bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunohistochemical findings of IgG recognized in the planum semilunatum of the guinea pig
Authors: Ikeda Minoru , Morgenstern Claus
Published: November 2007

The planum semilunatum is located on the lateral side of the crista ampullaris of thesemicircular canal. With regard to the functions of the planum semilunatum, some researchers assume the existence of secretory activity based on the microstructural features observed in isotopic experiments. In the present study, in order to confirm the existence of an immunological mechanism in the ampulla of the semicircular canal, the distribution of immunoglobulins in the semi-circular canal of guinea pigs was investigated immunohistochemically. Positivity of IgG wasobserved in the constituent cells of the planum semilunatum or beneath the basement membrane ofthe cells.It is concluded that ample IgG, which is an important constituent of the body fluids, is collected within this region. The planum semilunatum containing such ample amounts of IgG might be involved in the immunological mechanism operating in the ampullar of the semicircular canal.
The antrum exclusion technique in cholesteatoma surgery
Authors: Villarejo P. López , Baños E. Cantillo , Ramos Jurado
Published: November 2007

A new surgical technique for the treatment of cholesteatoma is reported. The technique involvesautoexclusion for exteriorization of the attic and tympanic box only. The resulting cavity is rather small.

The technique allows visual post-operative control of the attic and tympanic membrane. There isno visual access to the mastoid cavity which, however, is the most unlikely site for occurrenceof a residual cholesteatoma.

The proposed technique was applied to 102 patients and both the anatomic and functional resultsobtained are reported.
Radical mastoid cavity reconstruction—the pedicled musculofascial flap
Authors: Dawlatly E. E.
Published: November 2007

This paper reports a new procedure used successfully in the reconstruction of 12 radical mastoid cavities in King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. A composite pedicled flap composed of temporalis muscle and its fascia attached along one border, based posteriorly, is rotated in to the radical cavity. The muscle is used to obliterate the cavity and the fascia is hinged forward as a tympanic membrane graft.
The Groningen valve voice prosthesis in Sheffield: a 4-year review
Authors: Parker A. J. , O'Leary I. K. , Wight R. G. , Clegg R. T.
Published: November 2007

The Groningen valve was first used in Sheffield in 1986 in a patient who underwent laryngectomy for malignant disease. Since then a further 21 patients have made use of this device, 17 of whom underwent insertion at the time of surgery. All patients were male, two patients have since died and the median length of follow-up to date has been 22.0 (range 2–41) months.

Prostheses were replaced mainly under general anaesthesia if they leaked or resulted in difficult phonation. A total of 73 valve insertions have been performed with a median time of 4.0 (range 0.25–27) months between each. of the 15 men in whom the prosthesis is currently in use, speech was generally good-excellent.

The Groningen valve provides a highly acceptable means of obtaining vocalization after laryngectomy in the patients in this series.
Myringitis bullosa haemorrhagica: clinical course influenced by tympanosclerosis
Authors: Woo John K. S. , van Hasselt C. Andrew , Gluckman Paul G. C.
Published: November 2007

Observations based on two contrasting cases of myringitis bullosa haemorrhagica indicate that tympanosclerosis involving the tympanic membrane may have a significant effect on the clinical course of the disease. The evidence suggests that the bullae associated with the condition arise from the epidermal layer of the eardrum.
Viability of chondroplastic graft
Authors: Spencer M. G. , Mackay A. M.
Published: November 2007

The operation of chondroplastic graft augmentation rhinoplasty was described in a previous paper by the present author. Seventeen months following one such clinically successful operation, the opportunity was taken at a subsequent nasal procedure to remove a small portion of the original graft and submit this to histological examination. The results of this confirm the viability of a graft harvested and implanted by this technique.
Pneumoparotitis
Authors: Curtin J. J. , Ridley N. T. F. , Cumberworth V. L. , Glover G. W.
Published: November 2007

Pneumoparotitis is a rare cause of parotid enlargement. It is due to a reflux of air through Stensen's duct into the acini of the parotid gland with subsequent dilatation. We report a case which followed a long history of autoinflation of the middle ears by the Valsalva manoeuvre. The plain radiographic, sialographic and ultrasound findings are presented.
Ossification of the epiglottis
Authors: Milroy C. M.
Published: November 2007

The epiglottis is formed of elastic cartilage. Unlike the hyaline cartilage which forms the thyroid cartilage, cricoid and arytenoids, the elastic cartilage of the epiglottis does not undergo ossification with age. A case of ossification of the epiglottis is presented and heterotopic ossification in the head and neck is discussed.
The acceptability of secondary tracheo-oesophageal fistula creation in long standing laryngectomees
Authors: Camilleri A. E. , Mackenzie K.
Published: November 2007

