bluuebunny/crossref_metadata_2025 huggingface dataset:
Nasal airflow in inspiration and expiration
Authors: Viani Laura , Jones Andrew S. , Clarke Ray
Published: November 2007

Inspiratory and expiratory airflow rates were measured in 30 subjects during quiet respiration (at a pressure gradient of 150 Pa) and at peak flow rates.

For low flow rates airflow rate was greater for inspiration than for expiration. Conversely at peak flow rates flow was greatest during expiration. Thus there was a reversal in the phase relationship between inspiration and expiration as flow rate increased.

It was also found that peak inspiratory flow rate correlated better with values for nasal resistance than did peak expiratory flow rate. Flow rate measured by rhinomanometry during quiet respiration was more sensitive to physiologically induced changes in nasal resistance than was peak flow rate.

The findings are discussed with reference to previous work on the physiology of nasal airflow.
Malignant external otitis in an infant
Authors: Nir Dan , Nir Tsila , Danino Joshua , Joachims Henry Z.
Published: November 2007

Ten cases of malignant external otitis in children have been reported hitherto. These are reviewed, and an eleventh case, a three-month-old infant associated with genetic granulocytopenia, is presented. On the grounds of the reported paediatric cases, the erudition in childhood is compared with the more common form in the adult, and is found to be much less linked with diabetes mellitus and to have a far better prognosis, with practically no mortality.
Neuro-endocrine tumours of the head and neck
Authors: Soussi A. C. , Benghiat A. , Holgate C. S. , Majumdar B.
Published: November 2007

We report two types of neuroendocrine carcinoma of the head and neck, small cell carcinoma of the ethmoid and large cell carcinoma of the larynx, demonstrating a differential response to radiotherapy.
The British experience of an implantable, subcutaneous bone conduction hearing aid (Xomed Audiant)
Authors: Browning G. G.
Published: November 2007

Implantable bone conduction aids are potentially an important advance for those with a conductive hearing impairment. One system (Xomed Audiant bone conductor), which uses electromagnetic induction to vibrate a subcutaneous implanted skull magnet, has now been implanted in sufficient patients in the United Kingdom, for enough time, for its indicationsto be evaluated.

Seventeen of the total of 18 patients that have been implanted, satisfied the average threshold criterion for suitability for implantation (average bone conduction over 0.5, 1 and 2 kHz of 25 dB HL or better) yet only 10 of the 17 (59 per cent) currently use their Audiant aid. This was not because of technical reasons but was mainly influenced by the previous type of amplification. Current usage of a body level processor was 100 per cent) (6 of 6) in those that previously could only use a conventional bone conduction aid because of bilateral congenital or acquired atresia of their external auditory canals. In comparison, usage was only 36 per cent (4 of 11) in those that could potentially use a conventional ear level aid albeit with problems such as the discharge from active chronic otitis media. This relative non-use was considered due to a lack of power of the ear level processor and the general unwillingness of patients to change from an ear level to a body level device.
Acute ENT admission in Kawasaki disease
Authors: Murrant N. J. , CooK J. A. , Murch S. H.
Published: November 2007

Kawasaki disease (mucocutaneous lymph node syndrome) is an acute vasculitis of childhood carrying a 1–2 per cent mortality from cardiovasular complications. Despite the extensive literature on Kawasaki disease in paediatric journals, there has been a paucity of documentation in the otolaryngological literature. This is despite the fact that Kawasaki disease may present as an otolaryngological emergency before the diagnosis is established. We describe three cases of Kawasaki disease, all of which presented to the ENT department of this hospital within a period of two months. These cases illustrate the slow evolution characteristic of the disease and highlight the difficulties of diagnosis in the initial febrile stage. We emphasize the importance of considering the diagnosis when treating a young child with a pyrexia resistant to antibiotics, as prompt introduction of therapy may decrease the risk of fatal coronary artery or cardiac involvement.
Unterberger stepping test: a useful indicator of peripheral vestibular dysfunction?
Authors: Hickey S. A. , Ford G. R. , Buckley J. G. , O'connor A. F. Fitzgerald
Published: November 2007

Deviation of gait in a stepping test has been proposed as a useful indicator of peripheral labyrinthine dysfunction. A prospective study of 26 patients suspected of having uncompensated peripheral labyrinthine dysfunction and 49 normal patients with normal labyrinthine dysfunction showed no significant difference in performance of the Unterberger stepping test between patients with electronystagmographically significant canal paresis and those with normal vestibular function.
Delayed facial palsy following uncomplicated stapedectomy
Authors: Smith Michael C. F. , Simon Pacifica , Ramalingam K. K.
Published: November 2007

We report six cases of partial lower motor neurone facial palsy occurring between four and ten days after uncomplicated stapedectomy. The aetiology is unclear but recovery was rapid and complete in all patients.
Alternating cisplatinum and VAC ineffective in end stage squamous cell carcinoma of the head and neck
Authors: Siodlak M. Z. , Stell P. M. , Wilson J. A. , Green J. A. , Allison R. S. , Adler D. , Squadrelli-Saraceno M.
Published: November 2007

