bluuebunny/crossref_metadata_2025 huggingface dataset:
Nasopharyngeal carcinoma in an HIV-positive patient causing severe morbidity and early death
Authors: Hald Jesper , Larsen Per L.
Published: November 2007

A nasopharyngeal carcinoma was the first event in an otherwise symptom free HIV person. No reports of simultaneous nasopharyngeal carcinoma and HIV infection are known to us. A 46-year-homosexual man was admitted to the ENT department with a three week history of pain in the throat referred to the left ear. He was found to have an irregular tumour in the nasopharynx with a lymph node metastasis to the left side of the neck. The poor response to radiotherapy and the very aggressive progress after treatment raised suspicion of a co-existing disease process. The risk of sexually transmitted HIV was confirmed post mortem and could explain the rapid progression of the tumour. No anti-HIV treatment was given concurrently with radiotherapy.
The use of antibiotic/steroid ear drops to reduce post-operative otorrhoea and blockage of ventilation tubes. A prospective study
Authors: Salam M. A. , Cable H. R.
Published: November 2007

This prospective randomized study investigates whether the use of antibiotic/steroid ear drops (Betnesol-N) is effective in reducing early post-operative otorrhoea and blockjage of ventilation tubes (VTs). The study included 162 children who had bilateral VT insertion and used Betnesol-N ear drops in one ear only for three days after surgery, the other ear was left as cotrol. These children were reviewed two weeks later and their ears wer examined for VT patency, presence of blood or of mucopus. Statistical analysis of our results showed that the use of Betneso-N ear drops has significantly reduced the incidence of post-operative otorrhoes within two weeks of VTs insertion (p<0.01). However, these drops dids not have a significant effect on the blockage rates of VTs with dried bolld (p>0.05).
The use of clostridium botulinum toxin in palatal myclonus. A preliminary report
Authors: Saeed Shakeel R. , Brookes Gerald B.
Published: November 2007

Palatal myoclonus is a rare syndrome characterized by involuntary rhythmical movements of the soft palate giving rise to clicking objective tinnitus. The intrusive nature of the tinnitus prompts patients to seek medical advice but to date no single treatment modality has been shown to be consistently effective. We present three cases in whom various management regimes were unsuccessful and in whom botulinum toxin injection to the palatal muscles was undertaken. All three cases were rendered free of their tinnitus with complete abolition of the myoclonus. The questions of optimum dosage as well as frequency of injection will be answered as greater numbers are treated by this method.
Epidemic typhus fever and hearing loss: a histological study
Authors: Friedmann I. , Frohlich A. , Wright A.
Published: November 2007

Hearing loss as a frequent complication of louse–bome epidemic typhus fever has been well documented in the reports of ENT specialists serving in both the Allied and the German armies in the last war. The present paper describes the characteristic histopathological features as noted in sections of the temporal bones from five British soldiers who died in 1944 of typhus fever during the last war in Eastern Asia. The VHIth nerve showed multiple ‘typhus nodules’ and there was extensive interstitial neuritis of the VHIth nerve and demyelination of the nerve fibres. There were also widely scattered aggregations of mononuclear cells in the inner ear.

This unique study was based on the Hallpike collection of temporal bone sections.
Treatment of acoustic tumours in elderly patients: is surgery warranted?
Authors: Ramsay Hans A. W. , Luxford William M.
Published: November 2007

Controversy regarding the best and safest treatment of acoustic tumours in elderly patients still exists. These patients may therefore end up having either microsurgical tumour removal, stereotactic radiosurgery or no treatment at all, depending on where the treatment decision is made. We evaluated the results of microsurgery for acoustic tumour removal in 65 patients who were 70 years of age or older. Surgery was performed between 1982 and 1989, using the translabyrinthine approach. Total tumour removal was achieved in 61 patients (94 per cent). No deaths due to surgery occurred. Other than one case of meningitis, there were no serious complications. Seven cases had post-operative CSF leaks, and three required surgery for correction of the problem. Facial nerve function pre-operatively, at the time of discharge and at one year or more post-operatively was compared to that in a younger age group. No differences between the groups were found. Nor was there any significant difference in mean operative time, blood loss, or hospital stay between the older and younger patients.

We believe that total microsurgical tumour removal is the treatment of choice in patients who are in good health, regardless of age. Partial removal is acceptable only if the tumour is adherent to the facial nerve or if vital-sign changes occur during surgery. Other forms of treatment are reserved for cases where surgery is contraindicated or refused by the patient.
Naso-labial flap in the reconstruction of floor of the mouth defects
Authors: Al-Khabori Mazin Jawad Jafar , Natarajan Balaji , Thomas Michael , Irvine Brian
Published: November 2007

Defects caused by tumour excision in the floor of the mouth can be closed by different methods. We present thirteen cases treated in our department over the last seven years in whom naso-labial flaps were used. Twelve patients had squamous cell carcinoma of the floor of the mouth and one had fibro-sarcoma of the right lower mandible. Five received post-operative radiotherapy, one was resected following radiotherapy and seven were treated with surgery alone. Patient selection is important to give good functional results without compromising tumour clearance.
Scalp flap—a utility and reconstructive option for head and neck surgeons
Authors: Shenoy Ashok M. , Nanjundappa  , Nayak Umanath K. , Bhargava Asha K. , Naganoor Ibrahim A. , Vijayakumar M.
Published: November 2007

