheostomy—The horizontal tracheal incision
Authors: Kato I. , Uesugi K. , Kikuchihara M. , Iwasawa H. , Iida J. , Tsutsumi K. , Iwatake H. , Takeyama I.
Published: November 2007

The complication rate after emergency tracheostomy is two to five times greater than after elective procedures. One of the main causes of the high risk of complications in emergency tracheostomy appears to be the amount of time required to open the trachea. Therefore, simple and fast procedures are mandatory. We have developed a new procedure as follows: A horizontal skin incision is performed. Strap muscles are dissected and retracted laterally. A transverse cut between tracheal rings below the thyroid isthmus is performed up to membranous portion of the trachea. The cut ends of the trachea remain open naturally because of the elasticity of the trachea. Skin and tracheal cut-ends are then joined by interrupted sutures.

We have used this procedure during the past three years and have not experienced any major complications. This demonstrates the clear advantage and the more physiological nature of the procedure over various other incisions of the tracheal wall.
Unusual complication of pharyngeal pouch inversion
Authors: Kapur T. R. , Jayaramachandran S.
Published: November 2007

A case of valvular obstruction of the oesphagus following inversion of a pharyngeal pouch is described. This complication has not been described before.
Renal carcinoma metastasis to the parotid gland
Authors: Pisani P. , Angeli G. , Krengli M. , Pia F.
Published: November 2007

Metastatic tumours in major salivary glands are uncommon with a higher incidence of primary sites from the head and neck. The lungs and breast are the common primary sites, while metastases from the kidney are very rarely found. The authors describe a case of renal clear-cell carcinoma with metastastis to the parotid gland. The incidence of a metastasis in the parotid gland from a primary renal carcinoma, even if rare, should not be overlooked in making a correct differential diagnosis with acinic cell carcinoma and monomorphic clear cell adenoma.
Reliability of conventional ear swabs in tubotympanic CSOM
Authors: Raju K. G. S. , Unnykrishnan P. , Nayar R. C. , Dutt S. , Macaden R.
Published: November 2007

Conventional external ear swab cultures were compared with cultures obtained from the middle ear, in 25 cases of tubotympanic type (‘safe’), chronic suppurative otitis media. These cultures were identical in 22 of the 25 cases.

Anaerobic organisms were isolated in only one case. Mixed infections of both gram-positive and gramnegative organisms were seen in nine cases (36 per cent).

Staphylococcus aureus was the commonest single agent isolated (16 cases). Multidrug resistance was seen in 12 of these isolates.
Pott's puffy tumour reviewed
Authors: Blackshaw Gareth , Thomson Neil
Published: November 2007

The aim of this paper is to highlight Potts puffy tumour as a pathological entity distinct from other causes of peri- and supraorbital swelling. This uncommon condition is usuallynot recognised initially and is easily confused with neoplasms or local eye pathology. A case is reported and investigations and management reviewed.
Long-term results of revision endolymphatic sac surgery
Authors: Morrison G. A. J. , O'reilly B. J. , Chevretton E. B. , Kenyon G. S.
Published: November 2007

The results of revision endolymphatic sac surgery on 30 patients with unilateral Meniére's disease are presented. Good control is achieved in 73.3 per cent of cases at six months, falling to 56.7 per cent at one year and only 33.3 per cent by four years. The long-term results are disappointing but are more favourable if the initial surgery was successful, if the hearing remains fluctuant and improves on glycerol dehydration prior to the revision procedure and also if the sac is intubated. The current place of endolymphatic sac surgery is discussed and revision surgery only recommended for carefully selected cases.
A ‘silent’ intracranial complication of frontal sinusitis
Authors: Daya S. , To S. S.
Published: November 2007

Intracranial complications of frontal sinusitis, although rare today, do still develop despite widespread use of antibiotics. We report a case which demonstrates how silently a frontal lobe abscess may present with subtle changes in mood and behaviour, with no focal neurological signs. Diagnosis and management are discussed and a brief review of the incidence of intracranial complications of frontal sinusitis, mode of spread, clinical presentation, investigations, treatment and bacteriology is presented.
Effect of mircowave and ionizing radiation in patients with recurrent laryngeal carcinoma
Authors: Svetitsky P. V.
Published: November 2007