The use of a tracheo-oesophageal voice prosthesis was introduced to the Glasgow Royal Infirmary Otolaryngology, Head and Neck Surgery unit in 1986. Although it was the authors' impression that most total laryngectomees since then had been offered this method of voice restoration, it was thought that long standing laryngectomees were seldom offered tracheo-oesophageal fistula (TOF) speech. Therefore all 58 total laryngectomees currently attending the combined head and neck surgery/radiotherapy clinic were assessed. Thirtytwo had a tracheo-oesophargeal fistula with voice prosthesis. All of these patients had undergone their total laryngectomy since 1986 and 83 per cent had achieved TOF speech. The remaining 26 patients (who mostly had their laryngectomy before 1986) had not been offered TOF speech. An outpatient consultation was arranged for these patients and 63 per cent of those offered, accepted TOF creation and a voice prosthesis. When compared to those who refused, it was found that good oesophageal speech, age or interval since laryngectomy were not good predictors of likely refusal. This study indicates that all fit long standing laryngectomees should be offered secondary TOF creation.
Parapharyngeal neurofibromas
Authors: Tandon D. A. , Bahadur S. , Misra N. K. , Deka R. C. , Kapila K.
Published: November 2007

This paper is a retrospective study of 15 patients with parapharyngeal neurofibromas operated over a six year period. No patient presented with a neurological deficit. CT scans revealed a well encapsulated moderately enhancing mass in ten cases. The tumour was removed by a transcervical approach in ten cases while in five a cervical-transpharyngeal route with mandibulotomy was used; in three of the latter group the tumour was retropharyngeal. In two cases a recurrence was successfully excised. It was realized that a mandibulotomy was required when the internal carotid was displaced medially, or if the tumour extended to the base of skull or when its vertical diameter exceeded 8 cm.
Distribution of topical antibiotic preparations in mastoid cavities
Authors: Martin-Hirsch D. P. , Lannigan F. , Irani B.
Published: November 2007

Topical antibiotic preparations are widely prescribed in the treatment of infected mastoid cavities with no knowledge of the distribution of the preparation within the cavity. This study ascertains the distribution of drop and spray preparations within mastoid cavities and suggests methods of delivery to maximize coverage.
Malignant head and neck germ cell tumours
Authors: Lanza J. , Wooh K. , Goldberg S. , Har-El G.
Published: November 2007

Malignant germ cell tumours of the head and neck are extremely rare. Their behaviour, despite aggressive surgical and adjuvant therapy, is relentless with most cases resulting in a fatal outcome. In this paper we present a case of a cervical embryonal carcinoma and review the presentation, clinical course and treatment of malignant germ cell tumours.
Multiple ganglioneuroma of the neck
Authors: Shotton J. C. , Milton C. M. , Allen J. P.
Published: November 2007

A case of multiple ganglioneuroma arising along the entire length of the cervical sympathetic chain of one side of the neck is described. This is a distinctly unusual site and distribution of the disease and computed tomography proved invaluable to demonstrate its extent, in addition to excluding involvement of more caudal regions.
The clinical application of oto-acoustic emissions in paediatric audiological assessment
Authors: Baldwin Margaret , Watkin P.
Published: November 2007

The value of otoacoustic emissions as an objective screening test for normal peripheral auditory function in infants is currently the subject of extensive and promising research. Additionally the measurement of cochlear emissions is potentially useful when children cannot be tested reliably by traditional subjective methods but confirmation of normal hearing is diagnostically important. Three groups of children are described who present such audiological dilemmas: children with non-organic hearing loss, children with severe learning difficulties and more rarely children with an abnormal auditory brainstem response who also have damage to the central nervous system. In all three groups otoacoustic emission testing was found to be diagnostically useful in determining normal peripheral auditory function thereby resolving some of the dilemmas facing paediatric audiology and ENT clinics.
Otological manifestations of thalassaemia intermedia: evidence of temporal bone involvement and report of a unique cholesteatoma-like lesion
Authors: Sheikha Anwar , Kameswaran Mohan , Okafor B. C. , Al-Saigh Abdul-Aziz
Published: November 2007

Thalassaemia intermedia should be considered in any chronically anaemic patient presenting fromthe Middle East with hearing impairment. We report here three Saudi siblings with thalassaemia intermedia and features of severe bone marrow expansion, particularly invading the temporal bone. They were seen first for their otological problems before they had access to proper haematological evaluation. One member was admitted for surgical exploration of a cholesteatoma, which was then found to be marrow expansion of the temporal bone. Screening of the family revealed twomore anaemic siblings with thalassaemia intermedia. Audiological examination of all the family members showed that only the two affected members had a high frequency sen-sori-neural hearing loss.

Bone marrow expansion into the temporal bone is a rare feature of thalassaemia intermedia. Cholesteatoma-like lesion has not been previously described. It has to be considered in all cases of symptomatic thalassaemia intermedia manifesting with cavitation and lytic lesions in the mastoid system. The likelihood that sensorineu-ral hearing loss may complicate the thalassaemias israised and the possible mechanism for such involvement discussed. The proper management for different otological manifestations of the thalassaemias is suggested. These cases would suggest amore extensive involvement of the temporal bone in the thalassaemias than has been previously recognized. Further large scale studies are required to illuminate the subject.
Rhinosporidiosis in Europe
Authors: van der Coer J. M. G. I. , Marres H. A. M. , Wlelinga E. W. J. , Wong-alcala L. S. M.
Published: November 2007

Rhinosporidiosis is an inflammatory disease of the nasal mucosa caused by Rhinosporidium seeberi. The disease is endemic in India but very rare in Europe or other continents. The literature concerning aetiology, clinical appearance, morphology and treatment is reviewed. All reported European cases are summarized.
Neonatal vallecular cysts and failure to thrive
Authors: Gluckman P. G. C. , Chu T. W. F. , van Hasselt C. A.
Published: November 2007

The case of a vallecular cyst in a neonate is described. The presentation was with failure to thrive. This previously unreported mode of presentation is discussed, and aspects of the management are emphasized. In particular, the value of flexible nasopharyngoscopy in assessing the neonatal laryngopharynx is highlighted.
Pulmonary tuberculosis presenting as suspected foreign body aspiration
Authors: Irving R. M. , Richards A. , Fisher E. W.
Published: November 2007

Tuberculosis is a disease of protean manifestations, and despite a falling incidence is still prevalent in our society.