Regional scalp flaps are invaluable in resurfacing defects resulting from resections in the area of the upper face, orbit and scalp itself. The tissue lies adjacent to the defect, is easy to harvest, and can be termed as a ‘durable one-stage’ procedure. Scalp defects posterior to the vertex lend themselves to resurfacing by a posterior flap based on the occipital arteriovenous system. Anterior scalp defects including upper face and orbit can be resurfaced by an anterior scalp flap based on the superficial temporal arteriovenous system. While large areas can be resurfaced and the donor site effectively camouflaged, this flap finds less of an acceptance amongst patients with defects in the upper facial region when compared to the scalp defects. We recount our experience with these flaps and describe the high points of the reconstructive procedure and the results obtained in ten consecutive cases carried out over a three year period at the Department of Head and Neck Surgery, Kidwai Memorial Institute of Oncology, Bangalore, India. The short healing time and minimal morbidity make this reconstructive option an attractive one for the practising Head and Neck Surgeon.
One aid or two?—more visits please!
Authors: Vaughan-Jones Richard H. , Padgham Nigel D. , Christmas Helen E. , Irwin John , Doig M. Ann
Published: November 2007

A prospective trial of hearing aid provision was undertaken to define factors which might be used to allow hearing aids to be fitted optimally. Patients referred for the provision of a hearing aid were studied prospectively at each of five visits when they were questioned by means of a proforma. Fifty-six patients completed the trial and gave adequate responses for analysis. No audiometric or symptomatic criteria were found to be of use in predicting the final choice of hearing aid combination. It may be that initial sequential monaural aiding leads to a higher uptake of binaural aids in the long term. Patients valued multiple visits to the clinic and sequential trials of monaural aiding, the majority felt that binaural aids should be tried.
Some traditional treatments of hearing problems in Brittany and Wales
Authors: Stephens Dafydd
Published: November 2007

The traditions of the healing of deafness associated with the Celtic saints in Brittany and Wales are discussed. Many more have survived in Brittany because of the religious continuity in that country. Three Saints Cadoc (of Welsh origin), Egarec (of Irish origin) and Meriadec (of Breton origin) are associated with such traditions in a number of different locations.
Septoplasty and compensatory inferior turbinate hypertrophy: a randomized study evaluated by acoustic rhinometry
Authors: Grymer L. F. , Illum P. , Hilberg O.
Published: November 2007

The present study deals with the indication for inferior turbinate surgery in cases of concomitant anterior septal deviation. We define, by acoustic rhinometry, the characteristics of the obstructed nose and define mucosal turbinate hypertrophy. A random sample of 80 patients with nasal obstruction and anteriorly located septal deviation were objectively evaluated by acoustic rhinometry pre– and post–operatively. All had septoplasty and half were randomly selected to have anterior inferior turbinoplasty performed in the side opposite to the major septal deviation. Severe septal deviation, expressed by a minimal cross–sectional area less than 0.4 cm2 was present in 37 patients. In this group inferior turbinate reduction seems advisable. In the wide side, the minimal cross–sectional area and the cross–sectional areas at 3.3 and 4.0 cm from the nostrils increased in the turbinectomy group and decreased in the non–turbinectomy group after correction of the septal deviation. In the group with less pronounced septal deviation no influence of turbinate reduction could be detected.
Mast cell quantitation in nasal polyps, sinus mucosa and nasal turbinate mucosa
Authors: Otsuka Hirokuni , Ohkubo Kimihiro , Seki Harumi , Ohnishi Masaki , Fujikura Terumichi
Published: November 2007

The distribution and abundance of mast cells in nasal polyps, the maxillary sinus mucosa of patients with sinusitis and the turbinate mucosa of allergic rhinitis was microscopically examined using different methods of fixation. In the epithelium of the surface and the ducts of nasal polyps (n = 8), the mean number of mast cells was over 20,000 per mm3 using Mota's fixation and the increase was correlated with the epithelial thickness (P<0.05). On the other hand those of the maxillary sinus mucosa (n = 6) and the nasal turbinate mucosa (n = 7) were less than 6,000 per mm3. In the subepithelial layer or areas deeper than the area with the glands, however, mast cell counts were less than 3,200 per mm3 in all diseases. More than 70–90 per cent of all mast cells in the epithelium of the mucosal surface and the ducts of the polyp, the maxillary sinus mucosa and nasal turbinates were formalin sensitive. Most of the mast cells in the subepithelial and deeper areas were formalin resistant in all diseases.

These results suggest that conditions for mast cell growth differ between polyps and the other diseases, and that the conditions which affect mast cells may contribute to polyp development.
Ribavirin treatment for juvenile respiratory papillomatosis
Authors: Morrison G. A. J. , Kotecha B. , Evans J. N. G.
Published: November 2007