This study describes the treatment and survival of 54 patients with gross recurrent laryngeal carcinoma after radiotherapy. Twenty-six patients were treated with local ultra-high frequency hyperthermia in combination with radiotherapy and chemotherapy (HRCH). Twenty-eight control patients were treated with radiotherapy and chemotherapy (RCh). Eight patients (33 per cent) in HRCh showed a three year survival but no patient in the RCh group. At two years 18 patients (75 per cent) in HRCh and two (7 per cent) in RCh survived.
Intralaryngotracheal thyroid
Authors: Osammor J. Y. , Bulman C. H. , Blewitt R. W.
Published: November 2007

A case of intralaryngotracheal thyroid in a 57-year-old man is presented. The treatment modalities are considered and the previous literature is reviewed.
Tumefactive fibroinflammatory lesions of the head and neck
Authors: Prichard A. J. N. , Colloby P. , Barton R. P. E. , Heaton J. M.
Published: November 2007

The term ‘tumefactive fibroinflammatory lesion’ has been usedto describe a fibrosclerosing disorder which has a locally destructive nature but is characterized by a benign histological appearance. We report five patients, over a five year period, with such a lesion.

The clinical behaviour and surgical findings suggest the lesion to be an invasive malignancy. However, the histological appearance of an admixtureof chronic inflammatory cells and fibrosis is consistent with a benign condition.

We recommend surgical excision of the lesion as the mainstay of treatment; other studies report the use of steroids and radiotherapy.
Osteoma of the middle ear
Authors: Ito S. , Tanaka H. , Hirano M.
Published: November 2007

Osteomas involving the middle ear and causing a functional disturbance are rare. We report a case of a patient with an osteoma arising from the lateral semicircular canal. The main symptom was vertigo and to halt this the defect of the canal was obliterated with a bone chip and fibrin glue after removal of the tumour.
Oesophageal intramural pseudodiverticulosis
Authors: Baer S. , Watkinson A.
Published: November 2007

A case of oesophageal intramural pseudodiverticulosis is presented and the clinical, pathological and specific radiological features are documented.
Patrick Watson-Williams and the concept of focal sepsis in the sinuses: An historical caveat for functional endoscopic sinus surgery
Authors: Fairley James W.
Published: November 2007

From 1900 to 1940 the theory of focal sepsis was invoked to justify a number of dubious surgical procedures. Surgeons believed they were acting rationally. Patrick Watson-Williams advocated suction exploration of the paranasal sinuses for mental patients, claiming to cure criminal insanity by sphenoidotomy. Favourable contemporary reviews showed international approval. The rational basis of treatment was emphasised, but there was little systematic evaluation of outcome. Current enthusiasm for functional endoscopic sinus surgery is also based on a rational approach, logical deductions from pathophysiological ‘facts’. Outcome has still not been evaluated scientifically. We should learn from history. Treatment should not be based too readily on what seems to be rational now. Ideas of physiology and pathology change. What seems logical today may appear ridiculous tomorrow. Careful analysis of outcome, preferably by controlled clinical trials, is needed as a rational treatment requires empirical validation just as much as any other.
Recurrence of oropharyngeal carcinoma after radiotherapy
Authors: Viani Laura , Dammeijer Patrick , Jones A. S. , Dalby J. E. , Stell P. M.
Published: November 2007

Two-hundred-and-twenty-one patients with squamous carcinoma of the oropharynx treated by irradiation are presented.

The primary recurrence rate at five years in the previously untreated patients was 27%, but was dictated by neither host factors (age, sex and general condition) nor tumour factors (site, T-stage and histological grade).

Pre-operative histological diagnosis had a very high sensitivity but a low specificity, indicating that false positives are common but false negatives unusual. Twenty per cent of patients with a recurrent primary tumour were untreatable.

The five year survival after a primary recurrence was 31 per cent. Sixty-eight per cent of patients undergoing major surgery recovered without a major complication, and the hospital mortality rate was three per cent, due entirely to major medical catastrophes. The major complication rate in those undergoing flap repair after major resection was seven percent.

