bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of denervation on primate laryngeal muscles: a morphologic and morphometric study
Authors: Sahgal V. , Hast M. H.
Published: November 2007

Primate intrinsic laryngeal muscles studied consisted of Type I and Type II fibres. Type II fibres were larger than Type I fibres. The coefficient of variance of these muscles suggested that the fibre-size variation was similar in all of these muscles. Denervation resulted in shrinking of Type II fibres at two weeks in all the muscles, while at four weeks the thyroarytenoid showed an inflammatory reaction and far greater reduction in size than the other muscles. At eight weeks, however, all the muscles were fibrosed. We conclude that laryngeal muscles begin to show evidence of denervation at two weeks and are fibrosed in eight weeks. The thyroarytenoid muscle showed inflammatory degeneration, while the posterior cricoarytenoid and cricothyroid muscles showed classical changes of denervation. These findings should have clinical significance in the timing of reinnervation procedures.
Rhabdomyoma of the larynx
Authors: Rosenman D. , Gertner R. , Fradis M. , Podoshin L. , Misslevitsch A. , Boss J. H.
Published: November 2007

Since 1897 a total of 37 cases of extracardiac rhabdomyomas of the fetal type have been reported in the literature. Only two of these were localized in the larynx. We report an additional case of extracardiac rhabdomyoma localized in the larynx, and the pertinent literature is discussed. Although rare, its existence should be kept in mind in the differential diagnosis of laryngeal tumours.
Cartilaginous neoplasms of the head and neck
Authors: Webber P. A. , Hussain S. S. M. , Radcliffe G. J.
Published: November 2007

The presenting features and management of three cases of chondroma and one of chondrosarcoma in different head and neck sites are described. The rarity of this tumour is emphasized by a brief review of the literature. The fact that all the above cases presented within two years to one District General Hospital makes this series very unusual indeed.
Skeletal lesions in von Recklinghausen's disease of the head and neck in Nigerian Africans
Authors: Ijaduola G. T. A. , Ademiluyi S. A. , Olarenwaju D. A.
Published: November 2007

A study of skeletal lesions in the head and neck region of 20 adult patients with von Recklinghausen's disease, seen in the Surgical Out Patient clinic of Lagos University Teaching Hospital from 1979 to 1985, has been carried out. Among the 20 patients, 13 (65 per cent) had symptoms related to the head and neck while 7 (37 per cent) did not; however, on radiological screening, all of them were observed to have skeletal lesions. The commonest feature was enlarged intervertebral nerve root exit foramina from mesodermal dysplasia, which occurred in 16 (80 per cent) of our patients. Other major findings were erosion of the mandible, 8 (40 per cent); erosion of the wings of the sphenoid, 4 (20 per cent); poor mastoid bone pneu-matisation, 3 (15 per cent); erosion of the parietal bone, 3 (15 per cent) and heterotopic bone formation, 1 (5 per cent). Congenital calvarial defects were not detected. In view of the fact that all our patients showed radiologically detectable skeletal lesions of the head and neck, despite absence of symptoms in 35 per cent, it is advisable that all patients with von Recklinghausen's disease should routinely have radiological screening of this region, to detect early lesions.
Localisation of a CSF fistula by metrizamide CT cisternography
Authors: Luotonen J. , Jokinen K. , Laitinen J.
Published: November 2007

Localisation of a cerebrospinal fluid fistula in the nasal region is difficult. Lack of a suitable roentgen contrast medium for intrathecal use has earlier restricted theutility of cisternography. Metrizamide cisternography and CT have recently proved to be well tolerated and effective in revealing CSF fistulae. A case report of operatively treated CSF rhinorrhea recurring after three years is presented. With the help of CT metrizamide cisternography, the fistula could finally be localised in the sphenoidal sinus. The re-operation confirmed this finding. The technique of cisternography is described.
Dysequilibrium of ageing (presbyastasis)
Authors: Belal A. , Glorig Aram
Published: November 2007

We reviewed clinical findings in 740 patients over age 65 who consulted the Otological Medical Group, Inc., during a one-year period for dizziness. A thorough neurotologic evaluation is indicated in every such case to determine the specific cause of dizziness. In 21 per cent of these patients, a specific cause of dizziness was found. In the remaining 79 per cent, the diagnosis of primary dysequilibrium of ageing (presbyastasis) was made.

We classified dysequilibrium of ageing (presbyastasis) according to the character, time course, and precipitating factors of dizziness. Two clinical types were described: constant and unclassified. The histological finding in the temporal bones of four cases with dysequilibrium of ageing were reviewed. Pathological changes other than those in the peripheral vestibular system seem to be responsible for dysequilibrium of ageing.