Juvenile respiratory papillomatosis involving the tracheo-bronchial tree imposes a significant management problem and is sometimes life threatening. The mainstay of treatment is repeated vapourization with a CO2laser. To date, adjunctive medical treatments have been of limited value. A tracheostomized child with extensive laryngo-tracheo-bronchial papillomatosis who has required bronchoscopic lasering at two-weekly intervals for three years was treated with ribavirin, a broad spectrum anti-viral agent. The drug was administered in nebulized form using a small particle aerosol generator (S.P. A.G.) to the lower respiratory tract (6 gm/150 ml over nine hours) on three consecutive nights every two weeks over seven weeks and also administered orally (15 mg/kg/day). Endoscopic assessments were made every two weeks. At 14 days the papillomata were regressing and far less lasering was required. No further lasering was required up to 56 days. One month after stopping the ribavirin, however, a few sessile papillomata in the tracheo-bronchial tree had recurred and were treated with the laser. No adverse reactions were encountered. During the treatment period there was a significant reduction in the frequency of therapeutic endoscopies. This promising response requires further evaluation to define the role of ribavirin in the treatment of juvenile respiratory papillomatosis.
Iatrogenic pulsatile tinnitus
Authors: Agrawal R. , Flood L. M. , Bradey N.
Published: November 2007

We present an unusual case of iatrogenic arteriovenous malformation following a myringoplasty and its treatment by embolization. Thorough examination and investigation of patients with pulsatile tinnitus is stressed. Angiography is essential to diagnose life-threatening and treatable lesions in the presence of normal otoscopy, audiologic assessment and enhanced computed tomography.
Pyopneumothorax—a rare sequelae of retropharyngeal abscess
Authors: Lokman S. , Sani A. , Sidek D. S.
Published: November 2007

A case of massive pyopneumothorax as a rare sequelae of retropharyngeal abscess following fish bone ingestion is reported. An initial attempt at removal of the fish bone in the oesophagus using the fibroptic oesophagoscope was unsuccessful, causing failure of its removal and the development of this rare and potentially fatal complication. The intercommunication of the retropharyngeal space with other spaces of the neck and thorax that allow this and most other complications to occur is described. Rigid endoscopes are the instrument of choice in retrieving sharp foreign bodies in the oesophagus.
Broken tracheostomy introducer—an unusual tracheobronchial foreign body
Authors: Bhargava S. K. , Bhat N. , Bhargava K. B.
Published: November 2007

We present a rare case where the introducer of a metal tracheostomy tube became lodged in the tracheobronchial tree. This may be the only reported case. The literature is reviewed to study the possible cause of tracheostomy tube component fracture and to suggest methods for preventing this complication.
A review of the definition, terminology and pathology of aural cholesteatoma
Authors: Ferlito A.
Published: November 2007

Despite a considerable amount of discussion and research in the course of many years, aural cholesteatoma has remained a matter of controversy. This review concerns only the definition, terminology and pathology of this common and severe disease.
Clinical otosclerosis and auditory exostoses in ancient Europeans (investigation of Lithuanian paleoosteological samples)
Authors: Sakalinskas Virgilijus , Jankauskas Rimantas
Published: November 2007

The purpose of this investigation was to establish the incidence of clinical otoscierosis and auditory exostoses in Lithuanian paleopopulations. The total sample consists of 4080 skulls, dating from the Neolithic to the C 17th—C 18th a.d., investigated visually, under magnification and radiologically. Eight cases of clinical otosclerosis and 22 of auditory exostoses were identified. The general epidemiology of otosclerosis (0.19 ± 0.08 per cent) was established to be similar to contemporary populations. This suggests that there are no new aetiological factors attributable to our modern society. Clear diminution of the incidence of auditory exostoses from the 1st to the 2nd millenium A.D. (3.46 ± 0.76 per cent, against 0.06 ± 0.04 per cent, p <0.001) and definite sexual differences (males: 1.21 ± 0.28 per cent; females: 0.17 ± 0.10 per cent, p<0.001) were also noted. In general, auditory exostoses were found much more frequently than in recent populations.
Cerebellopontine angle lipoma
Authors: O'Keeffe L. J. , Ramsden R. T. , Birzgalis A. R.
Published: November 2007

A case of a cerebellopontine angle lipoma is presented with a typical clinical, audiometric and radiological features of an acoustic neuroma. The correct pre-operative diagnosis was elusive even with the aid of magnetic resonance imaging.
An unusual presentation of oat cell carcinoma
Authors: Capper R. , Stewart T. J. , Magennis J. P.
Published: November 2007

A case is reported of oat cell carcinoma of the lung presenting with unusual sites of metastasis to the orofacial region. Distant metastases are common in oat cell carcinoma but a literature review did not reveal any reports of metastases either to the hard palate or to medial canthus of the eye.
Audit of the incidence of persistent perforation of the tympanic membrane following grommet removal or extrusion
Authors: Todd G. B.
Published: November 2007

The incidence of persistent perforation following grommet removal or extrusion in 210 ears was assessed, and found to be zero per cent. Collar button grommets were retained longer than Shepard grommets, and the percentage of ears requiring two or more tube insertions was 51.9 per cent.
Steroids and control of post-tonsillectomy pain
Authors: Tewary A. K. , Cable H. R. , Barr G. S.
Published: November 2007

A prospective, randomized, double-blind study to assess the effect of steroids on post-tonsillectomy pain was performed on 82 adults. The premedication, anaesthesia, surgical technique and post-operative analgesia were standardized. Pain was assessed on a visual analog scale. Steroids were found to have no appreciable effect on the amount of post-operative pain.
Bony remodelling in an osteoma of the paranasal sinuses
Authors: Aldren C. P. , Soames J. V. , Birchall J. P.
Published: November 2007