We present a case of a child whose history and preoperative chest radiograph suggested the presence of a foreign body, but subsequent examination of the material removed at endoscopy revealed a diagnosis of tuberculosis. We suggest that all friable material removed from the lower respiratory tract be submitted for microscopy, culture and histopathology with this diagnosis in mind.
Correlation between temporal bone pneumatization, location of lateral sinus and length of the mastoid process
Authors: Turgut S. , Tos M.
Published: November 2007

The relationship between temporal bone pneumatization and the location of the lateral sinus and length of the mastoid process was investigated in 60 fresh frozen adult temporal bones, by plain X-rays, computed tomography and surgical dissection including otomicroscopic findings. Temporal bone pneumatization was classified as small, moderate and large. After drilling, the shortest distances between the middle fossa dura and mastoid tip representing the mastoid length and between the sigmoid sinus and posterior border of external auditory canal were measured and compared to the degree of pneumatization. The distances in the specimens with pathological eardrum and adhesions in the middle ear were compared to the ones without gross pathology. The length of mastoid process was significantly shorter in specimens with small pneumatization than those with large (Mann WhitneyP<0.001).

The specimens with a pathological eardrum and middle ear adhesions had a significantly shorter mastoid length than those without gross pathology. There was no significant difference between degree of pneumatization and the shortest distance between sigmoid sinus and external auditory canal (Mann WhitneyP>0.05). It is demonstrated that the ‘under-developed’ mastoid process can be a consequence of hampered pneumatization.
Milk nasendoscopy in the assessment of dysphagia
Authors: Wilson P. S. , Hoare T. J. , Johnson A. P.
Published: November 2007

The bedside assessment of dysphagia may be difficult, due to the inability to witness the act of swallowing directly. The milk test described in this paper gives a good assessment of swallowing, is cheap and easily portable and allows an instant decision to be made without recourse to special investigations.
Endoscopic endonasal surgery of posterior choanal atresia
Authors: El Guindy A. , El Sherief S. , Hagrass M. , Gamea A.
Published: November 2007

The use of the rigid endoscope in the management of posterior choanal atresia represents a significant advancement in choanal surgery. It provides an extremely sharp image with a magnified overview. It enables the surgeon to see the tips of his instruments, so that the bone is removed safely under direct endoscopic vision. It allows assessment of the size of the opening, in comparison to the normal choana. It ensures greater precision in flap preservation. The technique is short in time and safe, with early recovery and short hospitalization.
Radiation-induced antrochoanal fibrosarcoma
Authors: Liddington M. I. , Harrison R. F. , Path M. R. C. , Booth A. P. , Das Gupta A. R.
Published: November 2007

Therapeutic radiation for malignant conditions is known to cause sarcomatous change in an irradiated field after a latent period; equally this change may occur following radiotherapy to benign conditions which may result in a more difficult management problem later. Radiotherapy to benign conditions should be reserved for use after failure of conventional surgery or other interventional techniques.
Ballooned trachea as a consequence of intubation
Authors: Prinsley Peter
Published: November 2007

A case of iatrogenic tracheal dilatation is presented. This potentially fatal complication of endotracheal intubation may escape early detection. It is well demonstrated by CT scanning.
Facts and fantasies in modern otology: the ear doctor's dilemma
Authors: Smyth Gordon D. L.
Published: November 2007

Until it is accepted that many of the recommendations for surgical treatment of middle ear disease, based on impressions formed twenty years ago, are misleading, attempts to rationalize the use of hospital resources will be little more than cosmesis. Responsibility for the initiation of cost-effective reform is primarily that of surgeons and requires urgent self-audit and the provision of realistic advice to patients (and administrators) as to what benefits microsurgery of the ear can offer.
A five year follow up of incus transposition in relation to the first stage tympanoplasty technique
Authors: Donaldson I. , Snow D. G.
Published: November 2007

This study was set up, prospectively, to determine factors affecting the long-term hearing results of patients undergoing incus transposition as a second stage in ossicular reconstruction, following a successful drumhead repair in non-cholesteatoma ears. Seventy-one patients were entered into the study over five years from 1980–1985, 66 were available to be studied throughout the five year follow-up period.

