bluuebunny/crossref_metadata_2025 huggingface dataset:
The aetiology of lateral cervical (branchial) cysts: past and present theories
Authors: Golledge Jonathan , Ellis Harold
Published: November 2007

Four theories have been suggested to explain the aetiology of lateral cervical cysts. Ascherson (1832) suggested that the cysts arose due to incomplete obliteration of branchial cleft mucosa, which remained dormant until stimulated to grow later in life. His (1886) suggested these cysts were vestiges of the precervical sinus. Wenglowski (1912) believed lateral cervical cysts developed from the third pharyngeal pouch (thymopharyngeal duct).

A number of investigators during the 19th century noted the close relationship between lateral cervical cysts and lymphoid tissue (Lucke, 1861). Luschka (1848) suggested that cystic degeneration of cervical lymph nodes was the mechanism by which lateral cervical cysts were formed. This theory received little support until King (1949) studied the histology of a large number of lateral cervical cysts and concluded that these cysts resulted from cystic transformation of cervical lymph nodes.

The evidence for and against these theories of aetiology is discussed. The debate is centred on a study of 20 patients with lateral cervical cysts operated on in the Department of Otolaryngology, Bedford Hospital, between January 1986 and December 1991. In all twenty cases the wall of the cyst was found to be composed of lymphoid tissue, histologically identical to that present in lymph nodes. The mean age of presentation was 31 years, and in no case was a tract or cord found which connected the cyst to the skin or pharynx.

The evidence strongly suggests that lateral cervical cysts develop from the cystic transformation of cervical lymph nodes. Mechanisms by which this may occur are discussed.
The Provox™ voice prosthesis andCandida albicansgrowth: a preliminary report of clinical, mycological and scanning electron microscopic assessment
Authors: Natarajan B. , Richardson M. D. , Irvine B. W. H. , Thomas M.
Published: November 2007

Provox™ voice prostheses are low-resistance speech valves available since 1990 for post-laryngectomy voice rehabilitation.Candida spp. mycelial growth has always been a major problem in all prosthetic valves causing leakage and limiting valve life. We found that the Provox™ new valves were not exempt from the old problem. We performed a preliminary clinical, mycological and scanning electron microscopic assessment ofCandida spp. growth on these valves. In contrast to studies done with other valves we found that theCandidamycelium on these new valves was a surface colony rather than growing into the valve substance, thus it might be feasible to control the mycelial growth by either mechanical cleansing or by using topical anti-fungal agents.
Pallister–Killian syndrome: an unusual presentation
Authors: El-Naggar Mohamed , Hawthorne Maurice
Published: November 2007

We present a nine-month-old baby, diagnosed as having Pallister-Killian syndrome, whose referral and investigation for possible hearing loss has led to this diagnosis. Emphasis is placed on the importance of the skin biopsy for the diagnosis of this underlying genetic abnormality.
Retropharyngeal myxoma: a case report
Authors: Pahor Ahmes L. , Samant Sandeep
Published: November 2007

Myxomas are rare tumours which may occur in the head and neck region. About 60 cases have been reported in the literature so far. We describe a retropharyngeal myxoma in this paper.
Metastatic adenocarcinoma of the temporal bone
Authors: Kedjanyi W. K. , Bath A. P. , Ball R. Y. , Hosni A. A. , Wickstead M.
Published: November 2007

Metastatic carcinoma involving the temporal bone is extremely rare. A case is reported with an unusual presentation – recurrent episodes of acute mastoiditis. Mastoid exploration and biopsy established the diagnosis. We believe this to be the first reported case to present in this manner.
Removal of nasal foreign bodies with a Fogarty biliary balloon catheter
Authors: Nandapalan V. , McIlwain J. C.
Published: November 2007

Twenty-five children with a range of nasal foreign bodies, which were not easily amenable to anterior instrumental extraction, were considered for this study. These foreign bodies were removed by the use of a Fogarty biliary balloon catheter (Intimax) successfully in 23 children. In two children no foreign body was found. None of the children had any complications.

This is a safe procedure which can be performed as an out-patient. Whilst the cost of the catheter may appear expensive, in comparison to the cost of admission for removal of similarly sited foreign bodies under general anaesthesia, the catheter fares favourably.
Bismuth subgallate: a safe means to a faster adeno—tonsillectomy
Authors: Wormald P. J. , Sellars S. L.
Published: November 2007

Tonsillectomy, with or without adenoidectomy, is one of the most commonly performed surgical procedures and as such contributes significantly to the surgery performed by GPs and ENT surgeons. In this randomized controlled study we compared the use of a compound bismuth subgallate (BSG) during adeno-tonsillectomy with the standard operations.