Osteoma is the commonest benign tumour of the paranasal sinuses (Handousa, 1952). A case of a large osteoma removed from the frontal and ethmoid sinuses is presented. Histopathological examination of this tumour revealed evidence of bony remodelling similar to that seen in Pagets' disease which has not been previously reported. The pathological significance of this finding is discussed.
Parental preferences for duration of hospital stay following tonsillectomy
Authors: Tewary A. K. , Barr G. S. , Bickerton R. C.
Published: November 2007

Abstarct

Parents of children undergoing (adeno) tonsillectomy were questioned about their preferences for a period of hospitalization. The proportion wanting early discharge increased as their children recovered after surgery.
A wooden orbital foreign body
Authors: Rajah V.
Published: November 2007

Abstarct

A case is reported in which a patient presented, 18 months after initial injury, with a progressive proptosis of the left eye. X-rays did not reveal a foreign body but a fracture of the lateral orbital wall and an area of soft tissue density were seen on the CT scan. Exploration of the orbit revealed a 2 cm wooden fragment in the floor of the orbit.
Osteoblastoma of the nasal cavity
Authors: Chen Karl T. K. , Weinberg Richard A. , Simpson Preston R. , Tschang Tai-Po
Published: November 2007

Abstarct

The clinicopathological features of a rare case of osteoblastoma of the nasal cavity arising from the nasal turbinate are reported and compared with four reported cases of osteoblastoma with nasal cavity involvement. Two of the five tumours involved the nasal cavity and paranasal sinuses. The remaining three tumours were confined in the nasal cavity; one arose from nasal bone and two from nasal turbinate periosteum. Four tumours were successfully treated with local excision. One tumour recurred locally after excision; the recurrence was apparently controlled by further local excision.
Palato-pharyngo-laryngeal myoclonus: an unusual cause of dysphagia and dysarthria
Authors: Drysdale A. J. , Ansell J. , Adeley J.
Published: November 2007

Abstarct

We describe a case of palato-pharyngo-laryngeal myoclonus, an unusual variant of palatal myoclonus, which presented with dysphagia and dysarthna. The aetiology and presenting features of myoclonus are discussed. Various treatment options are considered.
Supraglottic laryngectomy: experience with 66 patients over 20 years
Authors: Nikolaou Angelos , Daniilidis John , Fountzilas George , Kouloulas Anthanasios , Sombolos Kostas , Velegrakis George
Published: November 2007

We reviewed the records of 66 consecutive patients with previously untreated supraglottic laryngeal carcinoma who underwent a supraglottic laryngectomy in our department between 1970 and 1989. There were 23 T1, 30 T2and 13 T3cases. Eight patients had neck metastases and underwent neck dissection also. Twentyfour (36 per cent) patients received post–operative radiotherapy. Two–year and five–year survival rates were 88.9 per cent and 82.2 per cent respectively. When the survival rates of the patients with T1, T2and T3lesions were calculated separately and compared with each other the differences were not statistically significant. Recurrences, post-operative complications, time to progression and indications for supraglottic laryngectomy are discussed.
Laryngeal closure at the level of the false cord for the treatment of aspiration
Authors: Kitahara Satoshi , Ikeda Makoto , Ohmae Yukio , Nakanoboh Manabu , Inouye Tetsuzo , Healy Gerald B.
Published: November 2007

A new procedure for aspiration which closes the larynx at the level of the false cords is reported. This method is not harmful to the vocal folds and maintains arytenoid movement, thus preserving phonatory function. With the advance of the operative technique for aspiration and swallowing rehabilitation, patients who have recovered from aspiration can be helped. Our procedure can be recommended for such cases.
Malignant schwannoma of the parapharyngeal space in von Recklinghausen's disease: a case report and review of the literature
Authors: Elias M. M. , Balm A. J. M. , Peterse J. L. , Keus R. B. , Hilgers F. J. M.
Published: November 2007

Neurofibromatosis (NF) or von Recklinghausen's disease is frequently accompanied by malignant tumours, which can occur at any site in the body. These malignancies are mainly of soft tissue origin. Of all head and neck malignancies, the number of soft tissue sarcomas is limited and in combination with NF this type of tumour is a rare event. In this report we describe the clinical course of a young female patient with NP, who presented with a massive malignant schwannoma in the parapharyngeal space, and review the pertinent literature.
Cochlear interdependence and micromechanics in Man and their relations with the activity of the medial olivocochlear efferent system (MOES)
Authors: Rossi G. , Actis R. , Solero P. , Rolando M. , Pejrone M. D.
Published: November 2007

Following stimulation of one ear with white noise (WN) or 0.5, 1 and 2 kHz tone bursts a statistically valid mean reduction in the amplitude of delayed evoked otoacoustic emissions (DEOE), elicited from the contralateral ear by bursts of the same frequencies, was observed in 10 people (19–23-years-old) with normal hearing. This reduction only appeared in response to a contralateral stimulus delivered 7, 8 and 9 ms earlier than that used to produce the DEOE. This inhibitory effect was just referable to the activity of the medial olivocochlear efferent system (MOES). This research has shown that: (i) the cochlear interdependence is linked to activation of the MOES; (ii) in man the activity of MOES is inhibitory and only appears for a stimulus of the same frequency or (for WN) including that used to elicit DEOE; (iii) the cochlear interdependence is frequency selective and the MOES thus establishes a direct functional interdependence between homologous sectors of the organs of Corti on the two sides; (iv) DEOE would appear to be no more than partly generated by outer hair cells (OHC) of the organ of Corti in relation to the frequency of the stimulus employed, thus substantiating the hypothesis that in their production the effects of an 'active' mechanism, represented by the 'slow' contractile activity of the OHC, is overlain by those of a 'passive' mechanism formed by the oscillations induced by the movements of the stapes in the basilar membrane (BM) or in the set of membranes and liquids of cochlear canal.
An in vitro comparison of the erbium: YAG laser and the carbon dioxide laser in laryngeal surgery
Authors: Herdman Rory C. D. , Charlton Andrew , Hinton Anthony E. , Freemont Anthony J.
Published: November 2007

