bluuebunny/crossref_metadata_2025 huggingface dataset:
Penetrating oral foreign body presenting as an aural polyp
Authors: Law S. , Watters G. W. R.
Published: November 2007

A case of a penetrating oral foreign body presenting with an aural polyp is described. The possibility of a penetrating oral injury should be considered whenever a child's fall is unwitnessed, as it is easily overlooked. An underlying foreign body should be considered in cases where an aural polyp fails to respond to standard therapy. MRI may be the best imaging technique to identify plastic foreign material.
The role of surgery in tuberculous mastoiditis: appropriate chemotherapy is not always enough
Authors: Weiner Graeme M. , O'Connell J. E. , Pahor A. L.
Published: November 2007

We present a case of tuberculous otitis media in which a facial palsy occurred after the start of appropriate chemotherapy. To our knowledge this circumstance has not been described previously. It has been argued that radical surgery is completely unnecessary if chemotherapy is commenced early in the disease. We would suggest that this is not always the case, and would advocate a more measured approach.
T cell lymphoma of the ear presenting as mastoiditis
Authors: Danino Joshua , Joachims Henry Z. , Ben-Arieh Yehudith , Hefer Tsila , Weyl-Ben-Arush Miriam
Published: November 2007

Mastoiditis is a complication of otitis media characterized by suppuration and destruction of air cell septa in the mastoid and petrous pyramid. Diagnosis is made by clinical findings and computerized tomography (CT) of the temporal bone. We present a patient initially diagnosed by CT as having chronic mastoiditis who was subsequently shown to have an unusual large-cell malignant lymphoma of T cell type.
Tuberculoma of the cheek: a case report
Authors: Hathiram Bachi T. , Grewal D. S. , Irani D. K. , Tankwal Paresh M. , Patankar Manish
Published: November 2007

Tuberculoma of the cheek in the absence of tuberculosis elsewhere in the body is rarely seen and hence rarely thought of as a differential diagnosis when such a patient presents.

In the following case, the patient was provisionally diagnosed as carcinoma of the cheek because of the exophytic nature of the growth and its presentation. However, histopathology of a biopsy revealed tuberculoma and the response to antituberculous therapy was rapid and curative.
Inflammatory myofibroblastic tumour of the tonsil
Authors: Gangopadhyay Kunal , Mahasin Zeyad Z. , Kfoury Hala , Ali M. Ashraf
Published: November 2007

Inflammatory myofibroblastic tumours are aetiologically enigmatic, nosologically confusing and biologically unpredictable lesions. The lungs are the organs of apparent predilection. These tumours have also been documented in a number of extrapulmonary sites including the head and neck. So far only two cases of inflammatory myofibroblastic tumour of the tonsil have been reported in the English literature. We document another case, occurring in a 41-year-old man with history of cadaveric renal transplant nine years ago. A comprehensive review of the literature is also presented.
Post-tonsillectomy bacteraemia in children
Authors: Walsh R. M. , Kumar B. N. , Tse A. , Jones P. W. , Wilson P. S.
Published: November 2007

It has been postulated that the bacteraemia rate following guillotine tonsillectomy is lower than that following dissection tonsillectomy due to intra-operative compression of tonsillar blood vessels by the guillotine. The aim of this study was to evaluate the incidence of bacteraemia following dissection and guillotine tonsillectomy. Sixty-four patients undergoing elective tonsillectomy for recurrent acute tonsillitis were randomly selected, 32 underwent dissection tonsillectomy and 32 guillotine tonsillectomy. Positive intra-operative blood cultures were obtained in 16 patients (25 %), nine (28.1 %) of the dissection group and seven (21.8 %) of the guillotine group. There was no significant difference between the two methods (Chi-squared test, p = 0.77).
Systemic absorption of gentamicin ear drops
Authors: Green K. M. J. , Lappin D. W. P. , Curley J. W. A. , de Carpentier J. P.
Published: November 2007

Aminoglycoside-containing topical preparations are commonly used in the treatment of chronic suppurative otitis media and otitis externa. We report a case where systemic absorption of topical Gentisone HC™ occurred producing a serum gentamicin level of 6.2 μg/ml.
‘Bath-plug’ technique for the endoscopic management of cerebrospinal fluid leaks
Authors: Wormald P. J. , McDonogh Mike
Published: November 2007

In the past cerebrospinal fluid (CSF) leaks were managed via a craniotomy with intradural repair. With the advent of endoscopic sinus surgery, transnasal repair has become more popular. The comparatively low morbidity and high success rate of endoscopic repair has made it the treatment of choice for CSF leak repair. As more surgeons practice endoscopic sinus surgery, the incidence of iatrogenic CSF leaks has increased. It is important that endoscopic sinus surgeons be aware of the techniques for closing such leaks. The aim of this study is to present a new technique for the endoscopic repair of CSF leaks. Since the technique was devised the authors have used the technique on six patients. All patients had lumbar drains inserted and five patients had intra-thecal fluorescein inserted for location of the leak. All repairs have been successful with an average follow-up of 13 months. The technique consists of introducing a fat plug with a specifically secured vicryl suture into the intradural space and placing traction on the suture to seal the defect much as a bath plug seals a bath. There were no complications in any of the patients either intra- or post-operatively. The difficulties and possible complications of the technique as well as the use of a lumbar drain and intra-thecal fluorescein are discussed.
Rosai-Dorfman disease presenting as a parotid mass
Authors: Norman L. , Bateman A. C. , Watters G. W. R. , Singh V. , Spedding A. V.
Published: November 2007