Two hundred and two tonsillectomies were randomized into two groups. BSG was used in 90 patients while the other 112 patients were used as controls. The mean operating time was reduced from 11.5 to 9.9 minutes, the number of swabs from 4.5 to 3.7 and number of ties from 3.4 to 2.1. All these reductions were significant (p-values all <0.05). There were no post-operative complications in either group. Thus the use of BSG during adeno-tonsillectomy or tonsillectomy alone significantly decreases the operating time and results in less intraoperative haemorrhage with fewer ties and swabs being required.
Alterations to the oropharyngeal and nasopharyngeal microbial flora of children after tonsillectomy and adenoidectomy
Authors: Manolis E. , Tsakris A. , Kandiloros D. , Kanellopoulou M. , Malamou-Lada E. , Ferekidis E. , Adamopoulos G. , Legakis N. J.
Published: November 2007

The oropharyngeal and nasopharyngeal microbial flora of 40 children with chronically hypertrophied and infected tonsils or adenoids, was studied. Twenty of the children were treated by tonsillectomy and 20 by adenoidectomy. Swabs were taken from the surgical field pre-operatively and from the oropharynx or the nasopharynx 10 and 30 days post-operatively. The swabs were cultured on suitable culture media and identification as well as quantitative estimation of the isolated bacteria, was carried out. Most of the potentially pathogenic bacteria exhibited β-lactamase production.

Interestingly, after surgical treatment, the respective microorganisms were quantitatively reduced and it was observed that their isolation rate was also lower. Furthermore, bacteria considered as normal inhabitants regularly showed an increase in their frequency of isolation despite the fact that a quantitative decrease was in some instances observed. These findings suggest that tonsillectomy and adenoidectomy result in an alteration to the abnormal oropharyngeal and nasopharyngeal microbial flora producing an almost normal one. It appears that, in cases of the failure of antimicrobial treatment, surgical procedures should be seriously considered.
Pyocele of the middle turbinate
Authors: Badia Lydia , Parikh Abhi , Brookes Gerold B.
Published: November 2007

Mucoceles are uncommon and the majority occur in the fronto-ethmoidal complex. We present the first case of a secondarily infected mucocele arising from a concha bullosa of the middle turbinate. It was excised intranasally with complete resolution of symptoms.
Late metastasis of breast carcinoma to the external auditory canal
Authors: Cumberworth V. L. , Friedmann I. , Glover G. W.
Published: November 2007

We present a case of secondary carcinoma of the external auditory meatus from a probable breast primary with a review of the literature.
Clinical applications of transcranial bone conduction attenuation in children
Authors: Vanniasegaram Iyngaran , Bradley Jane , Bellman Sue
Published: November 2007

It is a common belief that there is no significant transcranial attenuation across the skull by bone conduction (BC). In 32 children with proven unilateral sensorineural hearing loss the unmasked bone thresholds were measured on each side. There was a significant attenuation of BC at 4 kHz. Transcranial attenuation of BC at 4 kHz may explain the difference in sound perception between the two ears when bone conduction amplification is used. Further research should be undertaken to identify the better cochlea in mixed hearing losses.
Microscope and hot wire cautery management of 100 consecutive patients with acute epistaxis — a superior method to traditional packing
Authors: Quine S. M. , Gray R. F. , Rudd M. , von Blumenthal H.
Published: November 2007

The technique of microscope examination and hot wire cautery in a prospective study of 100 consecutive patients with acute epistaxis is described. The method was successful in arresting haemorrhage in 94 per cent of patients bleeding at the time of examination, and in 86 per cent, discharge home within one hour was possible. Due to improved illumination, magnification and control of the cautery instrument, nasal packing was required in only nine per cent of cases. By achieving this and by reducing the overall need for admission to 20 per cent, we recommend this method of treatment both as a successful cost saving measure, as well as advantageous to the patient.
Serum adenosine deaminase and total superoxide dismutase activities before and after surgical removal of cancerous laryngeal tissue
Authors: Canbolat Orhan , Akyol Ömer , Kavutcu Mustafa , Isik A. Ümit , Durak Ilker
Published: November 2007

In this study, pre- and post-operative serum activities of adenosine deaminase (ADA) and total superoxide dismutase (SOD) enzymes were measured in patients with squamous cell laryngeal cancer. Activities of both enzymes were found to be higher in cancerous patients compared to the controls. No significant differences were found however between pre- and post-operative values for both enzymes in the patient group.

It has been suggested that ADA and SOD enzymes leak from the cancerous laryngeal tissues into the blood stream. The absence of differences between pre- and post-operative serum enzyme activities has two possible explanations: Firstly, removal of previously released enzymes from the blood stream takes a much longer period than one month; and secondly, cancerous laryngeal tissue is not the only source of the enzymes mentioned even after removal of cancerous tissue by surgical operation, other sources such as adjacent tissues and/or metastatic tissues etc, still release these enzymes into the blood stream.
Primary extramedullary plasmacytoma in the middle ear: differential diagnosis and management
Authors: Kandiloros D. C. , Nikolopoulos T. P. , Ferekidis E. A. , Kaloterakis A. N. , Papadimitriou C. P. , Adamopoulos G. K.
Published: November 2007

Abstract: Primary extramedullary plasmacytoma (PEP) is an uncommon neoplasm of plasma cell origin which afflicts the head and neck mainly. In this study we report a rare case of a 34-year-old man who presented with left ear tinnitus, hearing loss, blocked feeling and headache. Exploratory tympanotomy revealed a mass extending into the attic and the mastoid antrum. Following canal wall-up mastoidectomy, the tumour was carefully removed. Histological examination (including immunoperoxidase staining) and thorough clinical, laboratory and radiological evaluation revealed an exclusively cytoplasmic monoclonal IgG immunoglobulin PEP. The combination of surgery (including a second-look procedure) and radiotherapy used in this case may be an over-treatment. However, the patient is still disease-free seven years after his first admission to hospital.
Aspergillosis of the larynx
Authors: Benson-Mitchell R. , Tolley N. , Croft C. B. , Gallimore A.
Published: November 2007

Primary infection of the larynx with Aspergillus spp. is rare. It is more commonly seen as part of a wider infection involving the respiratory system in an immunocompromised host. In noncompromised patients laryngeal aspergillosis may represent colonization rather than invasion requiring no systemic anti-fungal treatment. The diagnosis is important as the presenting symptoms are suggestive of malignant laryngeal disease.

