bluuebunny/crossref_metadata_2025 huggingface dataset:
Cephazolin and metronidazole prophylaxis in head and neck surgery
Authors: Strauss Melvin , Saccogna Phillip W. , Allphin Allan L.
Published: November 2007

A seven-day course of cephazolin and metronidazole chemoprophylaxis for clean-contaminated head and neck oncological procedures is compared to results with previously published antibiotic regimens. Aetiological factors associated with increased rates of wound complications are analyzed. Retrospective analysis of procedures over asix-year period was performed. The overall wound complication rate was 28.1 per cent, comparing favourably with previously published results. A major fistula was the most common complication with a rate of 9.2 per cent. Factors statistically associated with increased rates of wound complications included: radical neck dissection, extended surgical procedures requiring flap reconstruction, previous tracheotomy, and race. This is the largest single institutional study to show thata seven-day course of cephazolin and metronidazole is an effective chemoprophylactic regimen in head and neck surgery.
Combined approach intranasal endoscopic and external Lothrop procedure in chronic frontal sinus disease
Authors: Sharp H. R. , Spraggs P.D.R. , Mackay I. S.
Published: November 2007

The endoscopic approach to the fronto-ethmoidal recess (FER) in the treatment of chronic frontal sinus disease is now widely accepted. The Lothrop procedure was first described in 1914, but was largely replaced with more invasive open frontal sinus proceduresuntil the advent of the rigid Hopkins' rod, since when it has enjoyed enewed popularity.

We describe a modification of this technique which allows both transnasal endoscopic and external direct visualization of the FER and frontal sinus and a direct approach to the anterior buttress (or “nasofrontal beak”) which allows its quick and simple removal.
Unilateral abducens nerve palsy: a presenting sign of sphenoid sinus mucocoeles
Authors: Muneer A. , Jones N. S.
Published: November 2007

Sphenoid sinus mucocoeles can stimulate a variety of pathological conditions and patients can present to a range of specialists. Because of the relative rarity of sphenoid sinus mucocoeles, diagnosis is often delayed and these lesions can progressively expand and cause direct mechanical compression on adjacent structures. We present three cases which presented with an abducens nerve palsy. Early surgical intervention is advocated and these patient's symptoms resolved following surgery. Although several conditions can present with an abducens nerve palsy, it is important to consider a sphenoid sinus mucocoele in the differential diagnosis.
Tracheoesophageal speech following transmucosal pharyngeal myotomy with the potassium-titanyl-phosphate laser
Authors: Halvorson David J. , Kuhn Frederick A.
Published: November 2007

Successful communication following laryngectomy usually involves an electrolarynx or oesophageal speech. Only within the past decade has tracheoesophageal puncture been advocated for alaryngeal speech and evolved into the procedure of choice. Successful production of speech after total laryngectomy using tracheoesophageal speech may be impaired secondary to anatomical and functional difficulties. The primary limitation of tracheoesophageal speech is pharyngoesophageal spasm occurring in the upper oesophageal sphincter impeding airflow through this segment. Our report presents four patients who underwent a pharyngeal myotomy with the potassium-titanyl-phosphate (KTP) laser. Post-operatively, each patient was able to communicate with functional alaryngeal speech. A transmucosal pharyngeal myotomy may represent an alternative for patients with speech failure after tracheoesophageal puncture.
Nasopharyngeal carcinoma: clinical trends
Authors: Indudharan R , Valuyeetham K. A. , Kannan T. , Sidek D. S.
Published: November 2007

Nasopharyngeal carcinoma (NPC) is one of the most difficult diseases to diagnose at an early stage. The clinical presentation of 122 patients with confirmed NPC is described and the findings analysed. The common modes of presentation and cases where detailed nasopharyngeal examination need to be performed are highlighted. We emphasize the importance of health education and training for primary care physicians for early detection of these cases.
Cilia from a cystic fibrosis patient react to the ciliotoxicPseudomonas aeruginosaII lectin in a similar manner to normal control cilia – a case report
Authors: Adam Elizabeth C. , Schumacher Dietlind U. , Schumacher Udo
Published: November 2007

The ciliary beat frequency measurements taken from a nasal polyp from a cystic fibrosis patient were similar to that of the control nasal polyps. The addition of a ciliotoxic lectin produced byPseudomonas aeruginosastopped the beating of the cilia as in the controls. This reaction could be blocked by the pre-incubation of the lectin with its inhibitor fucose. As in the control, the addition of fucose after the cilia had slowed resulted in a return to normal ciliary beating within 24 hours. This shows that the delta F508 CF mutation observed in this patient does not affect ciliary beating and suggests that treatment with fucose in the early stages of aPseudomonas aeruginosainfection could be advantageous for cystic fibrosis patients.
Autograft ossicle selection in cholesteatomatous ear disease: histopathological considerations
Authors: Rupa V. , Krishnaswami H. , Job A.
Published: November 2007

In order to determine whether selection of autograft ossicles in cholesteatomatous ear disease should be based on upon their apperance under the surgical operating microscope, we studied the histopathological features of 113 such ossicles. We attempted to correlate the extent of erosion of the ossicle, as noted under the surgical operating microscope, with their histopathological apperance. There were 60 mallei and 53 incudes. Seventy-nine ossicles were eroded and 34 were intact. The commonest abnormality noted was erosion of the long process of the incus (75 per cent). Both intact and eroded ossicles had similar histological features. There was no evidence of intra-ossicular cholesteatoma. The results suggest that the extent of erosion of these ossicles as seen under the surgical operating microscope should in no wasy prejudice their use as autografts when required.
Frey's syndrome: treatment with botulinum toxin
Authors: Bjerkhoel A. , Trobbe O.
Published: November 2007