Sixteen patients with end stage squamous cell carcinoma of the head and neck were admitted to a phase II study of alternating courses of cisplatinum (100mg/m2) and VAC (vincristine 1.4mg/m2, adriamycin 50 mg/m2, cyclophosphamide 750 mg/m2) given at three weekly intervals. Only two patients achieved a response (12 per cent). The median survival time was 62 days which is much the same as that of a similar group of patients who received no chemotherapy in a previous trial (70 days).
Benign parotid tumour enucleation—A reliable operation in selected cases
Authors: Comoretto R. , Barzan L.
Published: November 2007

The method of surgical treatment for benign tumours of the parotid gland has not yet been rationalized, but many authors recommend parotidectomy as the most appropriate procedure. A series of 289 operations for parotid swellings is reported; the majority of mixed and Warthin's tumours underwent enucleation without either complications or recurrence. The rationale of parotidectomy versus enucleation is discussed but in fast growing, deeply infiltrating and recurrent tumours, parotidectomy appears to be the best choice. In the other group of more commonly occurring tumours, enucleation represents a reliable time saving option.
Unusual lymphoproliferative oropharyngeal lesions in heart and heart-lung transplant recipients
Authors: Fairley James W. , Hunt Beverley J. , Glover Garry W. , Radley-Smith Rosemary C. , Yacoub Magdi H.
Published: November 2007

Three unusual cases of oropharyngeal lympho-proliferative lesions were seen in recipients of heart and heart-lung transplants. Two caused acute upper respiratory obstruction necessitating urgent ENT intervention. All patients were receiving immunosuppressive drugs including cyclosporin. The two obstructive cases were adenotonsillar enlargement in a 6-year-old, and a tumour of the tonsil and tongue base with cervical lymph node enlargement in a 32-year-old male. Both were caused by Epstein-Barr Virus-associated lymphoproliferative disorder. The third patient, a 32-year-old female, had a presumed low grade T-cell lymphoma that regressed spontaneously.

Histopathological diagnosis of these lympho-proliferative disorders after transplantation usually requires immunocytochemistry to distinguish polyclonal proliferative disorders from true lymphoma. Polyclonal lymphoproliferative disorders after transplantation do not usually require aggressive cytoreductive therapy, but respond to simple measures such as the reduction of immunosuppression.
Quantitative analysis of the bacterial findings in otitis media
Authors: Stenfors Lars-Eric , Räisänen Simo
Published: November 2007

Qualitative and quantitative bacterial analysis of 200 samples of middle ear effusions collected from patients with current otitis media was performed. When middle ear pathogens (S. pneumoniae, H. influenzaeandB. catarrhalis) where found during current acute otitis media or otitis media with effusion infection, the quantity of these bacteria was of the magnitude 106–108/ml and 0–5 × 105/ml effusion material, respectively. Mucopurulent effusion material contained 6 × 105–108bacteria per ml whereas effusion from chronically discharging ears exceeded 109bacteria per ml. Serous effusions did not harbour middle ear pathogens. The appearance of the effusion material was dependent on the number of bacteria involved. Quantification of bacteria in various middle ear effusions offers opportunities to make the diagnosis of various otitis media infections more accurate and readily comparable.
The Dansac mini cap®: A new method of waterproof ear protection
Authors: Robinson Philip J. , Prince Joanna M.
Published: November 2007

The best method of providing waterproof protection for susceptible ears remains a contentious issue. Many evaluations have concentrated on the efficacy of intraluminal plugs in normal or model ears. We describe a new method, using a jejunostomy shower cap (Dansac mini cap®), which avoids intraluminal insertion.

This method has proved useful in some patients who have failed to avoid repeated otorrhoea after water exposure despite using a wide range of intraluminal ear plugs. The shower caps are best avoided in children because of teasing.
Radiological diagnosis of aspirated foreign bodies in children: Review of 343 cases
Authors: Mu Liancai , Sun Deqiang , He Ping
Published: November 2007

In our series of 400 Chinese children with foreign body aspiration (FBA),343 cases were evaluated by fluoroscopy and/or plain chest X-rays before endoscopic removal of the foreign bodies. The majority of the foreign bodies (FBs) were organic (378/400, 94.5 per cent). The results showed that mainstem bronchial foreign bodies were diagnosed correctly in 68 per centof cases compared with 65 per cent correct diagnoses with segmental bronchial foreign bodies, but only 22 per cent correct diagnoses with tracheal, and 0 per cent correct diagnosis in those with laryngeal foreign bodies. Eighty per cent (32/40) of the children with laryngotracheal FBs had normal X-ray findings, whereas 67.7 per cent (205/303) of the children with bronchial FBs had abnormal chest X-ray findings. The most common positive radiological signs in the children with tracheobronchial FBs were obstructive emphysema (131/213, 62 per cent) and mediastinal shift (117/213, 55 percent). The incidence of major complications was related not only to the size of the foreign body and its location but also the duration since aspiration. The most common types of bronchial obstructions by airway FBs are discussed.
Technetium–99m(v) Dimercaptosuccinic acid planar scintigraphy in head and neck cancer: Clinical, scintigraphic and radiological study
Authors: Watkinson J. C. , Todd C. E. C. , Lazarus C. R. , Maisey M. N. , Clarke S. E. M.
Published: November 2007

Technetium-99m (Tc99m)(v) Dimercaptosuccinic Acid (DMSA) is animaging agent which has been proposed as a scintigraphic marker for head and neck squamous cell carcinoma. Fifty-four patients were studied of whom 51 had a head and neck tumour. All patients were examined and then imaged using Tc99m(v) DMSA scintigraphy and computerized tomography.

