bluuebunny/crossref_metadata_2025 huggingface dataset:
Prediagnostic malakoplakia presenting as a chronic inflammatory mass in the soft tissues of the neck
Authors: Douglas-Jones A. G. , Rodd C. , James E. M. V. , Mills R. G. S.
Published: November 2007

Malakoplakia presenting in the head and neck is very rare. We present a case of an inflammatory mass in the neck, clinically mimicking actinomycosis in a 67-year-old man. Repeated culture of E. coli and histological and electron microscopic examination of biopsy material showed an infiltration of granular macrophages and intracellular gram negative bacilli, but no classical Michaelis-Gutmann bodies. The clinical and pathological findings and criteria for the diagnosis of malakoplakia are discussed.
Seroprevalence of Chlamydia pneumoniae infections in otolaryngeal diseases
Authors: Hashiguchi Kazuhiro , Ogawa Hiroshi , Kazuyama Yukumasa
Published: November 2007

We studied the seroprevalence of antibodies to Chlamydia pneumoniae, the third species of chlamydia, in patients with acute infections in otolaryngeal sites. The patients were divided into five diagnostic groups, i.e. sinusitis, otitis media, tonsillitis, laryngitis and bronchitis group. Antibodies were measured by the microimmunofluorescent method. Antibodies confirming past infection with C. pneumoniae were found 46.2 per cent of the patients in the diagnostic groups and 44.7 per cent of the subjects in the control group. The difference between these two groups was not statistically significant. Acute or recent antibodies were detected in 10.5 per cent (2/19) of these patients with sinusitis, 19.2 per cent (10/52) of those with tonsillitis, 23.5 per cent (8/34) of those with otitis media, 18.2 percent (6/33) of those with laryngitis and 22.8 percent (13/57) of those with bronchitis, whereas only one member of the control group had acute antibodies. These data suggested that C. pneumoniae is an important and common pathogen of otolaryngeal disease.
Quality of life of patients treated surgically for head and neck cancer
Authors: Jones E. , Lund V. J. , Howard D. J. , Greenberg M. P. , McCarthy M.
Published: November 2007

The quality of survival of 48 patients treated surgically for head and neck cancer was assessed using a problem-orientated self-administered questionnaire. The questionnaire was based on the European Organization for Research into the Treatment of Cancer (EORTC) core questionnaire to which a specific head and neck module was added. The following domains were studied: pain, fatigue, physical symptoms (gastrointestinal and ‘other’), functional activity, psychological symptoms, overall physical condition and overall quality of life. For the analysis, five groups of patients were considered: laryngectomy (n=15), pharyngolaryngoesophagectomy (n=5), craniofacial procedure (n=11), ‘other operations’ (n=9) and patients with disease recurrence (n=8). Each group identified different problem areas. Laryngectomees and ‘other operation’ patients reported relatively few problems, whereas patients with disease recurrence described difficulties in all of the domains examined. Symptoms of fatigue were common. Information collected in this way may facilitate improved rehabilitation and thus better quality of survival.
Necrosis of the incus by the chorda tympani nerve
Authors: Watson Carl
Published: November 2007

Ossicular necrosis is often associated with chronic adhesive otitis media. An unusual abnormality discovered in an incus removed during tympanoplasty is reported. The long process appears to have been grooved by pressure from the chorda tympani. An alternative theory to explain the vulnerability of the long process of the incus is suggested.
Tonsillectomy, adenoidectomy and adenotonsillectomy: Are they safe day case procedures?
Authors: Yardley M. P. J.
Published: November 2007

A review of 3,488 tonsil and adenoid procedures performed between March 1987 and April 1990 is presented.

A reactionary haemorrhage rate of 0.49 per cent was found. No deaths were recorded. All cases of reactionary haemorrhage occurred within the first eight hours post-operatively.

Based on this study, out-patient tonsil and adenoid surgery should be followed by at least an eight hour post-operative observation period before discharge. If day case adenoid and tonsil surgery is adopted, close medical audit would be necessary to detect and then prevent any possible increase in morbidity or mortality.
Adenoids: comparison of radiological assessment methods with clinical and endoscopic findings
Authors: Wormald P. J. , Prescott C. A. J.
Published: November 2007

Methods of evaluating adenoidal size pre-operatively are controversial. Symptoms and clinical evaluation have been both advocated and condemned. Depending on the methodology, measurement of the radiological adenoidal shadow has been difficult to correlate with the clinical patency of the nasopharyngeal airway and to the actual size of the removed adenoid.

Four different methods were used to measure the adenoidal size on 74 radiographs. The methods were evaluated against the degree to which the adenoids obstructed the nasopharynx on flexible endoscopy of the postnasal space. Obstructive symptomatology was also evaluated against the degree of obstruction.