Frey's syndrome, i.e. gustatory sweating on the cheek, is a fairly common embarrassment after parotid gland surgery. New surgical techniques have been proposed to avoid this complication, but are not widely in use. Hence, there is need for treatment of Frey's syndrome. All surgical and topical treatments have drawbacks. This study was set up in order to evaluate a recently described treatment. One hundred and two patients were interviewed after parotidectomy. Thirty-one of them had noticed gustatory sweating and 15 patients underwent Minor's starch iodine test before, and after, treatment with intracutaneous injections of botulinum toxin A (Botox®, Allergan Inc., USA). Thirteen of the patients did not experience any gustatory sweating at follow-up (one to 13 months). Minor's starch test showed total disappearance of gustatory sweating in 12 of the 15 treated patients. The only side effect was a discreet, transitory affection of the orbicularis oris muscle in one patient. As this treatment is minimally invasive it could be an attractive treatment for Frey's syndrome if the effect is maintained. Complaints of local hypoaesthesia and pain were also common after parotid surgery.
Cochlear implantation in patients suffering from Cogan's syndrome
Authors: Cinamon Udi , Kronenberg Jona , Hildesheimer Minka , Taitelbaum Riki
Published: November 2007

Among patients who receive cochlear implants, those with Cogan's syndrome make a unique group. On one hand they are part of the post-lingual patients and good results can be anticipated. On the other hand, their basic illness is thought to have an autoimmune aetiology and for that reason more susceptible to complications, especially flap problems. In a series of 60 patients who were implantedat the Sheba Medical Center, three had Cogan's syndrome. No post-operative complications, including flap problems, were observed (followed-up for at least 18 months). Subjective and objective hearing results were very good.
Leishmania braziliensis presenting as a granulomatous lesion of the nasal septum mucosa
Authors: Lohuis P. J. F. M. , Lipovsky M. M. , Hoepelman A. I. M. , Hordijk G. J. , Huizing E. H.
Published: November 2007

Differential diagnosis of granulomatous lesions of the nasal mucosa is difficult. One of the possible causes is an infection with Leishmania braziliensis as reported in this case. Therefore leishmaniasis should be included in the differential diagnosis of granulomatous lesions of the nasal mucosa in patients who have travelled to endemic areas.
Endoscopic ligation or diathermy of the sphenopalatine artery in persistent epistaxis
Authors: Sharp H. R. , Rowe-Jones J. M. , Biring G. S. , Mackay I. S.
Published: November 2007

Conventional methods of arterial ligation in persistent epistaxis often involve significant surgical morbidity, as well as failure due to arterial anastomosis.

We have performed endoscopic intranasal end ligation or diathermy of 11 sphenopalatine arteries in 10 patients with no complications and with no further episodes of epistaxis, with an average follow-up period of nine months.
Epstein-Barr virus BHRF1 prohibits the cells of nasopharyngeal carcinoma from apoptosis
Authors: Huang H. , Zhou J. H. , Zhou S. M. , Hu J. H. , Pan X. H. , Kong X. T. , Yu L. , Sun X. Y. , Wu W.
Published: November 2007

Epstein-Barr virus (EBV) is associated with nasopharyngeal carcinoma (NPC). The BHRF1 EBV protein is expressed at high levels in productively infected cells and certain latently infected cells. In order to investigate the effect of expression of BHRF1 on the biological behaviour of NPC cells, we constructed the BHRF1 high expression vector and transfected it into the NPC cell line, CNE2. Then, the alteration of proliferation and apoptotic rates in the cells were tested before and after camptothecin treatment. After treatment by camptothecin, BHRF1-CNE2cells could constantly and slowly proliferate and its apoptotic rate was less than in control groups, and the number of cells in the G phase decreased and in the S phase increased. So, it suggests that BHRF1 expression can enhance the resistibility of CNE2cells to DNA damaging agents that cause apoptosis.
Acute food bolus impaction: aetiology and management
Authors: Lacy Peter D. , Donnelly Martin J. , McGrath Joseph P. , Byrne Patrick J. , Hennessy Thomas P. J. , Timon Conrad V. I.
Published: November 2007

A prospective study into the aetiology of acute food bolus obstruction (AFBO) was carried out on 17 consecutive patients who presented with this complaint. There were nine males and eight females. Twelve patients (71 per cent) had symptoms of oesophageal disease and 10 patients (59 per cent) had prior food bolus obstruction. Investigations included endoscopy, barium swallow, oesophageal pH and manometry studies. Evidence of oesophageal pathology was found in 12/14 (86 per cent) of patients investigated. No patients had malignancy and the most common abnormality, gastroesophageal reflux (GOR) was found in eight out of 14 (57 per cent) of cases. Oesophageal dysmotility was seen in five out of 12 (42 per cent) patients who had manometric studies.