Scintigraphy was less sensitive than clinical examination in the detection of patients with cancer, patients with primary tumours and patients with metastatic neck disease. CT was as sensitive and as accurate as clinical examination but more senstive than Tc99m(v) DMSA in detecting patients with cancer and with primary tumours. CT was more sensitive and more accurate than both clinical examination and Tc99m(v) DMSA scintigraphy in predicting which patients had metastatic neck disease.

Although Tc99m(v) DMSA is accumulated by squamous cell carcinoma, its inability to detect low volume disease and apparent low specificity means it has no role to play in the management of patients with head and neck squamous cell carcinoma.
Hearing loss due to cranio-metaphysial dysplasia
Authors: Morgan D. W. , Aldren C. , Hoare T. J.
Published: November 2007

Craniometaphysial dysplasia is a rare cause of conductive hearing loss. It is a genetic disorder of bone due to decreased osteoclastic activity inthe endosteal and periosteal regions of craniofacial and long bones. The characteristic temporal bone abnormalities are attic fixation, abnormallyshaped ossicles and obliterated foramina ovale. Computerised tomography is helpful in predicting operative findings; surgery should be reserved for those with a severe hearing loss.
Vocal fold sulcus
Authors: Lee Stephen T. S. , Niimi S.
Published: November 2007

Vocal fold sulcus is a cause of dysphonia which has not been recognized until recently. Awareness of its existence combined with use of laryngostroboscopy would enhance the management of this group of patients. Five such cases were treated initially by voice therapy and subsequently combined with microlaryngeal Teflon injections of the vocal cord. Representative photomicrographs and the end results of treatment are presented. A good voice, subjectively and objectively, was obtained in three patients, with satisfactory improvement in the other two.
Early inappropriate secretion of antidiuretic hormone after trans-sphenoidal pituitary adenomectomy
Authors: Murty G. E. , Lamballe P. , Welch A. R.
Published: November 2007

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a rare but life-threatening complication of trans-sphenoidal pituitary adenomectomy. It has previously only been described as a late phenomenon. We report an early presentation within the first week. The pathophysiology, clinical features and treatment are discussed.
Cystic hygroma: massive recurrence in adult life
Authors: Scally C. M. , Black J. H. A.
Published: November 2007

Cystic hygroma is considered a disease of childhood. It may appear for the first time in adult life but recurrence by that stage is rare and may present difficulties in diagnosis due to previous treatment. The authors present a case where early pharmacological intervention may have prevented a potentially life threatening situation. The world literature is also reviewed.
Point and period prevalence of otitis media with effusion evaluated by daily tympanometry
Authors: Møller Henrik , Tos Mirko
Published: November 2007

Previous studies on daily tympanometric screening using an automatic impedance tympanoscope indicated relatively high incidences of type B tympanograms of one day's duration, which is contrary to our conceptions of the pathogenesis and pathology of otitis media with effusion. We therefore repeated the study in 51 otherwise healthy children (100 ears) attending kindergarten. Tympanometry was performed daily for one month using both the conventional impedance apparatus AZ 7 and the automatic impedance tympanoscope ZS 331. The impedance apparatus did not indicate any one-day type B tympanograms and only a few short-lasting episodes occuring either in the beginning or end of the study period. Several ears had type B tympanograms on all days examined. The point prevalence was 15 per cent and the period prevalence 17 per cent, which accord well with findings of previous epidemiological studies of secretory otitis. The impedance tympanoscope indicated 16 cases of B-curves lasting only one day and considerably higher point and period prevalences, which make the impedance tympanoscope unsuited for both scientific and clinical purposes.
Cochlear otoscierosis: statistical analysis of relationship of spiral ligament hyalinization to hearing loss
Authors: Abd El-Rahman Aly Gamal
Published: November 2007

This paper presents an analysis of the relationship of the amount of hyalinization of the spiral ligament, secondary to cochlear otosclerosis (spongiosis), to the amount of hearing loss. This relationship was previously studied by Parahy and Linthicum. It was found that the larger the amount of hyalinization, the greater the hearing loss. This hyalinization is a measure of the amount of toxic enzymes being excreted into the inner ear fluid. These enzymes are suspected to affect the metabolic function of the hair cells.
Haemangiopericytoma of the temporal bone
Authors: Birzgalis A. R. , Ramsden R. T. , Lye R. H. , Richardson P. L.
Published: November 2007

Haemangiopericytoma is an uncommon vascular tumour with a widespread distribution. Although meningeal involvement is well recognized, only a few sporadic cases of temporal bone lesions have been documented, all with doubtful sites of origin. Late presentation together with the restrictive anatomy of this region often precludes its effective removal and even minimal residual disease may progress rapidly. A series of three such patients are presented in order to discuss the natural history, histological features and treatment of this disease.
‘Two-stage turbinectomy’: Sequestration of the inferior turbinate following submucosal diathermy
Authors: Williams H. O. L. , Fisher E. W. , Golding-Wood D. G.
Published: November 2007

Submucous diathermy of the inferior turbinates is a widely practised procedure. Three cases are presented in which surgery was complicated by avascular necrosis of the turbinate bone. Each patient required a debridement procedure before healing and recovery of normal mucociliary function could take place.
Management of posterior epistaxis with the use of the fibreoptic nasolaryngoscope
Authors: Premachandra D. J.
Published: November 2007

