bluuebunny/crossref_metadata_2025 huggingface dataset:
Respiratory problems in acromegaly
Authors: Murrant N. J. , Gatland D. J.
Published: November 2007

Death from respiratory causes in acromegaly is three times more common than in the general population and is most often the result of upper airways obstruction, although less commonly pulmonary dysfunction and disturbance of the central nervous system may occur. These factors may be found alone or in combination.

Despite several reports of laryngeal involvement, upper airway obstruction in acromegaly is usually regarded as being due to macroglossia and pharyngeal soft tissue hypertrophy. We present four cases of acromegaly in which tracheostomy was required for laryngeal obstruction, with a review of the literature concerning the nature of respiratory problems in acromegaly.
Parathyroid cyst: Report of case in the mediastinum
Authors: Petri Niels , Holten Iben
Published: November 2007

Though a rare lesion a parathyroid cyst is of clinical significance because it usually mimics a thyroid cyst and can be associated with hyperparathyroidism. The cyst can be ectopic with location in the lateral neck or in the mediastinum and therefore constitutes a differential diagnosis to a branchial or thymic cyst.

A case report of a mediastinal parathyroid cyst without hyperparathyroidism is presented. Fine needle aspiration with parathyroid hormone assay on the cyst fluid will reveal the correct diagnosis. Surgical removal of the cyst is recommended, and hyperparathyroidism should be considered.
Audiological manifestations of Ramsay Hunt syndrome
Authors: Wayman D. M. , Pham H. N. , Byl F. M. , Adour K. K.
Published: November 2007

Ramsay Hunt syndrome is known to cause audiological signs and symptoms, including sudden, unexpected hearing loss. We carried out a retrospective review of the audiological manifestations of 186 patients with Ramsay Hunt syndrome, measuring their hearing loss patterns, hyperacusis, tinnitus, herpetic rash, facial paralysis, pain and vertigo. Statistical correlations of these parameters were equated with prognosis. Prognosis for eventual hearing recovery is, in general, excellent. Prognostic indicators of poor hearing recovery include advanced age, retrocochlear hearing loss, male gender, vertigo, and speech frequency hearing loss.
Role of tympanic neurectomy in otalgia
Authors: Cook J. A. , Irving R. M.
Published: November 2007

Tympanic neurectomy was first described 44 years ago. Although its indications have subsequently increased, it has not become a popular procedure. This paper concentrates on its use in treating otalgia. The history of tympanic neurectomy, the anatomy of the tympanic plexus and the aetiology of otalgia with specific reference to the tympanic plexus are discussed and a case of bilateral otalgia due to glossopharyngeal neuralgia successfully treated by staged, bilateral tympanic neurectomy reported. It is suggested tympanotomy performed under local anaesthesia with selective stimulation of the intra-tympanic nerves may lead to accurate diagnosis and treatment of the various forms of neuralgic otalgia.
Long-term safety and efficacy study of intranasal ipratroprium bromide
Authors: Milford C. A. , Mugliston T. A. , Lund V. J. , Mackay I. S.
Published: November 2007

Forty patients presenting with watery rhinorrhoea as their main complaint were entered in an open trial of long-term intranasal ipratroprium bromide. Fourteen of these (35 per cent) found it to be beneficial and completed one year of treatment. Side-effects were seen in 28 patients (70 per cent) but these were local and mild in nature. All resolved during the trial as patients adjusted the dosage to individual severity and frequency of symptoms. No significant systemic effects were noted during the course of therapy. Ipratroprium is a useful drug in the treatment of watery rhinorroea and appears safe for long-term use.
Basal cell adenocarcinoma of the parotid gland
Authors: Murty G. E. , Welch A. R. , Soames J. V.
Published: November 2007

