bluuebunny/crossref_metadata_2025 huggingface dataset:
Sensory interaction testing in platform posturography
Authors: Norré Marcel E.
Published: November 2007

Mostly techniques measuring the vestibulo-ocular reflex (VOR) have been used for the evaluation of patients with dizziness problems. Some investigators, however, have also tried to take into account the vestibulospinal reflex (VSR). So recording techniques for the Romberg-test have been proposed and called posturography (PG). By interfering with the visual and proprioceptive sensory inputs during this PG-testing one tries to find out how ‘sensory interaction’ is organized in the balance performance of the patient examined. To interfere with vision, closure of the eyes has been commonly used and to interfere with proprioception, the patient can be put on foam-rubber, which makes the contribution of the foot-ankle proprioception less adequate. These interferences are applied once separately and once combined. The degree of ‘abnormality’ is assessed by a score-system for parameters surface (S) and velocity (V), which measure the postural sway. A comparison of tests with and without influence on the sensory inputs gives an idea of the sensory interaction. Patients with peripheral vestibular disorders were examined: patients with BPPV, with spontaneous vertigo attacks and with a sudden vestibular deficit.

When applying this evaluation technique different formulae or patterns can be found. Firstly complete normal evaluation, which means that there is no influence of the vestibular disturbance upon the PG results. Secondly a normal balance when using all available sensory information, but disturbed balance as soon as one of the sensory inputs is influenced by the test conditions. Thirdly striking destabilization when closing the eyes. Fourthly striking destabilization when misleading the ankle and foot proprioceptor. Fifthly a combined effect, when the vestibular input is the only one not influenced by the test conditions and sixthly no specific effect, no complementary compensatory effect of this sensory interaction.

In the group of patients with peripheral vestibular disorders, no special pattern linked to a peripheral syndrome could be found. Not only in the acute stage could abnormal PG be found: in fact, PG provides ‘functional’ data, which are complementary to the ‘classical’ evaluation and subdivide the patients into other sub-categories. The sensory interaction testing points to some conditions where balance will be more inclined to be troubled.
Distribution of SP- and CGRP-immunoreactivity in the cat's larynx
Authors: Tanaka Yasumasa , Yoshida Yoshikazu , Hirano Minoru , Morimoto Masatoshi , Kanaseki Takeshi
Published: November 2007

The distribution of substance P (SP) and calcitonin gene-related peptide (CGRP) immunoreactive (ir) fibres in the cat's larynx was investigated utilizing immunohistochemistry. Many SP- and CGRP-ir fibres with varicosities were found within and below the epithelium and along the basement membrane of the mucosa of all different regions except in the membranous portion of the vocal fold. In the subepithelium, some SP- and CGRP-ir nerve bundles and nerve fibres were recognized around the vessels and glands. In the mucosa, the pattern of distribution and the density of SR-ir fibres were similar to those of CGRP-ir fibres. These reactive fibres were denser in the supraglottic region than in the subglottic region. In the taste bud-like structures, only SP-ir fibres appeared, whereas in the motor endplates, CGRP-reaction was found exclusively. The present findings suggest that the regional distribution of SP- and CGRP-immunoreactivity might be related with sensory and autonomic innervation in the larynx.
The relationship between SIgA and chronic granular pharyngitis
Authors: Li Youzhu
Published: November 2007

A survey of the SIgA content in saliva, serum and pharyngeal mucosa with lymphoid tissue (PMLT) of chronic granular pharyngitis patients was conducted by a double antibody PEG radio-immune method. These data were compared with those from a healthy control group. Result shows that SIgA in patients with chronic granular pharyngitis had dissociation of saliva, serum and PMLY. There was low salivary SIgA level but higher levels in serum and PMLT. These data suggest that the saliva and serum immunoglobulin pools are under separate regulation.
The globus syndrome: value of flexible endoscopy of the upper gastrointestinal tract
Authors: Lorenz Reinhard , Jorysz Gabriele , Clasen Meinihard
Published: November 2007

Flexible endoscopy of the upper gastrointestinal tract usually does not form part of the primary diagnostic evaluation of the globus syndrome. In a prospective trial, a flexible endoscopy was performed in 51 globus patients with normal results of the laryngologic and radiographic examination. Pathologic findings requiring therapy were diagnosed in 70.6 per cent of cases. The most frequent findings were reflux oesophagitis (n = 24; 47 per cent) and hiatial hernia (n = 25; 49 per cent). In 16 cases (31,4 per cent) these were accompanied by other pathologic lesions. A total of 32 patients (62.7 per cent) suffered from oesophageal diseases as sole aetiologic factors of the globus syndrome, which led us to postulate a causative relationship in these cases. Flexible endoscopy therefore can contribute significantly to the differential diagnosis of the globus syndrome. It must be kept in mind, however, that there is a ‘blind zone’ for endoscopic assessment in a region of the hypopharynx, thus some indications may require rigid endoscopy.
Mycobacterial infection of the parotid gland: an unusual cause of parotid swelling
Authors: O'Connell Janet E. , George M. K. , Speculand B. , Pahor A. L.
Published: November 2007

Six cases of mycobacterial infection of the parotid gland are reviewed. All six cases presented solely with a slowly enlarging parotid swelling clinically indistinguishable from a parotid tumour. All of the swellings required surgical removal, superficial parotidectomy in four cases, and enucleation in two cases to obtain a definitive diagnosis.
Laryngeal imaging by computerized tomography and magnetic resonance following radiation therapy: a need for caution
Authors: Briggs R. J. S. , Gallimore A. P. , Howard D. J.
Published: November 2007