Nine weeks post-operatively, 74 per cent of all patients has an air-bone gap of less than 15 dB (48/66). The type of first stage procedure had a significant effect on the hearing levels in the final five year assessment. The most successful sub-group were those patients who had a cortical mastoidectomy and silastic sheeting inserted in the first staging procedure. The air-bone gap, of less than 15 dB, was maintained in 71 per cent of this group (17/24). The sub-group who had a simple myringoplasty as the primary procedure had a good initial hearing level. By five years, however, only 30 per cent of the patients had maintained the air-bone gap of less than 30 dB (3/11).
Oncocytic papillary cystadenomatosis of the larynx
Authors: Martin-Hirsch D. P. , Lannigan F. J. , Irani B. , Batman P.
Published: November 2007

Symptomatic oncocytic disease of the larynx is rare. Review of the world literature reveals that isolated, symptomatic cases of oncocytoma of the larynx have been previously reported to involve discrete sites usually the laryngeal ventricles and vestibular folds. A unique case of multifocal cystic oncocytic hyperplasia necessitating laryngectomy is reported. CT scan of the larynx suggested destruction of the cartilage. Malignant histological features were not present.

This report raises the question whether previously described cases of oncocytoma of the larynx also had diffuse involvement. If oncocytosis is a diffuse process then it is suggested that patients should be kept under review for recurring lesions.
Treatment of allergic and vasomotor rhinitis by the local application of different concentrations of silver nitrate
Authors: Bhargava K. B. , Shirali G. N. , Abhyankar U. S. , Gadre K. C.
Published: November 2007

In 1980, Bhargava et al. reported a new treatment of allergic and vasomotor rhinitis by the local application of 15 percent silver nitrate. The results of further studies of the treatment by using different concentrations of silver nitrate ranging from 5 percent to 25 percent and normal saline as placebo are presented here; 15 percent has been found to be the most effective concentration giving successful results in 75.7 per cent of cases. It is applied to the anterior portion of both inferior turbinates and the anterior part of the nasal septum once aweek on five occasions.

Best relief was obtained from the most annoying symptoms of sneezing and rhinorrhoea. Asthma was controlled in 50 percent of such patients who had attacks of allergic rhinitis followed by asthma.

For this widely prevalent disease, the treatment was found to be simple, easy and useful, with negligible side-effects.
Difficult diagnostic laryngoscopy and bronchoscopy aided by the laryngeal mask airway
Authors: Maroof Mohammad , Siddique Mahmood , Khan Rashid M.
Published: November 2007

A case of difficult diagnostic rigid bronchoscopy is described. However, flexible fibrescopy could be easily performed through a laryngeal mask airway despite complete lack of experience by the operator. Excellent visualization of the larynx and bronchial tree with minimal haemodynamic disturbance accompanied the technique.
Acute stridor due to bilateral vocal fold paralysis as a presenting sign of myasthenia gravis
Authors: Fairley James W. , Hughes Marianne
Published: November 2007

We describe a case of myasthenia gravis in a 46-year-old man presenting as acute stridor with bilateral abductor paralysis of the vocal folds. Prompt diagnosis and medical treatment with pyridostigmine avoided the need for tracheostomy. It is important to remember the possibility of myasthenia gravis in cases of stridor due to bilateral vocal fold paralysis, since effective medical treatment is available.
Pseudomonal supraglottitis occurring in a patient with profound neutropenia secondary to virus-associated haemophagocytic syndrome
Authors: Connolly A. A. P. , Rowe-Jones J. , Leighton S. E. J. , Ball S. E. , Davies E. G. , Moore-Gillon V.
Published: November 2007

We present a case of virus-associated haemophagocytic syndrome following Epstein-Barr virus infection in which a fulminant pseudomonal supraglottitis developed. Increasingly, unusual pathogens have been found in immunocompromised patients. This is the first reported case of pseudomonal supraglottitis.
Tracheal reconstruction using a composite microvascular temporoparietal fascia flap and nasal septal graft
Authors: East Charles , Grant Henry , Jones Barry
Published: November 2007

The successful repair of a crushed cervical trachea using a composite microvascular graft is presented. The patient has been without a tracheostomy for four years.
Ectopic thyroid mass adherent to the oesophagus
Authors: Salam M. A.
Published: November 2007

A 51-year-old female presented with a sensation of a lump in the throat for five months. Clinical examination was normal.The barium swallow and the CT scan showed a well-defined mass to the left of the upper oesophagus and behind it. The mass was removed surgically and shown pathologically to be a nodule of ectopic thyroid tissue. This very rare pathology is discussed together with a review of the relevant literature.
The effect of epidural anaesthesia and size of spinal needle on post-operative hearing loss
Authors: Öncel Semih , Hasegeli Levent , Uguz M. Zafer , Savaci Serdar , Önal Kazim , Oyman Semiramis
Published: November 2007

Forty-five patients who were to undergo elective urological operations were evaluated. In the pre-operative period and on the third or fourth post-operative day audiometry was performed. Epidural anaesthesia was performed in 15 cases, spinal anaesthesia was performed in 15 cases with 25 G needles, and in 15 cases with 22 G needles. No statistically significant hearing loss was observed in the post-operative period compared to preoperative period in the epidural anaesthesia group. In the post-operative period, the hearing loss observed in the 25 G-spinal anaesthesia group was significantly (P<0.01) less than that seen in the 22 G group. None of the patients had headache after spinal anaesthesia. It was concluded that pure tone audiometry is a more sensitive indicator of cerebrospinal fluid leakage than post-operative headache.
Spontaneous pain in patients with maxillary sinus carcinoma in relation to T-classification and direction of tumour spread
Authors: Miyaguchi M. , Sakai S.
Published: November 2007

