bluuebunny/crossref_metadata_2025 huggingface dataset:
Localized mastoiditis simulating a facial nerve schwannoma on MRI
Authors: Vlahos L. , Yiotakis J. , Gouliamos A. , Kotoulas G. , Adamopoulos G.
Published: November 2007

A case of a single inflamed mastoid air cell is described. This was initially interpreted as a facial nerve schwannoma on MRI examination. Careful evaluation of the signal characteristics and additional findings from the high resolution CT examination helped to establish the correct diagnosis.
Rhinosporidiosis: immunohistochemical and electron microscopic studies
Authors: Azadeh Bahram , Baghoumian Nina , El-Bakri Osama T.
Published: November 2007

Sixteen biopsies of rhinosporidiosis (15 nasal and one conjunctival) from 16 Southern Indian male immigrant workers showed mucosal lymphoplasmacellular infiltrates together with transepithelial elimination of nodular bodies and destruction of some late stage nodular bodies in histiocytic granulomata with central neutrophilic microabscesses. Early nodular bodies were immunohistochemically positive for alpha1-AT, alpha1-ACT, CEA, S100, fibronectin, amyloid-p-component, IgG, IgA, CIqand C3. Electron microscopy showed organized

concentric lamellated bodies in early nodular bodies and not in end-stage nodular bodies which contained mostly amorphous electron dense materials. Structures formerly regarded as ‘sporangia’ and ‘spores’ are believed to be lysosomal bodies loaded with indigestible residues to be cleared via transepithelial elimination or segregated/destroyed by secondary immune/granulomatous responses.
Medical education: an audit of an Overseas postgraduate training programme in ENT
Authors: Baraka M. E.
Published: November 2007

For overseas doctors, looking for higher training posts, the chance of being employed in the developed countries is becoming bleaker. This article considers the need for an increase in the number of local postgraduate training programmes in the Arab world in keeping with other developing countries. The model used for this study was an internal audit, of the postgraduate programme in ENT offered by King Faisal University in Dammam, Saudi Arabia. A dropout rate of more than 30 per cent among those who joined the programme reflected either the tougher standard of the course, or an inappropriate selection process. A major reason was the frustrating inability of the trainees to cope with the basic sciences course. This point was also addressed in the audit with a view to rationalizing the course to meet specific objectives.
A new diagnostic approach to congenital stridor using a laryngeal mask airway and rigid endoscope
Authors: Samet A. , Talmon Y. , Frankel R. , Simon K.
Published: November 2007

Neonates with symptoms of stridor from birth, present a difficult diagnostic problem. We have demonstrated that by the use of a laryngeal mask airway in an anaesthetized baby breathing spontaneously, we are able to reach a diagnosis. This is accomplished by the introduction of a rigid fibre-optic endoscope through a Portex swivel connector and visualizing the glottis and larynx.
First cleft branchial fistula in a child – a modified surgical technique
Authors: Murthy P. , Shenoy P. , Khan N. A.
Published: November 2007

Congenital first branchial cleft fistulae, their embryology, anomalies, varied relationships to the facial nerve and surgical techniques for their excision have been well described in the literature. We report a case of a type II first cleft fistula in a three-year-old child which required a modification of the standard surgical approach to achieve safe and complete excision with identification and preservation of the facial nerve.
Submental abscess: an unusual delayed complication of primary Blom–Singer valve insertion
Authors: Denholm S. W. , Fielder C. P.
Published: November 2007

Voice restoration following laryngectomy can be achieved by the now well accepted technique of inserting a ’Blom–Singer‘ prosthesis through a tracheo-oesophageal fistula created either primarily or secondarily. Recognized complications of primary puncture and valve insertion include haemorrhage, oesophageal perforation, peristomal cellulitis and aspiration of saliva. We describe the previously unreported complication of a submental abscess developing probably as a result of air being forced from the fistula up between the trachea and the pharynx, this plane not having fully healed as a result of previous radiotherapy. The problem was compounded by the patient's over-zealous attempts to phonate. To prevent this problem arising in future we recommend leaving the fistula at least six weeks to mature before inserting the valve, when the patient has had previous radiotherapy, and encouraging relaxation when learning to phonate with this technique.
Aberrant thyroglossal cyst
Authors: O'Hanlon D. M. , Walsh N. , Corry J. , Mortimer G. , Flynn J. R.
Published: November 2007

A case is presented of a laterally occurring thyroglossal cyst. In conventional teaching, thyroglossal duct remnants occupy the midline, or a position adjacent to the midline, and are found in a line marking the descent of the thyroid anlage and move upwards on protruding the tongue. Laterally presenting thyroglossal duct remnants are unusual.
Mycobacterium marches back
Authors: Williams R. Gareth , Douglas-Jones Tony
Published: November 2007

The resurgence of tuberculosis world-wide and its association with HIV infection means a greater likelihood of otolaryngologists encountering the disease in one form or another. In this review the features of primary and secondary tuberculosis in various head and neck sites are described, and recent advances in diagnosis are discussed. For the otolaryngologists other important aspects such as infections with atypical mycobacteria, the differential diagnosis of cervical lymphadenopathy in HIV-infected patients, recently recognized problems in drug treatment, and the role of surgery in head and neck tuberculosis are also discussed.
The effect of long-term antibiotic therapy upon ciliary beat frequency in chronic rhinosinusitis
Authors: Scadding G. K. , Lund V. J. , Darby Y. C.
Published: November 2007

The mucociliary escalator is the first line of defence of the upper and lower respiratory tracts (Greenstone and Cole, 1985; Sleighet al., 1988). Failure of mucociliary clearance is associated with chronic or recurrent respiratory tract infection. Ten patients with chronic rhinosinusitis underwent nasal brushings for the assessment of ciliary beat frequency. In two no beating cilia were seen; in the remainder the mean value was 9.3 Hz ± 2.3; range 6.1–12.8 Hz (n = 8).