In the present series, about three-fourths of the patients had a daily dose of nicotinic acid to produce flushing of the skin. In 16 per cent, the dizziness was minor, requiring no special treatment. In the remaining 9 per cent with incapacitating vertigo, a vasodilator regimen, antivertiginous drugs, and Cawthorne's vestibular exercises were prescribed.
Efficacy of medical treatment as an adjunct to surgery in the treatment of secretory otitis media
Authors: Lesser T. H. J. , Clayton M. I. , Skinner D.
Published: November 2007

In a pilot controlled randomised trial of 38 children who had bilateral secretory otitis media, with effusion demonstrated at operation, we compared the efficacy of a six-week course of an oral decongestant—antihistamine combination and a mucolytic preparation with a control group in preventing the presence of middle-ear effusion six weeks after myringotomy and adenoidectomy. The mucolytic preparation decreased the presence of middle-ear effusion when compared to the decongestant-antihistamine combination and the control group (p=0.06).
Crosslinks between stereocilia in hair cells of the human and guinea pig vestibular labyrinth
Authors: Jeffries David J. , Pickles James O. , Osborne Michael P. , Rhys-Evans Peter H. , Comis Spiro D.
Published: November 2007

The saccules and ampullae of the semicircular canals from human and guinea pig temporal bones were fixed in glutaraldehyde without osmium. Crosslinks were seen between stereocilia of the vestibular hair cells, similar to those previously demonstrated in the guinea pig, although an additional set of crosslinks was displayed: first, horizontal crosslinks were seen between adjacent stereocilia, occupying most of the length of the hair bundle; secondly, a single upward-pointing link ran from the apex of each shorter stereocilium into the shaft of the adjacent taller ster-eocilium; thirdly, an extensive array of horizontal links were demonstrated between stereocilia close to their insertion into the cuticular plate. We suggest that these basal crosslinks support the long vestibular stereocilia rendering them more rigid, and that the upwind pointing crosslinks are responsible for the initiation of sensory transduction.
Surgical anatomy of the round window with special reference to cochlear implantation
Authors: Franz Burkhard K. H. , Clark Graeme M. , Bloom David M.
Published: November 2007

When the multi-channel cochlear implant electrode is inserted into the scala tympani through the round window the operation is best performed via a posterior tympanotomy. The view of the round window membrane, however, is incomplete because of its orientation and the fact that it has a conical shape. Nevertheless, a good view along the basal turn is obtained after the antero-inferior overhang of the round window niche and the crista fenestrae have been removed. It might be damaging to drill away the postero-superior overhang as the osseous spiral lamina lies extremely close to the round window membrane.
Prevalence of secretory otitius media among school children in Kuwait
Authors: Holmquist Jörgen , Al Fadala Sanad , Qattan Yaccob
Published: November 2007

Tympanometry and otoscopy were performed by the authors on 893 schoolchildren in Kuwait during early 1983. Based on tympanometry 31.3 per cent were found to have tympanograms indicating secretory otitis media. The otoscopic findings confirmed this high prevalence (30.0 per cent). At re-examination three months later, the point prevalence had decreased by almost 5 per cent which is well in accordance with the seasonal variation of this disease.
The nasal distribution of metered does inhalers
Authors: Newman S. P. , Morén F. , Clarke S. W.
Published: November 2007

The intranasal distribution of aerosol from a metered dose inhaler has been assessed using a radiotracer technique. Inhalers were prepared by adding 99Tcm-labelled Teflon particles (simulating the drug particles) to chlorofluorocarbon propellants, and scans of the head (and chest) taken with a gamma camera. Ten healthy subjects (age range 19–29 years) each performed two radioaerosol studies with the inhaler held in two different ways: either in a single position (vial pointing upwards) or in two positions (vial pointing upwards and then tilted by 30° in the sagittal plane).

The vast majority of the dose (82.5 ± 2.8 (mean ± SEM) per cent and 80.7 ± 3.1 per cent respectively for one-position and two-position studies) was deposited on a single localized area in the anterior one-third of the nose, the initial distribution pattern being identical for each study. No significant radioaerosol was detected in the lungs. Only 18.0 ± 4.7 per cent and 15.4 ± 4.1 per cent of the dose had been removed by mucociliary action after 30 minutes, and it is probable that the remainder had not penetrated initially beyond the vestibule. Since the deposition pattern was highly localized and more than half the dose probably failed to reach the turbinates it is possible that the overall effect of nasal MDIs is suboptimal for the treatment of generalized nasal disorders.
Fibrin glue in nasal septal surgery
Authors: Hayward P. J. , Mackay I. S.
Published: November 2007

We have successfully used fibrin glue to avoid operative nasal packing in 30 cases of septal surgery. Avoiding a nasal pack is not only more acceptable to the patient but may also reduce hospital stay. Analysis of our results showed some minor short-term complications but initial post-operative septal deviation tended to resolve spontaneously. Transient oedema and hyperaemia occurred in 37 per cent of cases and may represent an allergic response despite few classical allergic reactions having been reported.
Who should treat epistaxis?
Authors: John D. G. , Alison A. I. , Scott D. J. A. , McRae A. R. , Allen M. J.
Published: November 2007

A prospective study was undertaken of 75 patients complaining of epistaxis who presented to an Accident and Emergency Department.

The patients were placed into four groups according to their presenting features, and various forms of appropriate management applied.

