bluuebunny/crossref_metadata_2025 huggingface dataset:
Cervical abscess: A life-threatening complication of infectious mononucleosis
Authors: Westmore G. A.
Published: November 2007

The former view of infectious mononucleosis as an invariably benign disease has been modified in recent years by reports of life-threatening complications. A case is presented of a deep cervical abscess complicating infectious mononucleosis which came close to a fatal conclusion. The implications for the management of the illness are discussed in the light of this rare event, no exactly similar instance of which has been recorded.
True malignant mixed tumour of the parotid gland
Authors: Talmi Yoav P. , Halpern Marisa , Finkelstein Yehuda , Gal Rivkah , Zohar Yuval
Published: November 2007

Carcinoma ex-pleomorphic adenoma is an uncommon tumour of the parotid gland. True malignant mixed tumours of the parotid are rare and we could find only 14 such cases reported. A case of a 76-year-old man diagnosed as suffering from this entity is presented. The diagnosis was based on a series of immunohistochemical studies demonstrating the existence of two separate sarcomatous and carcinomatous elements. The clinical and histological data are presented and the literature is reviewed.
Risks of developing an otogenic intracranial abscess
Authors: Nunez D. A. , Browning G. G.
Published: November 2007

One-and-a-half per cent of adults have active chronic otitis media and its management to prevent complications is a considerable workload. The risks of developing these complications is relatively unknown but because of its mortality, intracranial abscess is the most relevant.

A 10-year review of all otogenic intracranial abscesses in Scotland was carried out. A 15 per cent allowance was made for missing records. The annual risk in an adult with active chronic otitis media of developing an abscess is about one in 10,000 but its development is three times more likely in males. This risk might appear low but the lifetime expectancy of an individual aged 30 years with active chronic otitis media developing an abscess is one in 200. However, as yet, there is no evidence that surgery reduces this risk. Unfortunately, because of the duration of follow-up needed and the size of the sample required, scientific evidence would be difficult to obtain. However, 5 per cent of abscesses currently occur in the immediate post-operative period following mastoid surgery.
Nasopharyngeal cyst simulating Kaposi's sarcoma in an HIV-infected patient
Authors: Harrison Henley C. , Tindall Brett , McCarthy Stanley W. , Cooper David A.
Published: November 2007

A case of nasopharyngeal cyst in a 30-year-old male homosexual intravenous drug user infected with the human immunodeficiency virus (HIV) is presented. The similarity in clinical presentation of nasopharyngeal cyst and Kaposi's sarcoma is discussed.
Chondroplastic Graft Augmentation Rhinoplasty
Authors: Spencer Michael G.
Published: November 2007

A challenging surgical problem is the correction of supra-tip depression of the nose following collapse of nasal septal support. Numerous materials have been used in augmentation rhinoplasties attempting to correct this deformity, all having certain disadvantages. A modified technique is described in which costal cartilage surrounded by perichondrium is grafted in such noses; the results of a small series is discussed. The problems of graft distortion and resorbtion appear to have been satisfactorily overcome by using this procedure.
Head and neck cancer in the young: A prognostic conundrum?
Authors: Lund Valerie J. , Howard David J.
Published: November 2007

A series of 116 young adults with cancer in the head and neck who had been followed up for five years or longer were reviewed. The study aimed to assess whether malignancy in this age group was increasing, whether their prognosis was worse and if so, why. They were compared with data available on the patient population as a whole treated during the same period. This demonstrated that it is the intrinsic characteristics of the tumour, its site and extent rather than the age of the individual which determines prognosis though the ratio of men to women was less in the young adults in several sites possibly due to a diminished impact of recognized aetiological factors.
Staple gun in the surgery of hypopharyngeal diverticula
Authors: Westmore G. A.
Published: November 2007

There have been many approaches advocated over the years for the surgical management of hypopharyngeal diverticulum, and this is a reflection of the absence of an ideal method both in terms of the surgical technique and of the frequency and severity of complications. Further experience with the use of the surgical staple gun is presented together with a discussion of its use in comparison with other operative methods. The ease and speed of the technique combined with a negligible complication rate suggest that it is a viable method for the management of large diverticula.
Symptoms in patients with maxillary sinus carcinoma
Authors: Miyaguchi M. , Sakai S. , Mori N. , Kitaoku S.
Published: November 2007

Symptoms at first onset and on initial examination were analyzed in 845 patients with maxillary sinus carcinoma. About 20–30 per cent of the patients became aware of swelling of cheek, nasal obstruction, nasal discharge and epistaxis as first symptoms. About 50–80 per cent of the patients complained of such symptoms on initial examination. Symptoms of maxillary sinus carcinoma are similar to those of chronic sinusitis which results in a delay in diagnosis. Such symptoms should be recognized to improve survival rate. CT and MRI scans are useful for early diagnosis and determination of tumour extension. Sinoscopy with biopsy is most important to detect the earliest tumour stage.
Polyarteritis nodosa presenting as bilateral sudden onset cochleo-vestibular failure in a young woman
Authors: Rowe-Jones J. M. , Macallan D. C. , Sorooshian M.
Published: November 2007

Sudden onset sensorineural hearing loss is an otological emergency. Although deafness is recognised as being associated with polyarteritis nodosa (PAN) only very rarely does it herald the disease. We describe a case of bilateral, sudden onset vestibulo-cochlear failure which with thorough investigation proved to be the presenting complaint of PAN.