Posterior epistaxis is usually treated by repeated nasal packing and in failed situations by ligation of feeding arteries with considerable morbidity and mortality. The most logical approach should be location of the bleeding site and arrest of haemorrhage by local treatment. The exact location of the bleeding area can be identified in actively bleeding noses with the fibreoptic naso-laryngoscope and the bleeding arrested by chemical, or thermal cautery and in failed situations by using small nasal packs confined to the bleeding site. This approach to the management of posterior epistaxis is effective and reduces the duration of hospital stay. It significantly reduces the discomfort to the patient. The current practice of indiscriminate blind nasal packing in the hope of arresting nasal haemorrhage by incidental pressure on the bleeding site should be re-evaluated.
The hayfork: an aid to safer tonsillectomy
Authors: Chevretton E. B. , Morrison G. A. J.
Published: November 2007

We report on the use of a little-known instrument for tonsillectomy.
Radiation-induced cranial nerve palsy: hypoglossal nerve and vocal cord palsies
Authors: Takimoto Toru , Saito Yasuo , Suzuki Masayuki , Nishimura Toshirou
Published: November 2007

Cranial nerve palsies are an unexpected complication of radiotherapy for head and neck tumours. We present a case of this radiation-induced cranial palsy.

An 18-year-old female with nasopharyngeal carcinoma developed a right hypoglossal nerve palsy 42 months after cancericidal doses of radiotherapy. In addition, she developed a bilateral vocal cord palsy 62 months after therapy. Follow-up over four years has demonstrated no evidence of tumour recurrence and no sign of neurological improvement.
Corrosion and fracture of a silver tracheostomy tube
Authors: Brockhurst P. J. , Feltoe C. K.
Published: November 2007

A sterling silver tracheostomy tube broke in use resulting in the death of a child. The nature of the fracture in the brazed joint is described, and corrosion identified as the mechanism of degradation of the joint. The corrosion is due either to exposure to body fluids over a long period, or to the use of hypochlorite solutions for cleaning and disinfection. The silver braze used had inferior corrosion resistance. It is recommended that appropriate grades of silver brazing alloy be used in the future, and that the mechanical integrity of medical devices joined with silver braze be regularly checked to anticipate failure in use.
Otological manifestations of a new familial polyostotic bone disorder
Authors: Adams D. A. , Gormley P. K. , Kerr A. G. , Smyth G. D. L. , Osterberg P. , Sloan J.
Published: November 2007

Fifty members of a family with a unique autosomal dominant bone disease were investigated. Nineteen of the family members were either known to have, or were strongly suspected of having the disease. All but one of these had a hearing loss which was conductive in the younger age group and mixed in the older members. The common finding in those who had middle ear surgery was replacement of the long process of incus by a fibrous band. The histological features were similar to those found in Paget's disease. The age of onset, distribution of lesions and radiographic findings, however, were not typical of this disorder.
Foreign bodies in the throat: a prospective study of 388 cases
Authors: Jones N. S. , Lannigan F. J. , Salama N. Y.
Published: November 2007

We present the results of a prospective study of 388 patients presenting with a history of swallowing a foreign body. We indicate whether the patients' symptoms and signs were associated with a retained foreign body. While tenderness on palpation was an unreliable sign, pooling at indirect laryngoscopy invariably predicted a retained object. In many patients, initial careful examination of the oropharynx by casualty officers would have shown a retained fishbone in the tonsil or tongue and would have resulted in 16 per cent fewer radiographs and 17 per cent fewer referrals to the ENT department. Radiography only improved management in a small minority and 35 per cent of films were interpreted incorrectly by casualty officers. A follow-up barium swallow disclosed a pathological lesion in a significant proportion of patients with bolus obstruction, whether or not this was passed spontaneously.
Does post-operative nasal packing cause nocturnal oxygen desaturation?
Authors: Buckley J. G. , Hickey S. A. , O'Connor A. F.Fitzgerald
Published: November 2007

Previous studies have shown an increased frequency and duration of apnoeic episodes during sleep when the nose is occluded. The aim of this study was to ascertain whether oxygen desaturation occurs with nasal occlusion by postoperative packing. Continuous digital pulse oximetry was carried out before and after submucous resection of the nasal septum in 17 otherwise healthy patients. Post-operative nasal packing produced a statistically significant change in oxygen saturation during sleep. The change was, however, of such small magnitude that it is unlikely to be clinically significant.
Bilateral carcinoma of the external auditory meatus
Authors: Munk-Nielsen Lene , Hansen H. S.
Published: November 2007

A 65-year-old woman had suffered for two months from bilateral tinnitus and discharge, pain in the right ear, and loss of hearing. Biopsy showed carcinoma of the squamous type on both sides. Tomography revealed bone destruction on the right. The patient was treated with radiotherapy. Two months after treatment, tomography showed tumour regression on the right side, but progression on the left. The literature on this subject is reviewed.
Frontal sinus carcinoma presenting as acute sinusitis
Authors: Reddy Krishna T. V. , Gilhooly M. , Wallace M. , Ali M. H.
Published: November 2007

Primary carcinoma of the frontal sinus is extremely rare. The aetiology of the tumour remains obscure, and even with rapid diagnosis and radical surgery the prognosis remains very poor.
Wegener's granulomatosis in two siblings: a family study
Authors: Stoney P. J. , Davies W. , Ho S. F. , Paterson I. C. , Griffith I. P.
Published: November 2007