The radiological method that best correlated to the endoscopic findings was that of Cohen and Konak (1985). However, obstructive symptomatology had the overall highest correlation to endoscopic findings.
Basaloid-squamous carcinoma of the nasal cavity
Authors: Wan S. K. , Chan J. K. C. , Tse K. C.
Published: November 2007

Basaloid-squamous carcinoma is a recently characterized, aggressive tumour occurring in the hypopharynx, larynx and base of tongue. We report a unique case involving the nasal cavity of a patient with a history of radiation therapy for nasopharyngeal carcinoma, raising the possibilit that basaloid-squamous carcinoma can be radiation-associated.
The dangers of minor blunt laryngeal trauma
Authors: O'Keeffe L. J. , Maw A. R.
Published: November 2007

Since the introduction of seat belts, laryngotracheal trauma has become a rare injury, comprising less than one per cent of blunt trauma cases seen at major trauma centres. However, a wide range of damage to the soft tissue and cartilaginous framework of the larynx may result from such injuries but signs of injury are easily overlooked leading to potentially serious consequences for the patient. We report a case of isolated blunt laryngeal trauma from a relatively minor injury which illustrates some of the problems resulting in these cases and review the treatment of blunt laryngeal trauma.
Surgical approach to submucosal lesions of the supraglottic larynx: the supero-lateral thyrotomy
Authors: Rubin John S. , Silver Carl E.
Published: November 2007

The surgical approach to the hypopharynx by lateral pharyngotomy as described by Trotter has found widespread use in management of supraglottic carcinoma. A similar but more conservative approach may be employed for removal of cysts and benign or well-encapsulated neoplasms of the epiglottis and supraglottic space. We call this approach a supero-lateral thyrotomy, to differentiate it from the classic lateral pharyngotomy.

Surgery consists of subperichondrial resection of the superior half of the ipsilateral thyroid cartilage with preservation of internal lining and superior laryngeal nerve. The lesion may then be enucleated or resected, and the defect, if any exists, closed with overlying mucosa and the flap of preserved perichondrium. The technique has been employed in cases of paraganglioma, haemangiopericytoma and saccular cysts.
Ventilation tube insertion using topical anaesthesia in children
Authors: Summerfield M. J. , White P. S.
Published: November 2007

Topical anaesthesia using EMLA cream is an established anaesthetic technique for ventilation tube insertion in adults. We report its use in 103 children (age range 3–12 years). Failure occurred in seven patients (6.8 per cent); complications occurred in two patients and were of a minor nature. This technique appears well tolerated provided the operator avoids the use of suction and allows a cream penetration time of greater than two hours. The use of a ‘T’ myringotomy is also recommended, to reduce tension on the drum at tube insertion.
Endoscopic transcanal myringoplasty
Authors: El-Guindy Ahmed
Published: November 2007

The role of the rigid endoscope has been evaluated in the management of 36 cases with dry central perforation of the tympanic membrane. The graft take rate was 91.7 per cent and the air-bone gap was closed to less than 10 dB in 83.3 per cent.

The use of the rigid endoscope in the management of dry central perforation of the drum represented a significant advance in middle ear surgery. It is used, in correlation with manometry, to evaluate the tubal function before ear surgery and to treat hidden causes of tubal obstruction. It replaces the operating microscope in observation and surgery of the tympanic membrane perforation. It overcomes anatomical variations that hamper access to the entire tympanic membrane during ear surgery. It provides an extremely sharp image with high resolution.
Augmentation rhinoplasty in nasal sarcoidosis
Authors: Scott P. M. J. , Morphopoulos G. , Bleach N.
Published: November 2007

We present a case of nasal deformity due to sarcoidosis. The surgical management is discussed. The risk of secondary involvement of implanted autologous cartilage by the disease is emphasized. For this reason an inert allograft (silastic) is recommended for augmentation in this group of patients.
Non-occupational recurrent bilateral pneumoparotitis in an adolescent
Authors: Ferlito Alfio , Andretta Marilisa , Baldan Marco , Candiani Francesco
Published: November 2007

This is a case report of recurrent bilateral parotid swelling with intraglandular gaseous bubbles in a 14-year-old boy, together with a review of the literature on this condition, which is usually called pneumoparotitis. The disorder has been reported as an occupational hazard in wind instrument players and glass-blowers and also as a rare non-occupational disease, mainly in adolescents and often associated with psychological problems.
Cystic lymphangioma in the adult parotid
Authors: Livesey J. R. , Soames J. V.
Published: November 2007

Cystic lymphangioma is a congenital lesion which rarely presents in adult life and even less commonly arises within salivary tissue. We report the sudden appearance of a large cystic lymphangioma within the parotid gland of a young man and discuss the management of this rare condition.
The Welch Allyn Audioscope and Microtymp: their accuracy and that of pneumatic otoscopy, tympanometry and pure tone audiometry as predictors of otitis media with effusion
Authors: Vaughan-Jones R. , Mills R. P.
Published: November 2007

Results of standard audiometry and tympanometry were compared with the Welch Allyn ‘Audioscope’ and ‘Microtymp’, in the diagnosis of secretory otitis media, in 100 children.

Standard pure tone audiometry had a specificity of 92 per cent and sensitivity of 51.6 per cent. The Welch Allyn ‘Audioscope’ a specificity of 84.2 per cent and sensitivity of 57.5 per cent; standard tympanometry a specificity of 71 per cent and sensitivity of 88 per cent; the Welch Allyn ‘Microtymp’ a specificity of 63 per cent and sensitivity of 90 per cent.

In view of cost, portability, and speed of testing the Welch Allyn instruments would be particularly suitable for community screening.