This diagnosis enabled definitive management of a multi-system disorder and resulted in an improvement of the initial symptom with the chemotherapeutic regime discussed.

We review the involvement of PAN in deafness and hope this case will remind otolaryngologists of the need for full investigation of the above mentioned emergency, in an attempt to discover and hence direct management towards a specific underlying pathology.
Extra-Skeletal Ewing's sarcoma of the nasal fossa
Authors: Lane S. , Ironside J. W. , Path M.R.C.
Published: November 2007

Extraskeletal Ewing's sarcoma is rarely found arising in the head and neck region. An unusual case arising in the nasal fossa in a young child is reported and the differential diagnosis, pathology and treatment discussed.
Comparison of the Goode T-tube with the Armstrong tube in children with chronic otitis media with effusion
Authors: Wielinga Eize W. J. , Smyth Gordon D. L.
Published: November 2007

Treatment of otitis media with effusion is focused on reaeration of the middle ear cavity. In achieving longterm aeration, the insertion of ventilation tubes that have a long duration of stay can be beneficial. The results are presented of a trial in which the Goode T-tube was compared with the Armstrong tube. Fifteen children were treated between 1981 and 1986 with a T-tube in one ear and a conventional tube in the other. The results are different with regard to duration of stay in the tympanic membrane. Re-insertions were necessary in 47 per cent in the Armstrong group and in 20 per cent in the T-tube group. Otorrhoea occurred in 20 per cent of the Armstrong and 13 per cent of the T-tube intubated ears. A persistent perforation was present in 6 per cent of the ears in both groups. It is concluded that the Goode T-tube is indicated primarily in cases when long-term ventilation is needed.
Smoking cessation in chronic Reinke's oedema
Authors: Højslet Poul-Erik , Moesgaard-Nielsen Villy , Karlsmose Mogens
Published: November 2007

In evaluating the long term results of surgical treatment of Reinke's oedema, there has been found to be a high incidence of recurrence. The recurrence rate is significantly lower amongst those patients who gave up smoking after treatment. A group of patients with chronic Reinke's oedema were followed for six months. Maximum efforts were made to help the patients to stop smoking. Twenty-nine patients entered the study, but only eight of them (28 per cent) refrained from smoking; all were women (39–70 years) and all experienced reduced discomfort, although none of the voices were restored to normal. Diffuse laryngitis disappeared completely, but the oedema did not disappear entirely in any patient. Before treatment of chronic Reinke's oedema patients must be well advised and informed, and if surgery is decided upon, they must be urged most strongly to stop smoking, if they wish to enhance the possibility of satisfactory long-term results.
Head and neck cancer and ageing: a retrospective study in 438 patients
Authors: Barzan Luigi , Veronesi Andrea , Caruso Giuseppe , Serraino Diego , Magri Donatella , Zagonel Vittorina , Tirelli Umberto , Comoretto Roberto , Monfardini S.
Published: November 2007

To evaluate whether age over 70 years represents a prognostic factor in head and neck cancer, we reviewed all cases observed between 1981 and 1984. Four hundred and thirty-eight (438) patients were considered in relation to three age groups (<59, 60–69, and >70 years, defined as non-elderly, mid-elderly and elderly respectively).

The main parameters analyzed included histological diagnosis (no difference emerged among the three age groups); anatomical site (hypopharyngeal carcinoma was most frequent in non-elderly patients); TNM stage (an higher incidence of early stages was seen in the elderly); performance status (better in the nonelderly); previous illnesses (life-style related diseases were more frequent in the non-elderly); contraindications to surgery (more frequent in the elderly); surgical treatment (‘en bloc’ resections were more often employed in the non-elderly); post-operative complications and local control (no difference between the three groups); multiple primary malignancies (head and neck, oesophagus and lung were more frequent in non-elderly patients) and survival (no difference).

Although age affects several features of head and neck cancer patients, it does not appear from the present study to be an independent prognostic factor for local control and survival. With regard to survival, stage appeared to be the most important prognostic factor.
Infectious mononucleosis complicated by lingual tonsillitis
Authors: Har-El Gady , Josephson Jordan S.
Published: November 2007

Although upper airway obstruction and superimposed infection are well-known complications of infectious mononucleosis, lingual tonsillitis in this context has not been mentioned in the literature. We describe a case of acute bacterial lingual tonsillitis with airway obstruction complicating infectious mononucleosis. The role of the base of tongue region in the pathophysiology of infectious mononucleosis is discussed.
Acute upper airway obstruction following Teflon injection of a vocal cord; the value of nebulized adrenaline and a helium/oxygen mixture in its management
Authors: Solomons Neil B. , Livesey Jonathan R.
Published: November 2007

A 67-year-old man presented with a 45-year history of a weak voice. This was the result of polio which had left him with a right vocal cord palsy.