For patients with laryngeal tumours, the use of computerized tomography (CT) or magnetic resonance imaging (MR) may facilitate accurate staging by the demonstration of cartilage invasion or tumour extension to areas such as the pre-epiglottic space. The role of imaging in the follow-up of patients after radiotherapy, however, has not been examined. A prospective study of 18 patients undergoing laryngectomy was performed. The results of pre-operative CT and MR imaging were correlated with the pathological findings from whole organ axial sections of the laryngeal specimens. In five patients (28 per cent) both CT and MR images were significantly impaired by movement artefact. In the eight patients without previous radiotherapy, seven had adequate quality imaging and both CT and MR accurately demonstrated the site, size and extent of laryngeal tumour. In eight of the ten patients following radiation therapy the presence of tumour was correctly identified, however there was a poor correlation between the imaging and pathological findings. Two patients had radionecrosis alone. Neither CT nor MR imaging could differentiate between radionecrosis and recurrent tumour.
The treatment of primary recurrence following laryngectomy for laryngeal carcinoma
Authors: Jones A. S. , Ravi M. , Stell P. M.
Published: November 2007

Of the 397 patients undergoing total laryngectomy for squamous cell carcinoma by Professor P. M. Stell between 1963 and 1991,73 are known to have suffered a local recurrence. Of these, 17 were treated by radiotherapy and/or further surgery. Secondary surgery was reserved for selected cases of peristomal and pharyngeal recurrence: of the 35 peristomal recurrences, eight were treated surgically. Previous reports of recurrence after total laryngectomy have focused on the problem of peristomal recurrence. Patients with pharyngeal recurrences can also be treated satisfactorily with microvascular surgical reconstruction techniques. Though rarely curative, secondary total pharyngectomy can be highly palliative and results in little additional morbidity.
Cervical lymphadenopathy due to mycobacterial infection: a diagnostic protocol
Authors: Davis J. P. , Prinsley P. R. , Robinson P. J.
Published: November 2007

Mycobacterial cervical lymphadenopathy is relatively uncommon in the United Kingdom; when cases do occur opportunities for early diagnosis and treatment may be missed. We have reviewed twenty-three cases of mycobacterial cervical lymphadenopathy presenting to an urban general hospital over a four-year period. We discuss the techniques available to aid a diagnosis of mycobacterial disease and suggest a protocol to allow efficient use of these techniques.
Eye protection in ear, nose and throat surgery
Authors: Prior A. J. , Montgomery P. Q. , Srinivasan V.
Published: November 2007

The aim of this study was to quantify the risk of blood splashes to the conjunctiva during ear, nose and throat surgery. Two hundred and sixty consecutive operations by three surgeons were assessed for contamination of safety glasses and other factors. We found that 15 per cent of operations resulted in blood droplet contamination of safety glasses. In 92 per cent of these, contaminations were on the exterior of the glasses and eight per cent were on both sides. We concluded that about one and a half per cent of operations would result in droplet contamination of the conjunctiva and that safety spectacles reduced the risk by a factor of about 10. This study generally concurs with that of previous research in the areas of general and orthopaedic surgery and necropsies. We substantiate the need for eye protection for all ear, nose and throat procedures. Spectacles do provide a reasonable degree of protection but where absolute protection is needed i.e. in high risk groups, goggles should be used in preference to safety spectacles
A variation of first branchial cleft anomalies
Authors: Violaris N. S. , Pahor A. L.
Published: November 2007

First branchial cleft anomalies are considered to be duplications of the external auditory meatus (EAM) and pinna with a sinus that runs parallel to the EAM (Type 1) or with a sinus that runs from an opening in the neck and ends blindly near the cartilaginous EAM (Type 2). In this paper we discuss a young patient that presented with an infected sinus that did not resemble either of the two known types of first branchial cleft anomalies.
Prostatic metastases in the nose and paranasal sinuses
Authors: Saleh H. A. , O'Flynn P. , Jones N. S.
Published: November 2007

Prostatic metastases in the nose and paranasal sinsuses are rare. Seven cases have previously been reported in the world literature. We describe the clinical presentation of a patient with prostatic metastases and the use of prostate specific antigen in confirming the diagnosis. We also review the literature about metasases involving the nose and paranasal sinuses.
Sensorineural hearing loss in sickle cell anaemia – a United Kingdom study
Authors: Ajulo S. O. , Osiname A. I. , Myatt H. M.
Published: November 2007

Sensorineural hearing loss (SNHL) has been a well-documented complication of sickle cell disease in the literature from West Africa, West Indies, United States of America and the Middle East. We present a study of 52 patients with homozygous sickle cell disease and 36 control patients with haemoglobin genotype AA, matched for age and sex. Seven patients with sickle cell disease (13.5 per cent) were found to have sensorineural hearing loss i.e.>20 dB at two or more frequencies, while all the patients in the control group had normal hearing (p<0.05).

Our study shows the incidence of SNHL in the UK to be similar to that reported in the US A and much lower than that found in malaria endemic areas of the tropics.