We present a 62-year-old man with a short history of hoarseness. Direct laryngoscopy and biopsy confirmed the diagnosis of aspergillosis. Clinical presentation, diagnosis and the important pathological characteristics of this infection are discussed.
Squamous cell carcinoma of the maxillary antrum metastatic to the heart and skin
Authors: Calvert R. J. , Quinn C. M.
Published: November 2007

A case of squamous cell carcinoma of the maxillary antrum is presented in which autopsy examination revealed widespread disseminated disease including metastatic deposits in the unusual sites of the myocardium and skin. Apart from the skin deposit the metastases were clinically unsuspected. This case demonstrates the role of the autopsy in the study of malignancy and the possible effects of local disease control on the natural history of the disease process.
Parotid acinic cell carcinoma with undifferentiated spindle cell transformation
Authors: Ferreiro Jorge A. , Kochar Amarjit S.
Published: November 2007

This report describes a 59-year-old black man who had an acinic cell carcinoma with associated malignant spindle cell transformation in the parotid gland. To the best of our knowledge, a similar lesion in the salivary gland has not been previously reported.
The natural history of otitis media with effusion – a three-year study of the incidence and prevalence of abnormal tympanograms in four South West Hampshire Infant and First schools
Authors: Williamson I. G. , Dunleavey J. , Bain J. , Robinson D.
Published: November 2007

Otitis media with effusion (OME) is both extremely common in young children, and variable in its duration and severity. This study aims to gather and consider new and reliable information about the incidence and prevalence of OME in British school children.

Eight hundred and fifty-six school children aged five to eight years from four South West Hampshire schools were examined over a three-year period by tympanometry, a method used to detect OME (>90 per cent specificity and sensitivity) performed once per school term. Normal ears were recorded in 54.9 per cent of children throughout with 27 per cent recording evidence of effusion. However in only one out of 10 of the affected children did the fluid persist for a year or more. This impressive clearance is due in part to natural resolution, with the intervention of surgery occurring in about one in eight of the children with identified effusions.

OME is more common in five-year-olds with an annual prevalence of 17 per cent compared to six per cent in eight-year-olds and is more common in the winter months. Because of the variability of the condition at least two screenings are recommended as a basis for good management.
The possible contributing factors for the success of steroid therapy in Bell's Palsy: a clinical and electrophysiological study
Authors: Shafshak Tarek S. , Essa Aymen Y. , Bakey Fathy A.
Published: November 2007

Incomplete recovery from Bell's palsy was observed in some patients even after the intake of corticosteroids. This prospective study was performed on 160 patients with unilaterial nonrecurrent Bell's palsy in order to investigate the role of prednisolone on the prognosis of Bell's palsy. Ninety-three patients were given prednisolone tablets (1 mg/kg body wt/day up to 70 mg) for six successive days, then the dose was reduced gradually over the next four days. The remaining 67 patients were not given prednisolone (control group). Facial nerve recovery was assessed clinically and electrophysiologically for up to one year. The results of this study suggested that the most probable contributing factor for the success of prednisolone in improving the prognosis of Bell's palsy was its early intake (within the first 24 hours following onset).
Microvascular free flaps in head and neck surgery
Authors: Macnamara Marcelle , Pope Sarah , Sadler A. , Grant H. , Brough M.
Published: November 2007

This study is a retrospective review of 60 patients who had microvascular free flap reconstructions in the head and neck region. They were all performed over a 10-year period by a single surgeon. The series includes a wide range of flap types and analyses pre-operative risk factors for flap failure as well as complications and outcome. Smoking and advanced age did not appear to prejudice flap survival but peripheral vascular disease, cardiac disease and alcohol withdrawal were found to increase the likelihood of flap failure. The most frequent complications encountered were thrombosis of one of the anastomosis and haematoma. The most successful flap in terms of survival and function was the fasciocutaneous radial forearm flap. The literature is reviewed in relation to the general principles of microvascular free flap surgery and the results of this series are placed in context.
Reconstruction of the mandible with conventional bone graft: an evaluation
Authors: Tiwari Rammohan , Snow Gordon B. , van der Waal Isaac
Published: November 2007

Eighteen patients with bony defects of the mandible had the mandible reconstructed using conventional nonvascularized bone grafts from the iliac crest. After surgery they received radiotherapy for cancer in the oropharynx or oral cavity. This study was carried out over a 10-year period. All patients were followed-up both for their tumour growth and the results of their reconstruction. Four to 10 years after surgery 55.5 per cent were alive and well. Full dental rehabilitation was achieved in 33 percent and 12.5 percent were without dental rehabilitation.
Fibrosacroma of the vocal fold: a late complication of radiotherapy
Authors: Nageris B. , Elidan J. , Sherman Y.
Published: November 2007

The carcinogenic effect of ionizing radiation is a well known phenomenon. However, the induction of malignancies following irradiation for head and neck cancers is quite rare (Steeves and Vataini, 1982). Most reported cases are osteogenic sarcomas with soft tissue sarcomas encountered less often.