The patient underwent a Teflon injection of the right vocal cord under general anaesthesia to improve the quality of his voice. In the immediate post-operative period, he suffered acute upper airway obstruction. The problem of acute upper airway obstruction following Teflon injection is considered and its management with nebulized adrenaline and a helium/oxygen mixture is discussed.
Adenoid cystic carcinoma: a comparison between CT, MR and Gd MR imaging techniques
Authors: Wake M. , Phelps P. D.
Published: November 2007

Nasopharyngeal carcinoma continues to be a difficult diagnostic problem in many patients. It is well known that amongst the many and varied manifestations of this disease, a unilateral middle ear effusion in an adult should be regarded with suspicion. Such a case in a 42-year-old patient is presented. In this case the benefit of Gadolinium enhanced magnetic resonance imaging over and above computerized tomography is demonstrated.
Why paranasal sinuses?
Authors: Blaney S. P. A.
Published: November 2007

This essay attempts to address the perennial question ‘Why Paranasal Sinuses?’. In doing so it highlights the flaws in many much-favoured but ill-founded theories concerning the role of these sinuses in humans. It is concluded that the question can only be fully answered through a greater understanding of differential growth changes within the craniofacial massif.
Mucosal thickening on sinus X-rays and its significance
Authors: Wilson Paul S. , Grocutt Mark
Published: November 2007

Mucosal thickening is commonly seen on X-rays of the paranasal sinuses taken in the ENT department. This sometimes leads to a sinus washout, which is clear, even though the X-rays were strongly suggestive of disease.

This paper examines the prevalence of sinus X-ray anomalies in a general population, having facial X-rays for conditions other than possible sinus disease. The study suggests that up to 50 per cent of the socalled normal population may have sinus X-ray appearances consistent with sinus disease, and this may partly explain clear returns on sinus washout.
Another hazard of ear syringing: malignant external otitis
Authors: Ford G. R. , Courteny-Harris R. G.
Published: November 2007

A case of malignant external otitis is presented. This occurred in a healthy 72-year-old non-diabetic, non-immunocompromised man after ear syringing. The infection was treated with oral ciprofloxacin for eight weeks with complete resolution.
Laryngeal metastasis from colonic adenocarcinoma
Authors: Cavicchi O. , Farneti G. , Occhiuzzi L. , Sorrenti G.
Published: November 2007

Metastases to the larynx from distant primaries are very rare. Usually the secondary lesjon comes from an hypemephroma or malignant melanoma. A case of metastatic laryngeal tumour from a colonic adenocarcinoma, occurring in a 59-year-old woman, is presented and the routes for laryngeal spread are discussed. The poor survival-rate of these patients justified only conservative surgery.
The effect of rifampicin on rhinoscieroma: an electron microscopic study
Authors: Gamea A. M. , El-Tatawi F. A. Y.
Published: November 2007

Twenty-five cases suffering from rhinoscleroma were divided into two groups The first group consisted of 15 patients treated with rifampicin systemically The other group consisted of 10 patients treatcd locally with rifampicin in the form of ointment. Electron microscopic study of the pathological changes in the lesions showed that rifampicin is highly effective both systemically and locally in the treatment of rhinoscleroma.
Monomorphic adenomas of the major salivary glands: clinicopathological study of 44 cases
Authors: Mauluzi M. , Salvinelli F. , Capelli A. , Carbone A.
Published: November 2007

We report 44 cases of monomorphic adenoma (MA) of the major salivary glands observed during the years 1979–1989. All of these tumours were reviewed and classified on the basis of the World Health Organisation (WHO) criteria. Histological type, site, sex and age were considered. 34 cases of adenolymphoma were observed, all of them located in the parotid glands; 10 MA without lymphoid stroma were located in both parotid and submandibular glands. Distinctive histological and clinico-pathological features of the latter group of tumours are discussed, as well as the diagnostic criteria in distinguishing these tumours from pleomorphic adenoma and adenoid-cystic carcinoma.
Role of routine fluid replacement in children undergoing tonsillectomy
Authors: Wilson P. S. , Snow D. G. , O'Connel J. , Proops D. W. , Barrow M.
Published: November 2007

It has been suggested that children undergoing tonsillectomy would benefit from an intravenous infusion, to counteract the period of pre-operativefasting combined with the blood loss at operation.

A prospective study of 50 children undergoing tonsillectomy was undertaken. The children were randomly allocated into two groups, one to receive an infusion and a control group.

There were no significant differences between the two groups, although the children with an infusion had a longer mean post-operative stay.

There would seem to be no role for routine intravenous fluid replacement in children undergoing uncomplicated tonsillectomy.
Vertical partial laryngectomy on demand
Authors: Krajina Z.
Published: November 2007

The author proposes the term ‘vertical partial laryngectomy on demand’ for all modifications of vertical laryngectomics (frontal, frontolateral, vertical and hemilaryngectomy). This term includes two conditions: the first is complete oncological removal of the tumour (proven by histological examination and with the use of magnification or the operating microscope during the operation); secondly, reconstruction of the laryngeal defect by various procedures. The author uses the sternohyoid fascia in vertical and frontolateral partial laryngectomies. From 120 operated cases, a five-year survival rate of 81 per cent was achieved. The fascia showed resistance to post-operative complications and irradiation.
Use of EMLA cream as an analgesic in the management of painful otitis externa
Authors: Premachandra D. J.
Published: November 2007