We highlight the factors which we consider responsible for these differences and suggest that the crucial period in the development of SNHL in sickle cell disease may be intra-uterine or during the first few years of life. All sickle cell patients should be encouraged to have regular hearing assessment.
Posterior crus stapedectomy
Authors: Vartiainen Eero , Nuutinen Juhani , Karjalainen Seppo , Pellinen Pentti
Published: November 2007

The results of stapedectomy were compared between 162 otosclerotic ears operated on using the posterior crus technique and 182 otosclerotic ears undergoing Teflon piston stapedectomy. The large fenestra technique with fascia seal to the oval window was used in all cases. Mean follow-up period was 9.6 years. Neither short- nor long-term hearing results showed any significant differences between the two surgical technique groups. Complications of surgery were more common in patients undergoing Teflon piston stapedectomy. On the other hand, a re-operation for recurring conductive deafness was performed significantly more often in patients undergoing posterior crus stapedectomy.
Malignant melanoma of the ear
Authors: Davidsson Åke , Hellquist Henrik B. , Villman Kenneth , Westman Gunnar
Published: November 2007

This paper reports on 16 cases of primary malignant melanoma of the external ear and the patients were followed up for two to 116 months. Fourteen patients had surgical excision with wide margins as initial treatment, whilst two had an amputation performed. Eleven patients had no recurrences, two died of other diseases, and four died of malignant melanoma. The five patients who developed recurrences received further surgery and two also radiotherapy.

Seven of the cases were histologically of the nodular type, six were superficial spreading, two were in situ melanoma, and one was a lentigo maligna. The thickness ranged from 0.15 to 11.5 mm. Classification according to Clark et al. (1969) revaled that as many as nine cases were Clark level IV or more. Immunostaining with PCNA yielded strong positivity in all cases, however, statistical analysis did not reveal any differences that could be correlated to the prognosis. Estimation of the vascularization at the base of the tumours by means of immunostaining with CD31 did not reveal any significant differences either.

We concluded that in our material the thickness of the tumour is of greater prognostic value than the estimation of proliferation by PCNA and vascularization by CD31. The value of PCNA and CD31 as possible prognostic parameters needs to be evaluated in a larger series. It is emphasized that malignant melanoma of the external ear is a highly malignant tumour, and that four of our 16 patients died of their disease, three of them within a year after diagnosis. Malignant melanoma of the external ear is readily inspected and thereby an early diagnosis should be possible.
Medical therapy of rhinosporidiosis with dapsone
Authors: Job Anand , Venkateswaran Sarada , Mathan Minnie , Krishnaswami Hemalatha , Raman Rajagopal
Published: November 2007

Clinical, histopathological and ultrastmctural studies in three cases of rhinosporidiosis show complete remission of infection within one year of therapy with dapsone. Light and electron microscope studies confirmed arrest of the maturation of the spores and accentuated granulomatous response with fibrosis following dapsone therapy.
Near-total laryngopharyngectomy with pectoralis major myocutaneous flap in advanced pyriform carcinoma
Authors: Su Chih-Ying , Hwang Chung-Feng
Published: November 2007

Successful restoration of phonation, as well as swallowing in laryngopharyngeal surgery for patients with advanced pyriform carcinoma still remains a major challenge. In a five-year period, near-total laryngectomy perations were performed on 21 patients with laryngopharyngeal carcinoma. This report particularly emphasizes the value of near-total laryngopharyngectomy with a pectoralis major myocutaneous flap for four extensive hypopharyngeal carcinoma cases (three of which were of pyriform origin). All four patients regained intelligible shunt speech and smooth swallowing. The follow-up period ranged from 19 to 44 months. They ave had no recurrence of disease since surgery.

The authors suggest that an advanced pyriform carcinoma case, with a normal contralateral hemilarynx and pyriform sinus, is a candidate for a near-total excision of the laryngopharynx.
Palpation compared with ultrasound in the assessment of malignant cervical lymph nodes
Authors: John D. G. , Rhys Williams S. , Ahuja A. , Evans R. , To K. F. , King W. W. K. , Van Hasselt C. A.
Published: November 2007

This prospective study compares the results of pre-operative clinical examination and simple ultrasound examination of the neck in 18 patients with proven head and neck primary tumours and palpable cervical lymphadenopathy, who then underwent 21 radical neck dissections. Neck palpation and ultrasound examination were compared with histological examination. Ultrasound did not add significantly to the information obtainable by simple neck palpation in this group of patients.
Otorhinolaryngological diseases in the minoan era
Authors: Velegrakis George , Skoulakis Charalambos , Bizakis John , Segas John , Helidonis Emmanuel
Published: November 2007

Minoan civilization was one of the civilizations of the past and flourished in the island of Crete between the years 2600 B.C. and 1100 B.C. Archaeological excavations brought to the light buildings and items, showing that the Minoans had an extensive knowledge about hygiene and health matters.

Among the items were idols, depicting anatomical parts of the human body and different pathological changes. These idols were offered by suffering people to gods and goddesses in order to beg for their help in curing them.