It was found that in the group that had ceased bleeding on presentation, whether or not a bleeding point was visible, there was no benefit obtained by treatment. If the nose was still bleeding on presentation, and the bleeding point was visible, successful management could be obtained by cauterising the bleeding point. This is a treatment that could be carried out by either the General Practitioner or the Accident Department. If the nose was actively bleeding, and the bleeding point could not be seen, then even initially successful treatment by the Accident Department was usually found to be ineffective within forty-eight hours. It is suggested that this group should be referred to an ENT unit on presentation.
A view of partial laryngectomy in the treatment of laryngeal cancer
Authors: Shaw H. J.
Published: November 2007

Attention is drawn to the problems of surgical resection by partial laryngectomy after full therapeutic dosage of telecobalt irradiation. Material is presented from two treatment centres to indicate trends in surgical treatment and the complications experienced. Results will be given which confirm a reasonable expectation of cure and functional conservation by vertical partial laryngectomy for recurrence of glottic cancer after irradiation. The results of treatment of recurrent supraglottic cancer by horizontal partial laryngectomy gave more cause for concern in terms of complications and survival. In conclusion an attempt is made, based on the quoted experience, to define the position of conservation surgery in two centres for laryngeal cancer in the United Kingdom.
The use of the underpressure chamber in the treatment of patients with Menière's disease
Authors: Van Deelen G. W. , Hulk J. , Huizing E. H.
Published: November 2007

Thirty-four Menière patients (43 ears) were treated in an underpressure chamber. Békésy audiometry and impedance audiometry were performed immediately before and after the exposure to underpressure. A hearing gain of more than 10 dB. was found in 19 per cent of the ears (8/43). In five ears this improvement lasted for a few days. Only one patient (2 per cent) reported a relief of tinnitus. In 9 out of the 30 patients (30 per cent) with recent vertiginous attacks a positive subjective effect on the vertigo was obtained.
Squamous cell carcinoma of the larynx with osteoclast-like giant cells
Authors: Ferlito A. , Fmedmann I. , Recher G.
Published: November 2007

An unusual squamous cell carcinoma of the larynx containing numerous multinucleated osteoclast-like giant cells in described. These cells occurred in areas of vigorous angiogenesis and haemorrhage. To our knowledge, this is the first case of laryngeal squamous cell carcinoma with osteoclast-like giant cells reported in the literature. The patient has remained alive and free of clinical disease 5 years and 4 months after the original diagnosis.
Does submucosal diathermy to the inferior turbinates reduce nasal resistance to airflow in the long term?
Authors: Jones A. S. , Lancer J. M.
Published: November 2007

The operation of submucosal diathermy is commonly performed for the relief of nasal obstruction due to mucosal swelling. In this study the effect of the procedure on nasal resistance to airflow is assessed by rhinomanometry. The results show that although the operation is effective in the short term (two months), there is no significant difference between the nasal resistances prior to surgery and at 15 months after surgery.
A case of nasal glioma and neurofibromatosis A new association
Authors: Pollard K. , Carter D. A.
Published: November 2007

A man of 25 with von Recklinghausen's neurofibromatosis (VR) developed nasal polyps. Subarachnoid haemorrhage occurred shortly after surgical excision and he died 9 weeks later. Post-mortem examination showed chronic hydrocephalus due to aqueduct stenosis. Histologically the polyps were a nasal glioma, a forme fruste of anterior encephalocoele not previously associated with VR, though other cranial defects are well recognized. Nasal glioma should be considered in the differential diagnosis of nasal lesions in VR.
Parapharyngeal malignant ectomesenchymoma: Combined malignant fibrous histiocytoma and primitive neuroectodermal tumour with neuroglial differentiation
Authors: Kasantikul V. , Shuangshoti S. , Cutchavaree A. , Bunyaphiphat P.
Published: November 2007

A parapharyngeal ectomesenchymoma consisting of mixed malignant fibrous histiocytoma and primitive neuroectodermal tumour with neuroglial differentiation occurred in a 36-year-old woman. Immunohistochemical and electron microscopic studies verified the combined mesenchymal and neuroectodermal components within the tumour. Only 9 similar cases, including the present one, are on record. The patients ranged in age from 6 months to 49 years, with an average age of 18 years. The male: female ratio was 4:5. The tumour location was widespread. All reported ectomesenchymomas were histopathologically malignant. Recurrence and/or metastasis was/were common. The neural crest has been suggested as the origin of the ectomesenchymomas.
A study of three preparations in the treatment of otitis externa
Authors: Slack R. W. T.
Published: November 2007

Twenty-seven patients with an initial diagnosis of otitis externa, untreated for the previous 2 weeks, were treated with weekly aural suction toilet and a choice of three topical drops. Two contained combinations of antibiotics and steroids, one of which also contained an anti-fungal agent. The third was boric acid in spirit. The patients were assessed at weekly intervals until a remission was established. From this study it would appear that antibiotic-based drops confer no real advantage over boric acid in spirit.
The true shape of the tympanic membrane
Authors: Wajnberg Joseph
Published: November 2007

Twenty-eight human tympanic membranes (TM) are presented. In almost all of them the horizontal axis is longer than the vertical. This is contrary to the accepted view, which describes the tympanic membrane as being longer in its Vertical dimension.
Fine needle aspiration biopsy and the otolaryngologist
Authors: Wilson Janet A. , McIntyre Margaret A. , von Haacke N. P. , Maran A. G. D.
Published: November 2007

A survey of the diagnostic value of fine needle aspiration cytology in ENT practice was carried out over a 3-year period. The 119 aspirates were taken from a variety of head and neck sites and examined by an experienced cytopathologist. Cytology was accurate in 111 (93 per cent), with two false negative aspirates (1.7 per cent) and no false positive results. There were no complications and the technique was found to be a rapid, safe and cost-effective diagnostic tool.
Auditory brainstem evoked potentials in sudden deafness
Authors: Wilder A. , Pratt H. , Rosen G.
Published: November 2007

Auditory Brainstem Evoked Potentials (ABEP) were recorded from 53 adult subjects suffering from sudden deafness at the time of examination. The onset of sudden deafness was up to three years prior to the study. ABEP were recorded in response to 75 dBHL clicks presented at rates of 10/sec and 40/sec. ABEP peak latencies as well as interpeak latency differences, and also the effect of increasing stimulus rate, were determined for each patient and compared with the clinical symptoms. The psychoacoustic and ABEP detection thresholds were also compared.