A case of basal cell adenocarcinoma of the parotid gland is reported. Histologically it is to be distinguished from basal cell adenoma and adenoid cystic carcinoma. Clinically the presentation may appear benign. Surgical excision is the treatment of choice. The prognosis is uncertain because of lack of follow-up data.
Anaesthesia of the tympanic membrane: Comparison of EMLA cream and iontophoresis
Authors: Sirimanna K. S. , Madden G. J. , Miles S.
Published: November 2007

The authors undertook a study to evaluate the effectiveness of two methods for providing local anaesthesia of the tympanic membrane for the purpose of inserting a grommet. The methods compared were the application of EMLA (Eutectic Mixture of Local Anaesthetics) cream and the use of iontophoresis. Both methods seem to provide a satisfactory level of local anaesthesia. It was felt that where multiple procedures were to be performed in one outpatient session the use of EMLA cream might be a more efficient technique.
Otitis media with effusion: can erythromycin reduce the need for ventilating tubes?
Authors: Møller Per , Dingsør Gjert
Published: November 2007

Otitis media with effusion (OME) is a common condition among children and is characterized by nonpurulent fluid in the middle ear and fluctuating conductive hearing loss. Most children will spontaneously regain normal air-filled middle ears, but a certain number will have persistent problems. In our department we will treat annually about 500 children on an outpatient basis, with the insertion of ventilating tubes in the eardrum. The reason for this study was to evaluate the effect of erythromycin, instead of inserting a ventilation tube, in children with bilateral OME of longer duration than three months (double blind/placebo). The study comprises 147 children, 1–15 years of age, 83 boys and 64 girls, all with OME for more than three months. All the patients were candidates for tube insertion. In the group treated with erythromycin, 12 patients out of 69 had bilaterally air-filled middle ears after one month, as compared to 19 out of 72 in the group treated with the placebo. No difference was noted due to sex or age. The results support our indication and timing for ventilation tube insertion.
Carcinoid tumours of the larynx: Report of two cases
Authors: Casolino D. , Caliceti U. , Sorrenti G.
Published: November 2007

Carcinoid tumour of the larynx is extremely rare. The increasing number of these lesions reported is due to the application of ultrastructural and immunological methods in the diagnosis. Two new cases of this malignant neoplasm are presented and discussed with particular reference to the difficulty in distinguishing carcinoids from other tumours of the larynx. The accurate pathological identification of the tumour is essential for treatment and prognosis.
Aneurysmal bone cyst of the maxillary sinus
Authors: Hady M. R. , Ghanaam B. , Hady M. Z.
Published: November 2007

Aneurysmal bone cyst is a cystic vascular osseous tumour which destroys and expands bone. The skeleton may be affected, the femur, tibia and the vertebral column being most commonly involved. It has previously been reported in the sphenoid sinus, this is the first reported case of such pathology in the maxillary sinus.
Diathermy haemostasis at tonsillectomy: Current practice—A survey of U.K. otolaryngologists
Authors: Murty G. E. , Watson M. G.
Published: November 2007

The use of diathermy in achieving haemostasis at tonsillectomy was assessed by means of a postal questionnaire sent to consultant otolaryngologists practising in the U.K. A response of 81 per cent was obtained. Forty-four per cent presently use diathermy. Few considered the age of the patient or a history of a quinsy a contraindication to its use. The diathermy experience of users and non-users with regard to speed, postoperative pain and haemorrhage differs markedly. This dichotomy of opinion is confirmed by a review of the literature. Clearly there is a need for further studies to clarify the role of diathermy in tonsillectomy.
Ligmaject system for local anaesthesia in otology
Authors: Ryan Rowena M.
Published: November 2007

The Ligmaject® syringe for local anaesthetic injection incorporates a pistol-grip handle and a ratchet system designed to inject a very tiny aliquot of anaesthetic per ‘click’. This instrument was used to provide local anaesthesia for 22 otological procedures on consenting adults. The performance of the Ligmaject syringe compared favourably with that of the conventional dental syringe in terms of patient acceptability and user convenience.
Laryngeal growth in infancy
Authors: Sellars I. , Keen E. N.
Published: November 2007

Growth of the cricoid ring in infants is studied. In the first two weeks of life a small ring seems correlated with the fact of early infant death. Therefore we suggest that mortuary specimens at this age are not a reliable guide to the size of the cricoid in thriving infants.