In a study carried out on idols kept in the Heraklion Museum, a number of interesting anatomical details and pathological changes, concerning the head and neck area were recognized.
CGRP-immunoreactive cells supplying laryngeal sensory nerve fibres in the cat's nodose ganglion
Authors: Tanaka Yasumusa , Yoshida Yoshikazu , Hirano Minoru
Published: November 2007

Through a combination of retrograde staining by wheat germ agglutinin (WGA) and immunohistochemistry, calcitonin gene-related peptide (CGRP)-reactive sensory neurons projecting from the laryngeal mucosa were detected in the feline nodose ganglion. The size of the CGRP-immunoreactive cell which was regarded as a laryngeal sensory neuron, was about 60 ±m in diameter: the shape of the immunoreactive laryngeal sensory neuron was unipolar. CGRP-reacted laryngeal sensory cells were found in the rostral part of the nodose ganglion extending to the middle part. They aggregated in the most rostral part, were sparse in other parts and were approximately 50 per cent of WGA-reactive laryngeal sensory neurons in number. Our results suggest that this neurotransmitter might play an important role in laryngeal peripheral sensory innervation.
Recurrent meningitis due to a congenital fistula of the stapedial footplate
Authors: Kaddour H. S.
Published: November 2007

A rare case of a congenital fistula of the stapes footplate, in a 10-year-old girl, resulting in recurrent meningitis, is reported. A full ENT examination and a high index of suspicion, is essential if the diagnosis is to be made.

Exploratory tympanotomy should be considered on clinical grounds, even if a high resolution CT scan of the temporal bones does not show any anomalies, in order to ascertain the definite diagnosis of a fistula and to seal it permanently.
Twelve cases of glottic carcinoma in situ treated by radiotheraphy: an observation on clinical course versus response
Authors: Brooks J. P. , Morgan D. W. , Glaholm J.
Published: November 2007

Carcinoma in Situ (CIS) of the glottis is an uncommon and poorly understood condition with few, large, long- term studies. Twelve cases are presented which were treated with radiotherapy. At three-year follow-up all the patients are disease free and in 83 per cent the mucosa has returned to normal. The alternative methods of treatment are discussed.
Trismus in patients with malignant tumours in the head and neck
Authors: Ichimura Keitchi , Tanaka Toshlyoshi
Published: November 2007

In order to elucidate the causal mechanism of trismus in head and neck cancer, 21 patients manifesting trismus out of 212 patients with malignant tumours in the head and neck (treated in Tokyo University Branch Hospital from 1983 to 1991) were reviewed. Nine patients developed trismus either by infiltration of the muscles of mastication or by reflex spasm. Trismus was considered to have developed as a result of irradiation in five cases and of surgical intervention in seven cases. In some cases of oropharyngeal cancer, CT revealed no evidence of tumour invasion into the infratemporal fossa when trismus occurred, suggesting that trismus was caused either by the reflex spasm of muscles or by microinvasion too small to be seen in CT films. Maxillary sinus tumours were often without tnsmus even when they extended posteriorly to the infratemporal fossa.
Conchal flap meatoplasty
Authors: Martin-Hirsch D. P. , Smelt G. J. C.
Published: November 2007

A meatoplasty technique is described which has proved successful in the treatment of chronic otitis externa. The procedure opens the superficial meatus by eliminating the sharp rim at the junction of the conchal bowl and the posterior canal wall cartilage; thinning the skin and increasing the circumference of the external auditory orifice.
Primary tracheal tuberculosis in an otherwise healthy 65-year-old Caucasian woman
Authors: Dilkes M. G. , Gautama P. , Knowles C. H. , Chevretton E. B.
Published: November 2007

We report a case of primary tracheal tuberculosis that presented with a hard, fixed lymph node in the right supraclavicular fossa, and progressive dysphagia due to an inflammatory mass caused by a tuberculous lesion in the trachea. This case underlines the old adage that tuberculosis is ‘the great masquerader”.
Dysphagia caused by a foreign body in the thyroid
Authors: Chowohury C. R. , Bennett J. D. C.
Published: November 2007

A case is described where neck pain of unknown origin associated with dysphagia was found to be caused by a foreign body in the thyroid gland.
Pressure exerted by head bandages used in otological surgery
Authors: Hill J. , Allans W. , Malhan D. , Williams E. D.
Published: November 2007

he pressure exerted by head bandages at the operation site following ear surgery was measured using a balloon catheter and pressure transducer. The initial pressures achieved, their diminution with time and the relationship of pressure to the induction of headache in the patient were studied.

The principal findings were that the standard otological head bandage is rarely tight enough to prevent haematoma formation, bandages have lost their efficacy after the first hour and headaches are associated with a significantly higher initial bandage pressure.
Observer variations in the evaluation of facial nerve function after acoustic neuroma surgery
Authors: Buchwald Christian , Tos Mirko , Thomsen Jens , MØller Henrik , Parving Agnete
Published: November 2007

This investigation was performed in order to evaluate the observer variations in facial nerve function after surgery for an acoustic neuroma. From 1976–90, 507 patients were operated on by the same surgical team (M.T. and J.T.) using a translabyrinthine approach. One hundred and forty-four patients living in Copenhagen City and County were invited for interview and objective examination. Only 128 patients attended the interview and examination which were carried out by the same ENT physician. Data concerning observation of the facial nerve function only is presented. Its function was clinically evaluated (using the House and Brackmann (1985) grading scale) by two different observers i.e the ENT physician and one of the surgeons. The patients were asked face-to-face with the ENT physician to estimate the degree of facial nerve function according to a 0–100 per cent scale. Comparing normal and abolished facial nerve function the judgments of the ENT physician and the surgeon agreed with the patient‘s own evaluation.
Extra-pharyngeal neck pathology complicating pharyngeal pouch surgery
Authors: Shotton J. C. , Russell G. A. , Cathrine M. Milton , Sergeant R. J.
Published: November 2007

One case each of: (1) low grade thyroid lymphoma; (2) supraclavicular and para-oesophageal metastasis of a uterine adenocarcinoma; and (3) recurrent multinodular goitre have been encountered in very intimate relationship with the neck of a pharyngeal pouch within the tracheo-oesophageal gutter raising the possibility that the two conditions were interrelated. The practical importance of these cases is that a surgeon excising a pouch from the neck ought to be able to resect a thyroid lobe should it prove necessary, and occasionally endoscopic diverticulotomy is the only reasonable option.
Cervicofacial actinomycosis: an unusual cause of submandibular swelling
Authors: Gaffney R. J. , Walsh M. A.
Published: November 2007

Two cases of cervicofacial actinomycosis, resulting in submandibular swelling, are presented. How actinomycosis may present under the guise of malignancy is well demonstrated.