Sinus histiocytosis with massive lymphadenopathy (SHML) is a rare, benign disease of unknown aetiology. This disease typically presents with massive, painless cervical lymphadenopathy but may occur in a wide variety of extranodal sites. Our report describes a 71-year-old man who presented with a discrete, unilateral parotid mass which was clinically suggestive of a primary salivary gland tumour. Initial cytological examination of a fine needle aspirate specimen taken from the mass demonstrated a discohesive cell population with nuclear atypia, raising the possibility of malignancy. However, excision of the mass and histological examination enabled a definitive diagnosis to be made.
The Midland Institute of Otology and its Founder: William Stirk Adams (1896–1978)
Authors: Pahor A. L. , Stansbie J. M.
Published: November 2007

To celebrate the 50th Anniversary of the establishment of the Midland Institute of Otology (MIO) a. meeting was held in the Belfry Hotel, West Midlands, 19–21 September 1997. The meeting comprised an excellent academic conference, social events and a golf tournament. A report on the academic conference has been published (Stansbie and Pahor, 1997).

The MIO has been established to further the cause of ENT in the Midlands and it has succeeded in its aim to a great extent. An historical overview of the Institute is of interest and would serve perhaps as a model for similar organizations, especially in the provinces.

The Institute was the brainchild of William Stirk Adams. He remained the President from the conception of the Institute till his death.It is befitting to present a biography of such a dedicated personality.
Complications of palatoplasty for snoring or sleep apnoea
Authors: Lee W. C. , Skinner D. W. , Prichard A. J. N.
Published: November 2007

A questionnaire was sent to consultant Otolaryngologists (483) throughout the UK to identify any mortality associated with uvulopalatoplasty and other forms of palatoplasties for snoring and/or obstructive sleep apnoea. The response rate was 76.8 per cent (371). Six intra- and post-operative deaths were reported and four were known to have obstructive sleep apnoea. Life-threatening morbidity occurred in at least seven patients (three known apnoeic), two required immediate tracheostomy and two were managed in the intensive care unit. This suggests that the apnoeic patients undergoing palatoplasties experienced significant mortality and morbidity. Pre-operative sleep study should be performed in all snoring patients to identify the apnoeic subgroup. Continuous positive airway pressure, management of excessive obesity, elective tracheostomy and other strategies should be first considered before palatoplasties in these patients.
A Case of intractable epistaxis
Authors: El Jassar P. , Moraitis D. , Spencer M. , Sissions G.
Published: November 2007

The surgical management of intractable epistaxis by external carotid artery ligation may become complicated if there is a high bifurcation of the common carotid artery. Occlusion of the bleeding vessels by catheter embolization is described in a patient in whom exploratio n of the neck had failed to locate the external carotid artery.
Vocal fold abductor paralysis as a solitary and fatal manifestation of multiple system atrophy
Authors: Hughes R. G. M. , Gibbin K. P. , Lowe J.
Published: November 2007

A patient is presented who had bilateral abductor vocal fold paralysis pathologically proven to be due to multiple system atrophy (MSA) in the absence of other neurological features. MSA is a degenerative neurological condition that includes olivopontocerebellar atrophy, Shy-Drager syndrome and striatonigral degeneration. The usual predominant features of MSA are cerebellar ataxia, autonomic dysfunction and Parkinsonism. Stridor is present in over one third of patients and has been reported previously as a presenting symptom in MSA: however previously reported patients have always gone on to develop other neurological symptoms. The usual investigations of bilateral abductor vocal fold paralysis caused by MSA will not reveal the pathological process and we believe that magnetic resonance imaging (MRI) of the medulla and brain stem and autonomic function tests are probably the investigations of choice. It is a worthwhile exercise attempting to identify MSA as the cause of stridor as the prognosis is good in the medium term if appropriate support is offered.
Granular cell tumour of the larynx
Authors: Victoria Luis V. , Hoffman Henry T. , Robinson Robert A.
Published: November 2007

Granular cell tumour (GCT) is a benign tumour with abundant eosinophilic cytoplasm filled with granules of varying sizes. These granules are the defining characteristic of the GCT and are believed to represent lysosomes in varying stages of fragmentation. The commonly used term granular cell myoblastoma, found in the older literature, is a misnomer because the tumour is clearly not of muscle origin. Among the major theories of origin, some support the tumour's derivation from neuronal tissue, histiocytes, fibroblast or Schwann cells. In the larynx, pseudoepitheliomatous hyperplasia may predispose to confuse the GCT with squamous cell carcinoma.

The most common region of GCT is in the head and neck, accounting for approximately 30 to 50 per cent of all lesions. The larynx is relatively an uncommon location for these tumours, accounting for approximately three to 10 per cent of the reported cases.

Affected patients typically present with persistent hoarseness, stridor, haemoptysis, dysphagia, and otalgia, but the tumour may be asymptomatic and be discovered only incidentally during a routine examination.

Complete excision with an attempt to maintain normal stuctures generally results in cure.