This study compares the relative thermal damage caused by a surgical CO2 laser and the Erbium: YAG laser when used to incise the human vocal fold in vitro. Results show that charring is completely eliminated when using the Erbium: YAG laser. The depth of coagulative necrosis adjacent to an incision is reduced from 510 ±m(µ 75) using the CO2 laser to 23 ±m(µ 12) using the Ebrium: YAG laser and at the base is reduced from 125 ±m (µ 45) using the CO2 laser to 12 ±m (µ 8 ) using the Erbium: YAG laser. The potential advantages regarding post-operative healing after laryngeal surgery are discussed.
Gastric pull-up by eversion stripping of oesophagus
Authors: Rajan Ranjit , Rajan Rajamma , Rajan N. , Pai U. Santhosh
Published: November 2007

Gastric pull-up is a reliable method of one-stage reconstruction following total laryngopharyngoesophagectomy (TLPE). However, the technique of blunt finger dissection for extrapleural extraction of the oesophagus is liable to produce chest complications like pneumothorax. We report a series of 45 patients who underwent gastric pull-up using the technique of oesophageal extraction by stripping which produced virtually no thoracic complications. This simple technique has greatly reduced morbidity associated with gastric pull-up.
Vascular malformation of the internal auditory canal
Authors: Saleh Essam , Naguib Maged , Russo Alessandra , Taibah Abdel Kader , Sanna Mario
Published: November 2007

A report of a case with a vascular malformation of the internal auditory canal (IAC) is presented. A review of the literature of this rather rare lesion is also made in an attempt to outline its clinical features, radiological diagnosis and management. The differential diagnosis and distinction between vascular malformations and other internal auditory canal tumours are discussed.
Periorbital abscess due to ethmoiditis in a neonate
Authors: Saunders M. W. , Jones N. S.
Published: November 2007

Orbital complications of ethmoiditis are not uncommon in children. They are, however, much rarer in the very young. A case is presented in which a neonate of gestational age 39 weeks developed a periorbital abscess. The relevant literature is reviewed with respect to embryology, aetiology and treatment.
Vomiting in pregnancy resulting in oesophageal perforation in a 15-year-old
Authors: Woolford T. J. , Birzgalis A. R. , Lundell C. , Farrington W. T.
Published: November 2007

Spontaneous perforation of the oesophagus is extremely rare in children, as is perforation due to vomiting in pregnancy. We report the case of a 15-year-old in whom vomiting inearly pregnancy resulted in oesophageal perforation with subcutaneous emphysema causing marked facial swelling in the absence of other signs. The more common clinical presentation of spontaneous oesophageal rupture (Boerhaave's syndrome) is discussed.
Primary synovial sarcoma of the middle ear
Authors: O'keei L. J. , Ramsden R. T. , Birzgalis A. R.
Published: November 2007

Synovial sarcoma is a soft tissue malignancy which most commonly affects the lower limbs of young adults and rarely occurs in the head and neck region. The term synovial sarcoma may be a misnomer as most of these tumours occur in tissues not known to contain synovial tissue. There has only been one previously reported case affecting the middle ear, which was metastatic, and we report the first case of primary synovial sarcoma of the middle ear.
Benign hamartomatous polyp of the palatine tonsil
Authors: Lupovitch Aaron , Salama Dafir , Batmanghelichit Olivia
Published: November 2007

A rare and possibly unique benign polypoid tumour of the palatine tonsil is described. It contained the two basic tissue types of the tonsil–lymphoid and epithelial–in the characteristic close anatomical relationship of tonsillar tissue. The features of this rare lesion lend support to the hypothesis that benign tumours of the tonsil may be hamartomas of tonsil or branchiogenic remnants rather than true neoplasms.
Eustachian tube submucosal glands in normal and pathological temporal bones
Authors: Berger Gilead
Published: November 2007

Histological data concerning the structure and the topographical distribution of the eustachian tube submucosal glands is presented in 94 serially-sectioned temporal bones with and without otitis media. The vast majority of the tubal glands are located adjacent to the nasopharynx in the pharyngeal and midportion regions. Mixed glands which contain equal amounts of mucoid and serous elements are found in all age groups, in most specimens, either with or without otitis media. Furthermore, the glandular tissue, along these two medial regions of the tube, does not disclose significant quantitative differences between normal and inflamed specimens. Temporal bones without otitis media harbour few glands in the lateral four regions of the tube, while those with otitis media show a moderate increase of gland formation which is more noticeable in the pretympanum than in the regions around the isthmus (pre-isthmus, isthmus and post-isthmus regions). It is apparent that chronic inflammatory conditions like simple chronic otitis media and secretory otitis media are more often accompanied by gland formation, along the lateral four regions of the tube than acute otitis media.
Radical mastoidectomy: its place in otitic intracranial complications
Authors: Singh Bharath , Maharaj Tejprakash Jugpershad
Published: November 2007

Standard recommended treatment for patients with intracranial complications from otitis media, has been radical mastoidectomy, whether cholesteatoma is present or not. This was established in the pre-antibiotic era to improve survival. Over a six-year period, from January 1985 to December 1990, 268 patients were admitted with intracranial and extracranial complications of otitis media. The prospective treatment consisted of antibiotics and surgery. Surgery entailed mastoidectomy and drainage of intracranial collections of pus in all patients.