The metastatic rate in lymph nodes was 44 per cent at five years, and again this did not depend on any host or tumour factors. The survival at five years after node recurrence was a mere 19 per cent, and the length of survival was related to the primary site of the original tumour and the presence of extranodal disease. Two-thirds of patients had advanced disease (N2 and N3) when node recurrence was diagnosed and about 15 percent were unsuitable for surgery.
Modifying the translabyrinthine approach to preserve hearing during acoustic tumour surgery
Authors: McElveen John T. , Wilkins Robert H. , Erwin Andrea C. , Wolford Robert D.
Published: November 2007

Removing an acoustic schwannoma using the translabyrinthine approach has previously been considered incompatible with hearing preservation. By modifying the approach and preventing the loss of endolymph, we have successfully removed an intracanalicular acoustic schwannoma, which originated from the inferior vestibular nerve, and preserved hearing in the operated ear. This report represents the preliminary findings using this particular technique in the management of an intracanalicular acoustic tumour.
Unusual presentation of squamous cell carcinoma of the middle ear and mastoid
Authors: Ajulo S. O. , Khambata A. S. , Pushpala S. M.
Published: November 2007

An unusual case of squamous cell carcinoma of the middle ear and mastoid in which syncope was a major presenting feature is reported. No such case has been reported in the literature. A possible explanation is offered.
Leiomyosarcoma of the larynx: emergency laryngectomy
Authors: Tewary A. K. , Pahor A. L.
Published: November 2007

Leiomyosarcoma of the larynx is extremely rare. A patient with respiratory obstruction due to such a tumour is presented. This was originally misdiagnosed as hysteria. The treatment of choice was an emergency laryngectomy.
Unusual cause of intranasal injury
Authors: Soussi A. C. , O'Flynn P. , McFarlane H. W.
Published: November 2007

Intranasal injury without external involvement is not common. To our knowledge this is the first reported case of such an injury, caused by an assailant's two fingers forced up the nostrils of our patient causing severe mucosal laceration and excessive bleeding.

The patient died two weeks later.
Histology of aural polyp as a predictor of middle ear disease activity
Authors: Hussain S. S. M.
Published: November 2007

This study compares the histology of aural polyp with the subsequent clinical course of the middle ear disease. AH cases of aural polyps that presented to the department during 1988 and 1989 were included. Patients who had previous ear surgery were excluded as were cases where the operation was part of clearance of known cholesteatoma rather than polypectomy alone.

We found that the histology of the aural polyp was not a precise predictor of the presence or absence of cholesteatoma, nor of the subsequent course of the middle ear disease.
Human papilloma virus and carcinoma of the laryngopharynx
Authors: Morgan D. W. , Abdullah V. , Quiney R. , Myint S.
Published: November 2007

The presence of human papillomavirus (HPV) genomes 6, 11, 16 and 33 in 16 patients with laryngopharyngeal carcinomas was examined by means of a polymerase chain reaction. HPV genomes were detected in 75 per cent of cases. In hypopharyngeal carcinoma, HPV 6 and 11 were present in adjacent tissue but absent from the tumour. HPV 16 and 33 were present in 40 per cent of laryngeal tumours and adjacent tissue. These results suggest that HPV 16 and 33 may be closely associated with the development of some laryngopharyngeal carcinomas.
Blood transfusion and survival after laryngectomy for laryngeal carcinoma
Authors: Ell Stephen R. , Stell P. M.
Published: November 2007

Survival of patients with surgically treated malignancy may be adversely affected by blood transfusion. Immune suppression due to transfusion has been implicated but remains unproven. We conducted a study of 240 patients with squamous cell carcinoma of the larynx undergoing laryngectomy to assess the effect of per-operative blood transfusion on survival.
Prophylaxis of nasolacrimal duct obstruction after major sinus surgery using a silicone stent
Authors: Fisher Edward W. , Clarke Peter M. , Cheesman Anthony D.
Published: November 2007

Damage to the nasolacrimal duct during major sinus procedures results in troublesome symptoms of epiphora and acute infection. Prophylactic stenting of the lacrimal apparatus using a silicone stent is described as a means of preventing such complications.
Serum antibodies against respiratory tract viruses in episodes of acute otitis media
Authors: Harsten Göran , Prellner Karin , Löfgren Bengt , Kalm Olof
Published: November 2007

Although the findings of epidemiological studies have suggested viral respiratory tract infection (RTI) to be crucially involved in the development of acute otitis media (AOM), the relationship between AOM and viral RTI remains unclear. Serum samples, obtained in the acute and convalescent phases of 57 AOM episodes (in 35 children during the first three years of life) were analysed for IgG antibodies against influenza A viruses, influenza B viruses, parainfluenza virus type 1, respiratory syncytial virus and adenoviruses.