Following three months continuous oral antibiotic therapy repeat nasal brushings demonstrated increased ciliary beat frequencies in all patients, mean value 13.7 Hz ± 1.6; range 11.5–16.3 Hz (n = 10); (p<0.001 pairedt-test).

Depression of mucociliary clearance can occur secondarily to chronic infection and is improved by prolonged antibiotics.
Anterior cervical pain syndromes: hyoid, thyroid and cricoid cartilage syndromes and their treatment with triamcinolone acetonide
Authors: Kunachak Somyos
Published: November 2007

Fifty-one patients who presented with anterior cervical or throat pain, without apparent cause, were selected for study at the ENT outpatient department from January 1987 to January 1992. Their clinical symptoms, probable aetiologies and treatment were studied. The most common diagnosis was hyoid syndrome, followed by thyroid cartilage syndrome and cricoid cartilage syndrome. These last two syndromes have not been previously reported because they were coined in Ramathibodi Hospital for patients who had similar clinical patterns localized to the thyroid and cricoid cartilages respectively. Treatment using intralesional triamcinolone acetonide injection was effective in all cases. There was no recurrence after one-five years follow-up.
Cordectomy: a solution to Teflon granuloma of the vocal fold
Authors: Russell J. D. , Perry Alison , Cheesman A. D.
Published: November 2007

Teflon injection has been widely used for the treatment of unilateral vocal fold paralysis. Complications are few and infrequent. Overinjection and Teflon granuloma are the two commonest problems encountered. Treating such complications and restoring vocal quality is widely regarded as difficult. Endoscopic transmucosal excision of the excess Teflon and/or granuloma has not been successful in improving phonatory quality. Cordectomy is proposed as an alternative surgical approach for managing both the convex vocal fold and Teflon granuloma after injection.
Palatal myoclonus affected by neck position
Authors: Tomkinson A. , Craven C. , Brown M. J. K. M.
Published: November 2007

Palatal myoclonus is defined as a continuous, rhythmic contraction of the palatal musculature. Reverberant neuronal activity in a region of the brain stem known as the Guillain-Mollaret triangle is believed to underlie this condition.

We present a case of palatal myoclonus which could be abolished, by anterior neck flexion. The pathology and management of this condition is briefly discussed.
Glomus tumour of the oropharynx
Authors: González-Cámpora Ricardo , Rodríguez José Luis Villar , Ramírez Francisco Vázquez , Cano Salvador Díaz , Ruiz Hugo Galera
Published: November 2007

Haemangiopericytoma and glomus tumours are infrequent neoplasms in otorrhinolaryngology. A case of glomus tumour with haemangiopericytomatous features of the left amygdalar fossa tsaeported. Its clinical, surgical and histological features are described. This case report supports the unitary concept of smooth muscle tumours of the small vascular wall.
Aerodigestive tract obstruction as a late complication of radiotherapy
Authors: Nageris Benny , Elidan Joseph , Sichel Jean-Yves
Published: November 2007

Oedema, fibrosis, and stenosis of the hypopharynx and the oesophageal inlet are described in a few publications as a complication of post-laryngectomy irradiation treatment.

In this paper a case of laryngeal carcinoma, treated exclusively by irradiation, where severe laryngeal and hypopharyngeal stenosis with complete occlusion of the oesophageal inlet were manifested as a late complication is described. We have found no similar case described in the English literature.
Hearing loss and pigmentary disturbances in Waardenburg syndrome with reference to WS Type II
Authors: Liu Xuezhong , Newton Valerie , Read Andrew
Published: November 2007

Thirty families in which there were 149 individuals affected by the Waardenburg syndrome (WS) were investigated for penetrance of hearing loss and pigmentary abnormalities. Twenty two families contained 89 individuals affected by WS Type II and eight families with 60 individuals affected by Type I. A bilateral symmetrical sensorineural hearing loss was found to be the most common type of hearing loss. The most frequent degree of hearing loss category was a hearing loss of > 100dB HL with no difference between syndrome types.

Although there was no significant difference in the frequency of pigmentation disorders between Type I and II, considering these abnormalities as a whole, heterochromia irides was more common in Type II than Type I and other pigmentation disorders were more frequent in Type I: 62 per cent of Type I patients had more than one pigmentary defect, but only 28 per cent of Type II. Pigmentary disturbances were not significantly more frequent in the hearing impaired group than in the normally hearing group in either Type I or II when taking into account the occurrence of only one pigmentation disorder. There was a significantly higher proportion of pigmentary defects in the hearing impaired group with Type I when only those having more than one pigmentary abnormality were compared: 93.3 per cent of Type I patients and 88.5 per cent of Type II patients with a profound hearing loss had pigmentary defects. The frequency of pigmentation disorders was not greater when the hearing loss was more severe in either type. Penetrance for hearing loss and pigmentary abnormalities showed marked intrafamilial and interfamilial variation.
An audit of the management of acute otitis externa in an ENT casualty clinic
Authors: Raza S. Ali , Denholm Stuart W. , Wong Jimmy C. H.
Published: November 2007