We present the case of a patient with typical features of a GCT of the larynx. The gross appearance, histopathology and brief discussion of the current literature are also presented.
Changes in the male voice at puberty: vocal fold length and its relationship to the fundamental frequency of the voice
Authors: Harries Meredydd , Hawkins Sarah , Hacking Jeremy , Hughes Ieuan
Published: November 2007

Ultrasound measurements of the vocal folds were taken for a number of boys passing through puberty. The boys were grouped according to their pubertal stage as defined by Tanner and there was a gradual increase in the length of the vocal folds as puberty progressed. The fundamental frequency of the boys' speaking voice was recorded via laryngography and a good correlation between the length of the vocal folds and the frequency of the voice was seen. The sudden drop in frequency seen between Tanner stages 3 and 4 did not correlate with similar changes in the length of the vocal folds at this time but stroboscopic findings suggest a change in the structure and mass of the vocal folds at this time of maximum frequency change.
The predictive value of p53, MDM-2, cyclin D1 and Ki67 in the progression from low-grade dysplasia towards carcinoma of the larynx
Authors: Pignataro Lorenzo , Capaccio Pasquale , Pruneri Giancarlo , Carboni Nadia , Buffa Roberto , Neri Antonino , Ottaviani Antonio
Published: November 2007

To evaluate the predictive role of the oncogenes p53, MDM-2 and cyclin D1, and the proliferative marker Ki67, in the progression from low-grade dysplasia to carcinoma of the larynx. We studied immunohistochemically a series of 32 low-grade pre-neoplastic laryngeal lesions, 10 of which progressed to invasive carcinoma. Immunoreactivity in more than 10 per cent of the dysplastic cells was detected in five cases immunostained with anti-p53 (≈ 15 per cent), in two with anti-MDM-2 (≈ six per cent), and 11 with anti-Ki67 antibodies (≈ 34 per cent), whereas none of the cases showed cyclin D1 overexpression. No significant association was found between p53 and MDM-2 immunoreactivity and the evolution to carcinoma; on the contrary, Ki67 expression was detectable in all but one of the 10 cases developing an infiltrative tumour (90 per cent), and in two of the 22 cases that did not progress (≈ nine per cent) (p = 0.01). These findings indicate that immunohistochemical assessment of the proliferative index in bioptic samples of dysplastic laryngeal mucosa may be useful in selecting patients who should undergo a more specific follow-up evaluation.
Vocal fold palsy following vinca alkaloid treatment
Authors: Burns B. V. , Shotton J. C.
Published: November 2007

We report two patients with Hodgkin's disease on chemotherapy, one with vincristine, the other with vinblastine, who were referred to the ENT department with a vocal fold palsy. These drugs are commonly used in the treatment of haematological malignancies, and head and neck sarcomas. Examination showed a unilateral immobile fold. No causative local pathology was identified, and they were otherwise thought to be achieving remission, but the development of a fold palsy suggested a poor response to treatment. One patient's palsy resolved following completion of chemotherapy, but the other patient's persists, despite an otherwise good response to the treatment. The vinca alkaloids are neurotoxic, usually causing a peripheralneuropathy, but cranial mononeuropathies are a rare side-effect. A total of 27 previous cases of vocal fold palsy have been reported with the use of the vinca alkaloids, and such a lesion should not be assumed to be due to advancing lymphoma.
Laryngeal aspergillosis in an acquired immunodeficiency syndrome patient
Authors: Delbrouck C. , Chantrain G. , Kampouridis S. , Petein M.
Published: November 2007

Aspergillosis is a rare infection. It varies considerably in its virulence depending on whether or not the patient affected is immunodepressed. The serious form is characterized by vascular invasion with haematogenic dissemination, tissue infarction andnecrosis. The most often affected site is the lung. A laryngeal localization is exceptional and usually results from dissemination from a lower airways portal of entry. Diagnosisis difficult: cultures are only positive in 50 per cent of cases, while in 60 per cent of cases the characteristic histological features reminiscent of sprigs of mistletoe are only found on postmortem examination. In view of the high morbidity and mortality in acquired immunodeficiency syndrome (AIDS) sufferers, this condition must be treated early and aggressively. Treatment is based essentially on amphotericin B and itraconazole.
Polymerase chain reaction in the diagnosis of parotid gland tuberculosis
Authors: Güneri Enis Alpin , İkiz Ahmet Ömer , Atabey Nese , İzci Özlem , Sütay Semih
Published: November 2007

A parotid gland mass with presenting features of malignancy is a diagnostic and therapeutic challenge. The histological nature of the lesion must be clearly determined before proceeding with facial nerve sacrificing surgery. Although rare, tuberculosis of the parotid gland must be included in the differential diagnosis of a parotid gland mass especially when the social characteristics of the patient suggests a mycobacterial infection. Primary tuberculosis of the parotid gland is generally encountered among populations with a high incidence of pulmonary disease. The difficulty in the differential diagnosis of a parotid gland malignancy may be helped by a high degree of clinical suspicion, since laboratory tests generally do not identify the specific causative organism. This article reports the first case of parotid gland tuberculosis with clinical and radiodiagnostical features simulating malignancy in which the diagnosis was confirmed by the polymerase chain reaction (PCR).
Cyclin Dl expression as a prognostic factor in advanced hypopharyngeal carcinoma
Authors: Nishimura Goshi , Tsukuda Mamoru , Zhou Li-Xin , Furukawa Shigeru , Baba Yuh
Published: November 2007