We report a rare case of fibrosarcoma of the larynx, following radiation therapy for glottic carcinoma.
Mast cell ultrastructure in the adenoids of children with and without secretory otitis media
Authors: Drake-Lee Adrian , Price Jacqueline , Varley R.
Published: November 2007

This study was designed to compare the differences in morphology of the mast cells from the adenoid in children with otitis media with effusion (OME) and those from children with recurrent tonsillitis. Tissue for electron microscopy was prepared in the standard manner and between three and 10 blocks were examined for each child. All the mast cells with nuclei were photographed and the condition of the granules noted. The number of electron dense granules in each cell was assessed on a scale between zero and 10. Sixteen unselected children with OME were compared with 19 children with recurrent tonsillitis. There were no obvious differences in the degree of degranulation between the two groups although there was more vacuolation than reviously described in the normal nose but less than in those patients with perennial allergic rhinitis. Allergy and mast cell reactions do not seem to predispose to OME. It was concluded that the adenoids are not the ideal tissue in which to study normal mast cells.
Cervical node metastases presenting with features of branchial cysts
Authors: Flanagan P. M. , Roland N. J. , Jones A. S.
Published: November 2007

For many years it has been recognized that seemingly benign neck cysts may contain carcinoma. The true incidence is unknown. This paper investigated nine out of 270 patients presenting with a neck mass — which proved to contain a squamous carcinoma. Records (from a 30-year period) of over 3400 patients with squamous carcinoma of the head and neck, were examined. The histology slides were reviewed, the number of cystic lesions was noted and also the clinical outcome. Out of the 270 patients nine presented with a cystic lesion and these were studied. Six cystic lesions were originally diagnosed as branchial cysts although the youngest age was 39 years. All patients underwent a simple excision.

In six cases the tonsil was the primary site, in one the primary was in the base of tongue and in two the primary remained occult. One-third of the patients had died of their disease by the time this report was written and the maximum follow-up time for the remaining patients was 18 months. Therefore 16 per cent of branchial cysts in this series represented metastases from squamous cell carcinoma.

At the Royal Liverpool University Hospital only 25 patients had branchial cysts excised between 1988 and 1993: out of these only four contained squamous carcinoma.

In patients over 40 years of age panendoscopy and ipsilateral tonsillectomy is mandatory prior to cyst excision.
Vile bodies: an endoscopic approach to nasal myiasis
Authors: Badia Lydia , Lund Valerie J.
Published: November 2007

Nasal myiasis is the infestation of the nasal cavities by larvae (maggots) of Diptera flies. Several species of flies deposit their ova in the nose and the larvae feed on the host's tissues. We present a case of nasal myiasis by larvae of Oestrus ovis – Sheep Nasal Bot Fly. The larvae of Oestrus ovis are well known parasites in the nasal cavities and paranasal sinuses of sheep and goat. In Britain very rarely larvae may be deposited in the eye, nostrils or outer ear of man, usually husbandry workers. Reputedly, the larvae never survive beyond the first stage with acute catarrhal symptoms lasting only a few days.

This is the first reported case in the UK of an urban-dwelling patient infected by mature, third instar larvae of O. ovis. His nasal infestation resolved after endoscopic removal of the live maggots.
Surgical management of a case of third branchial pouch fistula
Authors: Dutt Sunil N. , John Herman , Nayar Ravi C. , Nalinesha K. M. , Prasad Devi
Published: November 2007

A case of left pyriform sinus fistula in a 20-year-old male is presented. The surgical management of this uncommon condition is discussed. Its embryological and clinical aspects are reviewed.
Subcutaneous tissue reaction to synthetic auditory ossicle (Apaceram®) in rats
Authors: Cui Peng-Cheng , Ohsaki Katsuichiro , Ii Kunio , Tenshin Satoru , Kawata Terushige
Published: November 2007

A study was carried out in order to obtain further information about the soft tissue response to thin Apaceram®discs of dense hydroxyapatite (HA) implanted in rats for various periods of time between one day and 10 months. The Apaceram®discs were implanted subcutaneously into the interscapular region of 33 rats. A sham operation was performed on eight rats used as controls. Decalcified histological sections stained with haematoxylin and eosin and Mallory's azan were examined and the different cell types found around the implants were counted. It was found that an acute inflammatory reaction occurred after one day and disappeared at about two weeks after implantation. In the test groups, macrophages and lymphocytes disappeared about one week later, and no inflammatory reaction was observed from one to three months. However, a tissue reaction occurred at six months with the appearance of macrophages and lymphocytes, and decreased gradually at 10 months. Meanwhile, a few foreign body giant cells at the Apaceram®-tissue interface and a thick layer of fibrous connective tissue around the Apaceram®disc were observed at 10 months. No osteogenesis was observed in any specimen. The results obtained so far suggest that Apaceram®is still a useful material for reconstructive surgery, despite the possible appearance of a slight macrophage reaction at six months.
Neonatal upper airway obstruction caused by chlamydial rhinitis
Authors: Shinkwin C. A. , Gibbin K. P.
Published: November 2007

This paper reports the case of a six-week-old infant who presented with severe rhinitis and upper airway obstruction due to infection withChlamydia trachomatis.
Post-radiation primary intranodal leiomyosarcoma
Authors: Fujii Hiroaki , Barnes Leon , Johnson Jonas T. , Kapadia Silloo B.
Published: November 2007

An unusual case of post-radiation primary intranodal leiomyosarcoma of the cervical lymph node is presented. The patient was a 32-year-old white man who was treated in 1986 with hemiglossectomy and right neck dissection, followed by radiation therapy, for squamous cell carcinoma of the tongue. Six years later, he presented with an enlarged left cervical lymph node which on biopsy showed a high grade spindle cell malignant neoplasm. Immunohistochemistry and electron microscopic study verified the smooth muscle origin of the tumour.