The management of acute otitis externa is variable, despite the fact that it is one of the commonest otological emergencies. We formed the impression that many patients attending our ENT casualty clinic with otitis externa were being treated and followed up inappropriately. To test this hypothesis we performed a retrospective pilot study on our practice which revealed a lack of uniformity in the management and follow-up of these patients. And as a result of this, guidelines were developed to improve our management of otitis externa and decrease the number of unnecessary review visits. Our practice was then audited prospectively over a six-month period with the guidelines in place. An improvement in the overall management and a rationalization of follow-up for otitis externa was seen by applying basic audit principles to this common clinical problem.
Chondrosarcoma of the larynx
Authors: Koka Venkata N. , Veber Francois , Haguet Jean-Francois , Rachinel Oliver , Freche Charles , Liguory-Brunaud Marie-Dominique
Published: November 2007

A case of a low grade chondrosarcoma of the cricoid cartilage which had been diagnosed intially as a chondroma is presented. The tumour reurred twice after limited surgical resections. Total laryngectomy was inecvitable due to near total involvement of the cricoid cartilage and subsequent histological examination revealed a low grade chondrosacroma. We have discussed in brief, the diagnosis and treatment of chondrosarcomas of the larynx and support the view of consecutive surgical managaement of low grade tumours as they are slow growing and metastates are infequent. A total laryngectomy may be reserved for salvage or primarily when more than half of the cricoid cartilage needs to be resected.

Histologicalgrading reveals the biological behaviour of the tumour and CT scans help in planning the surgery. A regular follow-up is necessary for early detection of recurrences and metastases.
Chondroradionecrosis of the larynx: still a diagnostic dilemma
Authors: Rowley H. , Walsh M. , McShane D. , Fraser I. , O'Dwyer T. P.
Published: November 2007

Following radiation treatment for carcinoma of the larynx it may be very difficult to differentiate between persistent or recurrent tumour and severe radiation effects particularly chondroradionecrosis. Despite repeated negative biopsy it may be necessary to perform total laryngectomy where the concern about persistent cancer remains and the larynx is non-functioning. We report nine cases presenting as chondroradionecrosis over a five-year period. Two patients settled on medical treatment. Of seven patients treated with laryngectomy the histology on two revealed residual or recurrent carcinoma.

We outline the dilemmas in diagnosis and propose management strategies to deal with this condition including recommendations for prevention and treatment.
Metastatic melanoma of the tonsil and the nasopharynx
Authors: Ramamurthy L. , Nassar W. Y. , Hasleton P. S.
Published: November 2007

Metastatic melanoma of the tonsils is rare. This paper describes one such case, highlighting the histopathology and the mode of spread.
The pharyngocele: infrequently encountered and easily misdiagnosed
Authors: van de Ven P. M. , Schutte H. K.
Published: November 2007

A pharyngocele is a rare condition. According to the literature and our own experience it is usually not recognized or is mistaken for a laryngocele.

short review of the literature, a description of the condition and three cases are reported.
Chondromyxoid fibroma of the nasal bone with extension into the frontal and ethmoidal sinuses
Authors: Koay C. B. , Freeland A. P. , Athanasou N. A.
Published: November 2007

Chondromyxoid fibroma is a rare benign tumour whose histological appearance may easily be misinterpreted as chondrosarcoma. It has a tendency to recur locally unless completely excised. A rare case of the tumour affecting the nasal bone with extension into the frontal and ethmoidal sinuses and impingement on the cribiform plate is presented. Complete excision was achieved any the craniofacial resection approach.
Epithelial migration in open mastoidectomy cavities
Authors: Youngs Robin
Published: November 2007

Twenty patients who had undergone open cavity mastoidectomy for chronic middle ear disease were selected for study. Following initial microscopic aural toilet, each cavity was painted in its medial aspect with a marker solution of Bonney's Blue dye. Each patient was assessed at weekly intervals for a minimum of three months following application of dye, and a photographic record made of the cavity. Information was also sought regarding the clinical behaviour of the mastoid cavities, with particular regard to degree of otorrhoea, and accumulation of debris. Migration of epithelium inferred by visible movement of dye occurred in 17 of the 20 mastoid cavities. In all these cases migration occurred in a medial to lateral direction, towards the exterior. In two cases there was no visible migration throughout the period of observation, and inspection after six months revealed the dye to be still present in the original position. Both these cases were of dry trouble-free cavities in which accumulation of debris did not appear to be a problem. This finding calls into question the assumption that clean trouble-free cavities are maintained by a satisfactorily functioning epithelial migration. In the four cavities which suffered from intermittent otorrhoea, epithelial migration occurred at a similar rate to that in dry cavities.
A confidential comparative audit of stapedectomies: results of the Royal College of Surgeons of England Comparative Audit of ENT Surgery 1994
Authors: Harkness P. , Brown P. , Fowler S. , Grant H. , Topham J.
Published: November 2007