A new application of EMLA cream is described. Relief of pain in otitis externa is difficult and systemic analgesics for this localized condition are often ineffective. Meticulous cleaning of the external auditory meatus is an essential step in the treatment. EMLA cream is an effective analgesic which can be used to relieve pain and anaesthetize the external auditory meatus to allow cleaning in patients with intact tympanic membranes.
Fourth branchial pouch anomaly
Authors: Takimoto Toru , Yoshizaki Tomokazu , Ohoick Hiromi , Sakashita Hiofo
Published: November 2007

We present an extremely rare case of fourth branchial fistula in a 23-year-old male. The characteristic clinical feature was a recurrent left lower neck abscess which did not respond to appropriate medical and surgical therapy. Radiography and a computed tomographic scan with contrast material revealed a fistula running from the apex of the left pyriform sinus (internal opening) to the left lower neck abscess. The fistula tract was excised surgically. Histological examination of the excised fistula revealed a squamous epithelial lining and subepithelial lymphoid tissue. This pyriform sinus fistula is thought to be of fourth pharyngeal pouch origin, because of its surgical aspects and the histologicalfindings of the excised fistula.
Postauricular cerebellar encephalocoele secondary to chronic suppurative otitis media and mastoid surgery
Authors: Ramanikanth T. V. , Smith Michael C. F. , Ramamoorthyt Ravi , Ramalingam K. K.
Published: November 2007

Cerebellar herniation into the mastoid through the posterior aspect of the temporal bone as a result of chronic suppurative otitis media and mastoid surgery is a rare event. A case is reported in which such a hernia presented subcutaneously behind the pinna; its repair is discussed.
Attachment of bacteria to tonsillar epithelium during acute tonsillitis
Authors: Stenfors Lars-Eric , Räisänen Simo
Published: November 2007

Epithelial cells were scraped from the tonsillar surfaces of 15 patients with current acute tonsillitis (AT) and of 15 individually matched healthy persons. The cellular mixture was stained with acridine orange and bacteria seen to be attached to the epithelial cells under the fluorescent microscope were calculated. Conventional bacterial culturing was also performed simultaneously. Significantly more bacteria were attached to epithelial cells from the AT group than from the controls (>10 attached bacteria per cell p = 0.0103, >50 attached bacteria per cell p 0.0212). In vivo determination of bacteria attached to epithelial cells offers prospects of gaining a better understanding of the aetiopathogenesis of acute tonsillitis.
Extramedullary nasal plasmacytoma
Authors: Navarrete M. L. , Quesada P. , Pellicer M. , Ruiz C.
Published: November 2007

The literature on this rare tumour has been reviewed and three cases of nasal plasmacytoma are described. Immunohistochemistry demonstrated cytoplasmic IgA and Kappa determinants in all cases. Two patients are disease-free at the present time, the third developed an IgG-k multiple myeloma, previously not described in the literature.
Intracordal Teflon injection: a question of timing
Authors: Habashi S. , Croft C. B.
Published: November 2007

Intraeordal Teflon injection is commonly performed for recurrent laryngeal nerve palsy. It is generally agreed that injection should not be performed for a period of six months from the onset of an ‘idiopathic’ paralysis. A case is presented in which recovery occurred late, after intraeordal injection, with unfortunate results. Successful removal of the Teflon is described. The advisability of a longer wait before surgery for ‘idiopathic’ recurrent laryngeal nerve palsy is considered.
ENT presentation of Ollier's disease
Authors: Pfleiderer A. G. , Thomson P. , Milroy C. M.
Published: November 2007

Cartilaginous tumours occurring in the head and neck are usually regarded and seen as solitary lesions. However, we present an unique case where the cartilaginous tumour in the ENT region was the presenting feature of Ollier's disease (multiple enchondromatosis). It is recommended that further investigations be carried out in patients with cartilaginous tumours presenting in the head and neck to exclude the possible presence of this unusual and interesting syndrome.
Acoustic neuroma (schwannoma) surgery 1978–1990
Authors: Dutton J. E. M. , Ramsden R. T. , Lye R. H. , Morris K. , Keith A. O. , Page R. , Vafadis J
Published: November 2007

A series of 151 patients with 154 acoustic schwannomas have been operated upon in Manchester Royal Infirmary by a joint Otological and Neurosurgical team, employing either the translabynnthine or the sub-occipital approach. The perioperative mortality rate was 3 per cent. Anatomical preservation of the facial nerve was achieved in 89 per cent of tumour removals and a good to normal functional result in 79 per cent of cases. Attempts at hearing preservation have been unsuccessful, largely because of the small number of patients in the series in whom useful hearing was present preoperatively. Complications included major brain stem ischaemia (1.2 per cent), CSF fistula (5 per cent) and facial dysaesthesia (7 per cent). The incidence of mortality and morbidity is directly related to tumour size and to the experience of the surgeons. A number of patients experienced an unusual type of post-operative dreamlike state which appeared to be a form of hypnagogic hallucination, and the possible neurophysiological mechanism responsible for this phenomenon is discussed. The continuing failure to attain the ideal of early diagnosis is lamented, and the importance of a flexible bidisciplinary surgical approach emphasized.
Acoustic rhinometry used as a method to monitor the effect of intramuscular injection of steroid in the treatment of nasal polyps
Authors: Elbrønd O. , Feeding J. U. , Gustavsen K. M.
Published: November 2007