However, prospectively in these patients the ear pathology and not the complication dictated the type of mastoidectomy performed. Cortical mastoidectomy was performed in non-cholesteatomatous ears and radical mastoidectomy in cholesteatomatous ears.

Recurrence of intracranial complications occurred in only four patients (two per cent), a temporal lobe cerebritis in the non-cholesteatomatous ear group, and, a temporal lobe abscess, posterior fossa abscess and subdural empyema in the cholesteatomatous ear group. The temporal lobe cerebritis settled on intravenous antibiotics whilst the temporal lobe abscess, posterior fossa abscess and subdural empyema required redrainage. In none of these was the ear surgery revised.

There were 15 deaths (eight per cent), all occurring in patients with intracranial complications, 12 associated with brain abscess, two with subdural empyema and one with meningitis. Eight were from the non-cholesteatomatous group and seven from the cholesteatomatous group. The mortality was directly related to the patients consciousness level on admission and not to the type of ear pathology.

It can therefore be concluded that radical mastoidectomy is unwarranted in the non-cholesteatomatous ear, even with an otogenic intracranial complication.
Cerebrospinal fluid (CSF) otorhinorrhoea following vestibular schwannoma surgery treated by extended subtotal petrosectomy with obliteration
Authors: Kronenberg Jona , Bendet Erez , Findler Gideon , Roth Yehudah
Published: November 2007

Extended subtotal petrosectomy as a treatment for persistent cerebrospinal fluid (CSF) otorhinorrhoea is presented. Four patients were successfully operated on by this technique, all previously having undergone suboccipital removal of vestibular schwannoma: other interventions used had failed to seal the fistulae. The internal auditory canal was the usual pathway for CSF leakage as well as retrosigmoid, retrolabyrinthine, retro- or perifacial cells. Total exenteration of middle ear and mastoid cell tracts, skeletonization of sigmoid sinus, jugular bulb and facial nerve, drilling out of semicircular canals, vestibule, and cochlea, and skeletonization of the internal auditory canal, followed by obliteration, are the main steps of this approach.
Primary squamous carcinoma of the thyroid–a case report
Authors: Theander Claes , Lödén Brita , Berglund Jan , Seidal Tomas
Published: November 2007

We report a well-documented case of fatal thyroid cancer with histopathological characteristics of primary squamous carcinoma. A possible primary tumour elsewhere was excluded. The possible histogenesis of this unusual tumour and the therapy of choice are briefly discussed.
Haemangiopericytoma of the parotid salivary gland: report of a case with literature review
Authors: Whittam D. E. , Heller W.
Published: November 2007

Haemangiopericytoma is a rare, soft tissue, tumour with unpredictable biological behaviour. A case of haemangiopericytoma of the parotid salivary gland is reported. The clinical, surgical and histological features are described.
Otological relief work in romania
Authors: Frampton M. C.
Published: November 2007

The experiences of an otological surgical team during a brief visit to northern Romania are discussed. The importance of careful assessment of local deficiencies and needs is emphasized and sources of funding and equipment for use during such a trip are discussed.
Temporal bone dissection for display
Authors: Golding-Wood David G.
Published: November 2007

Increasing concern with medicolegal issues has heightened the need for surgical simulation in training. Familiarity with the surgical anatomy of the temporal bone is essential for effective and safe otological surgery. Refinement of surgical technique and intimate knowledge of temporal bone anatomy can be gained by accurate dissection. The products of such endeavours are both illustrative and instructive. The issues, methods and techniques necessary for display of anatomical dissections are discussed.
High-frequency jet ventilation – a review of its role in laryngology
Authors: Evans K. L. , Keene M. H. , Bristow A. S. E.
Published: November 2007

High-frequency jet ventilation (HFJV) is a safe, effective anaesthetic technique with a low risk of aspiration which has not yet gained wide acceptance in laryngology. Following anaesthesia and muscular relaxation the patient is intubated with a size 7FG infant feeding catheter and ventilation is achieved by delivering small bursts of anaesthetic gas at high frequency. The mechanisms of gas exchange are thought to be little different from those of conventional ventilation. We have found HFJV to be of value in laryngoscopy, laryngo-tracheal reconstruction, tracheoplasty, bronchoscopy and tonsillectomy.