One third of the AOM episodes (18/57) could be related to viral RTI, as evidenced by significant increases in viral serum antibody activity. Treatment failure occurred in four AOM episodes where increases in serum viral antibody activity were noted. In three of these failures, antibiotic treatment was unsuccessful despite the bacterial strains not being resistant to the drug used. This suggests that concomitant viral infection may be a determinant of treatment outcome in some AOM episodes.
Familial multicentric paragangliomas in a child
Authors: Ophir Dov
Published: November 2007

A 12-year-old girl presented with bilateral carotid-body paragangliomas and a unilateral jugular paraganglioma. The tumours were surgically removed. This is a rare combination of tumours in any patient and previously unreported in a child of this age. Her father died of a cerebellar astrocytoma and her mother underwent surgical removal of a large mediastinal paraganglioma. The association of astrocytoma with familial paragangliomas has never been documented. The literature on the epidemiology and inheritance pattern of familial paragangliomas is reviewed. The need for thorough pre-operative evaluation of the patient and close follow-up of family members is stressed.
Life-threatening cervico-mediastinal haematoma after carotid sinus massage
Authors: Tomás Manuel D. , Torres Alberto , García-Polo Julio , Gavilán César
Published: November 2007

Retropharyngeal and cervico-mediastinal haematomas are rare but potentially fatal entities. The potential for airway compression necessitates rapid assessment and treatment.

A cervico-mediastinal haematoma following carotid sinus massage which required cervical drainage is presented. This is a life-threatening event demanding a high index of suspicion. A review of the literature and indications for treatment are discussed.
Venous haemangioma of the neck and mediastinum
Authors: Nishimura Toshiro , Takimoto Toru , Ishikawa Shigeru , Ohmura Kenji
Published: November 2007

A case of cervico-mediastinal venous haemangioma with diffuse upper respiratory airway involvement is reported. The lesion was considered to be an ordinary supraglottic haemangioma at first. We recommend that adult cases of laryngeal haemangioma should be carefully examined for extra-laryngeal lesions.
Treatment of chronic mastoiditis by grafting of mastoid cavities with autologous epithelial layers generated by in vitro culture of buccal epithelium
Authors: Premachandra D. J. , Woodward B. , Milton C. M. , Sergeant R. J. , Fabre J. W.
Published: November 2007

Autologous cultured epithelial layers were established from biopsies from the mucosa of the cheek, a nonkeratinizing region of the oral cavity. These were grafted to the unepithelialized mastoid cavities of nine patients with chronic mastoiditis and severe otorrhoea varying from two to 30 years' duration. All procedures were performed on an out-patient basis, with no anaesthesia except for topical anaesthesia for the mucosal biopsy. In seven of the patients the grafts took well, with complete resolution of the otorrhoea for a minimum follow-up period of eight months. In one patient there was a partial take of the graft with substantial improvement in the rate of discharge. The mastoid cavities of two patients were biopsied five months after grafting, and demonstrated a stratified squamous epithelium, with keratinization of the epithelium clearly evident.
Emergency laryngectomy
Authors: McCombe Andrew , Stell P. M.
Published: November 2007

From 1974 to 1990, 31 patients underwent emergency laryngectomy for airway obstruction due to laryngeal carcinoma, in aneffort to avoid the complication of stomal recurrence. This group of patients had a greater proportion of multiregional tumours (35 per cent vs 13 per cent) than a comparison group of elective laryngectomies. In other respects the two groups were similar.

Early post-operative mortality (6.5 per cent vs 3 per cent), stomal recurrence rates (4.2 per cent vs 4.8 per cent) and survival (53 per cent vs 55 per cent) were not significantly different between the emergency laryngectomy group and the comparison group undergoing elective laryngectomy.
Cochleotoxicity due to Mianserin hydrochloride
Authors: Marais J.
Published: November 2007

A patient who developed bilateral tinnitus and symmetrical high frequency sensorineural hearing loss due to therapy with the anti-depressant Mianserin hydrochloride is presented together with a short review of available literature.
Aberrant central venous catheter complicating radical neck dissection
Authors: Camilleri A. E. , Davies F. W.
Published: November 2007

Abnormal migration of central venous catheters is especially common in the case of long lines inserted via the antecubital fossa. A case is described of internal jugular vein migration of a central venous catheter complicating an ipsilateral radical neck dissection.
Histological changes in free jejunal grafts used in pharyngeal reconstruction
Authors: Deans J. A. J. , Hill J. , Bennett M.
Published: November 2007