Acoustic rhinometry is a new method which describes the geometry of the nasal cavity and the epipharynx. The method, based on the reflection of an acoustic signal entered into the nasal cavity, can be used to evaluate the cross-sectional area of the nasal cavity asa function of distance from the nostril. The method has, together with nasal expiratory peak flow (NPF) and nasal index based upon a self assessment score, been used to evaluate, in an objective and dynamic way, the effect of systemic treatment of nasal polyps with steroids in a series of eight patients with recurrent nasal polyposis. The study shows a significant relationship between these three parameters before and after systemic treatment of nasal polyps with steroids. It is concluded that in this study acoustic rhinometry had an accurate and objective method for measuring the geometry of the nasal cavity before and after treatment for processes which block the nasal cavity.
Post cricoid lymphangioma
Authors: Smith N. M. , Staffordt F. W.
Published: November 2007

A 69-year-old female patient presented with symptoms characteristic of globus pharyngeus and barium swallow examination was normal. Her symptoms persisted and pharyngoscopy was undertaken; a post-cricoid polyp was found and removed. Histological examination revealed this to be a lymphangioma. Histological appearances, pathogenesis and treatment are discussed. The case illustrates that persisting symptoms presenting as globus pharyngeus should be further investigated to exclude rare lesions.
MRI of the paranasal sinuses: incidental abnormalities and their relationship to symptoms
Authors: Cooke Lynn D. , Hadley Donald M.
Published: November 2007

Magnetic resonance imaging is able to demonstrate a wide range of sinus abnormalities. Incidental findings in patients referred for neuroradiology because of suspected intracranial pathology are surprisingly common and were present in 37.5 per cent of 483 images examined. The maxillary and ethmoid sinuses were most commonly affected with 27 and 26 per cent of images abnormal whereas the frontal and sphenoid sinuses were less commonly affected with 5 per cent of each abnormal. If minor changes were excluded then 17 per cent of patients had either fluid, a polyp or marked mucosal thickening in at least one sinus. Nasal symptoms, other than the presence of a cold, showed no statistically significant relationship to abnormal findings. Many people with inflammatory changes in their sinuses demonstrated on MRI do not have symptoms classically attributed to sinusitis.
Reinke's oedema and thyroid function
Authors: White A. , Sim D. W. , Maran A. G. D.
Published: November 2007

Reinke's oedema (RO) of the vocal folds is a condition of unknown aetiology. Cigarette smoking and vocal abuse may contribute to its development. Hypo thy roidism has been described as an aetiological factor but, to date, no controlled study has been published confirming this association. This prospective, controlled study compared thyroid function in 61 consecutive RO patients with an age and sex matched control group (n = 65) without laryngeal disease. Thyroid function was assessed by measuring serum thyroid stimulating hormone (TSH), free thyroxine (T4) and tri-iodothyronine (T3). Hypothyroidism was diagnosed when TSH was above normal with a T3 and T4 below the normal range.

Four RO patients were hypothyroid at the time of diagnosis, compared to five of the control group. Six RO patients had past or present hypothyroidism compared to seven of the controls. One RO patient and two controls were euthyroid with marginally elevated TSH levels. Although the incidence of hypothyroidism in this group of Reinke's oedema patients is higher than expected in a normal population, it is similar to that in an age and sex matched control group, reflecting the prevalence of hypothyroidism in middle aged women.

This study suggests that hypothyroidism is not an aetiological factor in the development of Reinke's oedema.
Acanthoma fissuratum
Authors: Thomas M. R. , Sadiq H. A. , Raweily E. A. A.
Published: November 2007

Acanthoma fissuratum secondary to the use of spectacles is a rare clinical finding associated with an ill-fitting frame. An interesting case is presented to highlight such a problem. Surgical excision of such lesions is recommended with advice to the patient regarding the suitable fitting of spectacles.
Paradoxical vocal cord motion: an unusual cause of stridor
Authors: George M. K. , O'Connell J. E. , Batch A. J.
Published: November 2007

Stridor due to obstructive causes is relatively common. Functional airway obstruction with paradoxical vocal cord motion is uncommon. Only 12 cases have been reported in the literature in the past 15 years. The majority were young female patients. We have recently encountered two cases. Lack of awareness of this condition caused several problems in management.
Management of childhood cholesteatoma
Authors: Mills R. P. , Padgham N. D.
Published: November 2007

We report a retrospective study of 54 children with 57 involved ears who underwent surgery for cholesteatoma before their sixteenth birthdays. The majority of these underwent open cavity operations (modified radical mastoidectomy, radical mastoidectomy or atticotomy). The incidence of residual disease was only 6 per cent and overall 70 per cent of ears have been free of chronic discharge. The post-operative hearing thresholds were disappointingly low, though overall no worse than those recorded before surgery. The mean post-operative hearing level for the group was 39 dB and the mean air-bone gap was 29 dB. Open cavity surgery is the method of choice for childhood cholesteatoma, mainly because of the low incidence of residual disease.
Synchronous primary mucosal melanoma and mucoepidermoid carcinoma of the maxillary antrum
Authors: Davis J. P. , Maclennan K. A. , Schofield J. B. , Watkinson J. C. , Gluckman P.
Published: November 2007