Factors predisposing to the condition, difficulties with diagnosis, isolation methods of the causative organism and treatment of the disease, are discussed.
Temporomandibular joint capsule prolapse: a technique of repair using autograft cartilage
Authors: Saeed Shakeel R. , Saeed Nadeem R. , Brookes Gerald B.
Published: November 2007

Loss of bony integrity of the temporomandibular joint may result in prolapse of the joint capsule into the external auditory canal. This in turn gives rise to arthralgia, trismus and earache and a risk of septic arthritis.

We describe a technique of repair which is simple, uses autologous tissue and has an acceptable cosmetic and functional result.
Spontaneous regression of a symptomatic laryngopyocoele
Authors: Sütay Semih , Guneri E. Alpin , Gunbay M. Ufuk
Published: November 2007

A laryngopyocoele is a rarely encountered neck mass which may cause respiratory obstruction. Spontaneous regression of an established symptomatic laryngopyocoele is an even more unusual situation, since most of the reported cases require immediate intervention for impending airway obstruction. A case of a laryngopyocoele showing spontaneous regression after antibiotic therapy is presented and the clinical aspects are reviewed.
A common carotid artery aneurysm causing severe dysphagia
Authors: Rowe J. G. , Hosni A. A.
Published: November 2007

Extracranial carotid artery aneurysms are rare, but are occasionally recognized as causing dysphagia. These aneurysms generally occur at or above the bifurcation. Here we present what we believe is a unique case: a common carotid artery aneurysm compressing the upper oesophagus, and mimicking the obstruction of a post-cricoid carcinoma.
Evidence for thyroid development from the fourth branchial pouch
Authors: Ohri A. K. , Ohri S. K. , Singh M. P.
Published: November 2007

Fourth branchial pouch anomalies are rarely reported. A case is described of an isolated branchial cyst which was found to contain ectopic thyroid tissue. This case, together with four others previously reported, support the theory that the thyroid gland may receive contributions from the fourth branchial pouch during development.
Scleroma of the lower respiratory tract: case report and review of literature
Authors: Alfaro-Monge J. M. , Fernandez-Espinosa J. , Soda-Merhy A.
Published: November 2007

The case of a 46-year-old man who presented with acute respiratory distress due to a tracheal mass is reported. The patient underwent endoscopic resection of the mass and the histopathology revealed scleroma. No other sites of involvement by scleroma were found. This case is reported because laryngotracheal involvement by scleroma as the only manifestation of this disease is extremely rare.
Prostatic adenocarcinoma metastatic to the palatine tonsil: a case report
Authors: Millar Ewan K. A. , Jones Richard Vaughan , Lang Stephen
Published: November 2007

A case of prostatic adenocarcinoma presenting with dysphagia due to a tonsillar metastasis is described. Details of the clinical history, histopathological and autopsy findings are presented. A review of the literature suggests that this is only the second description of such an occurrence.
Vocal fold palsy: a re-evaluation of investigations
Authors: MacGregor F. B. , Roberts D. N. , Howard D. J. , Phelps P. D.
Published: November 2007

With easier access to more sophisticated imaging techniques, the investigation of vocal fold palsy is reassessed. A questionnaire was sent to all ENT surgeons in the UK to establish which imaging techniques are available to ENT departments and which tests are currently requested during the investigation of vocal fold palsy.

An extensive literature review established the aetiology of vocal fold palsy and the sensitivity and specificity of radiological investigations.

A simple protocol is proposed which would be suitable to implement in the majority of ENT departments in the UK.
Improvement in hand-held CO2 laser safety
Authors: Martin-Hirsch D. P. , Smelt G. J. C.
Published: November 2007

A modification of the CO2 laser hand-piece is presented which utilizes a simple finger controlled mechanical shutter. This instrument safeguards against accidental direction of the laser beam.
Angioleiomyoma of the nasal cavity – report of a case and review of the literature
Authors: Khan M. H. Z. , Jones A. S. , Haqqani M. T.
Published: November 2007

Angioleiomyoma of the nasal cavity is an extremely rare tumour (Sawada, 1990). We present an unusual case of angioleiomyoma arising from the lateral wall of the nasal cavity without any symptoms of pain or epistaxis. Another unusual feature was that the tumour clinically resembled an inverted papilloma.
B-cell non-Hodgkin's lymphoma of the paranasal sinuses
Authors: Juman Solaiman , Robinson Philip , Balkissoon Avinash , Kelly Kara
Published: November 2007

Primary nasal, paranasal, oral and pharyngeal (NPOP) lymphoma, thought to be a distinct entity among childhood lymphomas, may present with a wide variety of common ENT symptoms such as nasal obstruction, rhinorrhoea, epistaxis or sinusitis. The diagnosis may only be recognized when the disease results in symptoms such as visual loss, facial paraesthesia or lymphadenopathy, or systemic symptoms, such as fatigue, bone pain or abdominal pain

Full radiological assessment plays a vital part in making the diagnosis and planning treatment. Computerized tomography (CT) gives excellent bony detail but magnetic resonance imaging (MRI) using T2-weighted images, allows differentiation of mucosal thickening and retained sinus secretions from the tumour. Extension into the surrounding spaces and the cranial fossa is best assessed by coronal and sagittal T2 images.