A highly significant correlation was observed between ABEP detection threshold and the psychoacoustically determined hearing threshold, and the differences between them were found to be insignificant. The results of this study indicate a central component in sudden deafness. This impairment manifests itself in abnormal effects of increasing stimulus rate on ABEP, and may be related to reduced central synaptic efficacy.
Cholesteatoma following stapedectomy
Authors: Von Haacke N. P. , Wilson Janet A. , Murray J. A. M. , Duvall E.
Published: November 2007

Among the possible complications of stapedectomy for otosclerosis, cholesteatoma is extremely rare. We report a case which was secondary to implantation of keratinising squamous epithelium inadvertantly included in the fat graft taken from the ear lobe'to seal the footplate.
Posterior fossa ganglioglioma—an unusual cause of hearing loss
Authors: Dhillon R. S.
Published: November 2007

Intracranial or spinal gangliogliomas of the CNS are rare tumours. Although several cases have been reported over the years, controversy still remains as to their origin, treatment and prognosis. A case of an eight-year-old girl with a ganglioglioma in the cerebellum with extension into the cerebello-pontine angle is described. The histological basis of the diagnosis is discussed and a review of the literature is presented.
Tuning fork tests in children (An evaluation of their usefulness)
Authors: Capper J. W. R. , Slack R. W. T. , Maw A. R.
Published: November 2007

Despite the huge advances in clinical audiology over the past few decades, tuning fork tests are still used extensively in the diagnosis of hearing loss. This study investigates the usefulness, reliability and accuracy of tuning fork tests in a group of children involved in a prospective study of glue ear, and shows them to be of dubious value.
Haemostatic disorders in habitual nose-bleeders
Authors: Beran Martin , Stigendal Lennart , Petruson Björn
Published: November 2007

Ninety-one habitual nose-bleeders were screened for haemostatic disorders. 46 screening results in 38 nose-bleeders were outside the normal range. After extended investigation, it was found that 25 (27 per cent) habitual nose-bleeders had haemostatic disorders, all except one in the primary haemostasis. The disorders found could be classified as mild bleeding disorders (MBD) and compared to the estimated frequency of MBD in the population there was an increased incidence of haemostatic disorders in the habitual nose-bleeders. Abnormal vessels in the nasal mucosa were present in 85 per cent of the investigated nose-bleeders, equaly distributed between nose-bleeders with and without haemostatic disorders. This indicates that abnormal vessels and haemostatic disorders occur independently of each other. When screening for haemostatic disorders in habitual nose-bleeders, it is possible to detect previously unknown but clinically important disorders.
Hearing loss after general anaesthesia
Authors: Hochermann Max , Reimer Åke
Published: November 2007

Unilateral hearing loss has been reported as an unusual complication in general anaesthesia, and so far no reports on bilateral hearing loss have been published. In this paper we present a case with bilateral sensorineural hearing impairment immediately following a minor abdominal surgical procedure. The literature is reviewed and the mechanisms causing hearing loss during anaesthesia are discussed.
The early complications of inferior trubinectomy
Authors: Dawes P. J. D.
Published: November 2007

A retrospective study has assessed the early complications occurring in 90 patients who underwent inferior turbinectomy during a 3-year period. The operation was complicated by haemorrhage, adhesions, crusting, infection and septal perforation in a proportion of cases, the overall incidence being 20 per cent, and that of significant reactionary or secondary haemorrhage was 9 per cent. Attention has been directed towards possible aetiological factors and measures proposed that may minimise the occurrence of complications.
Intraluminal crystalloids in malignant salivary gland tumours
Authors: Ro Jae Y. , Mackay Bruce , Batsakis John G. , Cartwright Joiner
Published: November 2007

The ultrastructural, X-ray microanalytical, histochemical and immunocytochemi-cal features of intraluminal crystalloids found in adenocarcinomas of the parotid gland have been studied. The crystalloids, putatively derived from an abnormal crystalization of salivary duct proteins, are considerably different from the crystalloids found in normal parotid glands, pleomorphic adenomas, and sialocysts.
Pendred's syndrome
Authors: Johnsen T. , Larsen C. , Friis J. , Hougaard-Jensen F.
Published: November 2007

Seventeen unrelated Danish patients with Pendred's syndrome, whose case stories have not been published previously, are presented. Acoustic and vestibular functions were examined and endocrinological screening was performed. There was a great variation in hearing ability as well as in thyroid function. Furthermore, in contrast to previous investigations, normal caloric function was demonstrated in the majority. In all patients a Mondini malformation was demonstrated. On the basis of this investigation it is concluded that: (1) the Mondini defect is part of Pendred's syndrome; (2) the inherited Mondini malformation is the underlying cause of the sensorineural hearing impairment; and (3) the hearing sensitivity varies greatly in these patients.
Bifid condyle of the mandible with associated polythelia and manual anomalies
Authors: Zohar Yuval , Laurian Nelo
Published: November 2007