We present a case of contiguous primary malignant melanoma of the nose and maxillary antrum and mucoepidermoid carcinoma of the maxillary antrum. We believe that this association has not been previously recorded; whether this represents divergent differentiation in a single tumour or ‘collision’ of two separate tumours is uncertain.
Rare presentation of a parapharyngeal schwannaoma
Authors: Dilkes M. G. , Morrison G. A. J. , Orr W. P.
Published: November 2007

Schwannoma, or neurilemmoma, is included in the differential diagnosis of masses in the parapharyngeal space. Schwannomata do not usually cause acute inflammation, and therefore do not tend to present as emergencies as in this case, in which there was acute respiratory embarrassment
Nasal endoscope in posterior epistaxis: a preliminary evaluation
Authors: Mcgarry G. W.
Published: November 2007

The findings of a preliminary, prospective evaluation of the role of endoscopy in the management of adult posterior epistaxis are presented.

A cohort of patients managed by the endoscopic technique was compared with a control group managed by the traditional methods of nasal packing or epistaxis balloons.

The endoscope allowed visualization and direct treatment of previously undiagnosed posterior bleeding points. Patients managed by the endoscopic technique had a significantly shorter duration of in patient stay than those managed by traditional methods.
Staging carcinoma: its value in cancer of the larynx
Authors: Reid A. P. , Robin P. E. , Powell J. , McConkey C. C , Rockley T.
Published: November 2007

Three thousand four hundred and forty-five cases of cancer of the larynx were examined and 3,235 assigned to their TNM group. While good correlation with prognosis could be seen, the value of the detailed subsite (as opposed to the main laryngeal regions) was limited to defining T1a and T1b and aiding that of T2. T status gives some indication of prognosis, but the N status is of almost overriding importance.
Inhalation of foreign bodies by children: Review of experience with 74 cases from Dubai
Authors: Al-Hilou R.
Published: November 2007

Seventy four out of 94 cases of bronchoscopy carriedout over a five year period are reviewed. The clinical history of choking followed by recurrent spasmodic cough were found to be the most important element in making the diagnosis and proceeding to diagnostic and therapeutic bronchoscopy. Radiology was inferior as a diagnostic aid although radioactive scanning may be helpful in difficult cases.
Eyelid gold weights in the management of facial palsy
Authors: O'Connell Janet E. , Robin P. E.
Published: November 2007

We reviewed our experiences with 20 patients with established facial palsy who had a total of 24 gold weights inserted. All patients had corneal symptoms: ulceration, exposure keratitis or discomfort abolished. Functional improvement i.e. reduction of lagophthalamos and restoration of the blink reflex was good in our opinion and that of the patients in all cases. Dissatisfaction with the cosmetic result was expressed by two patients due to the prominence of the weight under the thin eyelid skin. Three patients had to have the weight replaced because it was too light. Two patients had their weightsremoved because of recurrent eyelid infections. In two patients the weights were removed as they had migrated over the tarsal rim. In one of these patients the weight was replaced immediately in the appropriate position, in the other it was not replaced as dissatisfaction hadbeen expressed due to the bulky appearance of the weight under the eyelid skin.
Effect of nasal packing on Eustachian tube function
Authors: Thompson A. C. , Crowther J. A.
Published: November 2007

Sixty-three patients undergoing surgery to the nasal septum followed by bilateral packing had pre- and post-operative tympanometry in order to determine the effect on eustachian tube function. Fifty-five of the 126 ears tested (46 per cent) developed a reduction in middle ear pressure of at least 50 daPa; 76 per cent became normal within 24 hours of removing the nasal packs. All ears were asymptomatic and no patient had evidence of middle ear effusion. Nasal packing following septal surgery is a frequent cause of shortlasting eustachian tube dysfunction but rarely severe enough to cause symptoms or middle ear effusion. Tubal dysfunction is most likely due to a combination of surgical oedema and a direct effect of the nasal packing.
Source of tubercle bacilli in cervical lymph nodes: A prospective study
Authors: Lau S. K. , Kwan S. , Lee J. , Wei W. I.
Published: November 2007

A prospective study searching for associated mycobacterial infection of the upper aerodigestive tract in patients with cervical tuberculous lymphadenitis (TBLN) was carried out. One hundred and thirteen patients with a clinical suspicion of cervical TBLN were included. All patients had a physical examination of the upper aerodigestive tract. Routine endoscopy and biopsy of the nasopharynx were performed. All of them had surgery to the cervical lymph node. Seventy-five patients had histologically confirmed cervical TBLN. Culture of the lymph node specimen showed Mycobacterium tuberculosis in 68 (90 per cent). In 45 (60 per cent) patients with cervical TBLN the primary foci of infection could not be found. Twenty-nine (39 per cent) had radiographic evidence of active or healed pulmonary tuberculosis. Sputum culture from two patients showed Mycobacterium tuberculosis. Five patients (six per cent) had tuberculous nasopharyngitis. In one of them (one per cent) the tuberculous nasopharyngitis was primary as no other evidence of mycobacterial infection was found. In the present study, mycobacterial infection of other parts of the upper aerodigestive tract was not found.
Pathology of labyrinthine ossification
Authors: deSouza Christopher , Paparella Michael M. , Schachern Pat , Yoon Tae H.
Published: November 2007