Spontaneous pain was one of many complaints on initial examination of 845 patients with maxillary sinus carcinoma. The pain was analysed; cheek, teeth, head and eye pain were compared with the T-classification and the anterior-posterior direction of invasion. The incidence of the cheek, teeth, head and eye pain was 48,39,29 and 23 per cent respectively. The incidence of both the cheek and teeth pain was increased according to the advancement of T-classification and invasion towards the posterior. Head and eye pain was often referred. In the localized posterior group which tend to be diagnosed late, spontaneous pain occurred in 15 to 48 per cent of the patients. Maxillary sinus carcinoma should always be a differential diagnosis in patients with unclear cheek, teeth, head ana eye pain. A careful investigation should be performed in order to diagnose malignant diseases as early as possible
Ethmoidal scleroma: endoscopic diagnosis and treatment
Authors: Gamea A. M. , El-Tatawi F. A. Y.
Published: November 2007

Twenty patients with medically treated rhinoscleroma and residual ethmoidal manifestations were examined using CT scanning. Cases with positive radiological data of the ethmoids underwent diagnostic and therapeutic nasal endoscopy.

It has been found that ethmoidal scleroma is not as rare a condition as was previously thought. The diagnostic and therapeutic value of nasal endoscopy in ethmoidal scleroma is discussed.
Treatment of tympanic membrane retraction pockets by excision. A prospective study
Authors: Sharp J. F. , Robinson J. M.
Published: November 2007

The treatment of tympanic membrane retraction pockets by simple excision is described in 66 ears in 50 patients. After one operation 65 per cent of the retraction pockets were successfully treated (mean follow up 14.1 months). Persisting perforations occurred in five patients after one excision. Retrotympanic cholesteatoma was found in one patient, after two retraction pocket excision operations. The number of myringotomies with grommet insertion and the presence of bilateral disease does not predict the outcome of the procedure. Simple excision should be considered in the first instance, rather than reinforcement tympanoplasty using temporalis fascia or cartilage graft, in the treatment of tympanic membrane retraction pockets.
Dysphagia as a major symptom of tetanus
Authors: Ross J. , Murrnt N. J.
Published: November 2007

Dysphagia is a common symptom presenting to ENT departments. Two cases of tetanus with dysphagia as a major symptom are discussed, together with a review of previously reported cases. Although tetanus is a rare disease in the United Kingdom, the possibility of this diagnosis should be borne in mind in patients presenting with progressive dysphagia, especially if there are other head and neck symptoms present.
Prescription of hearing aids for the elderly: The views of general practitioners
Authors: Newton V. E. , Hillier V. F. , Stephens S. D. G.
Published: November 2007

A questionnaire survey was carried out to examine the views of general practitioners in one Northern city regarding whether or not they thought that hearing aids should be prescribed from general practice, who they thought should prescribe them and whether or not additional resources and training would be needed if the responsibility for hearing aid prescription for the elderly was placed upon general practitioners.

The survey indicated that whereas many general practitioners would be in favour of prescribing hearing aids from Health Centres, many would need extra training and resources to enable them to do so.
Endoscopic management of posterior nasal obstruction
Authors: El-Guindy Ahmed
Published: November 2007

The use of the rigid endoscope has been investigated in the management of 63 cases with posterior nasal obstruction. It was found to be a true advance in rhinology, since it visualizes and localizes the site of the obstruction which is classified into pre-choanal, and post-choanal. Moreover, the nasal endoscope allowed complete and safe removal of most of the obstructing lesions under direct endoscopic vision.
Comparison of methods of evaluating hearing benefit of middle ear surgery
Authors: Toner J. G. , Smyth G. D. L.
Published: November 2007

The objective of this paper is to compare two methods of predicting the level of subjective patient benefit following reconstructive middle ear surgery. This should have always been an important consideration in advising patients regarding surgery, but assumes even more relevance in these days of clinical audit and cost benefit analysis. The two methods studied were the ‘15/30 dB rule of thumb’ (Smyth and Patterson, 1985) and the ‘Glasgow plot’ (Browninget al., 1991). The predictions of benefit for each of the two methods were compared to the assessment of actual benefits by the patient post-operatively. The results of this comparison in 153 patients were analysed, the rule of thumb was found to be somewhat more sensitive in predicting patient benefit.
The cellular mechanism of ossicular erosion in chronic suppurative otitis media
Authors: Lannigan F. J. , O'Higgins P. , Mcphie P.
Published: November 2007

This is the first report of the application of a new examination technique for the assessment of cellular activity during bone resorption in chronic suppurative otitis media (CSOM). A total of nineteen incudes removed during the course of tympanomastoid surgery were studied (retraction pocket: 2; tubo-tympanic CSOM: 4; attico-antral CSOM: 13). The microscopic surface topography of each specimen was examined using the scanning electron microscopy (SEM), and the appearances are interpreted in terms of cortical cellular activity. The results suggest that the mechanism of ossicular erosion in CSOM is similar regardless of the exact type of disease. Extensively, pitted areas were seen in all specimens. These pits are morphologically indistinguishable from those characteristic of osteoclastic activity (Howship's lacunae). We conclude that in all causes the surface topography of eroded incudes is consistent with the activity of osteoclasts.
Cefotaxime prophylaxis in major non-contaminated head and neck surgery: one-dayvs.seven-day therapy
Authors: Mustafa Erkan , Tahsin Aslan
Published: November 2007