Hypopharyngeal carcinoma (HPC) has a poor prognosis. We investigated the expression of cyclin D1 in 34 advanced HPCs, and the value of cyclin D1 expression was evaluated as a predictive marker in terms of the prognosis of HPC, compared with other clinical factors. Using immunohistochemical staining, 20 of 34 patients showed positive immunoreactivity for cyclin D1. The statistical trend of the survival rate was lower in the cyclin Di-positive patients than in the cyclin D-negative ones (p = 0.0805). The predictive factors for the survival rate were effectiveness of neo-adjuvant chemotherapy (F = 8.698) (p = 0.0066), cyclin D1 expression (F = 6.244) (p = 0.0191) and N classification (F = 5.037) (p = 0.0335). The cyclin D1-positive patients had approximately four-fold higher mortality than the cyclin D1-negative ones. These data indicate that the expression of cyclin D1 in advanced patients with hypopharyngeal carcinoma is a useful marker for prognosis.
Use of a disposable electrode for recurrent laryngeal nerve monitoring
Authors: Srinivasan V. , Premachandra D. J.
Published: November 2007

Our experience with a non-invasive, disposable electrode for intra-operative identification and monitoring of the recurrent laryngeal nerve is described. The electrode system, while simply attached to the endotracheal tube, acts as a laryngeal surface electrode and detects electromyographic activity of the intrinsic laryngeal muscles when the recurrent laryngeal nerve is stimulated. We have successfully used this electrode to monitor 19 recurrent laryngeal nerves in 15 patients who have undergone partial or total thyroidectomy. We feel that this device can be useful particularly in cases of re-exploration and malignancies of the thyroid gland.
Lymphoblastic lymphoma/leukaemia presenting as perichondritis or the pinna
Authors: Indudharan R. , Arni T. , Myint K. K. , Jackson N.
Published: November 2007

Extra-nodal non-Hodgkin's lymphoma (NHL) of the pinna has only been reported once in a patient with immunodeficiency. We report an unusual case of lymphoblastic lymphoma in a patient without any immunodeficiency, presenting as an inflammatory lesion of the pinna, which illustrates the need to biopsy any nonhealing lesion as soon as possible to ensure that such a treatable malignancy is diagnosed at an early stage.
Laser assisted uvulopalatoplasty: six and eighteen month results
Authors: Wareing Michael J. , Callanan Vincent P. , Mitchell David B.
Published: November 2007

Our ongoing evaluation of the results of laser assisted uvulopalatoplasty (LAUP) for snoring is presented. Follow-up between 18 and 24 months post-treatment completion, of patients with a successful result at six months, reveals that 22 per cent of these patients suffer failure of snoring control between these two evaluation points. This equates to an overall success rate at this time of 55 percent.

LAUP, like other surgical remedies for snoring, has a continued relapse rate. This must be considered when counselling patients.
Choroid metastasis of undifferentiated nasopharyngeal carcinoma
Authors: Özyar Enis , Kiratli Hayyam , Akbulut Serap , Uzal Dilek , Atahan I. Lale
Published: November 2007

Choroid metastasis of primary nasopharyngeal carcinoma is an infrequent event. Here, we report a case of nasopharyngeal carcinoma with metastases to the choroid successfully treated by external beam radiotherapy.
Idiopathic diffuse erosion of the skull base presenting as cerebrospinal fluid rhinorrhoea
Authors: Conboy P. J. , Johnson I. J. M. , Jaspan T. , Jones N. S.
Published: November 2007

We present an unusual case of generalized erosion of the skull base. We have not found a similar case reported in the world literature. The presenting symptom was spontaneous cerebrospinal fluid (CSF) rhinorrhoea which arose from a bony defect associated with herniation of the right temporal lobe into the sphenoid sinus. We discuss the management of such a case including imaging of the skull base and the endoscopic repair of the bony defect.
A megalith of the parotid salivary gland
Authors: Kesse W. K. , Shehab Z. P. , Courteney-Harris R.
Published: November 2007

We present a rare case of a giant intra-parotid calculus in a 64-year-old man with recurrent parotitis. The literature is also reviewed.
Actinomycosis of the middle ear
Authors: Böör A. , Jurkovič I. , Friedmann I. , Benický M. , Dudriková Katarína , Krajcár R.
Published: November 2007

Another case of actinomycosis of the ear is described in a nine-year-old boy, drawing attention to the increasing incidence of diseases of the ear considered to be rare. The patient presented with the clinical signs of chronic purulent otitis media, not responding to conservative treatment. After the diagnosis of actinomycosis was established the patient was treated by surgery and long-term antibiotic medication, responding favourably.
Simultaneous leukaemic infiltrate and cholesteatoma in the same temporal bone
Authors: Effat K. G. , Naguib A. W.
Published: November 2007

Leukaemic relapse in the ear is very rare. We report a case of relapse of acute lymphoblastic leukaemia in the left ear. The patient presented with an aural polyp and ipsilateral facial palsy. The temporal bone showed simultaneous leukaemic infiltrate and cholesteatoma. To our knowledge, this is the first case reported with such pathology.
Selective lateral neck dissection for laryngeal cancer in the clinically negative neck: is it justified?
Authors: Ferlito Alfio , Rinaldo Alessandra
Published: November 2007

Selective lateral neck dissection is a recently-introduced surgical procedure for the treatment of cervical lymph nodes believed to be at risk of metastasis from primary malignant neoplasms of the upper respiratory and digestive tracts. Its value in the management of the clinically negative neck in cancer of the larynx is discussed.
Low velocity gunshot injuries to the temporal bone
Authors: Sabin Steven L. , Lee Dennis , Har-El Gady
Published: November 2007

Objective

To review the presentation, symptoms and management associated with low velocity gunshot injuries to the temporal bone.