Ossification of the inner ear is the result of multifactorial pathogeneses, such as infection or malignant infiltration, and otosclerosis. Ossification of the innerear spaces is a well documented sequela of suppurative labyrinthitis. In this study of human temporal bones, sections from 14 patients (28 temporal bones)were studied. In additionto the osseous tissue within the inner ear, findings included neoplasms, otosclerosis, otitis media, trauma, and Fabry's disease. We have attempted to correlate these conditions and their influence on the formation of osseous tissue within the spaces of the inner ear. Tympanogenic infection and vascular compromise were found to play an important role in ossification. The scala tympani ofthe basal turn of the cochlea was frequently the site involved.
Bilateral facial nerve palsies: Groote Schuur Hospital experience
Authors: Wormald P. J. , Sellars S. L. , de Villiers J. C.
Published: November 2007

Bilateral facial nerve palsies are rare. This article details the Cape Townexperience of 24 patients with this condition seen over the past 20 years and highlights the three main groups in which these bilateral facial nerve palsies occurred. These are Bell's palsy, fracture of the temporal bones and sclerosteosis. Avariety of other rare causes was also found. Bell's palsy remains a diagnosis of exclusion though there has been some evidence to suggest implication of the Herpes simplex virus. The mechanism whereby temporal bone fractures cause bilateral facial nerve palsies is discussed. The clinical presentation and management of sclerosteosis is also discussed
Transnasal sinusectomy with combined microscopic and endoscopic technique
Authors: Teatine G. P. , Stomeo F. , Bozzo C.
Published: November 2007

Severe, diffuse polyposis can be adequately treated through a transnasal approach which combines microscopic and endoscopic surgery. The operating microscope is used to perform ethmoidectomy, usually from the front to the back, and to open the sphenoid sinus and the antral window. The telescopes allow the sphenoid and maxillary sinuses to be cleaned under direct view control as well as enabling good drainage to be performed from the frontal sinuses. The results from 22 consecutive patients were good, with a very low rate of minor post-operative complications.
Intralabyrinthine schwannoma
Authors: Birzgalis A. R. , Ramsden R. T. , Curley J. W. A.
Published: November 2007

Intralabyrinthine schwannomas are rare tumours which present with symptomssimilar to Meniere's disease. Preoperative diagnosis is rarely possible and most are foundincidentally during labyrinthectomy for persistent vertigo. A further case of this tumouris reported together with a review of the literature.
Air cyst of the maxillary sinus (pneumosinus dilatans, pneumocoele)
Authors: Tovi Ferit , Gatot Albert , Fliss Dan M.
Published: November 2007

A cystic dilatation of a paranasal sinus by an entrapped air mass has beentermed pneumosinus dilatans or a pneumocoele. The occurrence of this condition in the maxillary sinus is quite rare. In the present case, a mid-face mass mimicking an osteoma was the presenting sign of the disease. The pathogenesis, clinical features and radiological aspects of this entity are reviewed. In order to avoid confusion with other conditions ofdifferent aetiopathogenesis, we propose to label the lesion as ‘air cyst’ of the paranasal sinus, a term that best describes the nature of the lesion.
An audit into the incidence of handicap after unilateral radical neck dissection
Authors: Shone G. R. , Yardley M. P. J.
Published: November 2007

Forty-six patients who had undergone a radical neck dissection more than six months previously were assessed to determine the degree of handicap that results from division of the accessory nerve. Employment problems, amount of pain, and social and recreational difficulties were assessed. Forty-six per cent of those in employment prior to their operation gave up their work specifically because of problems with their shoulder; this affected more manual than non-manual workers (11 out of 20 manual compared with zero out of four non-manual). Thirty per cent complained of moderately severe or severe pain related to the shoulder. The amount of pain could not be correlated with age, sex, side of operation in relation to handedness, physical build of the patient, or whether the patient had been treated with radiotherapy. Although this is the largest study to address this question since that of Ewing and Martin in 1952, the small numbers involved mean that if any such correlation exists then it may not have become apparent. In view of this incidence of pain and occupational handicap, we feel that efforts should be made to preserve accessory nerve function in cases where surgical clearance of the tumour field is not compromised as a result.
Latent mastoiditis: no room for complacency
Authors: Martin-Hirsch D. P. , Habashi S. , Page R. , Hinton A. E.
Published: November 2007

The administration of antibiotics in otitis media alters the natural course of the disease process. If the antibiotics used are inappropriate, or if dosage or duration of treatment is inadequate, an imminent intracranial complication may be masked.

A case of latent mastoiditis presenting with Pott's puffy tumour is described.
Bilateral acoustic schwannoma: post-operative hearing in the contralateral ear
Authors: Farrell Michael L. , Harries Meredydd L. L. , Baguley David M. , Moffat David A.
Published: November 2007

A patient with neurofibromatosis two (NF2) presented with bilateral acoustic neuroma. Pre-operative audiometry revealed a dead right ear and severe left-sided sensorineural hearing loss. Following surgical removal of the larger right acoustic neuroma we have documented a sensorineural improvement of 45 dB in the contralateral ear on pure tone audiometry, which as far as the authors are aware has not previously been described.
Acinic cell carcinoma of minor salivary gland origin
Authors: Zbaeren Peter , Lehmann Willy , Widgren Sven
Published: November 2007

The occurrence of acinic cell carcinoma in the minor salivary glands appears to he exceptional. A review of the English language literature revealed about 80 previously reported cases. In this paper. the clinical behaviour and pathological findings in three cases are reported.