Pure tone audiometry with a pass threshold of 25 dB, at 2 and 4 kHz is a poor indicator of effusion.
Management of acute dilatation of the oesophagus presenting as stridor
Authors: Davis J. P. , Hyde J. A. J.
Published: November 2007

Acute dilatation of the oesophagus causing stridor is rare. A case is presented and the literature is reviewed with emphasis on the management of this problem.
Bilateral internal jugular phlebectasia
Authors: Walsh R. M. , Murty G. E. , Bradley P. J.
Published: November 2007

Internal jugular phlebectasia is a venous anomaly commonly presenting as a unilateral neck swelling in children. The clinicopathology, aetiology and management are discussed. Bilateral doppler ultrasonography is the diagnostic investigation of choice and should be performed in all suspected cases. Conservative management of the bilateral case is recommended.
Fine needle aspiration cytology of a head and neck swelling in a child: A non-invasive approach to diagnosis
Authors: Derias N. W. , Chong W. H. , O'Connor A. F. Fitzgerald
Published: November 2007

A 12-year-old boy presented with a three-month history of a painful parotid swelling. Fine needle aspiration cytology indicated a pleomorphic adenoma—an uncommon lesion in a child. This diagnostic technique plays a useful role in the investigation of head and neck swellings.
An unusual prevalence of complications of chronic suppurative otitis media in young adults
Authors: Shamboul K. M.
Published: November 2007

The complications of chronic suppurative otitis media as seen in 117 patients are presented. Fifty per cent of the patients had cholesteatoma, and 28 per cent revealed complications. Two-thirds of these complications, especially the serious intracranial ones, were encountered in young females. This female predominance was attributed to late presentation because of social reasons, or to undue susceptibility to the destructive effect of cholesteatoma.

Radical and modified radical operations were recommended to render the ears safe, as most of the patients came from distant rural areas and were judged to have poor compliance to report for regular checks.
Computer simulation of human tympanic membrane
Authors: Bhide Avinash
Published: November 2007

Because of the difficulties in studying the mechanical properties of the human tympanic membrane in situ, structural data from the cadaveric tympanic membrane samples is used for simulation of the surface structure of the tympanic membrane with the help of a computer. The hitherto poorly understood contour of the tympanic membrane is available for the development of a tympanic membrane and middle ear model.
The use of pyriform sinus mucosa for reconstruction after vertical partial laryngectomy
Authors: Salam M. A. , El-Kahky M. , El-Mehiry H.
Published: November 2007

This prospective study included 30 patients with glottic carcinoma of the larynx who were treated primarily by vertical partial laryngectomy. The pyriform sinus mucosa was used to reconstruct the new laryngeal wall and to form a pseudo-vocal fold at the side of resection. Our results showed that 90 per cent of patients were decannulated, 80 per cent were able to eat a normal diet, 70 per cent developed excellent voice quality after surgery and a 97 per cent three-year survival was achieved. The pyriform sinus mucosa proved to be a reliable material for reconstruction after vertical partial laryngectomy.
New methods of dealing with the complications of panendoscopy
Authors: Mendel Paul , Anaes F. C. , Bristow Aubrey
Published: November 2007

A 70-year-old man with chronic obstructive airways disease was scheduled to undergo panendoscopy following a course of radiotherapy for carcinoma of the larynx. He was anaesthetized using a propofol infusion and high frequency jet ventilation (HFJV). The jet ventilation catheter was left in situ at the end of the procedure. This enabled oxygenation to be maintained in the presence of post-operative laryngospasm by re-attaching the jet ventilator. Subsequently he developed respiratory failure, and a Bullard laryngoscope was used to visualize the vocal folds despite oedema of the tumour which made direct laryngoscopy impossible.

A catheter was passed through the biopsy channel of the Bullard, enabling HFJV to be commenced. A conventional endotracheal tube was then railroaded over the catheter to facilitate conventional ventilation.
Ionomeric bone cement in neuro-otological surgery
Authors: Ramsden Richard T. , Herdman Rory C. D. , Lye Richard H.
Published: November 2007

The use of a polymaleinate glass ionomer cement in 80 neuro-otology cases is described. It has pf oved of great value in translabyrinthine acoustic neuroma surgery, reducing the incidence of CSF fistula to nil. It is the method of choice for fixation of the Nucleus cochlear implant, and has many other applications in the field of otology and neuro-otology. It is easy to use and appears to have no side effects.
Cochlear implants for congenital deformities
Authors: Phelps P. D.
Published: November 2007

There have been few accounts of multi-channel cochlear implants in patients with congenital structural deformities of the inner ear which are associated with severe and sometimes progressive deafness. These malformations can now be recognized easily on 2 plane thin section high resolution CT studies which are mandatory for the pre-implantation assessment. However, no attempt seems to have been made to describe which of these malformations would be suitable for an implant or for which would this procedure be contra-indicated. True Mondini deformity of both the cochlea and dilated vestibular aqueduct type would appear suitable for a multi channel implant, but this type of implant should not be used for a primitive otocyst, severe labyrinthine dysplasia or the characteristic X-linked deformity.
Draffin and his rods
Authors: Courtnay Bennett J. D. , Young J. Riddington
Published: November 2007

Draffin's rods or bipods are now a well-known, internationally accepted ENT instrument. Before their invention in 1951, the attendant anaesthetist or nurse was obliged to support the mouthgag during tonsillectomy.