A histological study was performed of biopsies taken from jejunal free grafts used in pharyngeal reconstruction. The main findings were a decreased crypt/villi ratio and a mild chronic inflammatory infiltrate. There was no evidence of metaplastic or dysplastic transformation.
Subtotal parathyroidectomy for secondary hyperparathyroidism in chronic renal failure
Authors: Fabretti F. , Calabrese V. , Fornasari V. , Poletti I.
Published: November 2007

Twenty-seven patients on chronic haemodialysis and with secondary hyperparathyroidism underwent subtotal parathyroidectomy during the period 1985–1989. The operation was indicated by severe clinical symptoms and evidence of radiological abnormalities not responsive to conservative treatment (low phosphorus diet, phosphate binding substances, oral calcium and vitamin D). If despite intensive medical management, inadequate control of parathyroid hyperplasia continues surgical intervention becomes necessary. Ultrasonography was performed pre-operatively in all 27 cases and detected 42 of 99 glands (42.5 per cent). Also scintigraphy was carried out in every patient but it gave a relatively low detection rate (24.5 per cent). Surgery was followed by improvement in 20 patients and progression of hyperparathyroidism in seven cases. Three of the seven patients failed to improve after subtotal parathyroidectomy, necessitating a reintervention; the remaining four responded sufficiently to medical therapy. From our experience we conclude that subtotal parathyroidectomy for renal hyperparathyroidism is recommended.
Prognostic significance of hearing loss as a lateralizing indicator in the surgical treatment of vertigo
Authors: Shone Geoffrey , Kemine John L. , Telian Steven A.
Published: November 2007

In patients with peripheral vertigo the presence of an asymmetrical hearingloss is an important lateralizing sign, having both diagnostic and prognostic significance. In a consecutive series of 83 patients undergoing retro-labyrinthine vestibular nerve section for uncontrolled vertigo, asymmetrical hearing loss was associated with an 83 percent incidence of complete control of vertigo and a 49 per cent incidence of complete relief from dysequilibrium. In the absence of a lateralizing hearing loss, the figures were 50 per cent and 24 per cent respectively (p<0.01 and p<0.05). The explanation for this finding may be that the presence of a hearing loss is more often associated with an exclusively peripheral disorder (controllable by peripheral surgical ablation), whereas inpatients with symmetrical hearing there may be an unrecognized central or contralateral pathology resulting in lesseffective results from a unilateral peripheral surgical approach. The bithermal caloric test did not give such useful diagnostic or prognostic information.
Beta adrenoceptors in human nasal mucosa
Authors: Woodhead C. J. , Nimmo A. J.
Published: November 2007

The significance of the beta adrenergic system in the nasal mucosa isunclear. The authors have used the technique of autoradiography to localize and classify beta adrenoceptors in human nasal mucosa. The receptors have been found to beexclusively of thebeta-2 subtype and the highest density is found in the glandularducts. It is suggested that the beta-adrenergic system may have a physiologically important role in controlling the electrolyte composition of nasal secretions.
Khat and oral cancer
Authors: Soufi Hissam E. , Kameswaran Mohan , Malatani Tarek
Published: November 2007

Oral cancers in the Asir region of Saudi Arabia have been observed to occurmostly among patients who have been long-term khat users. In a survey that reviewed cancers for the past two years there were 28 head and neck cancer patients, 10 of whom presented with a history of having chewed khat. One of these was a case of metastatic cervical lymph node and unknown primary, one was a parotid tumour, and the remaining eight presented with oral cancers. All were non-smoking khat chewers and all of them had used itover a period of 25 years or longer. We conclude that this strong correlation between khat chewing and oral cancer warrants attention.
Cochlear fistula found in a naturally healed tympanic cavity
Authors: Suzuki Mamoru , Nishida Isao , Hirakawa Katsuhiro , Nikaido Masafumi , Harada Yasuo
Published: November 2007

A cochlear fistula found in a naturally healed mastoid cavity is reported. The patient is a 53-year-old Japanese woman who was complaining of unsteadiness. She hada long history of otorrhoea in childhood. Her tympanic and mastoid cavities were widely open and were covered by thin epithelium. The posterior wall of the ear canal was missing. She had no hearing in the ear but responded to electrical promontory testing. Exploratory surgery was indicated at which fistulae of the basal turn of the cochlea and the horizontal semicircular canal were found. These fistulae were sealed by pieces of bone andmuscle.
Cholesteatoma in children: results in openversusclosed techniques
Authors: Marco-Algarra J. , Gimenez F. , Mallea I. , Armengot M. , De La Fuente L.
Published: November 2007