Two brothers with Wegener's granulomatosis are presented. HLA status and associated genes in the brothers and the immediate family are explored. No specific association could be found with tissue types within the family.
Fanconi's anaemia and post-cricoid carcinoma
Authors: Snow D. G. , Campbell J. B. , Smallman L. A.
Published: November 2007

A case of post-cricoid carcinoma, occurring in a patient with Fanconi's anaemia is presented. The case illustrates the rare association of the two diseases. The problems with the management of such a case are discussed.
Malignant fibrous histiocytoma of the larynx
Authors: Bernáldez Ricardo , Nistal Manuel , Kaiser Carlos , Gavilán Javier
Published: November 2007

Malignant fibrous histiocytomas of the upper respiratory tract are rare, aggressive mesenchymal neoplasms. We report a case of a glottic malignant fibrous histiocytoma of the larynx on a 54 year old man. Only a few have been reported in the English literature. The clinical behaviour and degree of malignancy of these tumours cannot be predicted. Wide, aggressive excision of the tumour with a margin of normal tissue appears to be the treatment of choice. About two years after total laryngectomy the patient is well and free of disease.
Use of hearing aids by patients with closed mastoid cavity
Authors: Terzis T. F. , Robinson J. M.
Published: November 2007

Twenty-five patients who had undergone a closed-cavity tympanomastoidectomy in our Unit and wore a hearing aid in the operated ear were reviewed, and information was recorded on the use of the aid, and the patients’ impression about it. The information obtained was analysed and compared with similar data from 39 hearing aid users of similar age with no history of ear surgery. Eighty per cent of the patients with a closed mastoid cavity were satisfied with the aid, and no significant difference was found between the two groups regarding the impression about the aid (chi square 3.06, p = 0.08), or the problems with it, which, in most of the cases, were related to several changes of mould (chi square 2.19, p = 0.13). The various recorded parameters are discussed, and it is concluded that the patients with a closed mastoid cavity can tolerate a hearing aid in the operated ear at least as well as the control subjects with no ear surgery.
Maxillary sinus barotrauma with fifth cranial nerve involvement
Authors: Murrison A. W. , Smith D. J. , Francis T. J. R. , Counter R. T.
Published: November 2007

A case of neurapraxia of the infraorbital nerve occurring as a result of maxillary sinus barotrauma in a diver is presented. Existing reports of a similar nature are reviewed and the pathogenesis of cranial nerve involvement in barotrauma is discussed. Guidelines for treatment are suggested.
latrogenic epidermoid cyst of the parotid region following ear surgery
Authors: Thompson A. C. , Bradley P. J.
Published: November 2007

Iatrogenic implantation of squamous epithelium may result in formation of an epidermoid cyst. These cysts have been described in various sites around the head and neck following otological procedures. A case of iatrogenic epidermal cyst in the parotid region following repeated myringoplasty is reported. The clinical features and differential diagnosis are discussed.
Experience of pulse oximetry in children with croup
Authors: Stoney P. J. , Chakrabarti M. K.
Published: November 2007

We report our experience with 199 patients requiring admission with a diagnosis of croup over an 18 month period. The value of using pulse oximetry to monitor these children was critically examined. Twenty-nine patients with clinically significant stridor were monitored for an average of 12 hours. There was poor correlation of clinical status and respiratory rate with hypoxia as shown by the technique, with frequent dips in oxygen saturation being caused by technical problems such as movement artefact. Pulse oximetry is a useful adjunct to the clinical assessment of croup, but cannot be relied upon solely for monitoring these labile patients.
Scanning electron microscopic study of nasopharyngeal carcinoma
Authors: Gulisano M. , Polli G. , Dallai S. , Altavilla E. , Pacini P.
Published: November 2007

The study has been carried out on biopsies taken from four patients affected by squamous cell carcinoma and four patients affected by undifferentiated carcinoma of nasopharyngeal type (UCNT). Three healthy volunteers have served as controls.

All the specimens have been studied by SEM. The neoplastic conditions cause obvious alterations both in the mucosal surface and in the morphology of the cellular apex.
Hazardous party trick (infolding of the pinna)
Authors: Hickey S. A. , Clarke P. M.
Published: November 2007

Two cases of habitual pinna folding are reported. One case was complicated by the development of bilateral haematoma auris as a direct result of the trauma caused by the folding.
Synchronous arytenoid and pancreatic neuroendocrine carcinoma
Authors: Laccourreye Ollivier , Chabardes Eric , Weinstein Gregory , Carnot Francoise , Brasnu Daniel , Laccourreye Henri
Published: November 2007

Neuroendocrine laryngeal carcinoid tumours are uncommon. The supraglottis is the main location of these tumours. Eighty-one cases have been reported in the world literature. We present the first case of a synchronous laryngeal and pancreatic neuroendocrine tumour.
Chloral hydrate and middle ear pressure
Authors: Abdul-Baqi Khader J.
Published: November 2007

Middle ear pressure and tympanic membrane compliance were measured in 34 infants and young children (66 ears) with normal middle ears under oral choral hydrate hypnosis. Tympanograms were performed before and 40 to 60 minutes after administration of the drug. Results showed that the middle ear pressure increased significantly in all cases and in both sexes. This increase ranged between +19 and +219 mm H2O. In all cases the pressure returned to its prehypnotic values after recovery. Results of tympanic membrane compliance showed significant increase in males and not significant decrease in females.
Peritonsillar abscess: Risk of disease in the remaining tonsil after unilateral tonsillectomy à chaud
Authors: SøRensen Jens Ahm , Godballe Christian , Andersen Niels Henrik , JøRgensen Karsten
Published: November 2007