Extensive work-up for a second primary lesion was negative. Primary intranodal leiomyosarcoma is extremely rare. We briefly discuss the histological differential diagnosis of spindle cell lesions of lymph nodes, leiomyosarcoma of the vessel wall and radiation-associated sarcoma.
Squamous cell carcinoma of the posterior pharyngeal wall: characteristics compared with the lateral wall
Authors: Barzan Luigi , Barra Salvatore , Franchin Giovanni , Talamini Renato , Zanelli Giuseppe , Caruso Giuseppe , Maione Arturo , Pin Marco , Politi Doriano , Gobitti Carlo , Minatel Emilio , Trovo Gaetano M. , Comoretto Roberto
Published: November 2007

Squamous cell carcinoma of the posterior oro-and hypopharyngeal wall (SCCPPW) is a relatively rare tumour. A retrospective investigation of 63 patients with SCCPPW and 449 patients with carcinoma of the lateral oro- and hypopharyngeal wall, treated between 1964and 1992, has been carried out. Most SCCPPW were asymptomatic, macroscopically superficial and at early stages. They were usually detected by chance during an examination for a different type of malignancy. Fifty-seven per cent of SCCPPW patients had multiple tumours; however this occurrence did not alter the survival rate. The crude five-year survival rate for SCCPPW was 22 per cent and was not significantly different from that of patients with lateral wall tumours. Moreover, both local control and recurrences also were not statistically different.
A modification to the brow incision for access to the anterior skull base and paranasal sinuses
Authors: Beasley N. J. P. , Jones N. S.
Published: November 2007

We present four cases where a brow incision was indicated for access to the anterior skull base and paranasal sinuses. We discuss the indications for this incision and present a modification of the incision, to improve cosmesis over the nasion.
An unusual presentation of squamous cell carcinoma of the pyriform fossa as a pedunculated polypoidal mass — a case report
Authors: Singh Mangal , Ahluwalia Hemant
Published: November 2007

A rare case of a squamous cell carcinoma of the left pyriform fossa is presented. It was found as a pedunculated polypoidal mass in a 17-year-old Hindu girl. A review of literature is included.
Polycystic disease of salivary glands
Authors: McFerran D. J. , Ingrams D. R. , Gallimore A. P. , Grant H. R.
Published: November 2007

Polycustic disease of salivary glands is a rare condition which hitherto has been reported only glands. We report a case in which and accessory salivary gland had evidence of plycystic disease.
Bismuth subgallate – its role in tonsillectomy
Authors: Fenton J. E. , Blayney A. W. , O'Dwyer T. P.
Published: November 2007

There have been many attempts at identifying substances and describing methods that would assist the surgeon and be of benefit to the patient undergoing a tonsillectomy. The use of bismuth subgallate as a haemostatic adjunct during tonsillectomy has only been described previously in retrospective studies. A controlled prospective randomized trial of 100 paediatric patients, in which 50 patients had a tonsillectomy performed using bismuth subgallate as a haemostatic agent and in which the remainder did not have any associated haemostatic substance, is presented here.

Data on 72 patients was analysed, 39 patients belonging to the bismuth subgallate group and the remaining 33 to the control group. The time for haemostasis was three to 18 (mean 7.8) minutes in the bismuth group. It was four to 16 (mean 9.9) minutes in the non-bismuth group. These figures are statistically significant.

The range of ties used in the bismuth group was none to three (mean 1.5) ties and one to seven (mean 3.4) ties in the non-bismuth group. These figures are also statistically significant. The remainder of the recorded parameters did not differ significantly.

It was found that bismuth subgallate/adrenaline paste decreases operating time by significantly reducing the haemostasis time and the number of ties required but does not decrease post-operative morbidity.
The future of stapedectomy — the Singapore problem
Authors: Leong H. K.
Published: November 2007

Concern has been expressed in the recent literature regarding the problem of a dwindling number of stapedectomy cases and an increasing number of surgeons trained to do this operation. In Singapore, the problem is made worse by the very low incidence of this disease in its main ethnic groups of Chinese and Malays who together make up more than 90 per cent of the population.

We report here an audit of 47 ears that underwent stapedectomy in a teaching hospital over a six-year period. The hearing results for consultants and surgical trainees were compared. Closure of the air–bone gap to within 10 dB was obtained in 64 per cent of Consultants' cases and 68 per cent of trainees' cases. These results fall short of the 90 to 95 per cent figure reported by experts in this procedure and only comparable to the less satisfactory results of several series recorded by residents in North America.