With such a high incidence of recurrence of AFBO, we suggest that patients with this condition be investigated to exclude malignancy and to identify benign oesophageal pathology using techniques such as oesophageal pH and manometry. Appropriate treatment of oesophageal disease may help prevent recurrence of this distressing condition.
Asphyxial death caused by a laryngeal schwannoma: a case report
Authors: Gardner Patrick M. , Jentzen Jeffrey M. , Komorowski Richard A. , Harb Joseph M.
Published: November 2007

Neurogenic tumours of the larynx are unusual, with approximately 115 cases reported in the literature to date. Most of these lesions are benign, solitary submucosal nodules which present with hoarseness and are amenable to surgical resection. We present a case of a large pedunculated schwannoma arising in the aryepiglottic fold associated with sudden asphyxial death in an otherwise healthy young female.
More about pain in the neck: thyroid cartilage and mastoid process syndromes
Authors: Hefer Tsila , Nir Dan , Joachims Henry Zvi
Published: November 2007

Eight patients with cervical pain were examined. The only positive finding was an impressive tenderness over the thyroid cartilage (in seven patients) or over the area of the insertion of the sternocleidomastoid muscle to the mastoid process (in one patient). The diagnosis of thyroid cartilage syndrome and mastoid process syndrome were suggested and the patients were treated with oral and topical non-steroidal anti-inflammatorydrugs (NSAIDs) which reduced the symptoms. These syndromes are rare. The thyroid cartilage syndrome has been previously reported only once in the literature and this is the firstreport on the mastoid process syndrome. These syndromes, although rare, should be included in the list of causes for cervical pain and better recognition of the syndromes will save patients from undergoing unnecessary investigation and inappropriate treatment.
Otolaryngological treatments in hagiographical Byzantine texts (324–1453 A.D.): miracles or reality?
Authors: Lascaratos John , Poulacou-Rebelacou E. , Yiotakis John
Published: November 2007

Hagiographical texts of the Byzantine period contain a significant number of miraculous treatments of several diseases of the ear, nose and throat. The comparison of the conservative treatments referred to as well as the often concealed surgical interventions of these texts with those known from the medical texts of the eminent Byzantine physicians, lead the writers to conclude that a series of real treatments were carried out in the churches or in the Xenones (hospitals) of Byzantium.
ENT day surgery in England and Wales – an audit by the Royal College of Surgeons (Eng.) Comparative Audit Service
Authors: Brown Peter M. , Fowler Sarah , Ryan Rowena , Rivron Raymond
Published: November 2007

An audit of day surgery was carried out by the Royal College of Surgeons (Eng.) Comparative Audit service. Data from 121 respondents on over 3 962 day cases were analysed from both retrospective information and from prospective individual patient proformas. The day surgery rate is 31 per cent. The variability of facilities for day-surgery, the timing of lists, type of anaesthetic used and case-mix are discussed. Outcome and the reasons for admission to an overnight bed are analysed. The overall admission rate was found to be 2.8 per cent (range 0.6–19.5 per cent between consultants). Seventy per cent of ENT day-surgery was performed on morning lists which have a lower admission rate than afternoon lists. The main reasons for admission are vomiting 30 per cent, haemorrhage 20 per cent and inadequate recovery from anaesthetic 22 per cent. A more detailed analysis of reasons for admission were given for tonsillectomy, adenoidectomy, FESS, and grommets. Recommendations are given which might increase the scope of safe day-surgery and reduce admission rate.
Craniofacial necrotizing fasciitis secondary to sinusitis
Authors: Raboso Eduardo , Llavero Maria T. , Rosell Antonio , Martinez-Vidal Antonio
Published: November 2007

Necrotizing fasciitis is a rare condition which usuallyaffects the trunk, perineum and limbs. Head and neck involvement is very uncommon and in most cases it is secondary to orbital or dental infection. We report a case of craniofacial necrotizing fasciitis (CNF) secondary to a maxillary sinusitis. The patient was treated intensively with antibiotics, surgical procedures and life-support measures.Despite all efforts, the patient died one week after admission. This case highlights early diagnosis and aggressive management as decisivefactors for the outcome of the patient.
Oncogenic osteomalacia: case report and review of head and neck associated tumours
Authors: Gonzalez-Compta X. , Mañós-Pujol M. , Foglia-Fernandez M. , Peral E. , Condom E. , Claveguera T. , Dicenta-Sousa M.
Published: November 2007

Oncogenic osteomalacia is an uncommon syndrome characterized by mineral metabolism abnormalities that disappear after the resection of an associated tumour. Head and neck is the second most frequent location of these tumours. We describe a case with an ethmoido-frontal phosphaturic mesenchymal tumour and review oncogenic osteomalacia-associated tumours. Among 21 cases found, 57 per cent affected the sinonasal area and 20 per cent the mandible. The diagnosis of the tumour lasted a mean of 4.7 years from the onset of osteomalacia, and most of them showed a significant vascular component. An aggressive surgical approach is recommended.
A qualitative assessment of randomized controlled trials in otolaryngology
Authors: Ah-See K. W. , Molony N. C.
Published: November 2007

In 1996 the CONSORT statement made recommendations on the strict reporting of randomized controlled trials (RCT). This will facilitate the future assessment of such trials and will highlight those trials that have been performed suboptimally and whose results may be biased.

We have devised a scoring system, based on CONSORT, to assess RCT quality and by reading each original paper in full we have now assessed the quality of trials published from 1966 to 1995.

The mean score for trials identified was 7.3 out of a maximum 12 points. No one journal was significantly better than the others. Trials in rhinology are reported better than head and neck oncology trials (mean scores 7.6 and 6.5 respectively). The past 30 years has not seen an improvement in the quality of the trials.