Syndromes of oro-mandibular-skeletal anomalies are confusing by their ambiguous and overlapping components. It is our purpose to bring attention to a case comprising a group of anomalies: bifid mandibular condyle, asymmetric contralateral ascending ramus of the mandible, supernumerary nipples (polythelia), supernumerary-rudimentary postaxial sixth fingers and clinodactyly. The associated malformations presented do not correspond to any previous report. The case may therefore represent a new malformation syndrome.
Middle ear effusion—A theoretical neuro mechanical hypotheses
Authors: Raman R.
Published: November 2007

An alternative theoretical neuro-mechanical hypothesis is presented in the pathogenesis of middle ear effusion, along with a review.
The use of Walkman mini-sterco system as a tinnitus masker
Authors: Al-Jassim A. H. H.
Published: November 2007

A study was done on 41 patients to compare the use of the Walkman Mini-stereo system with different types of phones to mask tinnitus, by using music, or relaxation or different bands of noise similar to those generated by a tinnitus masker or pure tone, and it was found that the Walkman Mini-stereo system with any types of phone, was as effective, and more economic, both to patients and to the N.H.S., than traditional tinnitus maskers. It should be recommended for the management of tinnitus i n preference to the traditional tinnitus maskers.
Meningitis after trans-sphenoidal excision of pituitary tumours
Authors: Gransden W. R. , Wickstead M. , Eykyn Susannah J.
Published: November 2007

Between 1974 and 1986, eleven of 114 patients undergoing trans-sphenoidal removal of pituitary tumours developed meningitis despite prophylaxis, usually with chloramphenicol. Nine patients had cerebrospinal fluid rhinorrhoea and one died. A variety of pathogens was isolated, including enterobacteria, and four of the eleven were resistant to the antibiotics given as prophylaxis. Enterobacterial meningitis was always associated with infection of the sphenoidal sinus involving the muscle graft or nasal pack (five cases), and removal of the muscle graft was necessary in three cases despite the use of appropriate antibiotics.
Thermal myringotomy
Authors: Ruckley R. W. , Blair R. L.
Published: November 2007

Thirty-six children with bilateral secretory otitis media were treated by thermal myringotomy and middle ear aspiration in one ear, and conventional myringotomy, middle ear aspiration and Shepard grommet insertion in the other ear. All children underwent adenoidectomy. Comparing the effectiveness of the two different procedures over a three-month review period, our main findings are as follows. All thermal perforations were closed by 42 days. Elimination of middle ear fluid was achieved in 81 per cent of the thermal myringotomy group, and in 100 per cent of the grommet group. While there was no significant difference in the hearing improvement between the procedures, conventional myringotomy and grommet insertion provided significantly better sustained middle ear ventilation.
Use of bronchoscopic CO2laser in palliation of obstruction tracheobronchial malignancy
Authors: Oswal V. , Flood L. M. , Ruckley R. W.
Published: November 2007

A review of 15 patients, who underwent 34 CO2laser bronchoscopic procedures, over a 2-year period, is presented. All had malignancies of the tracheobronchial tree and underwent laser surgery to palliate breathlessness or haemoptysis. Partially obstructing and more proximal tumours proved more easily manageable. One quarter of the patients required repeat procedures and there were two deaths in the early post-operative period. The indications for such surgery, the technique and its limitations, and the palliation obtained are discussed.
Exostosis of the internal auditory canal
Authors: Doan Huynh T. , Powell James S.
Published: November 2007

Although exostoses of the external auditory canal are not uncommon, those of the internal canal are extremely rare. One of these is described occurring in a 53-year-old man whose rapidly progressive hearing loss was without any associated abnormality.
An unusual complication of epistaxis
Authors: Prescott C. A. J.
Published: November 2007

Ten days after left-sided external carotid artery ligation for control of profuse epistaxis a complete left-sided facial nerve palsy developed in a 25-year-old male. Abnormal bleeding or clotting disorders had been excluded. It is postulated that either thrombosis or embolus obstructed the petrosal branch from the middle meningeal artery on the same side with subsequent ischaemia resulting in nerve degeneration of the intratemporal portion of the facial nerve.
Long-term presence of a denture fragment in the airway
Authors: Poukkula A. , Ruotsalainen E.-M. , Jokinen K. , Palva A. , Nuorviita J.
Published: November 2007

Two cases are reported in which a denture fragment was lodged in the bronchus for a period of six years. Bronchial asthma which did not worsen immediately after inhalation and other misleading factors made the diagnosis more difficult in the first case, whilst the respiratory symptoms in the second case appeared only 4 years after inhalation. Haemoptysis 2 years later led to a bronchoscopy and the removal of the foreign body.
The tympanic membrane in cross section: a finite element analysis
Authors: Lesser T. H. J. , Williams K. R.
Published: November 2007

This paper applies the technique of finite element analysis to the tympanic membrane. A Two-dimensional cross-sectional model of the tympanic membrane and malleus is described. A variety of experiments have been performed on this model, and displacements under a uniform load are analysed. The shape of the displaced membrane and the movement of the umbo were found tobe sensitive to a number of factors. These include the elastic modulus of the membrane, the presence and position of the axis or rotation of the malleus, and the size of the pars flaccida. Some implications of these results are discussed.
Staging in the treatment of maxillary carcinoma revisited
Authors: Liu Fang-Cheng , strome Marshall
Published: November 2007