The tumours took their origin from the hard palate, soft palate and lower lip. The three cases presented with malignant clinical behaviour; all three recurred. In one case the local recurrence was multinodular with capsular infiltration. Two cases developed regional lymph node metastasis, and one metasized to the lung and liver. In one the tumour infiltrated bony structures, and nerve in another. These cases tend to support the belief of some authors that acinic cell ‘tumours’ are clinically malignant and should be included in the carcinoma group.
A rare presentation of tuberculosis of the cervical spine
Authors: Dilkes M. G. , McGilugan J. A. , Chapman J.
Published: November 2007

Tuberculosis may present in many different forms and is known to occur in the cervical spine and salivary glands. It may present as in this case, with the signs of spread before the initial infection becomes apparent.
Direct referral hearing aid provision in the over sixties age group
Authors: Hawthorne Maurice R. , Nunez Desmond A. , Clarke Graham P. , Robertshaw Desmond
Published: November 2007

A prospective study was designed in which General Practitioners were issued with a standard referral letter for hearing aid provision. Unknown to the General Practitioner an independent otolaryngologist assessment was obtained at the time of first attendance. Three hundred consecutive patients selected by General Practitioners applying these guidelines were seen in a designated hearing aid clinic staffed by audiological technicians of senior grade or above. Referral pro formata were incomplete in 75 patients who were not assessed. Ninety-four patients (31 per cent) (95 per cent confidence interval 29–36 per cent) were accepted by the audiologist. Obstructing wax was the most common criterion failed. Clinical agreement between audiologist and otolaryngologist was 57 per cent greater than chance. None of the cases of clinical disagreement altered treatment. A direct referral system as proposed could have processed only 31 per cent of 300 referrals. However, experienced technical staff reliably detected otological pathology and with aural toilet facilities 91 per cent of 225 patients (confidence interval 88–94 per cent) were aided.
Functional endoscopic sinus surgery in the management of chronic rhinosinusitis. An objective assessment
Authors: Lund Valerie J. , Holmstrom Mats , Scadding Glenis K.
Published: November 2007

Considerable clinical success has been claimed for functional endoscopic sinus surgery but objective assessment of prospective series is lacking in the literature. Twenty-four patients with chronic rhino-sinusitis underwent assessment of symptoms by visual analogue scoring, nasomucociliary function by ciliary beat frequency, olfaction by qualitative olfactometry and nasal airway resistance by anterior rhinomanometry pre- and post-operatively. This demonstrated a significant improvement in all symptoms examined and in ciliary beat frequency. Quantitative olfaction and anterior rhinomanometry were not improved despite diminished symptoms. These results offer quantitative evidence of clinical improvement following functional endoscopic sinus surgery which supports the pathophysiological concepts on which the technique is based.
Adult tonsillectomy—results and patient selection
Authors: Thompson A. C.
Published: November 2007

One hundred and thirty two patients who had undergone tonsillectomy for recurrent sore throats were evaluated by a questionnaire regarding the effectiveness of their operation. There were 98 respondents of whom 88.8 per cent were satisfied with the benefit gained. Smoking habit did not affect the post-operative satisfaction rate. Dissatisfied patients were more likely to have changed their General Practitioner recently and more likely to have had multiple hospital referrals in the past. Improved patient satisfaction rates may be achieved by more careful assessment of patients with the latter characteristics.
Acute epiglottitis in the adult
Authors: Navarrete M. L. , Quesada P. , Garcia M. , Lorente J.
Published: November 2007

Acute epiglottitis in the adult is a rare disease, which has shown an appreciable increase since the sixties and in our locality since 1984. We present a review of the cases registered in our hospital, analyzing their aetiology, evolution and treatment. The disease is most likely to be suspected in the presence of any patient having a sudden dysphagia. especially if he shows symptoms of an acute infection and a lack of oropharyngeal pathology.
Intraglandular toxoplasmosis lymphadenitis of the parotid gland
Authors: Akiner Metin N. , Saatci Mustafa R. , Yilmaz Orhan , Erekul Selim
Published: November 2007

Toxoplasmosis is a protozoan infection manifested by systemic findings as well as generalized or localized lymphadenopathy. Although lympadenitis is the most common clinical form, involvement of the intraglandular nodes within the parotid gland found is a rare occurrence during the course of the disease.

This unusual form may mimic a parotid mass, and can cause difficulties in differential diagnosis. In this article, a case of intraglandular parotid lymphadenitis which developed due to toxoplasmosis is presented, and the relevant literature is reviewed.
Blast injuries of the ear as a result of the Peterborough lorry explosion: 22 March 1989
Authors: Bruins W. R. , Cawood R. H.
Published: November 2007

This incidence of blast trauma to the ears in significant numbers is relatively rare in peace time. This paper outlines the results and management of twenty patients injured as a result of the outside explosion of 800 kg of high explosives in Peterborough on 22 March 1989.