We conclude that the unsatisfactory results arise from the small number of surgical cases available for each surgeon to improve and maintain his skills in a technically demanding procedure. It is proposed that such cases be directed to those pursuing otology as a subspecialty rather than all otolaryngologists in general.
Tuberculoma of the mastoid
Authors: Grewal D. S. , Bhargava Puneet , Mistry Bachi , Gaikwad Ninad
Published: November 2007

Tuberculoma is a rare but known complication of tuberculosis. It rarely occurs in the mastoid bone. When it occurs in the middle ear cleft, it can lead to intracranial complications if there is a delay in the diagnosis and management.

A rare case of tuberculosis of the middle ear cleft which presented as tuberculoma of the mastoid bone with infranuclear facial palsy is described. The tuberculoma was removed and a canal wall down tympanomastoidectomy was performed. Post-operatively the patient was kept on antituberculous therapy. The various problems encountered in the diagnosis and management of this case are discussed.
Laryngeal papillomatosis with subsequent development of papillomata in the paranasal sinuses – is it seeding by intubation?
Authors: Colquhoun-Flannery W. , Carruth J. A. S. , Cheesman A. D.
Published: November 2007

Concern has been expressed regarding the seeding of viral DNA, in laryngeal papillomatosis, to other sites in the respiratory tract during treatment. Controversy exists regarding the concept of seeding by the laser plume. However, instrumentation and anaesthetic intubation are also strongly implicated in seeding DNA to the proximal respiratory tract. No cases of recurrent laryngeal papillomatosis and subsequent papilloma in the paranasal sinuses have been reported.
The G syndrome/Opitz oculo-genital-laryngeal syndrome/Opitz BBB/G syndrome/Opitz-Frias syndrome
Authors: Conlon Brendan J. , O'Dwyer Tadhg
Published: November 2007

We report on a family exhibiting a range of congenital anomalies consistent with the G syndrome of Opitz. Three members of the family had laryngo-tracheo-oesophageal clefts, one of which succumbed. There was a strong family history of perinatal mortality on the maternal side of the family. We note also the paucity of reported cases of this syndrome in the otolaryngological literature and stress the necessity of early diagnosis in the management.
Transection of cervical trachea following blunt trauma
Authors: Hosny A. , Bhendwal S. , Hosni A.
Published: November 2007

Laryngotracheal injuries are relatively rare but their mortality rate is fairly high. Complete disruption of the trachea is extremely rare and a systematic approach is needed for early diagnosis and favourable outcome. The patient's symptoms and physical signs do not necessarily correlate with the severity of the injury as this case report highlights. X-rays, CT scans, barium swallows and endoscopies are recommended for evaluation of such injuries. However, direct laryngoscopy and fibre optic bronchoscopy are the most accurate.
Hearing loss associated with weapons noise exposure: when to investigate an asymmetrical loss
Authors: Cox H. J. , Ford G. R.
Published: November 2007

The air conduction thresholds in the right and left ears, and the interaural asymmetry of thresholds at 0.5, 1, 2, 3, 4 and 6 kHz were measured in a group of 225 soldiers exposed to a variety of weapon noise who were referred for assessment because of a deterioration in hearing on routine testing. At 0.5 and I kHz the threshold levels rarely exceeded 25 dB and the interaural asymmetry was 10 dB or less in 90 per cent of cases. The degree of hearing loss and interaural asymmetry increased as the frequency increased, with the average loss being significantly greater in the left ear at 2, 3, 4 and 6 kHz.

Recommendations are made for the selection of cases of asymmetrical hearing loss exposed to weapon noise which require further investigation to exclude a retrocochlear cause or to define spurious hearing threshold levels.
Nasal laser mucotomy (L-mucotomy) of the interior turbinates
Authors: Englender Moshe
Published: November 2007

Eighty-seven patients who were treated by laser mucotomy (L-mucotomy) of the inferior turbinates were followed-up for one year. Patients presented for laser surgery because of one of the three following symptoms: sneezing, rhinorrhoea, or nasal obstruction. All of them had had prior conservative or surgical treatments for their symptoms without improvement in their complaints and/or quality of life. L-mucotomy is a simple procedure performed under local anaesthesia on an ambulatory basis. A controlled amount of tissue from the inferior turbinates is ablated with improvement in the symptoms, as reported by the patients one year after laser surgery.

The procedure is easy to perform, there is no bleeding, it is painless and without complications, but it requires rather expensive surgical equipment.
Case report: greatly enlarged jugular fossa with progressive sensorineural hearing loss
Authors: Good C. D. , Phelps P. D. , Lim D. P.
Published: November 2007

A case of a five-year-old child with a greatly enlarged jugular fossa and high jugular bulb with associated progressive sensorineural hearing loss is presented. While various forms of this anatomical variant have been described by many authors, this is an extreme example, and progressive symptoms are most unusual.
A comparison between two methods of measuring pressure in the pharyngeal airway: transducer probe versus open catheter
Authors: Tvinnereim M. , Haight J. S. , Hansen R. K. , Cole P.
Published: November 2007

A new multi-transducer probe system for measuring pharyngeal pressures was compared with an established open catheter system. Pharyngeal pressure measurements were made at the same time, and site, in subjects awake, at unmodified and with artificially increased nasal airway resistances, and during sleep documented by polysomnography. The two systems yielded almostidentical results. It is anticipated that the multi-transducer probe system will prove of clinical value.
Multidisciplinary management of dysphagia: the first 100 cases
Authors: Singh V. , Brockbank M. J. , Frost R. A. , Tyler S.
Published: November 2007