Patients who undergo major surgery of head and neck benefit from perioperative antibiotic prophylaxis. This study was developed to determine if seven days of antibiotic administration would be more effective than one day. A prospective randomized double blind study was designed. Patients were randomly assigned to receive cefotaxime sodium for either 24 hours or seven days. In each case, the drug was administered intramuscularly, beginning one to two hours pre-operatively and continued for the prescribed period. Sixty patients were included in the trial. Of 30 patients assigned to one day of perioperative prophylaxis, wound infection developed in four (13 per cent). Of 30 patients assigned to seven days of perioperative antibiotic prophylaxis, wound infection developed in three (10 per cent) (P>0.05). These data suggest that no beneficial effect from administration of antibiotics for longer than 24 hours post-operatively can be achieved in patients who undergo major head and neck surgery.
The mini-grommet and tympanosclerosis: results at two years
Authors: Dingle Ann F. , Flood L. M. , Kumar B. U. , Hampal S.
Published: November 2007

One hundred and sixteen children with otitis media with effusion (OME) underwent surgery with grommet insertion. A conventional Shah grommet was used in one ear, and a Mini-Shah grommet in the other. Final review of the subjects two years after surgery revealed a significantly lesser degree of tympanosclerosis in the ear into which the Mini-Shah grommet had been inserted. This benefit might have resulted from the lesser mass of the mini-tube or its shorter duration in situ.
A guided approach to surgery for aspiration: two case reports
Authors: Mendelsohn Martyn
Published: November 2007

Aspiration frequently occurs in patients with a competent glottis. Analysis using a modified barium swallow (MBS) can reveal an extraglottic mechanism of aspiration in these patients. The MBS examination guided the design of two surgical procedures in patients with severe aspiration. The surgery corrected the underlying extraglottic cause of aspiration while preserving glottic function. In one case the epiglottoplasty controlled aspiration due to spillage over the epiglottis into the airway. In the other case translaryngeal resection of the cricoid lamina combined with cricopharyngeal myotomy controlled aspiration of residue in the hypopharynx. After surgery, both patients had their gastrostomy and cuffed tracheostomy tubes removed and were discharged home on a normal oral diet. Detailed analysis of deglutition by a modified barium swallow canprovide a scientific basis to guide the surgical management of patients with severe dysphagia.
Larynx preservation after initial non-cisplatin containing combination chemotherapy plus radiotherapy, as opposed to surgical intervention with or without radiotherapy in previously untreated advanced head and neck cancer: final analysis after 12 years follow-up
Authors: Price L. A. , Shaw H. J. , Hill Bridget T.
Published: November 2007

After a median follow-up of 12 years, median overall survival of 73 patients with advanced squamous cell carcinoma of the larynx was 65 months. The 61 per cent of patients responding to two courses of initial schedule A combination chemotherapy, not including cisplatin, and the 81 per cent of patients achieving a final complete remission after definitive local therapy, had median overall survival figures of 95 and 97 months respectively. Overall survival and relapse-free survival in 51 patients treated with radiotherapy only with larynx preservation, were not significantly different from the 21 patients who completed their surgery with pre- or postoperative radiotherapy: median overall figures were 71 versus 65 months. These data add weight to our proposal that use of initial combination chemotherapy followed by radiotherapy may eliminate the need for radical surgery, so preserving the larynx in patients with advanced disease, and provides evidence of some long-term benefit with 32 per cent of this entire group surviving 12 years.
Surgical decannulation of children with tracheostomy
Authors: Al-Saati A. , Morrison G. A. J. , Clary R. A. , Bailey C. M.
Published: November 2007

Over a five-year period during which 99 children underwent successful ward decannulation, 14 other children were deemed unsuitable and underwent surgical decannulation. The technique of surgical decannulation involves excision of the tracheostomy tract with any granuloma and splinting of the anterior tracheal wall by the use of an indwelling nasotracheal tube for 48 hours post-operatively. It is indicated in carefully selected patients whose tracheostomies are complicated by large suprastomal granulomas, anterior tracheal wall collapse or previous anterior rib graft collapse into the airway. Nine of the 14 decannulations were successful. Success is dependent upon accurate prior endoscopic assessment and satisfactory previous reconstruction surgery in cases of subglottic stenosis. The five failures (4.42 per cent of all decannulations) represent some of the most demanding airway problems encountered.
Unchanged unilateral hearing loss and ipsilateral growth of an acoustic neuroma from 1 to 4 cm
Authors: van Leeuwen Jos P. P. M. , Cremers Cor W. R. J. , Thijssen Henk O. M. , Meyer Henk E.
Published: November 2007

Progressive sensorineural hearing loss is the most important early symptom of a cerebellopontine angle process. A case report is presented of a 42-year-old woman who was referred to our department in 1979. Oil cistemography showed non filling of the left internal acoustic canal. Audiometry was planned as the method of control, but she did not return until nine- years later. In 1988, an acoustic neurionoma of 4 cm diameter was found in the left CPA. Pure tone audiometry and speech audiometry showed that during the nine-year interval, her 60 dB flat sensorineural hearing loss and speech perception thresholds had remained almost unchanged. A follow-up with only tone and speech audiometry can lead to a false negative diagnosis in some of these cases. Calculation of the growth in tumour volume over nine years in this patient showed a tumour volume doubling time of about 15 months.
NdYAG laser treatment of a glomus tympanicum tumour
Authors: Robinson Philip J. , Grant Henry R. , Bown Stephen G.
Published: November 2007