The reporting of RCTs in the ENT literature is poor. CONSORT guidelines now exist and trialists are encouraged to adopt them when conducting future clinical trials.
Carbon dioxide laser stomaplasty for tracheostomal stenosis
Authors: Sani A.
Published: November 2007

A method of treating tracheostomal stenosis post-laryngectomy is described. The carbon dioxide (CO2) laser is used to fashion and ablate two triangular areas lateral to the stenosed stoma to provide an immediate enlarged stoma for comfortable breathing. This simple procedure is done under local anaesthesia, is almost bloodless, safe and takes just 10 minutes. Over the last five years eight patients underwent this procedure and seven had a satisfactory stoma without the need to use a tracheostomy tube.
Excision and low-dose radiotherapy for refractory laryngeal granuloma
Authors: Mitchell G. , Pearson C. R. , Henk J. M. , Rhys-Evans P.
Published: November 2007

Laryngeal granulomas are uncommon lesions of an inflammatory origin. They are conventionally managed by simple excision with the occasional use of adjuvant treatment depending on the aetiological factors. Unfortunately, recurrences can occur, requiring repeated excision. Some lesions are refractory to this approach and alternative management approaches include excision and immediate adjuvant radiotherapy. The use of radiotherapy in the management of benign disease can be limited by the risk of induction of late malignancy and informed consent of a patient must include an assessment of this risk. We describe a case of refractory laryngeal granuloma successfully treated by excision and immediate radiotherapy in a patient occupationally dependent upon his voice.
How long should ears be bandaged after otoplasty?
Authors: Bartley J.
Published: November 2007

A firm head dressing is usually applied after otoplasty. Some surgeons recommend that the patient should wear the bandage for up to 10 days after surgery. However, these bandages are frequently displaced or come off. Patients complain of reduced hearing, itch and the smell of old blood in the bandages. A case series of 52 patients undergoing bilateral otoplasty who had a head bandage on for only 24 hours was audited prospectively. Minor complications occurred in two patients. A head bandage does not need to remain on for more than 24 hours after otoplasty.
Closure of the nasal vestibule in atrophic rhinitis – a new non-surgical technique
Authors: Lobo C. J. , Hartley C. , Farrington W. T.
Published: November 2007

A new technique is described for closing the nasal vestibule in cases of secondarily-acquired atrophic rhinitis. This involves occlusion of the nasal vestibule with an obturator made from dimethylpolysiloxane. Being a non-invasive method it is specifically indicated in the management of cases of secondarily-acquired atrophic rhinitis where any surgical treatment is contra-indicated. We describe its use in a case each of unilateral and bilateral secondary atrophic rhinitis.
The management of massive pneumocephalus and cerebrospinal fluid rhinorrhoea as a consequence of biopsy in a patient with inverted papilloma
Authors: Kale U. S. , Raje S. G. , Wight R. G.
Published: November 2007

Nasal polypectomy is a common ENT operation. Cerebrospinal fluid (CSF) rhinorrhoea and pneumocephalus are rare complications. We present a patient who developed both these complications after biopsy of nasal polyps which subsequently proved to be an inverted papilloma. He had a defect in the ethmoid roof, which was repaired.

Whilst endoscopic repair of CSF leak is increasing in popularity, in this patient because of his pathology and difficulty of access a more traditional lateral rhinotomy approach was made with a successful outcome. An overview of the management of these complications is presented.
Intralaryngotracheal thyroid – ectopic thyroid or invasive carcinoma?
Authors: See Andrew C. H. , Patel Snehal G. , Montgomery Paul Q. , Evans Peter H. Rhys , Fisher Cyril
Published: November 2007

Intralaryngotracheal thyroid is a rare clinical condition with only about 125 cases described so far in the literature. We present an unusual case of intralaryngotracheal thyroid which had many clinical features of malignancy and yet appeared benign on histology. As in this case, well-differentiated thyroid cancer can present with locally aggressive clinical features and can pose a dilemma in management if treatment decisions are guided solely by histological features.
Teratocarcinosarcoma of the nasal cavity and ethmoid
Authors: Sharma Hari Shankar , Abdullah Jafri Malin , Othman Nor Hayati , Muhamad Mahayidin
Published: November 2007

Sinonasal teratocarcinosarcoma is very unusual malignant neoplasm histologically consisting of an epithelial element and one or more mesenchymal components. This is a report of teratocarcinosarcoma, in a 74-year-old male, involving the right nasal cavity and ethmoids with intracranial extension. The tumour was totally resected via the craniofacial approach and the patient was given post-operative chemotherapy. Extensive tumour necrosis, rapid growth and local destruction are the prominent features of this tumour. The clinical presentation, pathological features and clinical course of this rare malignancy are discussed with a review of the literature.
Impact of phenotype on treatment and prognosis of laryngeal malignancies
Authors: Ferlito Alfio , Rinaldo Alessandra , Devaney Kenneth O. , Devaney Stephanie L. , Milroy Christopher M.
Published: November 2007

An overview of the impact of the phenotype on treatment and prognosis of different laryngeal malignancies is presented.
Epithelial atypia and squamous metaplasia in nasal polyps
Authors: Baird A. R. , Hilmi O. , White P. S. , Robertson A. J.
Published: November 2007