This paper presents the results of a national confidential comparative audit of stapedectomy: 185 operations by 28 consultants over a two-year period were retrospectively analysed. This included 10 revision procedures. Small fenestra stapedectomies accounted for 63 per cent of the total. Thirty-nine per cent of consultants operated on the second ear. Of the 168 stapedectomies in which the hearing change was known at six months, 87 per cent achieved improved hearing, eight per cent had no change and five per cent were worse. The overall complication rate was 30 per cent with a ‘dead ear’ rate of two per cent.
Nasal tuberculosis – an increasing problem?
Authors: Johnson I. J. M. , Soames J. V. , Marshall H. F.
Published: November 2007

Nasal tuberculosis represents a rare manifestation of infection by Mycohacteriurn tuberculosis: a case is presented together with a review of the literature. The correct management is documented, especially the need to treat the patient as if there was a generalized condition, and the problems concerning drug resistance are also considered. The incidence of this disease is rising and its importance must once again he highlighted.
An unusual presentation of an unusual complication of infectious mononucleosis: haematemesis and melaena
Authors: Koay C. B. , Norval C.
Published: November 2007

Tonsillar haemorrhage is a rare complication of infectious mononucleosis. We present a case of life-threatening tonsillar haemorrhage secondary to infectious mononucleosis in a young man whose predominant symptoms at presentation were haematemesis and melaena. The origin of the haemorrhage was not obvious until the patient was examined under anaesthesia. The bleeding was controlled by emergency tonsillectomy.
Lipomas of the larynx and hypopharynx: a review of the literature with the addition of three new cases
Authors: Wenig Bruce M.
Published: November 2007

Lipomas of the larynx and hypopharynx are uncommon mesenchymal neoplasms. This report discusses the clinical and pathological features of three cases of laryngeal and hypopharyngeal lipomas. Two of the cases occurred in females and one in a male. The ages of the patients were 28, 51 and 51 years respectively. Two of the cases involved the supraglottic larynx (left arytenoid and left vestibular fold); the third involved the pyriform sinus. Symptoms included airway obstruction. dysphagia, throat discomfort, a sensation of excessive secretions in the throat and an increase in snoring. The complaints occurred over periods ranging from several months to one year in duration. Clinically, a polypoid lesion described as yellow in appearance was seen. Histologically. the tumours were composed of mature adipocytes without evidence of pleomorphism, lipoblasts or infiltrative growth. Surgery was the treatment of choice and included simple but complete excision in two of the cases. In these two cases, surgery proved curative with follow-up periods of 11 and seven years, respectively. In one case. the initial tumour was removed in pieces. This lesion recurred 15 years after the initial resection and was totally excised at that time. This patient has been free of tumour for more than five years.
Evolution of speech and voice following supracricoid partial laryngectomy
Authors: Crevier-Buchman Lise , Laccourreye Ollivier , Weinstein Gregory , Garcia Dominique , Jouffre Véronique , Brasnu Daniel
Published: November 2007

The evolution of voice and speech parameters following supracricoid partial laryngectomy (SCPL) has been evaluated in a prospective fashion over an 18-month period of time in three patients using the Computerized Speech Lab (from Kay Elemetrics). Preliminary results demonstrate the post-operative instability of voice parameters. Speech parameters remain stable with time. Our data stresses that voice is attained post-operatively even if one arytenoid cartilage is disarticulated at time of resection.
Thrombosed posterior-inferior cerebellar artery aneurysm: a rare cerebellopontine angle tumour
Authors: Morris David P. , Ballagh Robert H. , Hong Alvin , Moffat David A. , Hardy David G.
Published: November 2007

A case report of a thrombosed posterior-inferior cerebellar artery aneurysm is described. The tumour masqueraded as a vestibular schwannoma on imaging but the presenting featureswere unusual, the facial pain and weakness predominating despite well preserved hearing. This is an example of a rare cerebellopontine angle tumour and highlights the need for suspicion when lesions present atypically.
Tension pneumoperitoneum as an early complication after adenotonsillectomy
Authors: Vos Gus D. , Marres E. H. , Heineman Erik , Janssens Maurice
Published: November 2007

Pneumoperitoneum as a result of pneumomediastinum has been described already. Amongst the causes pneumoperitoneum due to a complication of adenotonsillectomy, has not previously been described.

We describe a five-year-old girl with tension pneumoperitoneum with respiratory and circulatory insufficiency half an hour after adenotonsillectomy. Removal of the intra-abdominal air witha 14 gauge needle restored normal respiration and circulation.
Mast cells in aural polyps: a preliminary report
Authors: Hussain S. S. M. , Hopkinson J. M.
Published: November 2007

Mast cells are a rich source of potent biologically active mediators and are found in connective tissue, associated with blood vessels in many varied inflammatory conditions. Mast cells have been described in nasal polyps and turbinates and in adenoidal tissue in the upper aerodigestive tract. As the middle ear lining is contiguous with the nose and the nasopharynx, the presence of mast cells in aural polyps is interesting.