Rates of growth from ages of two weeks to three years are given for the specimens examined. Comparison with similar measurements carried out in England show that the specimens collected here were systematically smaller for a given age.
Dysequilibrium and otitis media with effusion: What is the association?
Authors: Grace A. R. H. , Pfleiderer A. G.
Published: November 2007

An association between non-suppurative otitis media (NSOM) and symptoms of dysequilibrium has been observed but not previously quantified in children (Gates, 1980;Busis, 1983; Blayney and Coleman, 1984). This study compared the incidence of balance related problems in 154 children with surgically proven glue ear and 51 children with normal ear function. Symptoms ranging from true vertigo to mild ataxia were discovered in 22 per cent of the children with NSOM but in none of those within the control group (p>0.001). Periods of dysequilibrium were associated with episodes of otalgia in 64 per cent of the children but were not increased in those with unilateral compared to those with bilateral effusions. Complete resolution of symptoms occurred in 85 per cent of children following the insertion of grommets. A history of balance disturbance should be actively sought in all children with otitis media with effusion, and when present, provides a strong indication for early operative intervention.
Recurrent Bell's palsy in pregnancy
Authors: Deshpande Anand D.
Published: November 2007

A case of recurrent Bell's palsy occurring in two successive pregnancies in a 37-year-old woman is presented. The causes of facial nerve paralysis of the lower motor neurone type are discussed. The rate of recurrence of Bell's palsy during pregnancy is unknown. Treatment with corticosteroids of Bell's palsy during pregnancy poses the threat of possible side effects on the fetus.
Role of radiation therapy for ‘juvenile’ angiofibroma
Authors: Gudea F. , Vega M. , Canals E. , Montserrat J. M. , Valdano J.
Published: November 2007

Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign neoplasm which occurs primarily in male adolescents and is characterized by aggressive local growth. The controversy concerning appropriate treatment for patients with juvenile angiofibroma persists. Radiation therapy and surgical resection have both been reported to be effective to control a high proportion of these tumours. The case reported here demonstrates a locally advanced JNA controlled by radiation therapy.
Chronic sinusitis and the yellow nail syndrome
Authors: Camilieri A. E.
Published: November 2007

Diagnosing syndromes that include chronic sinusitis can expedite the management of both conditions. Yellow nail syndrome is usually described as the combination of yellow nails, lymphoedema and often respiratory manifestations such as chronic sinusitis, bronchiectasis and pleural effusions. The pathology responsible for the syndrome is believed to be lymphatic hypoplasia. Diagnosis of yellow nail syndrome is clinical not requiring anyspecialized tests. In the two cases described, the respiratory tract manifestations required the most active investigation and management. The significance of this syndrome to the otolaryngologist is discussed.
Antibiotic/steroid ear drop preparations: a cost-effective approach to their use
Authors: Reilly G. , Skinner D. W.
Published: November 2007

Otorrhoea is a common otological complaint reflecting infection in the outer and/;or middle ear. Guidelines as to which antibiotic/;steroid ear drop preparation to use in a treatment regime are few and no studies comparing the different types of preparation are available. This paper reviews the antibiotic/;steroid ear drop preparations used by consultant surgeons and general practitioners and presents a two fold rationale for deciding which preparation to use, based on microbial sensitivity and cost.
Oestrogen and progesterone receptors in acoustic neuroma
Authors: Curley J. W. A. , Ramsden R. T. , Howell A. , Healy K. , Lye R. H.
Published: November 2007

Tissue samples from fourteen consecutive (8 male: 6 female) acoustic neuromas were assayed for hormone receptors using either a monoclonal antibody (MA), dextran coated charcoal (DCC) or isoelectric focusing (IEF) technique.