Methods

A retrospective analysis of 26 patients treated for low velocity gunshot injuries to the temporal bone.

Results

Initial presentation included otorrhoea (69 per cent), facial nerve injury (27 per cent), hearing loss (65 per cent), intracranial injuries (50 per cent), and cranial neuropathies (58 per cent). Nine patients (35 per cent) underwent angiography, which showed vascular injury in five of them. Four patients died.

Conclusion

Low velocity gunshot injuries can be devastating and may result in functional sequelae. Low velocity missiles crush and lacerate surrounding structures, while high velocity missiles cause extensive wound cavity formation. Early aggressive management for intracranial, vascular and facial nerve injury can improve outcome.
The effect of cetirizine on symptoms and signs of nasal polyposis
Authors: Haye Rolf , Aanesen Jens P. , Burtin Bernard , Donnelly Fergal , Duby Christian
Published: November 2007

Forty-five patients with residual or recurrent nasal polyposis after ethmoidectomy were treated with either cetirizine at twice the daily recommended (20 mg) dose or placebo for three months. The number and size of polyps remained unchanged during the study period. Cetirizine was found to reduce nasal sneezing and rhinorrhoea effectively. The drug also had a beneficial effect on nasal obstruction in the latter part of the study. The side effects of 20 mg (double the recommended daily adult dose) of cetirizine were few and comparable to placebo.
Recovery of function after intracordal autologous fat injection for unilateral recurrent laryngeal nerve paralysis
Authors: Laccourreye Ollivier , Crevier-Buchman Lise , Pimpec-Barthes Francoise Le , Garcia Dominique , Riquet Marc , Brasnu Daniel
Published: November 2007

The present report documents the successful outcome in three patients with a unilateral recurrent laryngeal nerve paralysis managed with an intracordal injection of autologous fat who ultimately experienced a complete recovery of function. Such data demonstrates the safety of intracordal autologous fat injection in patients who ultimately recover function.
An unusual case of stridor due to osteophytes of the cervical spine: (Forestier's disease)
Authors: Papakostas K. , Thakar A. , Nandapalan V. , O'Sullivan G.
Published: November 2007

Stridor is a noisy breathing caused by compromised airway in the larynx and trachea. The causes can either be due to intrinsic or extrinsic compression. Stridor resulting from extrinsic compression due to anterior cervical osteophytes is rare.

We report an unusual case of acute stridor due to an osteophytic mass in the cervical vertebrae resulting in a mechanical upper airway obstruction. The underlying pathology was Forestier's disease or diffuse idiopathic skeletal hyperostosis (DISH). Stridor is a rare manifestation of DISH and it certainly represents the most lifethreatening one. Only a few cases have been reported in the English literature and are mainly secondary to impaired function of the vocal folds, or postcricoid ulceration and oedema. We present such a case, in that stridor was the result of direct airway obstruction by the osteophytic mass and an emergency tracheostomy had to be performed to establish an airway.
Retropharyngeal abscess. A rare presentation of nasopharyngeal carcinoma
Authors: Pak Martin Wai , Chan Ka Lai , van Hasselt Charles Andrew
Published: November 2007

Early symptoms of nasopharyngeal carcinoma (NPC) can often be deceptive and confusing. Most patients with nasopharyngeal carcinoma present at an advanced stage with metastatic cervical nodes present at the time of diagnosis. A deep neck abscess as the presenting feature has not been reported. We report two cases of nasopharyngeal carcinoma which presented with retropharyngeal abscesses and persistent lymphadenopathy. These two patients illustrate that refractory lymphadenopathy, despite adequate treatment of the associated infection, should prompt a search for underlying disease. The relationship between nasopharyngeal carcinoma and retropharyngeal abscess is discussed.
Juvenile angiofibroma: the lessons of 20 years of modern imaging
Authors: Lloyd Glyn , Howard David , Phelps Peter , Cheesman Anthony
Published: November 2007

Seventy-two patients with juvenile angiofibroma have been investigated by computerized tomography (CT) and/or magnetic resonance imaging (MRI) over a period of 20 years. The evidence from these studies indicates that angiofibroma takes origin in the pterygo-palatine fossa at the aperture of the pterygoid (vidian) canal. An important extension of the tumour is posteriorly along the pterygoid canal with invasion of the cancellous bone of the pterygoid base, and greater wing of the sphenoid (60 per cent of patients). Distinctive features of angiofibroma are the high recurrence rate, and the rapidity with which many tumours recur. It is postulated that the principle determinant of recurrence is a high tumour growth rate at the time of surgery coupled with incomplete surgical excision. The inability to remove the tumourin totois principally due to deep invasion of the sphenoid, as described above. In this series 93 per cent of recurrences occurred withthis type of tumour extension. A contributory cause in these patients is the use of pre-operative embolization. The treatment implications of these findings are examined.
Solitary plasmacytoma of the skull base presenting with unilateral sensorineural hearing loss
Authors: Vijaya-Sekaran S. , Delap T. , Abramovich S.
Published: November 2007

Solitary plasmacytoma of the skull base is a rare entity with only a few reported cases in the literature. We review the literature and present our experience with this lesion that produced ipsilateral sensorineural hearing loss, vertigo and ipsilateral sixth nerve palsy.
Invasion of the recurrent laryngeal nerve by adenoid cystic carcinoma. An unusual cause of true vocal fold paralysis
Authors: Hogg R. P. , Kuo M. J. , Olliff J. , Das Gupta A. R.
Published: November 2007