The advantages include:

(a) ease of intubation, especially in the presence of a supraglottic mass;

(b) improved surgical access compared with a conventional endotracheal tube; and

(c) protection of the airway by the inherent ‘auto-PEEP’ effect. Care must be taken to ensure that conditions allow adequate exhaust of expired gas. Humidification of inspired gas is essential during prolonged procedures.
Dilation of simultaneous laryngeal and oesophageal stricture with two T-tubes
Authors: Wang Zhi
Published: November 2007

The treatment of double strictures in the airway and the oesophagus has always been time-consuming and causes additional suffering. A new technique using an open approach with the placement of two Montgomery silicone T-tubes to support and dilate the two strictures was successfully performed on a patient after caustic substance ingestion. Scar tissue was incised before two T-tubes were positioned into the larynx and oesophagus through a laryngo-fissure approach. The tubes remained in position for one year and no complications occurred. No foreign body sensation or prosthesis migration was observed and the patient had nearly normal peroral alimentation. After removal of the tubes, follow-up for an additional two years revealed no recurrence of the stenoses and normal alimentation without stridor. This technique permits simultaneous stenting of strictures of the larynx and oesophagus by using a connecting suture between the superior parts of two stents.
Bilateral pneumothorax after emergency tracheotomy: two case reports and a review of the literature
Authors: Ameye F. , Mattelin W. , Ingels K. , Bradwell R.
Published: November 2007

Bilateral pneumothorax may occur after emergency tracheotomy, if a significant upper airway obstruction with a large negative intrathoracic pressure exists.
Surgery for external auditory canal exostoses and osteomata
Authors: Fisher Edward W. , McManus Terence C.
Published: November 2007

The popularity of water sports in Western Australia results in a high demand for surgery for meatal exostoses when compared to Europe or North America, and such procedures for advanced exostoses present a technical challenge.

We report on a decade of experience in exostosis and osteoma surgery consisting of 127 procedures on 102 patients. Exostectomy was an access manoeuvre for other otological procedures in 13 cases and five procedures were for regrowth of exostoses. Minor complications were seen after 22 per cent of operations. Major complications were experienced after five per cent for example canal stenosis, temporomandibular joint prolapse, sensorineural loss, persistent deep bony lip and persistent tympanic membrane perforation. There were no facial palsies.

Exostosis surgery should be reserved for failed conservative treatment and attention focused on adequate access, meatal skin preservation and tympanic membrane protection. An approach which concentrates on safe anterior landmarks and wide exposure is recommended to avoid serious complications.
The styloid process in ossicular chain reconstruction. II: Long-term analysis
Authors: Ogale S. B. , Dutt Sunil N. , Thakur Sugato , Pawar Manisha
Published: November 2007

The human cadaveric styloid process was used as a homograft material for ossicular chain reconstruction in 41 cases of chronic suppurative otitis media over a five-year period. Although technical success was achieved in about 88.23 per cent of the cases, actual patient benefit was around 70.58 per cent; this is comparable to results obtained with most other homologous graft materials. The problem of breakage while remodelling the bone has also increased the risk of transmitting the AIDS virus and consequently undermines the use of this material.
A prospective evaluation of direct referral to audiology departments for hearing aids
Authors: Swan I. R. C. , Browning G. G.
Published: November 2007

It has been suggested that a proportion of individuals with a hearing impairment can be fitted with a hearing aid without being otolaryngologically assessed. Such assessments are deemed advisable: (a) to identify otological pathology that might require management and (b) because surgery can be a viable alternative in those with a conductive impairment.

The aim of this study was to prospectively study individuals referred to an Otolaryngology Department in a teaching hospital to assess how technicians, at a direct referral clinic for the provision of a hearing aid, could screen to identify those meriting an otolaryngological opinion. Two hundred and forty-eight patients were evaluated by technicians using strict audiometric and tympanometric criteria. One hundred and twenty-five patients (50 per cent) failed these criteria and were referred to an otologist. The remaining 123 (50 per cent) were managed by technicians but were subsequently reviewed for the purpose of this study by an otologist and their management assessed. In only two patients (one per cent) was it thought that the initial management would have been different if seen by an otologist. Alternative criteria for deciding suitability for management by technicians were applied. The inclusion of tympanometry was essential to avoid missing middle ear pathology.
Coffin-Lowry syndrome with sensorineural deafness and labyrinthine anomaly
Authors: Higashi Koichiro , Matsuki Chikako
Published: November 2007

A case of Coffin-Lowry syndrome is described. The child had the typical face and also soft and puffy hands with tapering fingers. His psychomotor development was retarded. Audiological tests revealed profound hearing impairment. Anomalous labyrinths were shown by CT scan of the temporal bones. It is inferred that deafness is one of the symptoms of this syndrome.
An extensive vestibular schwannoma with both intracranial spread and lateral extension to the external auditory canal
Authors: Woolford T. J. , Birzgalis A. R. , Ramsden R. T.
Published: November 2007

An extensive schwannoma in a 54-year-old woman is described. There was extension intracranially to involve the brain stem, laterally to fill the middle ear and external meatus, and inferiorly into the infratemporal fossa. Initially the intracranial portion of the tumour was excised. Later a second operation was undertaken to remove the residual tumour from the temporal bone and infratemporal fossa.
Rosai—Dorfman disease of the paranasal sinuses
Authors: Gregor R. T. , Ninnin D.
Published: November 2007