The site of origin of maxillary sinus carcinoma will not infrequently predetermine the varied neurological signs at presentation. Modifying Ohngren's division, the maxillary sinus can be divided into for quadrants based on anantomical nerve correlates, thus facilitating identification of the primary site. An inclusive classification of maxillary sinus caricinoma based on Broder's grading, site of origin, the TNM classification and the patient's general condition, serves as the basic for a correlative therapeutic regimen.
Globus hystericus: globus syndrome?
Authors: Puhakka Heikki J. , Kirveskari Pentti
Published: November 2007

In a double-blind study, 22 patients with typical globus symptoms were investigated by both otolaryngological and odontological methods. All the patients underwent thorough hematological, endoscopic and radiological examinations. They were randomly divided into a treatment group and a placebo group and underwent either simple occlusal adjust or mock adjustment, respectivity. The result of occlusal adjustment was assessed immediately after completion of treatment. The effect of treatment on globus symptoms was assessed 2 to 3 months later in a double-blind study. Binomial tests showed that there was a significant association between the success of occlusal adjustment and disappearance of the globus symptom. A new name for this disease is proposed: the globus syndrome.
Clinical application of electrolaryngograph for speech rehabilitation in near-total laryngectomy with myo-mucosal valved neoglottis
Authors: Singh Waryam
Published: November 2007

Near-total laryngectomy with myomucosal valved neoglottis is the most recent of the various surgical proceedures for speech rehabilitation. The electrolaryngographic wave form (Lx), which was recorded initially to explore the site and mechanism of phonatory function of the neoglottis, has been successfully used in speech rehabilitation of these patients. In a pilot study it was tried as a visual feedback. The results confirm its utility for speech rehabilitation of these laryngectomees.
Adjuvant chemotherapy in stage III and IV squamous cell carcinoma of the head and neck
Authors: Klima A. , Klippstein TH , Bergmann L. , Szepesi S. , Ilberg C. V.
Published: November 2007

Summary Initial combination drug regimen containing cisplatin in patients with stage III and IV head and neck cancer produced a high percentage of clinical response. This trial was initiated to assess the role of multimodality treatment (chemotherapy plus radiotherapy) versus chemotherapy alone. Ninety-six patients entered into this study; 80 patients were evaluable at time of analysis (Table I). Patients were randomized between chemotherapy and radiotherapy (group I) and chemotherapy alone (group II). The chemotherapy administered consisted of cisplatin, bleomycin and methotrexate and was given in 2 cycles over 35 days. Local radiotherapy followed. In group II 3 cycles of chemotherapy were given without radiotherapy. The overall tumour response after chemotherapy rose up to 75 per cent. After radiotherapy in group II the response rate sank to 59 per cent. In both regimes the remission duration was very short. Patients receiving only two cycles of chemotherapy do not have a statistically shorter survival than patients, who were treated by chemotherapy plus radiotherapy, or by a 3rd cycle of chemotherapy.
Middle turbinate osteoma; an unusual cause of nasal obstruction
Authors: Whittet H. B. , Quiney R. E.
Published: November 2007

Osteomas are common benign tumours of the paranasal sinuses, but are usually asymptomatic and found as a coincidental finding during routine radiological investigations. We present a case report of a patient with an isolated osteoma of the middle turbinate presenting with unilateral nasal obstruction which required removal via a lateral rhinotomy approach. The aetiology, pathology and presenting features of these tumours are reviewed and their subsequent management discussed. In particular, adequate pre-operative radiological assessment to determine involvement of the cribriform plate region by computerized axial tomography (CAT Scanning) is emphasized since this may indicate the need for a cranio-facial surgical approach rather than a lateral rhinotomy to achieve complete removal.
Antroscleroma
Authors: Saad Ezzat F.
Published: November 2007

Oedema, hypertrophy, polyposis, atrophy or empyema of the maxillary sinus are common features of rhinoscleroma. However, actual involvement of the antrum by the nasal granuloma is rare and primary scleroma of the antrum is of extreme rarity. Three cases of antroscleroma are presented, one secondary to an extensive rhinoscleroma and two primary. The difference in the physical, biological and microbiological environment in the antrum from that in the nose might explain the rarity of antroscleroma.
Cerebrospinal otorrhoea—a temporal bone report
Authors: Walby A. Peter
Published: November 2007

Spontaneous cerebrospinal otorrhoea is a rare complication of a cholesteatoma. The histological findings in a temporal bone from such a case are reported. The cholesteatoma had eroded deeply through the vestibule into the internal auditory meatus.
Medical management of active chronic otitis media: A controlled study
Authors: Browning G. G. , Gatehouse S. , Calder I. T.
Published: November 2007

About 2 per cent of adults have active chronic otitis media, the majority being managed by medical means. Previous controlled studies have been unable to show benefit from any medication, including systemic or topical antibiotics, but the effect of the addition of topical steroids to the latter has never been evaluated.