This preliminary study investigated the presence of mast cells in inflammatory aural polyps using light microscopy. All patients presenting to the department in one year were included. Patients with previous ear disease or surgery and in whom cholesteatoma was suspected were excluded. Except for one patient mast cells were seen in all aural polyps. The implications of these findings is discussed. Further work is needed using electron microscopy.
Anticipation in Menière's disease
Authors: Morrison Andrew W.
Published: November 2007

The aetiology of Menière's disease (MD) remains obscure, but is likely to be multifactorial, one of the factors being a genetic predisposition. Forty-one families with more than one living member with MD were ascertained and affected and normal relations examined. Blood was collected and DNA extracted and stored. In these families the mode of inheritance is autosomal dominant, the penetrance of the mutation being about 60 per cent. Some of the family members exhibit a partial syndrome, vestibular symptoms predominating. Sporadic and familial cases exhibit the same clinical features. The striking finding is the phenomenon of anticipation, whereby with successive generations there is an earlier age of onset and a tendency to more severe manifestation. The inference, considering that the cells which regulate endolymph are of neuroectodermal origin, is that, like other neurodegenerative disorders which show anticipation, MD manifestation is likely to be related to trinucloetide expansion within a gene.
Giant cell tumour of the temporal bone presenting as vertigo
Authors: McCluggage W. G. , McBride G. B. , Primrose W. J. , Cullan J. , McNaboe E. J. , Bharucha H. , Fannin T.
Published: November 2007

We report a case of giant cell tumour of the temporal bone arising in a 31-year-old man. The presenting symptoms were unusual, being rotational vertigo, unilateral tinnitus, and hearing loss. A computed tomography (CT) scan showed a large mass within the right temporal bone and the infratemporal fossa. The radiological appearance was suggestive of an aggressive primary neoplasm arising within bone. Biopsy and subsequent resection showed a giant cell tumour of bone. The tumour was histological grade 1. At two-year follow-up, there was no evidence of tumour recurrence or metastasis.
Acute airway obstruction due to ruptured aneurysmal arterio–venous fistula: common carotid artery to internal jugular vein
Authors: Nandapalan V. , O'Sullivan D. G. , Siodlak M. , Charters P.
Published: November 2007

Fistulae between major vessels in the head and neck are uncommon. In both civilian and wartime reports, the total number of traumatic arterio–venous fistulae in head and neck region account for less than four per cent of all arterial injuries. Fourteen cases of congenital communication between the external carotid artery and external or internal jugular vein have been reported. We report and discuss the management of a case of ruptured carotico–jugular fistula secondary to infection which presented as acute upper airway obstruction. This appears to be the first description of such a case in the literature.
Oncocytic differentiation in salivary gland tumours
Authors: Ferreiro Jorge A. , Stylopoulos Nickolaos
Published: November 2007

An oncocytic mucoepidermoid carcinoma and an oncocytic pleomorphic adenoma occurred in a 47-year-old male and a 75-year-old female, respectively. Both presented as asymptomatic parotid gland masses without evidence of facial nerve paralysis and were treated by superficial parotidectomy. There has been no evidence of recurrence or metastasis. Oncocytic change is rare in major salivary gland mucoepidermoid carcinoma with only two previously reported cases. Marked oncocytic transformation of pleomorphic adenomas can cause their confusion with oncocytomas. Recognition of oncocytic differentiation in various salivary gland tumours is important to avoid misclassification of these lesions.
Canal wall down mastoidectomy: causes of failure, pitfalls and their management
Authors: Bhatia Sanjaya , Karmarkar Sandeep , DeDonato Giuseppe , Mutlu Cemil , Taibah Abdelkader , Russo Alessandra , Sanna Mario
Published: November 2007

Managing patients with failed canal wall down mastoidectomy, requires a meticulous approach to control the disease and restore hearing. The present article reviews the causes of failure of the primary procedure and pitfalls encountered in 105 patients referred to our centre for revision canal wall down mastoidectomy. At post-revision surgery there were no cases with residual or recurrent cholesteatoma. The failures in our revision procedure were due to tympanic membrane perforation which occurred in five percent (n = 4) and intermittent otorrhoea in two percent (n = 2). A dry cavity with adequate middle ear space allowed for optimum audiological function even in revision canal wall down procedures.
Tonsillar lipoma: a case report
Authors: Harada Hiroshi , Kashiwagi Shoichi , Morimatsu Minoru , Kameyama Tadamitsu , Takahashi Masami
Published: November 2007

Benign tumours of the tonsils are rare. Only a few cases of tonsillar lipoma have been previously reported. The case of a pedunculated polypoid lipoma of the palatine tonsil in a 44-year-old Japanese woman is presented. The ‘polyp’ was excised and an histopathological examination was carried out. The ‘polyp’ contained dilated lymphatics in the dense fibrous connective tissue beneath the overlying mucosal epithelium and below the mature fat tissue with intervening strands of fibrous tissue.
Angiomatous malformation of the floor of the mouth associated with fluctuating macroglossia in an adult: an unusual case report
Authors: Murthy P. , Shenoy P. K. , McClymont L. G.
Published: November 2007

We report an unusual case of a large vascular lesion of the floor of the mouth of rapid onset in a 50-year-old man who presented with an external swelling in the submental region and a history of fluctuating swelling of the tongue. The clinical features, investigations, treatment and course of this rare condition are discussed.
Inner ear involvement in rheumatoid arthritis: a prospective clinical study
Authors: Kastanioudakis Ioannis , Skevas Antonios , Danielidis Vasilios , Tsiakou Eleni , Drosos A. Alexandros , Moustopoulos M. Haralampos
Published: November 2007

Sensorineural hearing loss in rheumatoid arthritis (RA) has been reported to be the result of the extraarticular manifestation of the disease (rheumatoid nodular vasculitis) or due to drug ototoxicity.