The occurrence of disease in the remaining tonsil after unilateral tonsillectomy à chaudin the treatment of peritonsillar abscess, was studied in 536 patients. No patient had a history of previous severe tonsillitis at the time of the unilateral tonsillectomy, 6.1 per cent of the patients were readmitted for surgery of the remaining tonsil during the follow-up period. Ninety-seven per cent of these patients were younger than 30 years of age. Previous investigations have shown increasing frequency by age of pharyngitis after bilateral tonsillectomy. We suggest bilateral tonsillectomy in all cases of patients younger than 30 years old who suffer from peritonsillar abscess irrespective of previous tonsillar disease. Patients older than 30 should be treated with unilateral ablation, unless there is a clear indication for bilateral tonsillectomy.
Non-Hodgkin's lymphoma involving the tonsil: An immunohistochemical study
Authors: Watson M. G. , Crocker J.
Published: November 2007

Twenty-one patients with non-Hodgkin's lymphoma involving the palatine tonsil were studied in an attempt to relate pathological data to clinical outcome. Eleven tumours were classified as low-grade and ten as high-grade on morphological criteria. The results of immunohistochemical investigations are presented; all tumours but one were of B-cell origin. None of the pathological factors studied were found to be useful prognostic indicators.
Tegmental dehiscence and brain herniation into the middle ear cleft
Authors: Golding-Wood D. G. , Williams H. O. L. , Brookes G. B.
Published: November 2007

The tegmen tympani may occasionally be breached by herniation of the temporal lobe with or without dural cover. The clinical presentation may be obvious with CSF otorrhoea but less so with apparent middle ear effusion, CSF rhinnorrhoea, conductive hearing loss, recurrrent meningitis or intracranial sepsis. Diagnosis requires suspicion of the condition, which may be aided by radiological imaging. Surgical repair is to be recommended: various techniques are available but bone enveloped by fascia placed by subtemporal approach is preferred. The features of this problem are highlighted by four cases.
Bilateral parotid secondaries from primary bronchial carcinoid tumour
Authors: Dilkes Michael G. , Birchall Martin A.
Published: November 2007

Three years following a right lower lobectomy for primary carcinoid tumour of the bronchus, a patient presented with bilateral parotid masses. On investigation, both these were shown to be carcinoid tumours, consistent with metastatic spread from the primary bronchial tumour. This unique case is presented together with a discussion of the diagnostic methods employed.
Kikuchi's necrotising lymphadenitis
Authors: Fairley James W. , Cross Simon , Shaw John D. , Glover Garry W. , Bennett Michael H.
Published: November 2007

Three cases of Kikuchi's necrotizing lymphadenitiswithout granulocytic infiltration presented to the ENT department as cervical lymphadenopathy with neutropaenia. Differential diagnosis from malignant lymphoma was difficult both clinically and histopathologically. Two recovered spontaneously without treatment within three months, one improved initially but was lost to follow-up after one month.
Secretory IgA- and IgG-coated bacteria in chronically discharging ears
Authors: Stenfors Lars-Eric , Räisänen Simo
Published: November 2007

SIgA- and IgG-coated bacteria obtained from 17 discharging middle ears (14 patients, 9 male, 5 female, age range from 1 to 79 years) were evaluated using an immunofluorescence assay. Simultaneously, quantitative and qualitative bacteriological analyses of the middle ear effusions (MEEs) were performed. MEEs containingStaphylococcus aureusharboured bacteria which were intensely coated with both SIgA and IgG antibodies. In contrast, MEEs containingPseudomonas aeruginosadisplayed minimal, if any, SIgA- and IgG-coated bacteria. Two young patients harboured bacteria (Haemophilus influenzae and S. aureus/Streptococcus pneumoniae, respectively) which were heavily coated with IgG, but not with SIgA. Immunoglobulin-coating of bacteria involved in otitis media is of the utmost importance in eradication of the infection.
Anatomy of the temporalis fascia
Authors: Wormald P. J. , Alun-Jones T.
Published: November 2007

The anatomy of the different layers of the temporalis fascia is reviewed. The superficial and deep layers of the temporalis fascia have been studied by light microscopy to assess any histological difference between the two. We have also assessed the physical characteristics of the different layers by measuring their Young's modulus in the wet and dry states.

Anatomically the superficial layer is part of the epicranial aponeurosis and thus covers nearly the entire lateral aspect of the skull. The deep temporal fascial layer covers exactly the temporalis muscle and measures 10 × 12 cm. The fascial layers have a separate arterial and venous supply enabling them to be used as a homograft, a rotation flap or free microvascular flap. Histologically there is no difference between the two layers. A study of the physical characteristics of the two fascial layers using Young's modulus revealed no significant difference in elasticity between the two. The most significant factor affecting the elasticity was the state of hydration of the fascia.
Interpretation of maxillary sinus radiographs in children
Authors: Sherman I. W. , Phillips D. E. , Bowdler D. A. , Jones A. S.
Published: November 2007