Cholesteatoma in children presents characteristics that differentiate it from the adult condition. Surgery has been performed in 55 ears. The main reason for referral was otorrhoea (83 per cent), either alone (29 per cent) or with hearing loss (54 per cent). Apart from three cases with an intact eardrum, a perforation was always present mostly posterior-superior (50 per cent). Open techniques were performed in 27.3 per cent of the ears and the closed technique in 72.7 percent. Only in 18 per cent of cases was the ossicular chain normal and mobile. The attic was occupied by cholesteatoma in 79 per cent. Recurrence took place in 37 per cent and 13 per cent of the closed and open techniques respectively. Open techniques tend to be employed in the presence of extensive disease, whereas the closed technique is reserved for those with a more localized problem.
Alternative method of application of topical preparations in otitis externa
Authors: Dekker P. J.
Published: November 2007

Management of otitis externa and the discharging mastoid cavity accounts for a significant proportion of the ENT out-patient workload. A simple technique of topical application of dermatological preparations is described which is easy and effective.
Exostosis of the external auditory canal: an interesting histopathological finding
Authors: Pace-Baizan A. , Hawke M.
Published: November 2007

Perforation of the tympanic membrane is a frequent complication of surgery for exostoses of the external auditory canal We report an unusual histopathological finding in a temporal bone containing external canal exostoses which suggests that some of these perforations may be unavoidable.
Foreign body in the tongue: an unusual site for a common problem
Authors: Patel Kalpesh S.
Published: November 2007

Foreign bodies in the upper aerodigestive tract represent one of the commonest ENT emergencies. A case report of a fish bone penetrating the anterior tongue is presented which exemplifies this frequent problem. but at a rare site.
‘Priapism’ of the turbinates: A cause of nasal obstruction in sickle cell anaemia
Authors: Ajulo S. O.
Published: November 2007

A cause of nasal obstruction in sickle cell anaemia not previously described in the literature is presented.

The pathophysiology is the same as in priapism because of the similarities in the vascular arrangement of the turbinate and the penis.

Various treatment options are considered but the best results were achieved by surgical reduction of the inferior turbinates.
Gentamicin administration via peritoneal dialysis fluid: the risk of ototoxicity
Authors: Gendeh B. S. , Said H. , Gibb A. G. , Aziz N. S. , Zahir Z. M.
Published: November 2007

In a prospective study on 47 patients, 16 mg of gentamicin per two litres dialysate was administered intraperitoneally at every cycle of intermittent peritoneal dialysis, carried out over the course of several days. Serum gentamicin sampling, pure tone audiometry and caloric tests were performed before and during the treatment. The gentamicin levels reached at the end of the thirtieth cycle were observed to be low. In view of this, the risk of acute ototoxicity was considered to be minimal. This was confirmed by the absence of clinical audiometric or vestibulometric evidence of toxicity.
Posterior fossa vestibular neurectomy
Authors: Moffat D. A. , Toner J. G. , Baguley D. M. , Hardy D. G.
Published: November 2007

Many procedures have been devised to deal with intractable vertigo and conserve hearing, but despite this selective vestibular nerve section remains by far the most effective treatment.

A series of 14 patients who underwent posterior fossa vestibular neurectomy is reported. The results are reported for vertigo control, hearing and tinnitus. All of the patients achieved vertigo control according to the AAOO (1972) reporting system. A simple and reliable system for the classification of the disability in these patients has yet to be devised. This problem is addressed and a disability grading system proposed, and discussed.
Fibre-optic endoscopy in atrophic rhinitis
Authors: Kameswaran Mohan
Published: November 2007

Primary atrophic rhinitis seems to have a high prevalence in the arid regions bordering the great deserts of Saudi-Arabia. Fibre-optic endoscopy was performed on 42 patients treated surgically. Fibre-optic endoscopy demonstrated the presence of crusts in the nasal cavities and their subsequent reduction following surgery. It also demonstrated ulceration of the cartilaginous nasal septum in some cases and this may explain the pathogenesis of septal perforation noted in a high number of our patients. Fibre-optic nasendoscopy was also helpful in demonstrating the reappearance of free mucus in the nasal cavity and helped to determine the optimal time for reversing Young's procedure. Fibre-optic nasendoscopy is a reliable tool for verifying the results of surgery and comparing the efficacy of various treatment modalities.
Serum cotinine as an objective marker for smoking habit in head and neck malignancy
Authors: Whittet H. B. , Lund V. J. , Brockbank M. , Feyerabend T C.
Published: November 2007