Research into the life of their originator, David Alexander Draffin, reveals that in addition to his evident design skills, he was a surgeon of courage, wit and great charm.
A destructive false aneurysm of the maxillary sinus
Authors: Fagan J. J. , Gallow I.
Published: November 2007

A false aneurysm of the internal maxillary artery presented with clinical and radiological features suggestive of a malignant tumour of the maxillary sinus. This case illustrates a complication of antral lavage and an unusual clinical, radiological and pathological entity.
Familial stapes superstructure fixation
Authors: Kinsella J. B. , Kerr A. G.
Published: November 2007

Congenital stapes superstructure fixation was found in a mother in both ears and her daughter in one ear. The head of the stapes was fixed to the pyramid by a bony bar which lay immediately superior to a normal stapedius muscle. Removal of the bony bar resulted in normal hearing, which has been maintained. We believe that these are the first reported cases of this abnormality.
Idiopathic spontaneous tonsillar haemorrhage
Authors: Vaughan M. M. , Parker A. J.
Published: November 2007

Since the advent of antibiotics major spontaneous tonsillar haemorrhage is extremely rare. The causes are usually ascribed to vessel wall erosion secondary to bacterial infection or infectious mononucleosis. We report the case of a 20-year-old female, presenting to the ENT department with tonsillar bleeding in the absence of any identifiable infective or traumatic process.
Tularemia: A differential diagnosis in oto-rhino-laryngology
Authors: Nordahl Stein Helge Glad , Hoel Terje , Scheel Olaf , Olofsson Jan
Published: November 2007

Tularemia can present as an oto-rhino-laryngological disease. The clinical and radiological (CT) manifestations, diagnosis and treatment are discussed based on a case report where a patient with tonsillitis and enlarged cervical lymph nodes was admitted to the department of oto-rhino-laryngology of a hospital in Northern Norway.Francisella tularensiswas isolated from the blood and there was a high titre of agglutinating serum antibodies to F. tularensis. The patient's contaminated drinking water well is the suspect source of infection.
Warfarin and epistaxis — a case controlled study
Authors: Denholm S. W. , Maynard C. A. , Watson H. G.
Published: November 2007

Patients anticoagulated with warfarin form a small proportion of thos se admitted with epistaxis annually to ENT units. The authors formed the impression that such patients spend longer in hospital and have more complicated management than controls. A prospective age and sex matched controlled study of 20 consecutive patients admitted with epistaxis whilst anticoagulated was performed. This showed thath these patients spent significantly longer in hospital than cntrols, with an additional expense in the study periold of £10,500 for impatient bed nights alone. The management of these patients is more complicated and these is a subgroup of poorly controlled patients who present most of the problems. A potentioal solution is to improve community warfarin control and to involve general practitioners and haematologist in the re-establishment of warfarin following admission for epistaxis.
The use of balloon catheters in the treatement of epistaxis
Authors: McFerran D. J. , Edmonds S. E.
Published: November 2007

Inflatable balloon catheters are widely used in the treatment of severe epistaxis and are designed to be filled either with air or liquid. A postal survery revealed that 87 per cent of respondents used an inflantant which was deemed inappropriate by the manufacaturer. When ballons designed for water or saline were filled with air, they defalted rapidly, in some cases beings virtually empty after 24 hours. Better and more accessible instruction leaflets are required if the balloons are to be used as intended.

Foley catheters are frwquently used as nasopharyngeal packs, in conjunction with anterior nasal packs. Paraffin in the commonly used anterior packs damages the rubber of the catheter, resulting in the balolon bursting. This should be recognized by clinicans as a possible cause of rebleeding.
A randomized study of the surgical management of children with persistent otitis media with effusion associated with a hearing impairment
Authors: Dempster J. H. , Browning G. G. , Gatehouse S. G.
Published: November 2007

The object of this study was to compare the effect on the hearing of the insertion of a grommet, with or without adenoidectomy, against a non–surgically managed control ear in children with persistent hearing impairment due to otitis media with effusion.

Seventy–eight children (44 boys, 34 girls, mean age 5.8 years) with documented bilateral otitis media with effusion associated with a bilateral hearing impairment (pure tone average air conduction thresholds over 0.5, 1 and 2 kHz of ≥25 dB HL) over a three month period were admitted to a randomized, controlled trial. Each child was randomized to have or not to have an adenoidectomy. The ears in each child were then randomly allocated to have a grommet (tympanostomy tube) inserted. The children's hearing status was reviewed six and 12 months post–operatively. During follow–up, should a child redevelop a persistent bilateral hearing impairment (as defined above) for three months they were managed with a hearing aid. Thus no child had repeat insertion of a grommet.

Surgery of each type had an effect on the hearing and the presence of otitis media with effusion at six months post–operatively but not at 12 months when it was no different from natural resolution.

If resolution of the otitis media with effusion is the outcome measure, then adenoidectomy alone is significantly better than no surgery but only in boys rather than in girls. Even in boys it only resolves about 60 per cent of effusions. However, when combined with a grommet (one insertion) adenoidectomy gives no greater resolution (89 per cent compared with 86 per cent).