One hundred and sixty three adults with active chronic otitis media were randomly allocated to receive either antibiotic/steroid ear drops or placebo therapy over a 4–6 week period. Fifty-two per cent of ears receiving active therapy, as opposed to 30 per cent on placebo therapy (p<0.05), became otoscopically inactive if compliance to medication was greater than 70 per cent. However, when there was an open mastoid cavity, active therapy was no more successful than placebo. Though gentamicin was the antibiotic used, there was no evidence of ototoxic inner ear damage.

Surprisingly, correlation between clinical activity and patient report of a discharge was poor. Forty percent of both treatment groups considered that their ear had become dry following therapy and these were not the same patients whose ears had become otoscopically inactive.
Pseudomonas vaccination in chronic ear disease
Authors: Kent S. E. , Jones R.
Published: November 2007

This paper presents the results of a pilot study of vaccination in thirteen patients with chronically infected mastoid cavities or central perforations of the tympanic membrane. In each patient Pseudomonas aeruginosa was repeatedly cultured from the ear and a long list of medical and surgical treatments had been tried, without success, to control the infection. The clinical, bacteriological and immunological responses were monitored over a six-month period.

The results are extremely encouraging. Eight patients' ears became dry for the first time in many years. However, three months after vaccination three ears had become reinfected.

All of the patients except one had a good immunological response to vaccination, with many-fold increases in the total serum immunoglobulin G, A and M levels.
Pleomorphic adenomas of the parotid gland: superficial parotidectomy or limited excision?
Authors: Wennmo C. , Spandow O. , Emgård P. , Krouthén B.
Published: November 2007

In this retrospective study of parotid tumours. 57 patients with pleomorphic adenomas were treated with superficial parotidectomy and 33 patients with limited excision. The follow-up period has been 4–14 years. When the operation was superficial parotidectomy, recurrences occurred in 8.7 per cent compared to 6 per cent in cases of limited excision. Side-effects such as permanent weakness of the facial nerve or postoperative gustatory sweating were also more common when superficial parotidectomy was performed. The post-operative results observed suggest that limited excision under magnification is more favourable than superficial parotidectomy in the treatment of pleomorphic adenomas.
The surgical anatomy for multiple-electrode extracochlear implant operations
Authors: Franz Burkhard K-H. G. , Clark Graeme M.
Published: November 2007

Direct access to the whole length of the cochlear turns via endaural middle ear approach for the placement of extracochlear electrodes is severely restricted. Approximately 10 mm. of the cochlear turns are accessible, being less than a third of their length. The middle cranial fossa, the facial nerve, the internal carotid artery and the temporomandibular joint restrict the access. A further restriction is caused by the position of the cochlea and the direction of its axis. The anterior part of the cochlea lies anterior to the tympanic membrane and medial to the temporomandibular joint, thus limiting an endaural approach to a posterolateral direction. Despite this limitation small sections of the basal, middle and apical turns of the cochlea can be reached.
Auditory brain stem responses (ABR) in patients with acute severe closed head injuries
Authors: Elwany Samy
Published: November 2007

ABR were recorded in 68 cases suffering from severe acute closed head injuries. Abnormal recordings were observed in 60 per cent of patients, and the abnormalities ranged from prolongation of the interpeak latency intervals to complete absence of auditory brain stem activity. Based on the results obtained, a grading system was developed and correlated with the neurological outcome. It was concluded that ABR is a useful diagnostic and prognostic tool which can provide valuable information about the function of the brain stem in these patients. Inclusion of ABR studies in the head injury management protocol is strongly recommended.
A prospective randomized trial of suture material in aural wound closure
Authors: Willatt D. J. , Durham L. , Ramadan M. F. , Bark-Jones N.
Published: November 2007

The aim of the study was to compare synthetic monofilament suture materials with chromic catgut and silk in aural wound closure. Forty patients undergoing mastoidectomy or tympanoplasty were randomized to closure with either 30 PDS (Polydioxanone) to fascia plus 30 Prolene to skin, or 20 chromic catgut to fascia plus 30 silk to skin. Known or suspected factors affecting wound healing were recorded. Nine patients had post-operative wound infections. The infection rate was significantly lower in wounds closed with PDS and Prolene (χ2 = 6.05, p<.05), and in tympanoplasty operations (χ2 = 4.42, p<.05). Four patients suffered wound dehiscence, all four had been closed with catgut and silk. No other complication of wound healing was noted in the trial. In conclusion, PDS and Prolene are superior suture materials to catgut and silk in the closure of aural wounds.
Ipratropium bromide in the treatment of the ‘rhinorrhoea syndrome’
Authors: O'Dwyer T. P. , Lee R. J. , Kaye J. , Fennell G.
Published: November 2007

Conventional treatments for non-allergic perennial rhinitis have proven somewhat unsuccessful in the control of rhinorrhoea when it is the predominant symptom. Hence, a double-blind cross-over trial of Ipratropium, a parasympatholytic, and placebo were carried out over a 12-week period. There was a significant reduction in rhinorrhoea during active treatment, with the most noticable effect being in the moderate-to-severe rhinorrhoea group. No significant effect was noted on nasal obstruction or sneezing and no serious side-effects were seen. A carry-on effect was noted when active treatment was used initially. However, the group given active treatment following placebo had a better result overall. A strong placebo effect was also noted in both groups, in keeping with a trial of this order.
Intubation trauma
Authors: Davies J. E. , Lesser T. H. J. , Cobley M. A.
Published: November 2007

In recent years endotracheal tubes with low pressure cuffs have become available with the aim of reducing trauma to the trachea and larynx. This paper uses laryngographic methods to analyse intubation trauma in 20 short to medium term intubations.