Nasal symptoms are a frequent cause of referral to paediatric ENT clinics. It is the policy of our unit to view sinus radiographs without a report at the initial clinic attendance. This study demonstrates there is no statistically significant difference in the interpretation of the radiographs between two ENT surgeons and a radiologist although there was a tendency for the radiologist to have a greater specificity. This finding may have financial implications. In addition a clear sinus radiograph is shown to be a significant negative finding.
Submucous resection of the nasal septum as an outpatient procedure
Authors: Buckley J. G. , Mitchell D. B. , Hickey S. A. , O'Connor A. F. Fitzgerald
Published: November 2007

We report our experience of submucous resection of the nasal septum under local anaesthesia as an outpatient procedure. We have audited 50 consecutive cases and compared the results with a similar group of patients in whom the operation was carried out in the usual way under general anaesthesia. We have found the procedure to be safe, effective and economically advantageous.
Angiofibromas of the postnasal space: A critical appraisal of various therapeutic modalities
Authors: Mishra S. C. , Shukla G. K. , Bhatia Naresh , Pant M. C.
Published: November 2007

Angiofibromas of the postnasal space are an enigma to the treating surgeon in view of their extensions around the skull base. The availability of modern investigative procedures has to some extent facilitated the decision making process in choosing a suitable surgical approach.

Proper tumour staging and the earliest and widest possible exposure tailored to the needs of the specific situation together with adequate blood replacement is the key to success in minimizing the chances of the recurrence.

The present study aims at an evaluation of the methodology adopted in 100 serial cases of angiofibromas of the postnasal space. After initial surgery, a further 31 procedures were needed for the management of recurrences.
Malakoplakia of the temporal bone in a nine-month-old infant
Authors: Nayar R. C. , Garg I. , Alapatt J. J.
Published: November 2007

A case of malakoplakia, of the temporal bone in a nine-month-old male child is reported.

The lesion presented as an aural polyp, associated with a lower motor neuron facial palsy. On exploration, the granuloma was noted to involve the temporal bone, eroding the bony labyrinth. It was successfully treated with surgical debridement, and antibiotics. A review of the relevant literature is presented.
Meningitis from caninePasteurella multocidafollowing mastoidectomy
Authors: Dammeijer P. F. , McCombe A. W.
Published: November 2007

A case ofPasteurella multocidameningitis, following a mastoidectomy is presented. The association of close contact with pets, many of which harbourPasteurella multocidaas part of their normal buccal flora. This case confirms the potential benefit of taking an ear swab prior to mastoid surgery and in seeking an appropriate ‘pet’ history.
Nasal haemangiopericytoma
Authors: Osammor J. Y. , Howat A. J.
Published: November 2007

Haemangiopericytoma is an uncommon vascular tumour frequently diagnosed with difficulty. The immunohistochemical findings of strong positivity to vimentin together with other diagnostic features (histological and ultrastructural) improves the certainty of its diagnosis. We report a case arising in the nose and outline diagnostic problems especially relating to histopathology.
Subtraction magnetic resonance for tumours of the skull base and sinuses: a new imaging technique
Authors: Lloyd G. A. S. , Barker P. B.
Published: November 2007

A new imaging technique is described, in which photographic subtraction as practised in angiography, is combined with Gadolinium enhanced Magnetic Resonance (GdMR)imaging and applied to the investigation of the paranasal sinuses and skull base. The densities on the subtraction image are dependent upon the blood supply of the tissues examined, thus producing a record of their vascularity: in effect a vasculogram. The method has proved to be technically feasible, and is advantageousin certain situations, particularly those in which the anatomy is complex as in theskull base or where normal structures havebeen distorted by previous surgery. The technique provides a more accurate record of tumour extent than that shown on unsubstracted GdMR scans.
Sudden total deafness in sickle cell disease
Authors: O'Keeffe L. J. , Maw A. R.
Published: November 2007

Sickle cell disease is a world-wide problem which has been noted to cause high tone sensorineural hearing loss. We report a case with sudden onset bilateral hearingloss which progressed to total sensorineural deafness. To our knowledge there has been noreport of such a case occurring previously.
Craniofacial fibrous dysplasia
Authors: Camilleri A. E.
Published: November 2007

Fibrous dysplasia is a benign localized bone disorder of unknown aetiologyin which endocrinopathies, abnormal pigmentation of the skin and mucous membranes may formpart of the disease. Five cases involving the facial and cranial bones are described to illustrate the various presentations and radiological appearances including computerized tomography and magnetic resonance imaging. Some of these cases demonstrate that serial radiology may be adequate for diagnosis and management without the necessity for histological confirmation. The place of limited surgical treatment for the craniofacial sites is debated.
Plunging ranula following bilateral submandibular duct transposition
Authors: Balakrishnan A. , Ford G. R. , Bailey C. M.
Published: November 2007

Submandibular duct transposition is now a standard surgical procedure for the treatment of severe drooling. However, this is our first experience of a plunging ranula arising as a complication of the technique. In the surgical management of this complication, the single most important step is excision of the sublingual gland to prevent recurrence.
Extraskeletal myxoid chondrosarcoma of the maxillary sinus
Authors: Jawad J. , Lang J. , Leader M. , Keane T.
Published: November 2007

A case of extraskeletal myxoid chondrosarcoma of the maxillary sinus in a 45-year-old man is reported and discussed. This is the first report of this tumour in thissite.
Adenosquamous carcinoma of the hypopharynx
Authors: Sanderson R. J. , Rivron R. P. , Wallace W. A.
Published: November 2007