Glomus tympanicum tumours are highly vascular tumours of the middle ear. Their removal by conventional surgical methods requires an extensive procedure in many cases, often with ossicular disarticulation to allow adequate exposure prior to the ‘chaotic’ and haemorrhagic event of tumour removal. This paper reports on the use of an NdYAG laser in a case of a large glomus tympanicum tumour. The laser facilitated a transcanal approach, avoided ossicular disarticulation and allowed accurate and almost bloodless ablation of the entire tumour.

The NdYAG laser appears to be a very useful treatment modality in the management of these highly vascular tumours. Care should be taken to avoid accidental energy transmission to the cochlea.
The value of sonography in the management of cystic neck lesions
Authors: El-Silimy Osama , Corney Charles
Published: November 2007

Eight cases of cystic neck lesion of differing causes in whom sonography was carried out as part of investigation are described. These are thyroid cyst with haemorrhage, thyroglossal cyst, branchial cyst, cystic hygroma, parotid abscess of the neck secondary to malignant external otitis, cystic degeneration of a recurrent malignancy in the neck, sebaceous cyst and a cold abscess. They showed that sonography is better than clinical judgement in obtaining a diagnosis. Therefore, we recommend that ultrasound should be performed in all neck lesions prior to needle aspiration or open excisional biopsy.
Penetration of penicillin V to tonsillar surface fluid in healthy individuals and in patients with acute tonsillitis
Authors: Stjernquist-Desatnik A. , Samuelsson P. , Walder M.
Published: November 2007

In the treatment of group A streptococcal tonsillitis, as the bacteria are located on the epithelial surface, an important determinant of outcome is the concentration of penicillin in extracellular tonsillar surface fluid. Accordingly, we investigated the concentration of penicillin in serum, and penetration to tonsillar surface fluid and saliva in nine patients with acute group A streptococcal tonsillitis and in nine healthy controls.

Among the healthy subjects, despite high serum penicillin concentrations (mean, 2.04) (ig/ml), there was no penetration to tonsillar surface fluid or to saliva, whereas erythromycin penetrated to tonsillar surface fluid in 3/6 cases.

Of the nine patients with acute tonsillitis, on the first day of treatment eight manifested high concentrations of penicillin in tonsillar surface fluid (mean, 0.34 (ig/ml—i.e. well above the minimal inhibitory concentration (MIC) for group A streptococci), but penetration to saliva was found in only two patients. On the tenth day of treatment, penicillin was not present in the saliva of any of the patients and was present in the tonsillar surface fluid of only one. The results suggest that measurable concentrations of penicillin in tonsillar surface fluid can only be obtained in the presence of inflammation with fluid exudation through the tonsillar epithelium.
ENT Cancer in the West Midlands Region of England
Authors: Wake Mark
Published: November 2007

In the period 1978–1986, 2907 cases of ear, sinonasal and throat (ENT) cancers were registered in the computer data base of the West Midlands Cancer Registry, Birmingham. These cases have been examined by site and subsite in this article.
Squamous cell carcinomas continue to dominate ENT cancer with notable male predominance. Histology, male/female ratios and time trend analysis are reported for this group of cancers.
Tuberculous otitis media: a difficult diagnosis
Authors: Lee P. Y. C. , Drysdale A. J.
Published: November 2007

Two cases of tuberculous otitis media, both presenting with otorrhoea and facial paralysis, are reported. The difficulties of diagnosing this rare condition are highlighted, and a brief review of its clinical features from other series is presented.
Repeated insertion of foreign bodies into the tracheobronchial tree via tracheostomy
Authors: Barnes P. R. J. , Lomas D. A.
Published: November 2007

A case of persistent pneumonia in a depressed adult woman occurring as a complication of the repeated insertion of foreign bodies into the trachea via a tracheostomy is presented. This is an unusual complication of tracheostomy but should be considered in cases of persistent or unusual pulmonary infection in tracheostomy patients.
Primary radiotherapy for treating all laryngeal cancer: a district hospital experience
Authors: Reddy Krishna T. V. , Vinayak Bippon C. , Jefferis Anthony F. , Wallace Maurice
Published: November 2007

We report our experience of long-term follow-up of all patients treated during a ten-year period with primary radiotherapy irrespective of the disease stage of their laryngeal carcinoma. This policy was adopted in order to allow all patients the opportunity to save their larynx and to preserve their voice. In the present literature, surgery is favoured for treating advanced disease.
Two cases of nasopharyngeal branchial cyst
Authors: Shidara K. , Uruma T. , Yasuoka Y. , Kamei T.
Published: November 2007