MRI is the best technique for follow-up because no radiation is involved and better soft tissue delineation improves the distinguishing of tumour from fibrosis.
Plasma cell granuloma: maxillary sinuses
Authors: Muzaffar Muhammad , Hussain Syed Inayat , Chughtai Asad
Published: November 2007

Inflammatory pseudotumours or plasma cell granulomas are space-occupying, rounded masses appearing in various locations usually as an aftermath of recurrent infections.

Recurrent pain and mass have been the most common presentations (Durst et al., 1977). These have been confused with tumours but radical surgical treatment is unnecessary, in the absence of life-threatening complications. The prognosis is excellent after excision. The nature and pathogenesis of the inflammatory pseudotumours, their presentation as fever and anaemia in some cases, are unknown.

This report is probably the first case of a plasma cell granuloma involving the maxillary sinus causing focal erosion of the orbital wall, simulating a malignant tumour clinically.
Leiomyosarcoma of the larynx
Authors: Rowe-Jones Julian M. , Solomons Neil B. , Ratcliffe Norman A.
Published: November 2007

Leiomyosarcoma of the larynx is extremely rare. Histological diagnosis excluding other tumours, in particular fibrosarcoma and spindle cell carcinoma is often difficult. Immunohistochemical studies are helpful in arriving at an unambiguous diagnosis and we present a case characteristically positive for actin and desmin. The difficulties of determining treatment are discussed.
Non-Explosive blast injury of the ear
Authors: Berger Gilead , Finkelstein Yehuda , Harell Moshe
Published: November 2007

Non-explosive blast injury of the ear refers to the otological trauma caused by a blow to the ear that seals the external auditory meatus. It results in a sudden increase of air pressure within the ear canal that strikes the tympanic membrane. The present study portrays the various aspects of middle and inner ear damage in 91 patients resulting from an assault we entitled a ’non-explosive blast injury' to the ear. Sixty cases were caused by a slap or a fist, 13 patients suffered sport accidents, mostly in ball games, and 18 patients were injured during swimming and water sports activities. The common symptoms were hearing loss, earache, tinnitus, vertigo and otorrhoea. All 91 patients presented with acute perforations of their eardrums. The mean conductive hearing loss was 11.2 dB. A high tone sensorineural hearing loss was detected in only 20 per cent of the patients. A spontaneous closure of the perforation with a conservative management approach was observed in 94.8 per cent of the patientsHealing of the perforation was always associated with closure of the air-bone gap, while the results of the sensorineural hearing loss recovery were less favourable.
Head bandaging following otoplasty—how we do it
Authors: Simo R , Jones N. S.
Published: November 2007

One of the most common problems following otoplasty is that the bandage applied at the time of surgery slips prematurely, falling over the patient's eyes and thereby requiring replacement.

We present a simple technique which prevents this from occurring.
Acute bilateral vocal fold paresis as a symptom of benign thyroid disease
Authors: Kręcicki Tomasz , Łukiénczuk Tadeusz , Zalesska-Kręcicka Maria , Balcerzak Waldemar
Published: November 2007

A case of bilateral laryngeal nerve paralysis caused by a small goitre is reported. After thyroidectomy the return of vocal fold movements was observed. A review of the literature is presented. The possibility of acute airway distress caused by a slightly enlarged goitre is emphasized.
Epidermoid tumour of the cerebellopontine angle: diagnosis by MRI
Authors: Featherstone T.
Published: November 2007

Epidermoids are the third most common cerebellopontine angle tumour, and their diagnosis in the last two decades has been largely obtained using computed tomography (CT). More recently magnetic resonance imaging (MRI) has become a valuable diagnostic tool, and the signal characteristics and enhancement pattern of an epidermoid following intravenous gadolinium with MRI is presented and the literature reviewed.
Tuberculous nasopharyngeal cyst: diagnostic aspiration using the nasendoscope
Authors: Weiner Graeme M. , Pahor A. L.
Published: November 2007

A case of tuberculous lymphadenitis with a nasopharyngeal tuberculoma is presented where a novel use of the flexible nasendoscope to provide a diagnostic aspiration biopsy avoided an examination and biopsy under general anaesthesia. The use of this approach is discussed.
Lipoma of the left tonsillar fossa
Authors: Benson-Mitchell R. , Tolley N. , Croft C. B. , Roberts D.
Published: November 2007

Lipomas are common benign connective tissue tumours composed of adult adipose tissue. They are relatively rare in the upper aerodigestive tract, although they occur with considerable frequency in other areas, particularly in the subcutaneous tissues of the neck. Although there are several reports of this tumour occurring in the oropharynx, there is no recorded case of a lipoma of the tonsillar fossa. An 83-year-old man with a left tonsillar fossa lipoma is presented. Clinical presentation, management and a literature review are discussed.
Cholesteatoma: Ossicular destruction in adults and children
Authors: Sadé J. , Fuchs C.
Published: November 2007