Fifteen routine nasal polypectomy specimens submitted to our laboratory over an eight-month period were noted to show marked atypia within areas of squamous metaplasia to a degree suggestive of dysplasia. Reviewing the literature revealed little published work in this area, especially recently. Further nasal polyp cases from this, and a similar previous time period, were re-examined, and possible causes for these changes discussed.
Angiolymphoid hyperplasia with eosinophilia of the parapharyngeal space
Authors: Backhouse S. S. , Shone G. R. , Douglas-Jones A. G.
Published: November 2007

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon benign condition characterized by cutaneous nodules with a predeliction for the head and neck region. Extracutaneous involvement is rare. We report a 44-year-old woman who had a large submucosal ALHE tumour in the parapharyngeal space. Our patient is of interest because of the unusual, and as far as we are aware from the literature, unique site and presentation of her lesion.
Mucoceles of the paranasal sinuses: uncommon location
Authors: Arrué P. , Kany M. Thorn , Serrano E. , Lacroix F. , Percodani J. , Yardeni E. , Pessey J. J. , Manelfe C.
Published: November 2007

Mucoceles are the most common lesions causing expansion of the paranasal sinuses. The sinuses most commonly involved are, in decreasing order of frequency, frontal sinus, ethmoid sinuses, maxillary sinus and sphenoid sinus. We reviewed 46 cases of surgically proven mucoceles and the purpose of this study was to report five cases of mucoceles in an uncommon location.
Needle myringotomy: a useful technique with the increased prevalence of the human immunodeficiency virus
Authors: Thorp M. A.
Published: November 2007

Myringotomy is one of the most common procedures performed by ENT surgeons. Use of the tip of a hypodermic needle not only provides a neat and precise incision into the tympanic membrane, but is also a cheap and disposable means of doing so. Sterility is virtually guaranteed avoiding any possibility of cross contamination between consecutive patients.
Histological features and prognosis of patients with mucoepidermoid carcinoma of the parotid gland
Authors: Suzuki Masashi , Ichimiya Issei , Matsushita Futoshi , Mogi Goro
Published: November 2007

Histological features and prognosis of patients with mucoepidermoid carcinoma of the parotid gland were analysed. Tumours from 13 patients were classified according to histological grades and immunoreactivity for HEK-2/neu. Surgical resection of the tumour was performed for all patients, and the overall five-year survival rate was 69 per cent. The patients whose histological grades were 1 or 2 showed a 100 per cent five-year survival rate, but no patient with grade 3 survived five years. Also, patients who had tumours that overexpressed HER-2/new had a lower survival rate (25 per cent) than patients with tumours that had weaker immunostaining (89 per cent). We considered tumours classified as grade 3 plus strong HER-2/neu expression to be ‘high malignancy’, and compared them with ‘low malignancy’ tumours that were grade 1 or 2 and had weaker HER-2/new staining. Patients with high malignancy tumours had shorter recurrence-free intervals and shorter overall survival than patients with low malignancy tumours. The overall survival period of the low malignancy cases was much longer than the recurrence-free interval; unlike that in the high malignancy tumour patients. These results suggest that the combination of histological grades and expression of HER-2/neu may be a useful predictor of the prognosis for mucoepidermoid carcinomata.
Sudden hearing loss in a patient hepatitis C virus (HCV) positive on therapy with alpha-interferon: a possible autoimmune-microvascular pathogenesis
Authors: Cadoni G. , Marinelli L. , De Santis A. , Romito A. , Manna R. , Ottaviani F.
Published: November 2007

Alpha interferon (α-IFN) is used for the treatment of various systemic disorders. Side-effects of α-IFN therapy can involve numerous organ systems, but sudden hearing loss has only once been recorded. We report a case of sudden hearing loss occurring in a patient with chronic hepatitis C treated with α-IFN and recovered five days after the discontinuation of this agent. This is the first record of anti-endothelial cell antibodies detection in a patient with sudden hearing loss. The finding of anti-endothelial cell antibodies suggests an association between sudden hearing loss and microvascular damage during interferon therapy.
Computerized tomography of the glottis after intracordal autoiogous fat injection
Authors: Laccourreye Ollivier , Bély Natacha , Crevier-Buchman Lise , Brasnu Daniel , Halimi Philippe
Published: November 2007

According to the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology – Head and Neck Surgery, various surgical methods such as laryngeal framework surgery, laryngeal re-innervation, and injection laryngoplasty might be used to palliate inferior laryngeal nerve paralysis. In the present case report we document the survival and exact location of the boluses of autoiogous fat in one patient in whom this material was used for injection laryngoplasty.
A systematic approach to the interpretation of computed tomography scans prior to endoscopic sinus surgery
Authors: Mason J. D. T. , Jones N. S. , Hughes R. J. , Holland I. M.
Published: November 2007

Computed tomography (CT) provides an excellent map for the sinus surgeon aswell as providing information about the extent of disease and the presence of bony destruction. Surgeons need to be aware of the anatomical configuration of the sinuses and the presence of any structural changes such as a dehiscent lamina papyracea, asymmetric skull base, low level of posterior skull base or an Onodi cell, which place the patient at increased risk. Described here is a six-step guide to help the sinus surgeon avoid missing any of the radiologically important features.
Selective lateral neck dissection for laryngeal cancer with limited metastatic disease: is it indicated?
Authors: Ferlito Alfio , Rinaldo Alessandra
Published: November 2007