Two cases of nasopharyngeal cyst, in a two-year-old girl and a six-year-old boy, are described. The cysts were located in the right lateral wall of the nasopharynx in both cases. Histopathological examinations revealed that the cyst walls were lined with columnar epithelium. The positions of the cysts and pathological features indicated that they were of branchial origin, and they were assumed to originate in the second branchial pouch because of their anatomic location. They differed from previously reported cases in that they extended nearly to the base of the skull, occupying the parapharyngeal space. It was considered that they might have originated from the dorsal part of the second branchial pouch or the layer of endodermal cells cut off from the lower part of the eustachian tube.
Fourth branchial arch fistula: a case report
Authors: Mankekar Gauri , Nayak Sadhana R. , Kirtane M. V. , Ingle M. V.
Published: November 2007

Fourth branchial arch fistula is a rare anomaly. This report describes in detail the presentation and management of a fourth arch fistula.
Osseointegrated implants in the management of childhood ear abnormalities: the initial Birmingham experience
Authors: Stevenson D. S. , Proops D. W. , Wake M. J. C. , Deadman M. J. , Worrollo S. J. , Hobson J. A.
Published: November 2007

Over a four-year period 72 children with ear abnormalities have been referred for assessment by the extraoral osseointegrated implant team at The Queen Elizabeth Hospital, Birmingham. Thirty-two children have been judged suitable for rehabilitation. Twelve children have completed rehabilitation using bone-anchored hearing aids and/or auricular prostheses. Two fixtures (seven per cent of those loaded) have dislodged and required replacement. Audiological assessment of the bone-anchored hearing aid users shows only small improvements in their aided thresholds, compared to thresholds obtained with their previous aid. However all now have thresholds of 30 dB(A) or better and report a marked improvement in sound quality. When surveyed, hearing aid and prosthesis users report high levels of satisfaction with this form of rehabilitation. The technique adds a new dimension to the management of children with aural anomalies. The approach and results of a multidisciplinary programme are reported.
Recurrent pleomorphic adenoma
Authors: Jackson S. R. , Roland N.J. , Clarke R. W. , Jones A. S.
Published: November 2007

Of 209 cases of pleomorphic adenoma treated in a 30 year period, 38 were secondary referrals with recurrent disease following surgery. Of these, 25 were women and 13 men with a mean time to recurrence of 9 years 4 months. Thirty-four recurrences were in the parotid gland. three in the submandibular gland and one in the anterior faucial pillar.

Seven patients were untreated due to poor general condition or refusal of further treatment. Of the remainder, 15 had superficial parotidectomy and excision of the scar and nine a total parotidectonly. Three of these had extensive surgery with local flap repair. Of the patients with submandibular gland recurrence, two had local excision and one was treated with radiotherapy alone. One patient had a recurrence in the laucial pillar. Three patients developed malignant change in the recurrent tumour. of whom one died of disease.
Tympanic membrane ossification
Authors: Baer S. , Hehar S. , Maw A. R.
Published: November 2007

Ossification of the tympanic membrane after myringoplasty is recorded for the first time. Myringoplasty was performed for closure of a perforation which followed the surgical treatment of Otitis media with effusion and had included the insertion of a long-term T-tube.
Polypoid lipoma of the palatine tonsil
Authors: Bégin Louis R. , Frenkiel Saul
Published: November 2007

A polypoid, pedunculated tumour of the left palatine tonsil was incidentally detected in a 42-year-old female. It was composed of mature fat and was covered by a nonkeratinizing squamous epithelium with an underlying rim of fibrous tissue. The literature on tonsillar lipoma is reviewed and the differential diagnosis of polypoid lesions of the tonsil is discussed.
Acute osteomyelitis of the maxilla in the newborn
Authors: Loh F. C. , Ling S. Y.
Published: November 2007

Acute osteomyelitis of the maxilla in the new born is arare infective condition of the maxilla which subsequently spreads to include the eye, nasal and oral cavities with their attending signs and symptoms. Possible sequelae include death, ophthalmological, laryngological and dental complications. The organism responsible is usually Staphylococcus aureus and early diagnosis and treatment can result in rapid resolution of the condition.
Chondrosarcoma of the hyoid bone
Authors: Itoh Kazunori , Nobori Takuo , Fukuda Katsunori , Furuta Shigeru , Ohyama Masaru
Published: November 2007

Chondrosarcoma of the head and neck is relatively rare. We report the sixth case known to us in which the chondrosarcoma had originated in the hyoid bone. The patient, a 66-year-old man, underwent surgery. The resected tumour was a 5 cm encapsulated lesion composed of lobulated, firm, gray-white tissue. Histologically it showed mature chondrocytes without capsular invasion. There was high cellularity and a few binucleated chondrocytes. Although the tumour grade was prognostic significance, our literature review of the five other cases suggests that the location of the primary lesion and the adequacy of its resection to be more important. Our patient continues to do well 15 months post-operatively. However, long-term follow-up is essential as recurrences have been reported even after eight or 10 years.
The use of cortical bone grafts in ossiculoplasty
Authors: Mills R. P.
Published: November 2007

Abstarct

Concern about the possible risk of viral infection being transmitted by the use of homografts has renewed interest in cortical bone autografts as an ossicular substitute. Over the last four years I have used cortical bone on a regular basis. Comparison of hearing results obtained using ossicular and cortical bone grafts shows no significant difference between the two groups. Cortical bone appears to be satisfactory material for ossiculoplasty, but long-term studies of outcome are required to confirm this.