If improvement in hearing is the outcome measure, the overall results are similar. Adenoidectomy alone has an effect but if a grommet is inserted, adenoidectomy in addition does not improve the overall effect. However, these findings are not the case when analysed regarding the sex of the subject mainly because of the higher natural resolution rate in girls. In them, at six months surgery of any type or combination has no effect whereas in boys there is an additive effect of adenoidectomy on grommet insertion. Hopefully further studies can be conducted in larger numbers to investigate the differing effect in boys and girls suggested in this study.
Bone conduction errors at high frequencies: implications for clinical and medico-legal practice
Authors: Lightfoot Guy R. , Hughes Jacqui B.
Published: November 2007

The magnitude and origin of audiometric air-bone gaps in the range 3 kHz to 8 kHz was investigated in 20 normal subjects. The average gap ranged from a minimum of about 3 dB at 3 kHz to a maximum of about 19 dB at 6 kHz. Approximately 5 dB of the gap at high frequencies is caused by excess air-radiated sound from the bone vibrator. A larger error appears to result from discrepancies between the air and bone conduction standards to which audiometers are calibrated. These errors may influence diagnosis and we recommend that bone conduction tests at frequencies greater than 4 kHz are avoided. These findings have implications for medico-legal work where small air-bone gaps have diagnostic significance.
Anterior mandibulotomy for oral and oropharyngeal tumours
Authors: Singh Ajit Man , Bahadur Sudhir , Tandon D. A. , Pande R. M.
Published: November 2007

In the last six years, anterior mandibulotomy was used to approach tumours of the oropharynx and oral cavity in 39 cases. Twenty-six of these had primary lesions in the anterior two-thirds of the tongue. Eight cases had lesions in the base tongue, three in the cheek, and two in the tonsil. Twenty-six cases had T3tumours, nine had T2lesions, and four had T4tumours. Twenty-five patients received post-operative radiotherapy. In 16 cases the mandibulotomy was combined with a marginal mandibulectomy. In 23 cases reconstruction was carried out using a pectoralis major myocutaneous flap. Adequate margins on histopathology obtained in all but eight patients. Bone-related complications occurred in only three patients, all of whom were previously irradiated. Thus the anterior mandibulotomy provides excellent exposure for oral and oropharyngeal tumours, with low complication rate, and avoidance of segmental mandibulectomy.
Dermoid cyst in the middle ear
Authors: Minatogawa Toru , Node Michiko Nakamura , Fukuda Ikuo , Kumoi Takeo
Published: November 2007

A case of a moderate essentially low tone unilateral conductive hearing loss without a previous history of secretory otitis media in a six-year-old female patient is described. The condition was found to be due to a dermoid cyst in the tympanic cavity, which was confirmed by pathological examination of the surgically removed specimen. This is the sixth documented case of dermoid cyst in the tympanic cavity.
Acute pneumonitis caused by low density barium sulphate aspiration
Authors: Pracy J. P. M. , Montgomery P. Q. , Reading N.
Published: November 2007

The aspiration of contrast medium during the investigation of swallowing disorders is a well recognized hazard. It is therefore essential that the contrast medium administered is non-irritant to the lungs. A case is presented to illustrate the problems associated with the aspiration of a relatively non-irritant contrast medium.
Pneumoparotitis, subcutaneous emphysema and pleomorphic adenoma
Authors: Birzgalis A. R. , Curley J. W. A. , Camphor I.
Published: November 2007

Self-induced pneumoparotitis is a distinct clinical entity which should be considered in any inflammatory swelling of the parotid gland. When complicated by subcutaneous emphysema, other more important causes should be excluded. An unusual case is presented, which was further complicated by the presence of a pleomorphic adenoma.
A case of Quinsy in a fifteen-month old child
Authors: Shenoy P. , David V. C.
Published: November 2007

A case of peritonsillar abscess in an infant is described, which is a rare lesion in infants and young children. To our knowledge this is the youngest child described in the English literature. The clinical presentation and treatment of peritonsillar abscess in infants and young children are discussed. Serious complications can occur early in the course of the disease because of physiological and anatomical factors and thus early aggressive treatment is required.
Otoneurological manifestations in Chiari-I malformation
Authors: Albers F. W. J. , Ingels K. J. A. O.
Published: November 2007

The type I Chiari malformation consists of a caudal displacement of the cerebellar tonsils through the foramen magnum into the cervical spinal canal. The most common presenting symptoms, such as pain, weakness and headache, are frequently preceded by otoneurological symptoms. Sensorineural hearing loss, vertigo, nystagmus, dysequilibrium, tinnitus and other cranial nerve involvement have been reported in Chiari-I malformation. A case report is presented and the clinical features of the disease are discussed with emphasis on the otoneurological aspects.
Congenital cerebrospinal fluid fistula through the inner ear and meningitis
Authors: Phelps Peter D. , Proops David , Sellars Sean , Evans John , Michaels Leslie
Published: November 2007

Congenital deformities of the labyrinth of the inner ear can be associated with a fistulous communication between the intracranial subarachnoid space and the middle ear cavity. We describe seven such cases, six confirmed by high resolution CT and one by postmortem histological section. The seven patients all presented with meningitis although a cerebrospinal fluid fistula was demonstrated at subsequent surgery or postmortem. The lesions were bilateral in three patients, unilateral in three and probably bilateral in the postmortem case although only one temporal bone was obtained. In every case there was a dilated sac instead of the normal two and a half turn cochlea on the affected side and this was confirmed at surgery. The demonstration of the basal cochlear turn is of paramount importance in any deaf child presenting with meningitis. A true Mondini deformity with a normal basal turn and some hearing is not at risk of developing a fistula.
Value of pre-operative embolization in surgery for nasopharyngeal angiofibroma
Authors: Siniluoto Topi M. J. , Luotonen Jukka P. , Tikkakoski Tapani A. , Leinonen Aaro S. S. , Jokinen Kalevi E.
Published: November 2007