A report of the first 100 patients treated in the multidisciplinary Dysphagia Clinic in Salisbury District Hospital is presented. It was established in January 1992 and involves the Departments of ENT Surgery, Clinical Radiology and Speech and Language Therapy. In the first 18 months, 100 patients have been assessed and treated. These included 46 males and 54 females, between the ages of four and 93 years. Neurological problems accounted for 39 cases. The management comprised the assessment clinic, videofluoroscopy in 83 patients, and finally the appropriate treatment. Forty-four patients were treated primarily by swallowing therapy. Seventy-three patients showed complete recovery, resolution of their symptoms or did not require treatment. Two patients were still under treatment at the time of writing this paper.
Bleeding after tonsillectomy in severe von Willebrand's disease
Authors: Alusi G. H. , Grant W. E. , Lee C. A. , Pasi K. J. , Stearns M. P.
Published: November 2007

A case is reported of a HIV–positive patient with severe von Willebrand's disease describing the bleeding complications during and after tonsillectomy. This patient underwent surgery for asymmetrical tonsillar hypertrophy. The tonsils were spontaneously haemorrhaging and there therefore was a suspicion of neoplasia. Despite close cooperation between the ENT Department and the Haemophilia Centre, involving per–operative Factor VIII monitoring and replacement, the patient suffered both protracted primary and secondary haemorrhages. We report this as a cautionary tale as our previous experience with mild to moderate haemophilia has been uncomplicated, but on this occcasion there was massive haemorrhage. We feel that tonsillectomy should not be undertaken in a patient with a severe bleeding disorder without an absolute indicate.
Computed tomographic findings in peritonsillar abscess and cellulitis
Authors: Sakaguchi Masanori , Sato Susumu , Asawa Shiro , Taguchi Kiichiro
Published: November 2007

The differentiation of a peritonsillar abscess from peritonsillar cellulitis, although difficult on physical examination, is required in order to determine the appropriate treatment. Peritonsillar cellulitis can be treated with antibiotics alone, while a peritonsillar abscess should be drained. Computed tomography (CT) of the neck is often performed to identify the formation of a deep abscess in the neck, but is rarely used to diagnose peritonsillar infections. We report a patient in whom CT was a useful diagnostic tool for distinguishing peritonsillar abscess from peritonsillar cellulitis.
Polypoidal carcinosarcoma of the oropharynx: a clinicopathological and immunohistochemical study
Authors: Hansen Lars Trier , Kristensenan Søren , Moesner Jørgen
Published: November 2007

Polypoidal squamous cell carcinomas, with a sarcomatous stroma, in the upper aerodigestive tract are very rare but well described tumours. They are associated with a multifario?sjiomenclature because of different opinions regarding their histology and histogenesis. The main issue is whether the stroma component is a true sarcoma or a benign reactive lesion.

In order to draw the attention of otolaryngologists and pathologists to the characteristic features of this rare tumour, two cases originating from the oropharynx are presented. Both tumours were pedunculated and polypoidal, and their bulk consisted of a bizarre sarcoma-like stroma covered with granulation tissue. In some areas of the surface, however, atypical squamous cell epithelium with foci of invasive carcinoma was found. In the vicinity of the latter both tumours contained areas of adenocarcinoma. After surgical excision followed by radiation therapy, there was no recurrence after two and five years, respectively.

The histological and immunohistochemical findings support the assumption that these two tumours are carcinosarcomas. Adenocarcinomatous elements in this type of tumour have to our kowledge been reported only twice previously and have never been observed in the pharynx.
Terminal duct adenocarcinomas of the parotid gland
Authors: Kemp Bonnie L. , Batsakis John G. , El-Naggar Adel K. , Kotliar Sophia N. , Luna Mario A.
Published: November 2007

The major salivary glands are considered to rarely be the sites of primary terminal duct adenocarcinomas, a neoplasm with a considerable predilection for origin from intraoral minor salivary glands. We present a clinicopathological study of 22 terminal duct adenocarcinomas of the parotid gland, the largest single series to date. A comparison between the parotid neoplasms and over 200 minor salivary gland terminal duct adenocarcinomas indicates there is little difference in biological behaviour and confirms the low-grade quality of the carcinomas, regardless of site of origin.
The laryngectomee and swimming
Authors: Thomas M. R. , Natarajan B. , Garth R. J. N.
Published: November 2007

Following laryngectomy patients are usually advised that swimming is no longer possible. Under supervised conditions and using a swimming aid, such as described, a laryngectomee may return to an activity previously considered unavailable, rehabilitation thus being more complete. However, for a laryngectomee to proceed a safe supervised environment is required, and the path to this goal is often long and arduous, but with persistent dedication the Laryngectomy Swimming Club may become a reality bringing rich reward.
Tympanic membrane atelectasis in childhood otitis media with effusion
Authors: Tay H. L. , Mills R. P.
Published: November 2007