In an attempt to investigate the presence of sensorineural hearing loss and the possible causes for it we investigated prospectively 45 RA patients (42 female; three male) with a mean age of 52.5±10.7 years and a mean disease duration of 8.5±7.3 years. All patients underwent a complete physical examination and audiological evaluation which included pure tone audiometry and impedance audiometry (tympanogram, static compliance, acoustic reflex, reflex decay, acoustic reflex latency test.

We found a sensorineural hearing loss >20 dB HL in 44.4 per cent (40/90) ears. In all cases the site of hearing loss was the cochlea and in most of them it was bilateral and symmetric (16 patients out of 45 had bilateral sensorineural hearing loss i.e. 35.5 per cent.

There was no correlation between sensorineural hearing loss and age, sex, disease duration, articular and extra-articular manifestations and the presence of autoantibodies in our patients. In addition, no correlation was found between sensorineural hearing loss and drug therapy for one at least of the following drugs: NSAIDs, d-penicillamine, plaquenil and methotrexate.

We noticed a prologation of acoustic reflex latency in five patients (10 per cent) which was found to be correlated with the temporomandibular joint involvement and the presence of rheumatoid factor (RF).

We conclude that inner ear involvement in RA is expressed by: (1) mild symmetric, bilateral sensorineural hearing loss of cochlear type in 35.5 per cent of patients; (2) normal acoustic reflex thresholds; (3) nondecay; and (4) prologation of acoustic reflex latency which appeared in a small number of patients (10 per cent).
Syphilitic labyrinthitis – an update
Authors: Chan Y. M. , Adams D. A. , Kerr A. G.
Published: November 2007

Forty-eight patients with syphilitic labyrinthitis have been treated and followed up for periods of six months to 25 years; interpretation of the hearing results must be in the light of the natural history of this condition which is perceived to be progression of hearing loss to profound deafness.

At the beginning of the series treatment was with ampicillin alone and on this treatment 11 ears with useful hearing were maintained at this level. The group with combined ampicillin and prednisone treatment, which included some failures from ampicillin alone, maintained useful hearing in 28 out of 29 ears. Those treated initially with ampicillin and prednisone and later also given regular injections of ACTH, maintained hearing in 16 out of 17 ears.

At the outset, there were 29 profoundly deaf ears. One of these recovered some useful hearing but two ears with useful hearing at the outset became profoundly deaf so that at the end there were 30 profoundly deaf ears. However, all patients as opposed to ears, with useful hearing at the outset were left with some hearing; no patient became profoundly deaf.
Laryngeal carcinoma ex-papilloma in a non-irradiated, non-smoking patient: a clinical record and review of the literature
Authors: Hasan Suhel , Dutt Sunil N. , Kini Usha , Shariff Shameem , Nalinesha K. M. , Prasad Devi
Published: November 2007

Malignant transformation of respiratory papillomata is not uncommon in the presence of precipitating factors such as tobacco smoking and therapeutic irradiation. Respiratory papilloma changing to carcinoma in the absence of smoking and irradiation is seldom seen, with only about 20 documented cases presented in the literature. Here we report one such case in a 30-year-old male patient.
Tongue paralysis following head trauma
Authors: Kacker Ashutosh , Komisar Arnold , Kakani Rajesh S. , Reich Edward , Rothman Lewis
Published: November 2007

Paralysis of the tongue due to isolated bilateral hypoglossal nerve palsy is a rare occurrence. Due to a trauma the cause in our case may have been a traction injury to both hypoglossal nerves at the base of skull. In some cases a contributing factor may be malformation of the skull base. Most cases have a good prognosis for recovery.
Recurrent sialadenoma papilliferum of the buccal mucosa
Authors: Pimentel María Teresa Yebra , Amado Manuel López , Sarandeses Adolfo García
Published: November 2007

Sialadenoma papilliferum is a rare, benign, exophytic tumour of the salivary glands. The prognosis is exceptionally good. Since the lesion was first described, 30 cases have been reported in the English literature. and only one of these is known to have recurred.

A case of sialadenoma papilliferum occurring in the buccal mucosa with recurrence three years after local excision, is presented. The literature is briefly discussed.
Nonsurgical management of surgical otitis media with effusion
Authors: Rosenfeld Richard M.
Published: November 2007

The objective of this paper was to determine the effectiveness of combined steroid-antimicrobial therapy for otitis media with effusion (OME) of sufficient duration to justify tympanostomy tube insertion.

A consecutive sample of 122 children with bilateral OME of at least three months duration, or unilateral OME of at least six months duration, despite treatment with one or more beta-lactamase stable antibiotics was studied. The treatment group received prednisolone plus a beta-lactamase stable antibiotic for 10 days, with responders receiving an additional six weeks of chemoprophylaxis. The control group received no medication. The child's caregiver decided which group the child should be in.

Resolution of effusion in all affected ears occurred in 32 per cent of steroid-treated children and in 2 per cent of controls (p<0.001) at three to four weeks post-therapy. Relapse of effusion occurred in over 40 per cent of initial responders within six months, reducing the final resolution rate to 25 per cent (95 per cent CI: 15–36 per cent).

It was concluded that treatment with oral steroids should be considered in selected children with chronic OME prior to surgical intervention. One in every four children whose caregiver consents to this therapy may avoid or postpone surgery for at least six months.
An approach to the audit of tinnitus management
Authors: Sadlier M. , Stephens S. D. G.
Published: November 2007

This study examines the advantages and internal consistency of an open-ended queionnaire (Benefit problem questionnaire), over the Tinnitus questionnaire used by Jakeset al.(1985) in the auditing of a Stress management Programme.