True vocal fold paralysis and goitre are both common problems encountered in ENT practice. Their co-existence, however, should arouse suspicion of the presence of malignant thyroid disease. A rare case of true vocal fold paralysis caused by a clinically occult subglottic adenoid cystic carcinoma, in a 72-year-old, is described. The existence of multinodular goitre in this patient was co-incidental and confounded the diagnostic process.
Nasal manifestation of extranodal Rosai-Dorfman disease – diagnosis and management
Authors: Ku Peter K. M. , Tong Michael C. F. , Leung C. Y. , Pak Martin W. , van Hasselt C. Andrew
Published: November 2007

Two cases of Rosai-Dorfman disease with polypoid nasal infiltration mimicking nasal tuberculosis and malignant lymphoma are reported. This rare benign disease was first described by Rosai and Dorfman in 1969 and is characterized by histiocytic proliferation. It is seldom considered in the differential diagnosis of granulomatous diseases due to its rarity and histological similarity to other diseases. Extranodal manifestations of this disease are uncommon. Although no specific treatment can guarantee a sustained remission of this disease, surgery for loco-regional lesions can result in long-term symptomatic control and restoration of function. Both patients underwent endoscopic resection of the nasal polypoid lesions and have subsequently been free of recurrence. Loco-regional infiltration of the nasal cavity by Rosai-Dorfman disease is effectively managed by endoscopic resection.
Alfred Gardiner Brown (1838–1882) M.R.C.S.Eng., F.R.C.S.(Ed.)
Authors: Booth John B.
Published: November 2007

Alfred Gardiner Brown was the first designated Aural Surgeon to be appointed to the consultant staff of The London Hospital, at the age of 38. In July 1880 he published the paper showing his adaptation of the way in which the tuning fork was applied to the head and its use in measuring hearing power by comparing it with the sense of touch. Had he been blessed with a longer life it is highly probable that he would have made a significant contribution as he was of an innovative and inventive mind. He died at the age of 44.
Principles for correcting the septum in septorhinoplasty: two-point fixation
Authors: Jones N. S.
Published: November 2007

This article describes the principles which enable a bent septum to be corrected without the loss of tip or supratip support. These principles centre on the need for two points of fixation in order to provide adequate stability for the septal cartilage. These points include the maxillary spine, the vertical plate of the ethmoid bone (at least 4 mm in continuity with the septal cartilage), the vomer, the maxillary crest or suspension from the upper lateral cartilages. A columella pocket offers additional support but cannot be regarded as a primary anchoring point. An adequate height from the maxillary spine to the tip (approximately 28 mm) and dorsal length (24 mm) of cartilage are also needed to support the nasal dorsum. The main strategy for correcting a septal bend which is apparent externally, or a supratip depression is described and centres on the use of cartilage grafts to disguise any assymmetry.
Presentation and epidemiology of nasopharyngeal carcinoma in Jordan
Authors: Kamal M. F. , Samarrai S. M.
Published: November 2007

A retrospective study, which highlights some of the aspects of nasopharyngeal carcinoma (NPC) as seen in a large hospital for 20 years in Jordan, was performed. Collected data showed that NPC accounted for one per cent of all malignant tumours during the period. The present series showed an age range from six to 89 years old with a mean of 39.5 years. There was a bimodal peak at presentation at 16 to 20 and 46 to 50 years. A high incidence of childhood NPC was also noticed (two per cent of all childhood malignant tumours). The difficulty in early diagnosis urges for better awareness of the tumour especially among general practitioners. The tumour is still detected at an advanced stage with 34 per cent metastasis most frequently to bone. The study stresses the importance of full ENT examination in cases of persistent middle ear disease, recurrent or persistent nasal symptoms or headache, or neck swelling; and routine bone scanning for all cases with NPC. There is a need for prospective studies of the causal relationship of NPC to environmental factors including Epstein-Barr (EB) virus as well as occupational and domestic hazards.
Prognostic value of p53 expression and histopathological parameters in squamous cell carcinoma of oral tongue
Authors: Ünal Ömer Faruk , Ayhan Ayse , Hoşal Ali Şefik
Published: November 2007

The TNM staging system is helpful but not enough to determine prognosis of the patients with squamous cell carcinoma of the oral tongue. T -stage alone is not suggestive for prediction of occult nodal metastases. For this reason, histopathological examination of 70 patients with squamous cell carcinoma of the oral tongue was done retrospectively. The histological differentiation, tumour thickness, perineural and lymphovascular space invasions, the amount of lymphocyte infiltration and pattern of tumour invasion were examined. Immunohistochemical examination was used to determine p53 immunoreactivity as well. The effect of these histopathological parameters and p53 immunoreactivity on nodal metastases and locoregional recurrence were analyzed using the chi-squared test. In terms of nodal metastases the only statistically significant difference between the two groups was tumour thickness, either <9 mm or >9 mm (p<0.05, χ2 = 17.182). Tumour thickness, perineural invasion, lymphovascular space invasion, the amount of lymphocyte infiltration all correlated statistically with locoregional recurrence (p<0.05, χ2 = 6.293 for tumour thickness; p<0.06, p = 0.054 for perineural invasion; p<0.05, χ2 = 8.689 for lymphovascular space invasion; p<0.05, χ2 = 5.320 for lymphocyte infiltration). The immunoreactivity of p53 correlated significantly with larger primary tumour size (p<0.05, χ2 = 5.440), lymph node metastases (p<0.05, χ2 = 4.093) and with pathological tumour stage (p<0.05, χ2 = 5.713). These results reveal that the above-mentioned histological parameters and p53 determination could be used for handling a specimen from an anterior tongue squamous cell carcinoma.
Osteomyelitis of the temporomandibular joint in patients with malignant otitis externa
Authors: Midwinter Katie I. , Gill Kanwar S. , Spencer John A. , Fraser Iain D.
Published: November 2007