The records of 148 adults (aged 14 years and older) presenting previously untreated aural cholesteatomas are analysed with particular emphasis on ossicular destruction and other bony lesions in the middle ear. The findings are compared with those obtained in an earlier study of 63 children (aged 13 years and younger), also with untreated cholesteatomas. The rate of stapes and malleus destruction was similar in adults and children. The rate of incus destruction was significantly higher in adults. Semicircular fistulas as well as facial paralysis were also more prevalent amongst adults. Therefore, the notion of childhood cholesteatoma aggressiveness cannot be related to its effect on these bony structures. It may stem from its higher recurrence rate and from the more troublesome post-operative mastoid cavities, which are often larger in children than in adults.
Modified facelift incision for parotidectomy
Authors: Terris David J. , Tuffo Katherine M. , Fee Willard E.
Published: November 2007

The most commonly used incision for parotidectomies is the modified Blair incision. We have successfully used an alternative incision which allows good exposure, and leaves no neck scar.

Between 1 March 1989 and 1 August 1991, 18 parotidectomies were performed using a modified facelift incision. Fifteen parotidectomies were done for similar indications during the same period using a modified Blair incision. The mean age in both groups of patients was 40.3 years. The pathology and incidence of complications was similar in the two groups. The difference in mean (±SD) time of surgery between the two groups was not statistically significant: 3.14 ±0.75 hours in patients with a modified facelift incision and 3.25 ±1.27 hours in patients with a modified Blair incision (p<20.1).

The modified facelift incision is an alternative approach to parotidectomy for selected patients. It provides adequate exposure, even for a total parotidectomy and mastoidectomy and it results in improved patient satisfaction without additional risk of complications.
Spontaneous rupture of the tympanic membrane during anaesthesia
Authors: Vohra S. B. , Mason C. J.
Published: November 2007

A case of spontaneous rupture of the tympanic membrane during anaesthesia is reported and its possible aetiology discussed.
Intranasal button battery causing septal perforation: a case report
Authors: Brown Colin R. S.
Published: November 2007

A child presenting with fever, unilateral nasal discharge and sinusitis was found to have an alkaline disk button battery in the right nostril causing severe mucosal damage and septal perforation. "Nje case is presented and mechanisms of injury discussed.
Myasthenia gravis presenting during general anaesthesia for oesophagoscopy – a cautionary tale
Authors: Prior Andrew J. , Swanston Andrew R.
Published: November 2007

We report myasthenia gravis presenting as dysphagia of acute onset in a 56-year-old female who had no other stigmata of the disease and who was generally well despite rheumatoid arthritis and hypothyroidism. She recovered respiratory function following a general anaesthetic for oesophagoscopy only when antimyasthenic treatment was instituted. She remains well to date. In patients who are known to have autoimmune diseases and who present with dysphagia, features of myasthenia gravis should be specifically sought.
Leiomyosarcoma of the tongue: a very rare tumour
Authors: Mayall Frederick , Hickman Joy , Bulman Charles , Blewitt Robert
Published: November 2007

We describe a leiomyosarcoma of the tongue in a 60-year-old man. The diagnosis was supported by immunohistochemical positivity for desmin and alpha-1 smooth muscle actin.
Angioedema secondary to angiotensin-converting enzyme inhibitors
Authors: Pracy J. P. M. , McGlashan J. A. , Walsh R. M. , Gleeson M. J.
Published: November 2007

Angioedema secondary to angiotensin-converting enzyme (ACE) inhibitors is rare, but it is a side effect which is likely to be seen more frequently because of the increased use of these drugs to treat cardiac failure and hypertension. Presentation is variable and the diagnosis may go unrecognized for many months or years. The cases reported illustrate problems both in the diagnosis and management of this life-threatening condition.
Eccrine cylindroma of the ear canal – report of a case
Authors: Sharma H. S. , Meorkamal M. Z. , Zainol H. , Dharap A. S.
Published: November 2007

Eccrine cylindroma is a benign tumour arising from sweat glands in the skin. It favours the face, forehead and scalp involving the turban area and hence is called a turban tumour. Amongst a variety of tumours originating from adnexal skin structures, which may appear in the ear canal, eccrine cylindroma forms a very rare entity. We present such a case and discuss its pathological and clinical features.
Glycogen-rich clear cell carcinoma in the tongue
Authors: Rajab Esa , Akmal Sharifah Nor , Nasir Abdul Majid
Published: November 2007

The case of a minor salivary gland tumour, arising from the tongue, with nodal metastasis is presented. Biopsy of the tumour and fine-needle aspiration cytology of the neck swelling showed the presence of a clear cell carcinoma with evidence of nodal metastases. A commando operation was performed and the defect was reconstructed using a local tongue flap. The literature review indicated that the neoplasm was rare and its site of occurrence rather unusual.
Maxillary sinusitis in children with otitis media with effusion
Authors: Mills R. P. , Irani B. S. , Vaughan-Jones R. J. , Padgham N. D.
Published: November 2007

Sinus radiographs have been carried out on 240 new cases of childhood otitis media with effusion (OME). When the films were suggestive of infection, maxillary sinus washouts were carried out as part of the surgical treatment. Abnormal X-rays were obtained in 28 per cent of the study group, but only 16 cases (seven per cent) of sinus infection were confirmed on antral lavage. In those with positive washouts, there was an apparent relationship between the findings in the maxillary sinuses and middle ears of the same side in some of the cases. There was also evidence of improvement of the middle ear disease when the sinus infection was successfully treated. It does not appear that sinus infection is an important cause of OME, though it may be relevant in a small number of cases.
The hyoid syndrome: a pain in the neck
Authors: Robinson P. J. , Davis J. P. , Fraser J. G.
Published: November 2007

This paper reports on 13 patients with a pain syndrome arising from the region of the greater cornu of the hyoid bone. It is often missed and yet is readily treatable. The syndrome causes pain on swallowing in the region of the hyoid which may radiate to the ear, face and lower jaw or may be felt also in the pharynx. Treatment by an injection of a mixture of depomedrone and one per cent lignocaine is very effective.