This Tinnitus quesitionnaire showed very little difference pre- and post-treatment, while the Benefit/problem questionnarie showed good improvement over a number of variables. This included some of the more traditional orthogonal values of tinnitus complaint. The clinical assessment made blindly and over different tikme scale to the Benefit/problem questionnaire matched these positive results quite closely.
Broncho-alveolar lavage in chronic upper respiratory tract infections
Authors: Zeitoun H. , El-Husseiny W. , El-Sawi M. , Mandour M. A.
Published: November 2007

The relationship between upper and lower respiratory tract infections has been demonstrated previously, although the effect of chronic infection of One tract on the other has not been well studied. This work analyses the broncho-alveolar lavage fluid of patients with chronic purulent rhino-sinusitis and reveals and increase in the neutrophil nitro-blue tetrazolium dye reduction test positivity provides evidence for increased phagocutosis to compensate for the increased contamination of the lower respiratory tract.
Diet-modified sex hormone metabolism: is this the way forward in recurrent respiratory papillamatosis and squamous carcinoma prophylaxis?
Authors: Colquhoun-Flannery W. , Carruth J. A. S.
Published: November 2007

We report two cases of recurrent layngeal papillomatosis in women who subsequently developed squamous cell carcinoma as they approached the climateric. The role of human papilloma virus (HPV) and oestrogen metabolism is outlined. The use of indoles from cruciferous vegetables is also discussed.
Primary tonsillar tuberculosis: a case report
Authors: Selimoǧlu Erol , Sütbeyaz Yavuz , Çiftçioǧlu M. Akif , Parlak Mehmet , Esrefoǧlu Mukaddes , Öztürk Aziz
Published: November 2007

A 67-year-old man with an enlarged left tonsil underwent a tonsillectomy for the suspicion of malignancy. He had had a dental extraction six months earlier. Clinical and histopathological investigations established the diagnosis of primary tonsillar tuberculosis.
Post-tonsillectomy pain: the first ten days
Authors: Toma Abbad G. , Blanshard Jonathan , Eynon-Lewis Nick , Bridger M. W.
Published: November 2007

Forty-one adults were entered into a prospective study to investigate the pattern of pain over 10 days after elective dissection tonsillectomy. The severity of pain was scored by the patient on a visual analogue scale. The results confirm that tonsillectomy is a very painful experience and the provision of adequate analgesia is of paramount importance, especially if day-case tonsillectomy is performed.
Juvenile xanthogranuloma auris: an atypical presentation
Authors: Rassl Doris M. , Pahor Ahmes L.
Published: November 2007

We present a case of juvenile xanthogranuloma of the external ear canal in a 51-year-old woman and a review of the literature.
Haemangiopericytoma of the middle ear: case report and literature review
Authors: Sutbeyaz Yavuz , Selimoglu Erol , Karasen Murat , Ciftcioglu Akif , Ozturk Aziz
Published: November 2007

Haemangiopericytoma is an uncommon vascular tumour that rarely appears in the head and neck region. Such a tumour arising from the middle ear has not been reported since it was first described in 1942 by Stout and Murray. The present case therefore illustrates the first example of a primary middle ear haemangioperictyoma.
Cochlear reimplantation
Authors: Saeed Shakeel R. , Ramsden Richard T. , Hartley Christopher , Woolford Timothy J. , Boyd Paul
Published: November 2007

Since its inception in 1988 the Cochlear Implant Programme in Manchester has successfully implanted 69 adults and 23 children. Of these 92 procedures, three patients have undergone revision surgery with the insertion of either a new implant or re-positioning of the existing device. We examine the circumstances that lead to the need for reimplantation in these patients, discuss the technical aspects of revision surgery together with the functional results of such procedures.
Malignant myoepithelioma of the parotid gland: case report and review of the literature
Authors: Klumpp Thomas R. , Mohr Rose M. , Silverman Craig L. , Tang Chik-Kwun , Elfenbein I. B. , Dardick Irving
Published: November 2007

A 62-year-old male with a myoepithelioma of the right parotid gland was treated with surgical excision followed by adjuvant radiation therapy. Prior to the completion of radiation therapy, the patient developed progressive disease at local, regional, and distant metastatic sites. Combined modality treatment with radiation and chemotherapy resulted in a significant but transient shrinkage of the tumours at all sites. The patient succumbed to metastatic disease 212 days following the diagnostic biopsy. This case illustrates several of the distinctive clinical and pathological characteristics of this rare tumour.
Ramsay Hunt syndrome mimicking acoustic neuroma on MRI
Authors: Goldsmith P. , Zammit I. , Meikle D.
Published: November 2007

The authors present a case of Ramsay Hunt syndrome in whish the MRI appearance mimicked that of an intracanalicular acoustic neuroma.
Evolution of quality of life assessment in head and neck cancer
Authors: Morton Randall P.
Published: November 2007

Quality of life assessment as part of clinical practice in head and neck oncology began over 40 years ago. Early studies were narrative and cross-sectional; these were followed, at first, by simple quantitative measures of various parameters and later by longitudinal studies of greatercomplexity. More recently quality of life has been employed in a randomized clinical trial of head and neck cancer.