The most important prognostic factor in cancer of the larynx is the presence of cervical metastatic disease, which is the most common type of recurrence in such patients. Because micrometastases cannot be detected pre-operatively at present, selective lateral neck dissection is increasingly recommended as the standard treatment for patients with a clinically negative neck in order to reduce the recurrence rate. In cases of N+ disease, selective lateral neck dissection can be as valid as modified radical neck dissection, providing patients have only limited, occult metastatic disease.
Changes in the clinical presentation of chronic otitis media from the 1970s to the 1990s
Authors: Vartiainen Eero
Published: November 2007

Clinical features of 1123 patients with chronic otitis media referred to a Finnish university hospital for surgical treatment over a 20-year period were analyzed. The number of patients declined by 48 per cent from the period 1976–1985 to 1986–1995. The decline was evident in all age groups but the proportion of children increased significantly from 14 per cent in 1976–1985 to 20 per cent in 1986–1995. A male predominance was noted with the exception of patients with sequelae of otitis in whom the sex distribution was equal. In cholesteatomatous ears, no significant change occurred in the type or size of cholesteatomas or in the incidence of ossicular destruction. Likewise, no significant change was noted in the size of perforations or in the incidence of ossicular destruction in patients with dry eardrum perforations. However, hearing levels of patients treated 1976–1985 were significantly worse than those of patients 1986–1995. Severe complications caused by the disease were rare during both periods.
A clinic for the rapid processing of patients with neck masses
Authors: Vowles Richard H. , Ghiacy Sabour , Jefferis Anthony F.
Published: November 2007

Neck masses are common and may have serious underlying pathology. There is much anxiety and confusion in primary care as to which hospital department will provide the patient with the best service and the swiftest diagnosis. A clinic was set up at Wexham Park hospital to enable patients with neck masses to be seen early, and to undergo a one-stop specialist evaluation, ultrasound scan and fine needle aspiration biopsy. The clinic has yielded a wide variety of benign and malignant pathology. The first 100 patients are discussed and evaluated.
Mucocele mimicking a Warthin's tumour recurrence
Authors: Rejali D. , Simo R. , Small M.
Published: November 2007

We report an unusual case of an extravasation mucocele complicating superficial parotidectomy. The tumour excised was a Warthin's tumour. Three months following theprimary surgery a cystic lesion appeared in the parotid bed. It was initially thought to represent a recurrence. The area was re-explored and a mucocele excised. The pathogenesisof mucoceles and the difficulties encountered when dealing with parotid tumour recurrenceare discussed.
Pseudoaneurysm of subclavian artery – atypical presentation
Authors: Gupta A. K. , Gupta P. C. , Abrol Raman , Mann S. B. S.
Published: November 2007

We present a rare case of pseudoaneurysm of right subclavian artery who presented with supraclavicular mass. Injury of the subclavian artery causing pseudoaneurysm is a serious surgical emergency and a surgical intervention is indicated.
Mechanisms in noise-induced permanent hearing loss: an evoked otoacoustic emission and auditory brainstem response study
Authors: Xu Zheng-Min , Vinck Bart , De Vel Eddy , van Cauwenberge Paul
Published: November 2007

In this study 22 patients (44 ears) with noise-induced permanent hearing loss were audiologically evaluated using transient-evoked otoacoustic emissions (TEOAE) and auditory brain-stem response (ABR). Twenty-one normal subjects (42 ears) without exposure to occupational noise were used as controls. Based upon the hearing loss at 4, 3, 2 and 1 kHz on the pure-tone audiogram, they were classified into four groups. In group 1 (eight ears), emissions were present in all ears but their TEOAE-noise level and their reproducibility (percentage) proved to be weak. The auditory brain-stem response (ABR) indicated that the I/V amplitude ratio, the latency values of wave V and the I–V intervals fell within the normal range in all ears. In Group 2 (14 ears), 40 per cent had no emissions, whereas the remaining ears showed weak emissions. The ABR revealed that in all ears the I/V amplitude ratio became small while wave V peak latency as well as I–V intervals were within the normal range. In Group 3 (10 ears), emissions were absent in 50 per cent, while in the other ears the emissions were very weak. The ABR revealed that the I/V amplitude ratio, which could be calculated in the 60 per cent in which wave I was present, was smaller than in Group 2. Wave V latency as well as I–V intervals were within the normal range. In Group 4 (12 ears), none of the ears showed emissions. The ABR indicated that the I/V amplitude ratio was much smaller when wave I was present (27 per cent) as well as I–V interval values being within the normal range. Wave V absolute latency value (δV index) indicated a positive index in 17 per cent of this group (two ears) when wave I was absent. In the present study a dynamic process from cochlear outer hair cells to cochlear neurons was seen, correlating with an increasing hearing loss.
Bacteriology of chronic purulent secretions in chronic rhinosinusitis
Authors: Klossek Jean-Michel , Dubreuil Luc , Richet Hervé , Richet Béatrice , Beutter Patrice
Published: November 2007

The aim of this work was to study the bacterial flora of purulent secretions during chronic rhinosinusitis. We studied a total of 533 patients divided into two groups. The control population consisted of 139 adults (> 16 years) of both sexes seen in the community or hospitalized for less than 72 hours for non-rhinological conditions. The rhinosinusitis group consisted of 394 patients referred to the ENT clinic with chronic rhinosinusitis. All the patients with rhinosinusitis had had a post-nasal discharge for at least three months, associated with purulent or mucopurulent secretions originating from the involved sinus cavity. All samples were obtained endonasally under endoscopic guidance from the sinus ostium or from the sinus cavity during surgery. Cultures were positive in 81.3 per cent of the control subjects and 83.1 per cent of the patients with rhinosinusitis.