The underlying pathology is discussed and it is suggested that in some cases the pain and discomfort experienced by patients may be due to tenosynovitis of the intermediate tendon of the digastric muscle. Greater recognition of this relatively common condition would not only result in more effective treatment but would also avoid unnecessary investigation and surgery.
Acute bilateral blindness in childhood caused by rhabdomyosarcoma and malignant lymphoma
Authors: Maier W. , Laubert A. , Weinel P.
Published: November 2007

Sudden unilateral visual loss in children is usually caused by a complication of acute purulent sinusitis. Differential diagnosis must include malignant tumours of the orbit or the paranasal sinuses involving the optic nerve. Rapid and adequate diagnostic measures are required in this emergency situation. In comparison, acute or progressive bilateral blindness is a very rare disorder.

We report two cases of bilateral visual loss caused by malignant tumours and diagnostic and therapeutic strategies are described. Our reports show that these life-threatening disorders and their severe complications can be managed successfully if well-coordinated interdisciplinary cooperation is conducted from the beginning. If surgery is performed in this vulnerable region, it may be facilitated by computer-aided modelling techniques. During the last decade the prognosis for rhabdomyosarcoma and malignant lymphoma, the most frequent mesenchymal tumours of childhood, has improved dramatically. Thus, any loss of time causing a delay in correct diagnosis and the onset of adequate therapy must be avoided. Intensive cooperation with paediatric oncologists has to be enlisted from the beginning to avoid unnecessary, repetitive, invasive, or imaging diagnostics and to accelerate the onset of specific therapy.
Recurrent laryngeal nerve palsy secondary to benign thyroid disease
Authors: Fenton J. E. , Timon C. I. , McShane D. P.
Published: November 2007

Abstract: A recurrent nerve palsy occurring in the presence of a goitre is considered to be caused by thyroid malignancy until proven otherwise.

Three cases are described in which benign thyroid disease resulted in recurrent laryngeal nerve paralysis. Recent haemorrhage was implicated histologically as the possible aetiology in all three cases. The importance of identifying and preserving the recurrent laryngeal nerve in the surgical management is highlighted.
Thyroid metastasis from nasopharyngeal carcinoma: a case report
Authors: Jalaludin Mohd Amin , Rajadurai Pathamanathan , Umapati Prasad Rayappan Va
Published: November 2007

Anaplastic nasopharyngeal carcinoma (NPC) metastatic to the thyroid gland is rare. We report the first such case in a 54- year-old Malaysian Chinese woman. The correct diagnosis should be made so that thyroidectomy may be avoided and an appropriate chemoradiotherapeutic regimen instituted.
Parotid haemangiomas in childhood: a case for MRI
Authors: Huchzermeyer Philippa , Birchall M. A. , Kendall B. , Bailey C. M.
Published: November 2007

Seven infants with unilateral parotid haemangiomas seen at one centre are presented. Their case notes and special investigations are reviewed. Magnetic resonance imaging (MRI) is revealed as the investigation of choice because of picture quality, definition of soft tissues and lack of exposure to ionizing radiation. MRI allows a definite diagnosis to be made without any invasive procedure being required. A future study following up these infants may be of interest because of controversy regarding the spontaneous resolution of these lesions.
Blast injury of the auditory system: a review of the mechanisms and pathology
Authors: Garth R. J. N.
Published: November 2007

Blast injury of the auditory system is uncommon and our knowledge incomplete. This article reviews the literature to date giving an account of the interactions of blast waves with the ear, the mechanisms of injury, the pathology, the clinical features, and an outline of management principles.
Evaluation of upper airway obstruction after partial laryngectomies by radiological method and flow–volume loop analysis
Authors: Misiolek M. , Ziora D. , Oklek K. , Namyslowski G.
Published: November 2007

Anatomical and functional estimations of the upper airways in patients after partial laryngectomies (cordectomy, hemilaryngectomy, enlarged hemilaryngectomy) carried out due to cancer are discussed in this paper. The post-operative lumen of the larynx and the trachea were estimated by radiological examination. The coefficient larynx/trachea (L/T) was proposed to describe fixed obstruction.

At the same time, all patients underwent spirometric examinations. Inspiratory and expiratory parameters of the flow-volume loop were evaluated. In 39 patients the L/T coefficient was lower than in a group of patients with chronic bronchitis (P<0.05). Also inspiratory and some expiratory parameters of the flow–volume loop decreased in contrast to the group with chronic bronchitis. All results showed the usefulness of radiological and spirometric methods in detecting upper airway obstructions and confirmed their fixed character. The influence of the area of operation on the degree of upper airway obstruction was emphasized.