Malignant (invasive) otitis externa is an infection involving the external ear canal, often in elderly diabetic patients, which carries a high morbidity and mortality. It may involve widespread areas of soft tissue around the skull base, and in more advanced cases, may give rise to osteomyelitis and cranial neuropathy. We describe two patients who were treated for malignant otitis externa complicated by destructive osteomyelitis of the temporomandibular joint (TMJ). For both patients, diagnosis was made using magnetic resonance imaging (MRI), and repeat scans were employed during follow-up. Improved scan appearances mirrored improvements in clinical condition in both cases.
Cochlear implantation following temporal bone fracture
Authors: Camilleri Andrew E. , Toner Joseph G. , Howarth Katie L. , Hampton Suzy , Ramsden Richard T.
Published: November 2007

Seven cases of profound hearing impairment following either unilateral or bilateral temporal bone fracture are presented who were implanted with the Nucleus 22 channel or Ineraid devices. Six patients suffered bilateral temporal bone fractures. One patient had prior congenital unilateral profound hearing impairment. This patient suffered a unilateral temporal bone fracture. Six patients became regular users of their implants. One gained little benefit and became a non-user. Two of the regular users experienced facial nerve stimulation, which could not be programmed out. In these two cases the implant was removed and the contralateral ear successfully implanted. Implant-aided audiometry demonstrated a hearing threshold of 40–50 dB at nine months after switch-on. The reliability of computed tomography (CT) scanning in predicting cochlear patency in cases of temporal bone fracture will be discussed. The benefit of complimentary imaging with magnetic resonance (MR) is highlighted.
The magnetless Clarion® cochlear implant in a patient with neurofibromatosis 2
Authors: Graham J. , Lynch C. , Weber B. , Stollwerck L. , Wei J. , Brookes G.
Published: November 2007

We present our experience using the Clarion® magnetless multichannel cochlear implant with a woman profoundly deafened following bilateral acoustic neuromata as a consequence of neurofibromatosis 2 (NF2). The right neuroma had been previously removed without an attempt at neural preservation. On the left, however, a posterior fossa approach had been taken with the aim of preserving hearing. Although the left cochlear nerve appeared to be undamaged at the end of the operation, no hearing thresholds could be elicited on post-operative audiometry, because of damage either to the cochlear nerve or to the blood supply to the cochlea. Round window electrical stimulation subsequently produced a perception of sound, confirming that the cochlear nerve was capable of functioning and that a cochlear implant would be effective. Because she would need regular magnetic resonance imaging (MRI) to monitor existing and future NF2 lesions, it was decided to use a magnetless Clarion® implant, which has been shown to be MRI compatible. We report our experience of using the device in this case and discuss some of the issues related to the provision of cochlear implants to patients with NF2.
Schwannoma (neurilemmoma) of the tonsil
Authors: Lall G. S. , Walsh R. M. , Rowlands D. C. , Donaldson I.
Published: November 2007

Schwannoma of the tonsil is an extremely uncommon clinical entity with only one reported case in an adult in the medical literature to date. We report, to our knowledge, the first known case in a child.
The Westaby T-Y tracheobronchial stent in otolaryngology
Authors: Lacy P. D. , Fenton J. E. , Smyth D. A. , Colreavy M. P. , Walsh M. A. , O'Dwyer T. P. , Timon C. V. I.
Published: November 2007

The Westaby T-Y tracheobronchial silicone stent can be used for the relief of upper airway obstruction beyond the limit of a standard tracheostomy tube. We report on our experience in the use of the Westaby tube in 10 patients over a five-year period. The general features of the tube, indications for its use, and its method of insertion are described. The versatility and advantages over other stents are discussed. Two cases reports are described and the clinical course and outcomes of the individual patients are outlined.
Temporocele: CT findings and management
Authors: Devesa P. Martinez , Reid H. S. , Jefferis A. F.
Published: November 2007

The temporocele, a rare case of extra-mastoid pneumatization is discussed. It presented as a swelling over the mastoid in a 16-year-old female and the diagnosis was made by computed tomography (CT) scan. It was treated by obliteration by covering the sieve-like mastoid with bone dust and a large piece of temporalis fascia as well as ventilating the middle ear.
Partial anodontia in a case of Waardenburg's syndrome
Authors: Bandyopadhyay Sekhar , Prasad Sheokumar , Singhania Pradeep Kumar
Published: November 2007

On routine examination of a case of Waardenburg's syndrome apart from the usual features of the disorder, partial anodontia involving both the lower lateral incisors was evident.