Corynebacteria, coagulase-negative staphylococci, propionibacteria and peptostreptococci were the main commensal organisms, whileHaemophilus influenzae, streptococci,Streptococcus pneumoniae, Prevotellaspp andFusobacteriumspp were probable causative pathogens. Anaerobes were isolated from approximately 25 per cent of the patients in the rhinosinusitis group. Betalactamase producers represented 27.5 per cent ofH. influenzaeand 28 per cent ofPrevotellaspp isolates. Diminished susceptibility to penicillin was found in 13 per cent ofS. pneumoniaeisolates. The amoxycillin-clavulanate combination was the most active oral antibiotic tested against the pathogenic species in vitro.
Thyroplasty for functional rehabilitation of the incompetent larynx
Authors: Abdel-Aziz M. F. , Gad El-Hak N. A. , Carding P. N.
Published: November 2007

Type I thyroplasty was performed in 12 patients with unilateral paralysis of the vocal fold. Subjective as well as objective improvement in vocal performance was reported in 11 patients. Aspiration was improved in six out of eight patients. Effort closure was evaluated by the ability of the patient to voluntarily raise his intra-abdominal pressure during Valsalva's manoeuvre. A comparison of pre- and post-thyroplasty measures, showed a statistically significant improvement in the efficacy of effort glottic closure (p < 0.05), indicating a better physical performance. We had one case of wound sepsis and another case of implant extrusion.
Infectious mononucleosis and bilateral peritonsillar abscesses resulting in airway obstruction
Authors: Burstin P. P. , Marshall C. L.
Published: November 2007

Upper airway obstruction is an uncommon but recognized complication of infectious mononucleosis. The management depends upon the degree of airway compromise. In the case described, severe airway obstruction was treated by securing the airway with awake fibre-optic endoscopic intubation and then proceeding to tonsillectomy. Bilateral inferiorly loculated quinsies were encountered unexpectedly and drained. This is the first report of ‘bilateral’ quinsies, associated with infectious mononucleosis and severe airway obstruction. The association, pathogenesis and significance of this finding are also discussed.
A history of The Royal National Throat, Nose and Ear Hospital 1874–1982
Authors: Gould Glenice
Published: November 2007

Preface

This history of the Royal National Throat, Nose and Ear Hospital at Gray's Inn Road formed the core of a thesis submitted to the Open University for a Doctorate of Philosophy and is not an official history. I was encouraged to give it wider circulation particularly by Sir Donald Harrison and Mr Edward Donald. The Special Trustees of the Hospital have most generously sponsored this supplement which I hope will serve to provide some interest to those who have worked at Gray's Inn Road. I must begin with an apology as it does not attempt to record the achievements of all the staff at the RNTNE and many eminent contributors to the success of the Hospital have been omitted either through my own ignorance or through lack of space to cover all areas of the Hospital's development. I have been fortunate in obtaining both written and oral historical memoirs from retired doctors, nurses, administrators and technicians who worked for many years at Gray' Inn Road. I would like particularly to thank Peter Zwarts, librarian of the Institute of Laryngology and Otology, and the librarians at the Wellcome Institute for the History of Medicine and the Guildhall. I would like to thank Andrew Gardner of the ILO for a number of the illustrations. In particular I would like to thank my OU supervisor, Dr Noel Coley, for his patience and encouragement.
Secondary tonsillectomy haemorrhage and non-steroidal anti-inflammatory drugs
Authors: Smith I. , Wilde A.
Published: November 2007

Modern non-steroidal anti-inflammatory drugs (NSAIDs), are now widely accepted analgesics for posttonsillectomy patients, but their effect on secondary haemorrhage has not been fully evaluated.

This study attempts to evalute the influence of NSAIDs on the secondary haemorrhage rate, and also whether mode of dissection is an important factor.

The records of 557 consecutive patients undergoing tonsillectomy were studied to determine if there was a relationship between the secondary haemorrhage rate and discharge prescription of NSAIDs.

There was an overall secondary haemorrhage rate of 5.2 per cent (29) and a significantly increased secondary haemorrhage rate in those taking regular NSAIDs, 11 per cent, compared to those not taking NSAIDs, 1.47 per cent, ().

There was a higher rate of secondary haemorrhages with bipolar dissection than with standard dissection for both those taking and not taking NSAIDs (13 per cent vs seven per cent and 2.75 per cent vs 0.87 per cent) however this was not statistically significant ( and ). Both bipolar dissection and standard dissection individually showed very significant increases in secondary haemorrhage rate when on regular NSAIDs ( and ).