The value of embolization in surgery for nasopharyngeal angiofibroma is a controversial matter. We analysed retrospectively the results of surgical treatment in ten patients with a nasopharyngeal angiofibroma, the last five of whom underwent pre-operative embolization with Gelfoam®. Embolization reduced the intraoperative blood loss at primary surgery from an average of 1510 ml in the non-embolized patients to 510 ml in the embolized patients and transfusions from an average of 4.4 units to none. Seven reoperations were performed on four non-embolized patients on account of tumour recurrence, while no recurrences were diagnosed among the pre-operatively embolized patients. Blood loss in the reoperations averaged 4065 ml, and transfusions 7.1 units. The results indicate that embolization is effective in reducing intraoperative blood loss and contributes to improved surgical results. We recommend it as a routine pre-operative adjunct to surgery for nasopharyngeal angiofibroma.
Hypersensitivity to topical corticosteroids in otitis externa
Authors: Wilkinson S. M. , Beck M. H.
Published: November 2007

Over a12-monthperiod, nine patients were seen in a contact dermatitis clinic with an inflammatory dermatosis localized predominantly to the external auditory canal. Of these patients, four were found to have an allergic contact dermatitis which was exacerbating their dermatitis. All were allergic to one or more corticosteroids and topical antibiotics used in the treatment of their dermatitis. We would suggest that hypersensitivity to topical corticosteroids and other medicaments be considered in patients with otitis externa which fails to respond to treatment.
Spontaneous retropharyngeal haematoma: two cases and a review of the literature
Authors: Al-Fallouji H. K. , Snow D. G. , Kuo M. J. , Johnson P. J. E.
Published: November 2007

Retropharyngeal haemorrhage is a rare condition. The classical picture is described as a triad of features; superior mediastinal obstruction, anterior displacement of the trachea on a plain X-ray of the neck and subcutaneous bruising appearing on the neck and spreading on to the chest wall (Sandor and Cooke, 1964). Two cases are reported here, neither of which had mediastinal compression. The available literature is summarized.
Rhabdomyosarcoma of the adult head and neck: a clinicopathological and DNA ploidy study
Authors: El-Naggar Adel K. , Batsakis John G. , Ordónez Nelson G. , Luna Mario A. , Goepfert Helmuth
Published: November 2007

Abstarct

We investigated the DNA ploidy patten in thirteen primary and four recurrent rhabdomyosarcomas of teh head and neck from thirteen adult patients and conrrelated the findings with other clinicopathological factors and clinical outcome. Twelve (92.7 per cent) of the primary neoplasms manifested an aneuploid DNA pattern. All recurrent lesions were DNA aneuploid with DNA indices (DIs) Corresponding to their primary neoplasms. No correlation beteween the ploidy pattern and histological subtypes, tumours location, clinical stage and patient's clinical course was found. In this study, only two patients were long-term, survivors. Both patients had stage I neoplasms that were located in non-parameninigeal sites which manifested an alvellar histological pattern. Our data indicate that adult rhabdoyosarcomas of adult and neck are preponderantly DNA aneuploid and are highly aggressive malignant neoplasms. Our results alson suggest that tumours which are low stage and in a non-parameningeal location may pursue a less aggressive course.
Severe cochlear dysplasia causing recurrent meningitis: a surgical lesson
Authors: Stevenson D. S. , Proops D. W. , Phelps P. D.
Published: November 2007

Abstarct

Meningitis may be the sole presenting sign of a cerebrospinal fluid (CSF) fistula of the temporal bone. An eight-year-old boy suffering from recurrent meningits was found to hav ebilateral severe cochlear dysplasia. Bilateral tympanotomies were performed, planning to obliterate each vestibule. In the right ear a stapedectomy was oerfirned, resulting in terrntial ‘CSF gusher’ and difficulty in packing the vestibule. CSF rhinorrhoea requiring revision surgery and twon episodes of gram-negative bacterial meningtis complicated the post-operative management, resulting in a prolonged hospital stay. Subsequently, the left ear was managed in a different fasion, leaving the stapes in situ, with grafts placed to seal the oval window nche. We would recommended this alternative procedure in cases of severe cochlear dysplasia, where abnormalities of the vestibule and basal turn of the cochela mean that performing a stapeddectomy to pack the vestibule may result in a severe ‘CSF gusher’, by opening directly into the subarachnoid space.
Oncocytic mixed nasal tumour
Authors: Thomas M. R. , Ward K. , Al-Khabori M. , Natarajan B.
Published: November 2007

Abstarct

A case report of a rare tumour, not yet documented at this site, showing a characteristic histological appearance is described.
Salivary neoplasms of the palate: a flow cytometric and clinicopathological analysis
Authors: Carrillo Rosario , Batsakis John G. , Weber Randal , Luna Mario A. , El-Naggar Adel K.
Published: November 2007

In order to test the clinical and prognostic significance of flow cytometrically assessed DNA content in minor salivary gland tumours we evaluated 75 neoplasms of the palate, 55 of which were carcinomas. Benign neoplasms were exclusively DNA diploid with low S-phase fractions while 22 per cent of malignant tumours manifested a DNA aneuploidy and 23.5 per cent high S-phase fractions (>5 per cent). Significant statistical correlations between DNA content and tumour size, histological grade, lymph node metastasis and lethality were observed. Our findings suggest a potentially important role for flow-cytometry in the evaluation of these neoplasms.
What causes acute otitis externa?
Authors: Russell J. D. , Donnelly M. , Mcshane D.P. , Alun-Jones T. , Walsh M.
Published: November 2007

External otitis is an extremely common condition and can affect between five to twenty per cent of the patients attending ENT clinics (Hawke et al., 1984).