In this series there were no unequivocally positive results, a finding at variance with previously published results.
Uses and complications of uvulopalatopharyngoplasty
Authors: Croft Charles B. , Golding-Wood David G.
Published: November 2007

Uvulopalatopharygoplasty has become widely performed for chronic snoring and for cases of obstructive sleep apnoea. Unfortunately this operation is not without morbidity and complications. We report our results of a prospective series of 50 patients undergoing uvulopalatopharyngoplasty with a minimum follow-up of one year. Snoring was abolished in 18 (36 per cent) and substantially reduced in the remainder. Obstructive sleep apnoea syndrome, identified in 11 patients pre-operatively, was reduced in severity in all but three. Troublesome complications were seen in 18 (36 per cent) patients, namely intermittent velopharyngeal incompetence in five (10 percent), pharyngeal dryness in 11(22 per cent) and loss of taste in five (10 per cent). One patient had nasopharyngeal stenosis requiring correction. A cautious approach to this operation is required with rigorous case selection. The importance of full assessment and careful follow-up should not be underestimated.
Papillary adenocarcinoma of the middle ear
Authors: Robson A. K. , Eveson J. W. , Path F.R.C. , Smith I. M. , Maw A. R.
Published: November 2007

A case of papillary adenocarcinoma of the middle ear is presented. The patient had an unusually short history of otalgia, aural discharge and facial palsy, and, at presentation the tumour was too large for surgical resection to be a feasible option. The managementof this rare tumour is discussed and the relevant literature reviewed.
Enlarged adenoid and adenoidectomy in adults: Endoscopic approach and histopathological study
Authors: Kamel Reda H. , Ishak Elia A.
Published: November 2007

Adenoid enlargement is uncommon in adults and because examination of the nasopharynx by indirect posterior rhinoscopy is inadequate, many cases of enlarged adenoid in adults are misdiagnosed and accordingly maltreated.

This study was conducted on 35 cases of enlarged adenoid aged between 20 and 42 years. The nasal endoscope was utilized to identify the adenoid mass. Adenoidectomy under transnasal endoscopic control was performed and all the excised material was sent for histopathological examination. Adenoidectomy resulted in marked improvement in 94 per cent of cases without major complications. Histopathological examination revealed non-specific inflammatory reaction in 15 cases (43 per cent), pure reactive changes, predominantly follicular hyperplasia, in two cases (6 per cent) and mixed pattern in 18 cases (51 per cent). Endoscopic follow-up for an average 17 months identified recurrence in only two patients. It was concluded that enlarged adenoid tissue in adults has some histopathological differences from that in children and adenoidectomy under transnasal endoscopic control is safe and reliable.
Mandibular involvement in oral cancer
Authors: Bahadur Sudhir
Published: November 2007

It is difficult to predict the tumour invasion into the mandible by oral cancer pre-operatively, and consequently the decision to preserve or sacrifice the mandible is largely individualistic. The present study of 44 cases analyses the reliability of pre-operative parameters to assess mandibular involvement. Clinical, radiological and scintigraphic features have been compared with the detailed histology of the bone. This study confirms the usefulness of superior marginal resections in lesions which are close to but not involving the mandible, as well as for superficial lesions which are actually seen to involve the mandible but their CT and bone scans are negative for tumour invasion.
Non-Hodgkins lymphoma of the head and neck: experience in the Grampian area
Authors: Neilly I. J. , Dawson A. A. , Russell D. , Laing M. R.
Published: November 2007