No difference in laryngeal trauma was found between low pressure, large diameter cuffs when compared ot standard cuffs.
Nasal granuloma gravidarum
Authors: Mcshane D. P. , Walsh M. A.
Published: November 2007

Nasal granuloma gravidarum is a rare condition that arises exclusively during pregnancy. It usually presents with the non-specific symptoms of nasal bleeding and obstruction though occasionally a patient may notice an intra-nasal mass herself.

Three cases of nasal granuloma gravidarum are presented to add to those previously recorded in the literature. Although the aetiology of this condition is unclear, the authors speculate that it probably represents an excessive healing response to some minor trauma sustained in a tissue primed and sensitized by pregnancy.

The management of this lesion is discussed and a simple surgical procedure described for its removal.
Relapsing malignant otitis externa successfully treated with ciprofloxacin
Authors: Morrison G. A. J. , Bailey C. M.
Published: November 2007

Two cases are presented, both patients with advanced maligant otitis externa.

The antibiotic ciprofloxacin has strong anti-pseudomonal activity. It was given orally for six months to both patients, following administration of the traditional parenteral antibiotic courses, and in each case the disease has been extinguished. We therefore recommend that the management of patients shown to have malignant otitis externa should include strict diabetic control, regular local aural toilet, gentamicin ear drops and a six week course of parenteral antipseudomonal antibiotic agents (usually gentamicin and azlocillin) together with metronidazole to cover any anaerobic element in the infection. This regimen should be followed by a six month course of oral ciprofloxacin (750 mg b. d.). Indium scans should be used to monitor recovery. We believe that this regimen can significantly reduce the morbidity and mortality of patients suffering from malignant otitis externa with cranial nerve involvement.
Basal cell carcinoma of the middle ear—a natural history
Authors: Joachims H. Z. , Arieh Y.Ben
Published: November 2007

The natural course of basal cell carcinoma of the middle ear is described. This tumour is extremely rarely found in the middle ear and only two cases have been reported to date. The appearance of the tumour was heralded by earache and deafness, followed years later by wide local destruction of the temporal and parietal bones, base of skull, facial palsy and multiple distant metastases.

The patient refused both surgical and irradiation therapy and died 10 years after the initial diagnosis.
Laryngeal oedema complicating thyroid lymphoma
Authors: Watson C.
Published: November 2007

A case is described in which recurrent laryngeal oedema was the presenting feature of thyroid lymphoma. Conventional isotope scanning was of no value in reaching the diagnosis.
Cholesteatoma in children
Authors: Sadé J. , Shatz A.
Published: November 2007

Of 325 previously untreated cholesteatomas, 109 were found to be in children 13 years old and younger—however, these 109 ears were not found to consist of one clinical entity. Sixty-three of the 109 ears presented a marginal perforation or a retraction pocket, at the level of Shrapnell's membrane or beyond the posterosuperior quadrant. In this group the cholesteatoma was distributed mainly in the attic and mastoid and was associated with a non-cellular mastoid. A second group comprising 31 ears presented with cholesteatoma behind an intact drum and were considered to be primary cholesteatomas. These were distributed mostly in the tympanic cavity as cystic epidermoid formations—their mastoid was usually pneumatized. Eight cholesteatomas were related to a central perforation. These ears presented features very similar to the primary cholesteatomas i.e., a pneumatized mastoid and tympanic cavity distribution. The similar features of this group make us think that they may have also originated as primary cholesteatomas which eventually perforated and bring the percentage of primary cholesteatomas in children to 38.3%. Seven of the 109 ears with cholesteatoma were of an indeterminate character.
Perinatal salivary gland tumours (Embryomas)
Authors: Batsakis John G. , Mackay Brune , Ryka A. Francine , Seifert Robert W.
Published: November 2007

Epithelial salivary gland tumours presenting in the first month of life (perinatal tumours) are exclusively of major salivary gland origin and predominantly of the parotid gland. Approximately 25 per cent of these rare tumors have been histologically and/or biologically malignant. Except for an occasional pleomorphic and monomorphic adenoma, the majority of the tumors are proliferations suggesting a tumorous arrest of maturation of the salivary gland anlage, hence their designation as embryomas. A case report of an embryoma of the parotid is presented, accompanied by a review of the literature.
Acute epiglottitis in children and adults. Nasotracheal intubation, tracheostomy or careful observation? Current status in Scandinavia
Authors: Arndal H. , Andreassen U. K.
Published: November 2007

A review was performed of the treatment of 92 patients with acute epiglottitis with special reference to the different procedures employed in children and adults. Intubation was performed in 74 per cent of the children but in only six per cent of the adults. More than half of the children were initially observed only, but of these 58 per cent eventually needed intubation. No deaths occurred. We present our management protocol as well as a survey of the routine management of acute epiglottitis in children in the five Scandinavian countries. The number of initially observed patients ranged from nil per cent in Iceland to 35 per cent in Finland. When an artifical airway is needed, 92–100 per cent of the patients are intubated, 0-8 per cent tracheostomized, and 0-5 per cent one or the other, as a standard procedure. Tracheostomy is performed in departments where the facilities do not permit sufficient observation of patients treated by intubation.