The interesting association of partial anodontia and Waardenburg's syndrome is discussed along with relevant available literature.
Post-irradiation sudden deafness
Authors: Young Yi-Ho , Lou Pei-Jen
Published: November 2007

As in radiation-induced cancer, post-irradiation sudden deafness (PISD) is defined as sudden onset deafness in patients post-irradiation. Fifteen nasopharyngeal carcinoma (NPC) patients with PISD were enrolled in this study. The mean interval from the completion of irradiation to the occurrence of PISD was 12 years. Seven had total deafness, seven had profound hearing loss, and one had moderate hearing loss. Nine out of 15 (60 per cent) patients experienced hearing recovery within three months after treatment. In conclusion, PISD is a late complication in NPC patients post-irradiation. The causative mechanism is theorized as vascular insufficiency.
Bacteriology of endoscopically normal maxillary sinuses
Authors: Jiang Rong-San , Liang Kai-Li , Jang Jinq-Wen , Hsu Chen-Yi
Published: November 2007

The bacteriology of maxillary sinuses with normal endoscopic findings is reported in this study. When transantral sinoscopy was used to examine the maxillary sinuses, the whole maxillary sinus was inspected with different-angle endoscopes. If no lesion was seen over the whole maxillary sinus mucosa, no secretion existed in the maxillary sinus cavity, and the maxillary sinus ostium was wide open, the maxillary sinus was considered endoscopically normal. The bacteriology of these endoscopically normal maxillary sinuses was studied by passing cotton-tipped sticks through the cannula to collect swab specimens. In some cases, a biopsy forceps was also passed to obtain mucosal specimens. The specimens were sent to the laboratory for aerobic and anaerobic cultures. Between July 1990 and May 1998, 83 swab and 31 mucosal specimens were collected from 69 patients who had not taken any antibiotic within 10 days before endoscopy. The culture rates were 62.3 per cent (35/53) from swab specimens and 57.1 per cent (eight out of 14) from mucosal specimens in patients with the diagnosis of chronic paranasal sinusitis, and were 46.7 per cent (14/30) from swab specimens and 41. 2 per cent (seven out of 17) from mucosal specimens in patients without this diagnosis. This study shows that endoscopically normal maxillary sinuses are not sterile.
Size assessment of adenoid and nasopharyngeal airway by acoustic rhinometry in children
Authors: Cho Jin-Hee , Lee Dong-Hee , Lee Nam-Soo , Won Yu-Sung , Yoon He-Ro , Suh Byung-Do
Published: November 2007

Adenoid hypertrophy is known as the most common cause of nasal obstruction in children; thus, adenoidectomy with, or without, tonsillectomy is one of the most commonly performed surgical procedures in the paediatric population. Although many methods have been suggested, few studies have reported on how to assess adenoid size, pre-operatively. Acoustic rhinometry is an objective technique as well as a non-invasive method, which can be easily used in young children. This study confirmed that acoustic rhinometry is a non-invasive and objective technique for assessing the geometry of the nasal cavity and nasopharynx. Forty children were evaluated using symptomology, two different radiological measurements and acoustic rhinometry; the results were compared with endoscopic findings. Clinical symptoms and A/N ratio measured with Fujioka's method significantly correlated with the endoscopic assessment findings (r = 0.769 and 0.604 respectively). Significant increases in the cross-sectional area and volume of the nasopharynx were observed at the adenoid notch after adenoidectomy (p<0.005 andp<0.005, respectively). Acoustic rhinometry showed a high degree of correlation of which adenoid occupied the nasopharyngeal airway under endoscopic examination (r = 0.771). Thus, the study concluded that acoustic rhinometry can be as good an objective method for measuring adenoid sizes as endoscopy and can be used as one of the pre-operative examination tools for adenoidectomy.
An unusual complication of cochlear implant: benign paroxysmal positional vertigo
Authors: Di Girolamo Stefano , Fetoni Anna Rita , Di Nardo Walter , Paludetti Gaetano
Published: November 2007

Three days after the initial fitting of the cochlear device a 40-year-old woman complained of severe rotational vertigo following head movements associated with neurovegetative symptoms. Otoneurological evaluation revealed a horizontal paroxysmal positional nystagmus beating towards the lowermost ear, induced by rolling the patient's head from supine both to the right or to the left lateral position suggesting the diagnosis of benign paroxysmal positional vertigo of the left horizontal semicircular canal. The nystagmus characteristics were the same whether the cochlear device was switched on or off. The hypothesis of an otolith dislodging due to the electrical stimulation during the initial fitting is discussed.
Primary brain stem tethering: a rare cause of geniculate neuralgia
Authors: Buyse Geert G. , Caekebeke Jo , Demaerel Philippe , Plets Chris
Published: November 2007

This rare case of brain stem tethering presented with chronic and progressive geniculate neuralgia. In view of the fact that an occipital subcutaneous lipoma had been resected in childhood, it probably concerned a primary tethering, fitting in with an occult occipital dysraphism.

Magnetic resonance imaging (MRI) clearly demonstrated an underlying tethering, causing a distortion of the brain stem. Consequently, this led to the hypothesis that the geniculate neuralgia could be explained by traction on the lower cranial nerves secondary to the brain stem displacement. Untethering resulted in a considerable decrease of the neuralgia.

MRI proved to be essential in the diagnosis and treatment of this unusual case.
Laryngeal involvement by cutaneous lymphoma
Authors: Banerjee A. , Mclellan D. R. , Bingham B. J. G.
Published: November 2007

Laryngeal involvement by cutaneous lymphoma is rare; it may be isolated or part of systemic spread. We report a case of cutaneous T-cell lymphoma with isolated extracutaneous spread to the larynx, confirmed by the polymerase chain reaction in addition to histology. Awareness of this association may allow early recognition of symptoms heralding laryngeal embarrassment.