Its precise pathogenesis remains unclear, despite several aetiological classifications in the literature. The aim of this study was to investigate the relationship between infection, water exposure and trauma and the development of acute otitis externa. The study comprised 100 patients with their first attack of otitis externa and 150 age and sex matched controls. In only 40 per cent of cases could a primary microbiological cause be found.

There was no significant statistical difference found between the two groups regarding the use of agents capable of traumatizing the external canal. Regular swimming, showering and hair washing were significantly more common in patients with acute otitis externa. Allergic disorders were nearly three times more common in the external otitis group suggesting a possible immunological aetiology.
Metastatic hurthle cell tumour causing central airway obstruction
Authors: White S. A. , Goddard M. J.
Published: November 2007

A Hurthle cell tumour is a variant of follicular thyroid cell carcinoma. This is a report of metastatic Hurthle cell tumour causing central airway obstruction, emphasizing the difficulty in differentiating benign from malignant lesions.
Hyoid bone tumour mass presenting with cervical nodal metastasis
Authors: Timon Conrad I. , Brown Dale , Dardick Irving
Published: November 2007

This paper presents a quite unique case report of a patient presenting with the combination of cervical metastatic lymphadenopathy and a hyoid bone tumour mass. The differential diagnosis and treatment is discussed, with emphasis on the importance of immunohistochemistry and electron microscopy in the management of such a case.
When is a decibel not a decibel?: The application of decibel scales and calibration in clinical audiology
Authors: Beynon Graham
Published: November 2007

Decibel scales are a very important but potentially confusing subject for the clinician. Misunderstanding can, at worst, lead to inappropriate management which is detrimental to the patient. This paper sets out, from the viewpoint of an acoustician, the calibration and meaning of the various decibel scales in common use, shows how they are applied to the clinical setting, and explains their limitations.
Prevalence and aetiology of profound deafness in the general population of Sichuan, China
Authors: Liu Xuezhong , Xu Lirong , Zhang Silig , Xu Yin
Published: November 2007

People with profound deafness were surveyed in the general population of Sichuan. The results showed that the overall prevalence in Sichuan was 0.186 per cent (236/126 876) of the general population, males 0.2 12 per cent (135/63 741), females 0.159 per cent (101/63 135) (p 0.05). Two hundred and fifteen (92 per cent) cases were older than 10 years, but 227 (96 per cent) lost their hearing under the age of 10 years, 192 (80 per cent) under five years, and 104 (44 per entwere congenital). There was no significant difference in prevalence of deafness between the population located in urban and rural areas. However, the population living in the flat area and mountain area had a much higher prevalence than that of the hill people (p 0.05). Amongst the nationalities investigated, there existed significant differences in prevalence. Both the population of the Hui and the Lisu presented a significantly higher prevalence of profound deafness than that of the others. In aetiology, genetic factors may account for 43 per cent (101/236) of the cases, amongst which, autosomal recessive (AR) deafness is 92 per cent (95/104) and autosomal dominant (AD) 5.4 per cent. Environmental factors were thought to be responsible for 35.6 per cent (84/236) of cases, including infectious diseases (31 per cent), ototoxic antibiotics (2.6 per cent), injury (1.7 per cent), and asphyxia (0.4 per cent). The number of cases of unknown origin were 20.3 per cent. It is suggested that, in China, the importance of genetic factors in hearing impairment should be emphasized. In addition, infectious diseases and ototoxicity play an important role in causing deafness.
Per-oral excision of a pharyngeal branchial cyst after MRI study
Authors: Ruscito P. , Bicciolo G. , Rizzo S. , Frenguelli A.
Published: November 2007

A per-oral approach to pharyngeal branchial cysts is possible, and ideal when they are placed medially to the pharyngeal constrictors and no fistular duct is connected to the mass.

At present MRI is found to be the best means of achieving the correct diagnosis of morphology and site.
Cowden's disease—its importance for otolaryngologists
Authors: Šmid L. , Žargi M.
Published: November 2007

Cowden's disease is a rare predominantly inherited disease, characterized bymucocutaneous lesions, gastrointestinal polyposis and benign or malignant thyroid and breast tumours. The report deals with a typical case of this disease with emphasis on its importance forotolaryngologists.
MRI features in a malignant glomus jugulare tumour
Authors: Athanassopoulou Alexandra C. , Vlahos Labros L. , Gouliamos Athanassios D. , Kailidou Eliana D. , Papailiou John G. , Angeli Smaragde S.
Published: November 2007

Magnetic resonance imaging (MRI) features in a case of malignant glomus jugulare tumour are reported. Chemodectomas are benign in 95 per cent of cases and malignant in five per cent. Only one case report of CT findings in this unusual CP angle tumour with pulmonary metastases has been cited in the literature.