A prospective study on the dynamics of tympanic membrane atelectasis during the treatment for glue ear was performed in a sample of 115 ears of 83 children aged between one and 11 years. The progression in the degree of pars tensa atelectasis was analysed in relation to six potentially relevant factors. Multivariate analysis showed that the factor with the most predictive value on the progression of the pars tensa retraction was the grade of atelectasis at initial detection (p<0.0001). The use of grommets did not have any significant influence on the outcome grade of atelectasis. There was an association between previous grommet insertion and localized retractions in the inferior segment of the pars tensa (P<0.0001). However, localized retractions in the postero-superior quadrant were not associated with previous grommet insertion (P<0.02). Although the hearing thresholds of atelectatic ears were significantly worse than normal ears especially at 4 kHz (p<0.006), the difference was less than 5 dB.
Monitoring fluctuations in nasal patency in children: acoustic rhinometryversusrhinonygrometry
Authors: Fisher Edward W. , Palmer Christopher R. , Lund Valerie J.
Published: November 2007

Simple rhinohygrometry and passive rhinomanometry studies have suggested that the ‘nasal cycle’ in children is often different in pattern of that of adults and experimental animals. We aimed to establish whether this assertion was correct, using a reliable and sensitive method, acoustic rhinometry (AR), and to compare results with those of simple rhinohygrometry (RH). Healthy children with no evidence of nasal disease were examined (n = 15; age range three to 10 years; mean age six years). Simultaneous recordings using AR and RH were made on each child every 10–15 minutes over two to four hour periods. Six children underwent nine additional AR studies on separate occasions. ‘Classical’ reciprocal alternating patterns were evident in 80 per cent (12/15) AR and 53 per cent (8/15) RH studies, ‘in concert’ patterns in seven per cent (1/15) AR and 20 per cent (3/15) RH studies and ‘irregular’ patterns in 13 per cent (2/15) AR and 27 per cent (4/15) RH studies. The agreement between the two methods was 47 per cent, with a kappa (K) value of −0.17 (poor agreement compared to chance). Agreements between the acoustic rhinometry parameters were ‘fair’ for all data (K = 0.34) and excellent (K = 1.0) if irregular patterns were ignored. Repeated studies showed that the pattern of fluctuation varies within any particular individual. The nasal cycle is similar in pattern in children and adults, and acoustic rhinometry is currently the method of choice to further investigate and clarify this phenomenon.
KTP-532 laser tonsillectomy – a potential day-case procedure?
Authors: Raine N. M. N. , Whittet H. B. , Marks N. J. , Ryan R. M.
Published: November 2007

We report the results of a prospective pilot study of 54 adult patients undergoing tonsillectomy using the KTP-532 laser, designed to assess whether the technique would facilitate day-case adult tonsillectomy. Subjective and objective assessment at six hours post-operatively showed that only 43 per cent could, in our judgement, have been discharged at this interval. Furthermore, the overall complication rate was 31 per cent with a secondary haemorrhage rate of 19 per cent. We conclude that KTP-532 laser tonsillectomy as performed in this pilot study compares unfavourably with dissection tonsillectomy and we discuss possible reasons for this.
A case with symptoms of vestibular neuronitis caused by an intramedullary lesion
Authors: Tsunoda Atsunobu , Komatsuzaki Atsushi , Muraoka Hideki , Gou-Tsu Kazuo
Published: November 2007

We report on a patient with an intramedullary lesion who showed only symptoms of so-called vestibular neuronitis. From the neurological aspects and MRI findings, the lesion was thought to be localized to the vestibular nerve in the pons. Cerebrospinal fluid testing and MRI findings suggested a diagnosis of multiple sclerosis (MS), although the clinical features were not compatible with MS. This case may shed some light on the aetiology of vestibular neuronitis.
Superficial siderosis of the central nervous system: a case with an unruptured intracranial aneurysm
Authors: Lai Ming-Tang , Ohmichi Takuya , Yuen Koji , Egusa Kentaro , Yorizane Satoshi , Masuda Yu
Published: November 2007

We present a case of superficial siderosis (SS) of the central nervous system (CNS) with an unruptured intracranial aneurysm to illustrate that the commonly encountered unexplainable progressive sensorineural hearing loss (SNHL) can be an important sign for the early awareness of this rare disorder. The literature on SS is reviewed and the pathogenesis of SS is discussed.
Hearing loss and motorcyclists
Authors: McCombe Andrew W. , Binnington Jonathan , Davis Adrian , Spencer Helen
Published: November 2007

Motorcyclists are known to be exposed to excessive wind noise levels when riding. The potential adverse effects of this exposure on their hearing was investigated. Temporary threshold shift (TTS) was assessed by asking 18 riders to undertake a standard test run of one hour at a steady 80 mph, and performing audiometry before and immediately afterwards. Permanent threshold shift (PTS) was assessed by performing pure-tone audiograms on a highly screened group of 246 motorcyclists and comparing their hearing thresholds with those of an appropriate control group obtained from the MRC National Study of Hearing.

Significant TTS was found at 0.25, 0.5,1 and 2 kHz. The greatest TTS occurred at 1 kHz, with a mean hearing loss of 10.3 dB. The hearing thresholds of the motorcyclists were significantly worse than the controls at 0.25, 0.5, 1 and 2 kHz, andwas most marked at 0.5 and 1 kHz where their hearing loss (PTS) was, respectively, 3.7 and 3.6 dB greater than expected.

These findings demonstrate evidence of both temporary and permanent hearing loss from motorcycling and present a strong argument for the need for some form of remedial action.