A 57-year-old man presented with a history of nasal obstruction of five to six years duration. 'Nasal polyps' were removed on several occasions. He had previously had an episode of paraplegia which resolved after the removal of a spinal tumour. Histology from both sites was thought to represent a malignant fibrous histiocytoma. On presentation the patient had computed tomographical (CT) evidence of extensive ethmoidal disease, with threatened intracranial extension. He also had evidence of lung and retroperitoneal disease with pancreas and kidney involvement. The ethmoidal disease was considered potentially lethal and therefore a craniofacial resection was performed. Review of all the histology revealed that the diagnosis was extranodal Rosai–Dorfman disease (sinus histiocytosis). The patient's course is described, and the literature on this disease of unknown aetiology is reviewed.
Subtotal petrosectomy with external canal overclosure in the management of chronic suppurative otitis media
Authors: Parikh Abhi A. , Brookes Gerald B.
Published: November 2007

Subtotal petrosectomy with external canal overclosure has been used in the management of 10 patients with chronic suppurative otitis media in the past four years. These patients fall into two categories. One group consisted of patients with end-stage chronically discharging mastoid cavities, despite aggressive medical therapy. The other group comprised patients who had developed disabling peripheral vestibular symptoms and had a mastoid cavity from past surgery for chronic otitis media. In both groups the affected ear had absent or poor auditory function. In the second group, a translabyrinthine section of the vestibular and/or cochlear nerves was performed in conjunction with subtotal petrosectomy

The procedure has been very successful in relieving the persistent otorrhoea, giving the patient an ear without a cavity that would need regular care. No restriction on swimming and participation in other water sports is an additional advantage.

Illustrative cases are used to discuss the technique and indications.
Primary tumours of the trachea: analysis of clinical features and treatment results
Authors: Howard David J. , Haribhakti Vijay V.
Published: November 2007

Primary tracheal tumours are extremely rare and present with widely variant clinical and histological features. Treatment methods vary considerably, and few studies have sought to provide adequate guidelines. A retrospective analysis was carried out of all patients treated in our unit between 1965 and 1990. Our experience deals almost exclusively with high tracheal tumours involving the adjacent subglottic region. Squamous carcinoma (SCC) and adenoid cystic carcinoma (ACC) were the commonest subtypes, and presented with dyspnoea and hoarseness as the most frequent symptoms. ACCs occurred commonly in young individuals, presented insidiously, and ran a long, and often, unpredictable course. Endoscopic evaluation revealed the majority of the lesions to be bulky and obstructive in nature. Primary surgery with adjuvant radical radiotherapy, when indicated, appeared to provide optimal results. Debulking surgery followed by radiotherapy provided effective and lasting control in two cases of ACC. Other malignant subtypes behaved aggressively and progressed uncontrolled.
In vitro comparison of the Groningen high resistance, Groningen low resistance and Provox speaking valves
Authors: Heaton Judith M. , Parker Andrew J.
Published: November 2007

This paper compares the physical parameters of the newer Groningen low resistance and Provox indwelling laryngectomy prostheses with the established and original Groningen device.

In vitro pressure/flow profiles were determined, using specially designed apparatus, in 44 standard Groningen high resistance (GHR), 37 Groningen low resistance (GLR) and 19 Provox tracheo-oesophageal prostheses prior to insertion. GHR valves had significantly higher forward opening pressures than both the newer valves and the GHR was significantly higher than the Provox (p<0.01: Mann-Whitney U-test). The mean forward resistance of GHR was significantly higher than that of both; the Provox valve was significantly lower than that of GLR (p<0.0001: Mann-Whitney U-test). This may be of relevance with respect to patient acceptability, voice quality and effective duration of valve action.
Callus originating in the laryngeal skeleton, presenting as a neck lump: a case report
Authors: Hermans R. , Sciot R. , Delaere P. , Van Damme B. , Baert A. L.
Published: November 2007

Abtract

We report on the case of a young woman, presenting with a left lateral neck lump, which turned out to be a bony callus originating from the thyroid cartilage; similar but smaller lesions were found on the same side in the hyoid and cricoid cartilages. The CT, MRI and pathological findings are described.
Cystic vestibular schwannomas: neuroimaging and growth rate
Authors: Charabi Samih , Mantoni Margit , Tos Mirko , Thomsen Jens
Published: November 2007

In a series of 571 vestibular schwannomas (VS) operated on in the period 1976–1992, via the translabyrinthine approach, 23 tumours (4 per cent) from 23 patients were radiologically, peroperatively and histologically identified as cystic VS. Neuroimaging examinations (CT and MRI) revealed 15 tumours (2.6 per cent) with extracystic formations and in eight cases (1.4 per cent) intratumoural cysts. In 15 cases (65 per cent), tumours were located extracanalicularly with no involvement of the internal auditory canal (IAC). The extracanalicular tumour extension including the cystic elements ranged between 10 and 60 mm with a mean of 45 mm. In eight cases out of 23 (35 per cent) other diagnostic possibilities such as trigeminal schwannoma, epidermoid cyst and meningioma were proposed at the primary evaluation. Deformation, displacement and/or impression of the fourth ventricle was demonstrated in 17 cases (74 per cent). Three patients (13 per cent) had obstructive hydrocephalus which demanded shunt insertion. Residual tumour was detected in two patients (9 per cent). Growth rate in four cases was more than 10 times higher when compared to the annual growth rate of noncystic VS. The results of this study provide data on cystic VS attenuation demonstrated by CT or MRI which may be valuable in neuroradiological diagnosis of these cystic lesions and emphasizes that the wait-and-see policy should not be applied to the cystic variant of VS.