Quality of life has evolved to become a standard means of assessing clinical outcomes, and an accepted end point measurement in clinical trials, to be considered alongside survivorship and side effects/complications.
Charing Cross CT protocol for endoscopic sinus surgery
Authors: Rowe-Jones J. , Mackay I. , Colquhoun I.
Published: November 2007

The Charing Cross computerized tomography protocol for imaging the paranasal sinuses uses 2 mm thick slices with table increments of 8 mm: 10 to 12 coronal and two axial images are produced. These provide the necessary information for diagnosis of chronic rhinosinusitis and safe endoscopic sinus surgery. The technique is quicker and cheaper than previously described protocols and exposes the lens of the eye to less radiation
Magnetic resonance imaging after frontal sinus surgery with fat obliteration
Authors: Keerl R. , Weber R. , Kahle G. , Draf W. , Constantinidis J. , Saha A.
Published: November 2007

The obliteration of the frontal sinus via an osteoplastic approach is performed with the aim of achieving a permanent ‘switching off’ by final and conclusive clearing out. For this, freshly harvested abdominal fat has shown itself to be the best clinically. It is possible to demonstrate the vitality of fat transplanted into the frontal sinus without an operation i.e. by a macroscopical and histological examination using magnetic resonance imaging (MRI). The magnetic resonance examinations were carried out on a supraconductive 0.5 T Magnet (Gyroscan T.S.II, Philips Medicine Systems, Eindhoven, Netherlands) with a quadrature (square) head spool. We produced T1-weighted spin echo images (TR: 450–550 ms; TE: 20–25 ms), T2-weighted fast spin echo images or in double-echo technique in transverse orientation (Turbo SE or TR: 2000–2500 ms; TE: 50–90 ms) and short tau inversion recovery (STIR) sequences for fat suppression (TJ: 140 ms; TR: 1400 ms; TE: 30 ms). The fat implanted into the frontal sinus of 11 patients aged 22–65 years, having undergone an osteoplastic frontal sinus operation with obliteration, was examined post-operatively by MRI. Objectives were the time-dependent distribution of portions of vital fatty or connective tissue, the eventual development of necroses or cysts as well as recurrences, inflammatory complications or re-epithelization of the frontal sinus four to 24 months postoperatively. In only six out of 11 cases was vital fatty tissue found. Fatty necrosis occurred five times, whereas in four cases a transformation into granulation tissue and in one case into connective tissue could be seen. All 11 patients were complaint-free. Long-term observations are needed to see if differences in the recurrence rate of frontal sinus disease are dependent on whether the implanted fat remains vital or necrosed and transformed.
Papillary carcinoma arising in a thyroglossal duct cyst: a case report and literature review
Authors: Hilger Andreas W. , Thompson Stuart D. , Smallman Lesley A. , Watkinson John C.
Published: November 2007

Papillary carcinoma arising in a thyroglossal duct cyst is a rare finding. Less than 100 cases have been reported in the English literature. In most cases the diagnosis is only established after excision of a clinically benign thyroglossal duct cyst. The aetiology of such tumours is unclear but de novo origin and spread from a primary thyroid gland tumour has been suggested. This has important implications for therapeutic approaches. A further case of thyroglossal duct carcinoma is presented and the management is discussed on the basis of the current rationale for treatment of thyroid cancer.
Antimicrobial management of chronic sinusitis in children
Authors: Brook Itzhak , Yocum Paula
Published: November 2007

This study retrospectively investigated the microbiology and management of 40 children who suffered from chronic sinusitis.

The sinuses infected were the maxillary (15 cases), ethmoid (13), and frontal (seven). Pansinusitis was present in five patients. All aspirates were cultured for aerobic and anaerobic bacteria. A total of 121 isolates (97 anaerobic and 24 aerobic) were recovered. Anaerobes were recovered from all 37 culture- positive specimens, and in 14 cases (38 per cent) they were mixed with aerobes. Twenty-three 3- lactamase-producing bacteria were isolated from 16 (43 per cent) patients. The 15 patients who received clindamycin had the most rapid response to therapy and a change of therapy and surgical drainage was required in one case. Of the 16 patients who received amoxycillin or ampicillin, 16 responded to therapy, six needed a change of therapy, including four who also had surgical drainage. Of the six who were treated with erythromycin, three needed antibiotic change, two with surgical drainage. Of the three that received cefaclor, two were cured, and one had an antibiotic change. Resistant organisms were recovered in all the cases that required therapeutic change.

These findings support the important role of anaerobic bacteria in the polymicrobial cause of chronic sinusitis in children, and the superiority of therapy effective against these organisms.
Synovial sarcoma of the pharynx
Authors: Ramamurthy L. , Nassar W. Y. , Hasleton P. S. , Gattamaneni H. R. , Orton C. I.
Published: November 2007

Synovial sarcoma is rarely seen in the head and neck region. A case of synovial sarcoma of the pharynx in a child is presented.
A tumour derived from Ebner's glands: microcystic adnexal carcinoma of the tongue
Authors: Schipper J. H. , Holecek B. U. , Sievers K. W.
Published: November 2007

Microcystic adnexal carcinoma (MAC) is known as an infiltrating but non-metastasizing tumour of the skin, that derives from sweat glands or follicular epithelium. We report on a rare case of MAC of the tongue. The patient had noticed the tumour for two years with slowly increasing dysphagia but no other symptoms of an oropharynx carcinoma. Histological and immunohistochemical analyses showed a similarity between the tumour derived from Ebner's glands of the tongue and MAC of the sweat glands.