A rare case of adenosquamous carcinoma of the hypophraynx is presented. The importance of primary surgical treatment is emphasised.
Inhalation of dental plates—A hazard of radiolucent materials
Authors: Knowles J. E. A.
Published: November 2007

Many dental plates are made of materials that are radiolucent. If inhaled or swallowed they may be difficult to detect and where there is strong suspicion of inhalation, early bronchoscopy should be carried out even if plain X-rays show no abnormality. The details of three patients are reported.
Medullary (thyroid) carcinoma-like carcinoids of the larynx
Authors: El-Naggar Adel K. , Batsakis John G. , Vassilopoulou-Sellin Rena , Ordonez Nelson G. , Luna Mario A
Published: November 2007

The histopathological spectrum of neuroendocrine neoplasms of the larynx includes a subset that may be indistinguishable from a medullary carcinoma of the thyroid gland. For a patient who presents with a medullary carcinoma-like metastasis in a cervicallymph node and in whom there is no clinically demonstrable thyroid lesion, a laryngeal atypical carcinoid must be excluded. The literature's third example ofa primary medullary carcinoma-like atypical carcinoid of the larynx is presented.
CT and MR imaging in lateral sinus thrombosis
Authors: Irving R. M. , Jones N. S. , Hall-Craggs M. A. , Kendall B.
Published: November 2007

Abstact

Establishing a pre-operative diagnosis of lateral sinus thrombosis can be difficult, as the clinical features are non-specific and laboratory tests unhelpful. CT maydemonstrate abnormal high density of the lumen of the sinus, which does not enhance afterintravenous contrast medium. Enhancement of the dura surrounding the sinus may be prominent, causing the ‘empty triangle’ or ‘delta sign’ which may suggest the diagnosis. Magnetic resonance (MR) imaging may show both lack of flow and abnormal signal from the sinus, thus providing definitive evidence of thrombosis.
Cytomegalovirus ulceration of the oropharynx
Authors: French P. D. , Birchall M. A. , Harris J. R. W.
Published: November 2007

Cytomegalovirus (CMV) is a common opportunistic infection in both iatrogenic and HIV-induced immunosuppression. The usual sites of involvement are the gastro-intestinal tract, retina and lung. We present three cases of CMV ulceration of the oropharynx. All three patients presented with symptoms localized to the oropharynx and in each case the diagnosis was only made on histological examination of ulcer biopsy specimens. The patients all responded well to ganciclovir treatment and at writing none have required maintenance therapy (7–11 months post diagnosis).
Tracheo-oesophageal puncture without tears: the forceps technique
Authors: Rhŷs Evans Peter H.
Published: November 2007

Certain problems have been encountered using a rigid endoscopic technique for tracheo-oesophageal puncture in voice restoration following laryngectomy. An alternative method is described using a modified curved abdominal forceps which allows quicker and more predictable access to the puncture site.
Tracheo-oesophageal puncture: a review of problems and complications
Authors: Garth R. J. N. , McRae A. , Evans P. H. Rhŷs
Published: November 2007

Tracheo-oesophageal puncture now has a well established role and in several units is now the principal means of speech rehabilitation following laryngectomy. Although not a difficult procedure, there are a number of problems and complications that may be encountered. With proper management these can usually be overcome and a useful voice achieved.

This study looks at those problems in a series of 119 patients and discusses their management.
Bezold's abscess
Authors: Gaffney R. J. , O'Dwyer T. P. , Maguire A. J.
Published: November 2007

Since the introduction of antibiotics for the treatment of suppurative otitis media the incidence of complications from this disease has been greatly diminished. Acute mastoiditis, resulting in the deep neck abscess known as Bezold's abscess, has become very rare. A case of Bezold's abscess is presented with special reference to the clinical presentation and pathogenesis of this now uncommon condition. The variations in the routes of spread of the abscess in the fascial planes of the neck are described in detail. The difference between what is known today as a Bezold's abscess and the abscess that Bezold described in the early part of this century are presented.
Parapharyngeal (retrostyloid)—third branchial cleft cyst
Authors: Ostfeld E. J. , Wiesel J. M. , Rabinson S. , Auslander L.
Published: November 2007

This is the first description of successful surgical excision of a parapharyngeal (retrostyloid compartment) cyst remnant of the third branchial arch.
Can meta-analysis help uncertainty in surgery for otitis media in children
Authors: Bodner Elizabeth E. , Browning George G. , Chalmers Frances T. , Chalmers Thomas C.
Published: November 2007

While otitis media is perhaps the most common disease of childhood that receives medical attention, there is little agreement concerning the efficacy of the medical and surgical therapies employed to try to alleviate its symptoms or hasten its natural resolution. Because various surgeries including adenoidectomy, myringotomy, and insertion of tympanostomy tubes are frequently involved in the treatment of otitis media with effusion (OME), it is likely the most expensive condition being managed in national terms.

In an attempt to elucidate the most appropriate management of this condition, a meta-analysis was attempted to the 12 randomized control trials of surgical treatments for OME in children, published between 1966 and 1990. Heterogeneity both in the populations and comparisons studied and in the out comes presented made meta-analysis an inappropriate method for clarifying this area of clinical uncertainty. Important elements in the design of randomized control trials that should be included in future studies of treatment for OME are therefore discussed.