Although NSAIDs are very good analgesics, they may cause an increased secondary haemorrhage rate, and should be prescribed at discharge prescription with caution.
Effects of capsaicin pre-treatment in experimentally-induced secretory otitis media
Authors: Başak Sema , Türkütanit Serap , Sarierler Murat , Metin Kubilay K.
Published: November 2007

Neurogenic inflammation may play a role in the aetiology of secretory otitis media (SOM). The strongest candidate that initiates the characteristic symptoms of neurogenic inflammation is supposed to be substance P. Capsaicin is a specific antagonist of substance P. The effects of capsaicin on middle ear mucosa have not been studied yet. In an attempt to investigate the effect of pre-treatment with capsaicin on the development of SOM an experimental study was performed. Fourteen Wistar rats were divided into two groups. Seven rats were pre-treated with capsaicin (Group 1) and the others were administered isotonic saline solution (Group 2). Seven days after the third injection rats were operated on and the right tympanal orifice of the Eustachian tube was obstructed. Animals were sacrificed seven days after the operation. Their bullas were excised bilaterally and were studied by light microscopic technique. In Group 1 there was no effusion except for one case. The subepithelial layer was thickened by fibroblast proliferation. Capillary proliferation and some glandular atrophy were observed. In Group 2 the middle ear lumens were filled with effusion. Oedema with dilatation in capillaries and medium-sized vessels of lamina propria was observed as a common feature of the group. Subepithelial fibrosis was found in one case. Capsaicin pre-treatment prevented the formation of effusion in the middle ear lumen in spite of tuba occlusion. The results of this preliminary study lead us to consider that an imbalance in the autonomic innervation of the mucosa of the middle ear may play a role in the aetiology of SOM as in vasomotor rhinitis, and capsaicin may be an alternative in the treatment.
An adequate parameter evaluating the galvanic body sway test: comparison with the caloric test in patients with vestibular schwannomas
Authors: Tsutsumi Takeshi , Komatsuzaki Atsushi
Published: November 2007

It has been reported that the galvanic body sway test does not correlate with the caloric test. We evaluated the galvanic body sway test in patients with vestibular schwannomas using three parameters: the angle of deviation response onset, the maximum value of the deviation response, and the area of deviation. These parameters reflect velocity, position, and locus of the centre of pressure respectively. Among these parameters, only the angle of deviation response onset showed unilateral weakness of the response correlating with the canal paresis value, which indicates that velocity is responsible for conduction in the vestibular nerve. However, the galvanic body sway test is apt to be preferred to the caloric test. This might be attributed to the decreased sensitivity of this test.
Leiomyosarcoma of the larynx
Authors: Yoshizaki Tomokazu , Horikawa Toshiyuki , Nonomura Akitaka , Furukawa Mitsuru
Published: November 2007

Tumours of smooth muscle origin are extremely rare in the upper aerodigestive tract. Immunohistochemical studies are helpful for accurate diagnosis of leiomyosarcoma. Here, we report a case of well-differentiated laryngeal leiomyosarcoma that showed rapid local growth but no metastasis. Diagnosis and treatment of leiomyosarcoma are discussed.
A parapharyngeal myxoid liposarcoma
Authors: Fagan Johannes J. , Myers Eugene N. , Barnes Leon
Published: November 2007

We present a case of a parapharyngeal space myxoid liposarcoma. This case highlights the importance of wide surgical resection margins, and the difficult histological diagnosis.
Acute angle closure glaucoma precipitated by intranasal application of cocaine
Authors: Hari C. K. , Roblin D. G. , Clayton M. I. , Nair R. G.
Published: November 2007

We describe a patient who developed acute angle-closure glaucoma following the application of topical intranasal cocaine. A 46-year-old woman underwent an elective antral washout under general anaesthesia and with local application of 25 per cent cocaine paste to the nasal mucosa. Twenty-four hours post-operatively the patient developed sudden painful blindness which was found to be due to acute glaucoma. Cocaine with its indirect sympathomimetic activity causes mydriasis, that can precipitate acute angle-closure glaucoma in predisposed individuals with a shallow anterior chamber. Although the incidence is rare, otolaryngologists need to be aware of this potential complication.
The influence of pregnancy on sensation of ear problems – ear problems associated with healthy pregnancy
Authors: Tsunoda Koichi , Takahashi Shizue , Takanosawa Minako , Shimoji Yoshitaka
Published: November 2007

We wondered how many women had experienced a sensation of fullness in the ear during pregnancy. To address this question, data were obtained from a group of healthy women who attended the gynaecology clinic in our hospital as pregnancy cases between February 1995 and January 1998 and who volunteered to participate in our study. A control group was drawn from healthy female co-medical staff members of our hospital who had never been pregnant. The data used for comparing the two groups were taken from a questionnaire about ear problems that was presented to all subjects. The results suggest that ear problems may be increased in pregnancy, particularly for hypotensive pregnant women. However, even for pregnant women complaining of ear problems, pure-tone audiometry and impedance audiometry showed normal hearing in all cases. Furthermore, these women's complaints resolved completely on delivery of their babies.
How uncomfortable are the various positions recommended for the instillation of nose drops?
Authors: Kubba Haytham
Published: November 2007

Nose drops are widely used in the topical treatment of nasal disorders. Their efficacy has previously been shown to depend on the position of the head adopted during instillation. All three of the commonly recommended head positions (head back, praying-to-Mecca, Mygind's) are uncomfortable, and this may affect patient compliance. As yet, no assessment has been made of the discomfort encountered by patients. Twenty adults from a general otolaryngology clinic were asked to adopt each of three positions and then rate the discomfort experienced on a 10 cm visual analogue scale. The results show that although Mygind's position is well tolerated, the praying-to-Mecca position was significantly more uncomfortable than any other. In the absence of any evidence that the praying-to-Mecca position is clinically more efficacious than Mygind's, it seems inappropriate to continue to advocate its use.