Cigarette-smoking is a well-established aetiological factor in squamous cell carcinoma of the larynx. In Great Britain the majority of patients with laryngeal cancer are treated by radiotherapy with salvage surgery if necessary. A troublesome side effect of radiotherapy is mucositis which may exacerbate hoarseness, dysphagia, airway obstruction or pain. Although it is a common belief that continued smoking and alcohol consumption during radiotherapy may increase the frequency and severity of these side effects this has not been demonstrated objectively. This study confirms and illustrates the relationship between such radiotherapy reactions to continued smoke exposure by using an objective biochemical marker of smoking status.
A guide to the selection of paediatric tracheostomy tubes
Authors: Irving R. M. , Jones N. S. , Bailey C. M. , Melville J.
Published: November 2007

A large range of tracheostomy tube types and sizes are available for use in children. Regional preference, rather than individual patient assessment, tends to determine selection. We present a table designed to assist with appropriate size selection, and discuss the relative merits and shortcomings of the tubes currently available.
C.T. Demonstration of metastatic anaerobic orbital abscess
Authors: Tovi Ferit , Gatot Albert , Hertzanu Yanku
Published: November 2007

Orbital abscess of rhinosinogenic origin may develop, either by contiguous spread of the infection or by a thrombophiebitic process. While destruction of the bony walls of the paranasal sinus occurs in propagation of the infection by tissue continuity, haematogenous spread may take place through intact bone. Computed tomography demonstrates the status of the bony partitions shared by the orbit and paranasal sinuses, and the source of the orbital sepsis, thereby influencing the therapeutic approach.
Immunohistochemical evaluation with Ki-67: An application to salivary gland tumours
Authors: Murakami M. , Ohtani I. , Hojo H. , Wakasa H.
Published: November 2007

Using Ki-67, a monoclonal antibody, the proliferating capacity of 15 salivary gland tumours, including nine pleomorphic adenomas, four adenoid cystic carcinomas, one mucoepidermoid carcinoma and one acinic cell carcinoma was determined immunohistochemically, using normal salivary gland tissue as a control. The frequency of Ki-67 positive cells was 4.7 per cent in the normal salivary gland and one per cent in pleomorphic adenomas, whereas the average frequency in malignant tumours was 18.3 per cent. Among adenoid cystic carcinomas, the frequency was related to the morphological type; the solid sub-type had the highest frequency of Ki-67-positive cells. As this sub-type is recognized as the most aggressive of these tumours, this technique has the potential of providing an early indication of the clinical behaviour of a tumour.
Speech in noise: a practical test procedure
Authors: Jayaram M. , Baguley D. M. , Moffat D. A.
Published: November 2007

A simple and effective speech in noise test is described with clinical findings for patients with normal hearing, cochlear and retrocochlear pathologies and auditory dysacusis. The test utilizes material readily available in Audiology and ENT Departments. It was possible to obtain useful diagnostic information in patients who complain of hearing loss, but who demonstrate normalaudiometric thresholds and normal speech in quiet discrimination.
Branchial cleft and pouch anomalies
Authors: Ford G. R. , Balakrishnan A. , Evans J. N. G. , Bailey C. M.
Published: November 2007

We present a retrospective study of 106 patients with branchial cleft and pouch anomalies who presented to the Hospital for Sick Children between 1948 and 1990. The relevant embryology of the branchial apparatus is summarized and a theoretical description of individual anomalies given.

Second branchial cleft sinuses were the most common anomalies, and the majority were managed simply, with adequate excision and a low recurrence rate. Five cases of first branchial cleft anomalies are presented, emphasizing the delay in diagnosis, the need for complete excision to prevent recurrence, and for a parotidectomy incision to protect the facial nerve from damage. The two third branchial pouch anomalies presented with a cystic neck swelling, one with recurrent infection and discharge, and the other with stridor. In both, the diagnosis was made at operation. The single fourth branchial pouch cyst was an unexpected finding in a patient with stridor.