It is concluded that MRI can provide useful information about the nature of chemodectomas although it cannot dislinguish between benign and malignant tumours, except when regional lymph nodes are involved or when distant metastases exist.
Fistulae following laryngectomy in patients treated with irradiation
Authors: Natvig Ketil , Boysen Morten , Tausjø Johan
Published: November 2007

The development of fistulae following 197 consecutive laryngectomies performed from 1980 to 1987 have been examined. Fistulae were present in 28 patients (14 per cent). Age, T-classification, daily level of radiation dose and the time lapse between diagnosis and operation did not seem to influence the rate of fistula development. The study indicates that there is a two to three per cent risk of fistula development when a primary laryngectomy is performed. Fistula formation increased to about 10 to 12 per cent following radiotherapy, with an additional increase whenever previous operations on the neck had been done and/or if the disease demanded more extensive surgery. The study also indicates that the risk for fistula development is less when an experienced surgeon performs the operation.
Photodynamic therapy of malignant and premalignant lesions in patients with ’field cancerization‘ of the oral cavity
Authors: Grant W. E. , Hopper C. , Speight P. M. , Macrobert A. J. , Bown S. G.
Published: November 2007

The management of patients with ’field cancerization‘ of the oral mucosa, with multicentric foci of invasion, presents a considerable problem for the head and neck surgeon. Surgical resection of synchronous or metachronous primary squamous cell carcinomas, along with adjacent premalignant lesions, is likely to be associated with considerable mutilation. Photodynamic therapy (PDT) has been shown to be of value in the treatment of superficial tumours in the upper aerodigestive tract, with excellent healing of treated areas. This study reports the use of PDT to treat 11 patients with ’field cancerization‘ occurring in the oral cavity. Six patients had multiple primary cancers and five had single primary tumours. All had associated areas of leukoplakia. Each received Photofrin 2 mg/kg 48 hours prior to photoirradiation with 50–100 J/cm² red laser light by surface illumination. Six to eight weeks later treated areas in 10 of the 11 patients showed a complete response to PDT; one patient had areas of residual leukoplakia. Two patients developed further areas of leukoplakia or erythroplakia within 12 months but no patient has had evidence of recurrent invasive carcinoma in the treated areas. Longer term follow-up will be necessary to exclude further recurrence. It is concluded that PDT offers an effective repeatable treatment option, whether on its own or as an adjunct to local excision, for patients with ’field cancerization‘ of the oral cavity.
Papillary carcinoma in a thyroglossal duct remnant with normal thyroid gland
Authors: Yildiz Kadriye , Köksal Haydar , Özoran Yavuz , Muhtar Hayrettin , Telatar Münir
Published: November 2007

Carcinoma in the thyroglossal duct remnant is relatively uncommon. Since the first report by Uchermann (1915), more than 150 cases of carcinoma have been reported, and the majority have been papillary thyroid carcinomas (Li Volsi etal., 1974; McNicol etal., 1988). In this report, we present a case of papillary carcinoma in the thyroglossal duct with a normal thyroid gland
Acute bilateral vestibulo-cochlear dysfunction following occipital fracture
Authors: Feneley M. R. , Murthy P.
Published: November 2007

The case of a 57-year-old man who presented with acute bilateral deafness and vestibular dysfunction following occipital bone fracture is described. Plain radiographs and a CT scan of the head demonstrated a single fracture of the occipital bone. Complete loss of cochlear and vestibular function bilaterally was demonstrated and followed by partial recovery of auditory function over the following months. Review of the literature has not revealed a previously reported case.
An unusual cause of stridor in a neonate
Authors: Fah Koh Kwong , Tan Henry K. K.
Published: November 2007

We report an unusual case of unilateral vocal fold palsy due to intracranial haemorrhage in a neonate with undiagnosed haemophilia A. Bleeding disorders in neonates are briefly discussed and the importance of a systemic investigation of stridor in children is emphasized.
The nasopharynx, eustachian tube and otitis media
Authors: Sadé Jacob
Published: November 2007

It has been classically hypothesized that a mass in the nasopharynx causes an obstacle to air flow through the eustachian tube, thereby creating a negative pressure in the middle ear followed by an effusion. However, examination of the relevant data concerning the supposed obstruction of the eustachian tube by nasopharyngeal carcinomas, choanal polyps and adenoids does not seem to support this cause and effect relationship. Evidence points to other more sophisticated mechanisms which cause negative pressure and an effusion in pathological middle ear conditions. While the hypothesis of a nasopharyngeal mass as the usual obstructive cause of middle ear effusion is hard to maintain, evidence does exist to support the origin of middle ear infection, as seen in acute and secretory otitis media, as being associated, at times, with an ascending infection from the nasopharynx.
The otological manifestations of Wegener's granulomatosis
Authors: Fenton J. E. , O'Sullivan T. J.
Published: November 2007

Three cases of Wegener's granulomatosis are described in which the common presenting symptoms were those of aural discomfort and discharge. The otological manifestations of this disease process are discussed and a review of the literature is presented.
Major complications of sinus surgery: a review of 1192 procedures
Authors: Dessi P. , Castro F. , Triglia J. M. , Zanaret M. , Cannoni M.
Published: November 2007

Based on this review of 1192 intranasal sinus procedures under endoscopic control with video assistance, the risk of major complications was estimated to be about 1.3 per cent. Ethmoidectomy was the most hazardous procedure. Operation by a right-handed surgeon standing on the right side of the patient was an added risk factor. We stress ways of achieving prevention, peroperative recognition of cerebrospinal fluid leaks and proper management of complications.