The records of 44 cases of non-Hodgkins lymphoma (NHL) presenting to the ear, nose and throat department in the Grampian area from 1980–1988 were examined in relation to site of occurrence, histology, age at presentation, clinical stage, treatment and survival. The median age was 67 years and there was a preponderance of high grade histology, especially in disease affecting the tonsil. Most deaths occurred in the first year; patients with high grade disease and those in stages three and four had a significantly poorer survival during the first year. The site of disease had no influence on survival.
Ototoxicity of cis-platinum and its relationship to eye colour
Authors: Barr-Hamilton R. M. , Matheson L. M. , Keay D. G.
Published: November 2007

The following hypothesis is presented: that the susceptibility of an individual patient to hearing loss as a result of cis-platinum administration can be predicted on the basis of eye colour. The rationale is that the melanin content of the inner ears is related to that of the eyes; dark eyes contain more melanin than lightcoloured eyes; and melanin causes the accumulation of the ototoxic drug within the inner ear. Hence those with dark eyes will suffer greater damage to the hearing than those with pale eyes. An investigation that confirmed this hypothesis is reported. In addition to cochlear damage there is a significant likelihood of damage to the auditory nerve as a result of the treatment.
Limited CT scanning techniques of the paranasal sinuses
Authors: White Paul S. , Cowan Ian A. , Robertson Malcolm S.
Published: November 2007

Computerized tomographic (CT) imaging provides detailed information on the paranasal sinuses and is now well established as an alternative to standard radiographs. The planning and safety of surgery to the paranasal sinuses is greatly improved by CT imaging. We describe a new CT protocol comprising a limited coronal and axial scan series, based on ourexperience with the previously described ‘CT Mini-series’.
Pseudolymphoma of the parapharyngeal space
Authors: Kreel Barbara , Rubin John S. , Jaffe Elaine S.
Published: November 2007

A case report of pseudolymphoma of the parapharyngeal space is presented, together with a literature review of pseudolymphoma and management suggestions for such lesions when they occur in the head and neck. To the best of the authors' knowledge, this represents the first case report of pseudolymphoma presenting within the parapharyngeal space. The key to management of these lesions is based on accurate diagnosis, with differentiation of pseudolymphoma from lymphocytic lymphoma, the disease process which it mimics.
Benign thyroid adenoma causing recurrent laryngeal nerve palsy in a child
Authors: Habashi Sherif
Published: November 2007

The standard teaching is that only malignant thyroid masses produce recurrent laryngeal nerve palsy. An unusual exception to this rule is reported.
The mini-grommet and tympanosclerosis
Authors: Hampal S. , Flood L. M. , Kumar B. U.
Published: November 2007

One hundred and sixteen children with otitis media with effusion underwent myringotomy and insertion of a conventional pattern of Shah grommet in one ear and the much smaller Mini Shah grommet in the other. Close observation post-operatively determined the comparative rate of extrusion, recurrence of effusion, and of onset and degree of tympanosclerosis. At one year review, the Mini Shah shows a significantly earlier extrusion and a greater tendency to recurrence of otitis media with effusion. However, this is compensated by a decreased incidence of tympanosclerosis and reduced severity in those affected. This tends to support the view that shear forces produced by heavier patterns of ventilation tube promote tympanosclerosis.
Neurogenic sarcoma of the sinonasal tract
Authors: Hellquist H. B. , Lundgren J.
Published: November 2007

Five cases of a rare malignant sinonasal tumour of neurofibromatous nature are described. The term neurogenic sarcoma (or malignant peripheral nerve sheath tumour) is advocated instead of malignant schwannoma.

The clinicopathological features of this tumour are described, and the differential diagnosis are discussed. The necessity of using immunohistochemistry in the diagnosis of sinonasal tumours of fibromatous nature is emphasized. The clinical management consists of radical surgery and adjuvant radiotherapy. Clinically there seems to be a high-grade and a low-grade type of sinonasal neurogenic sarcoma, however, this could not be distinguished histologically in the present series.
Fracture of the hyoid bone
Authors: Lakhia T. S. , Shah R. B. , Kapoor L.
Published: November 2007

A patient complaining of dysphagia was diagnosed as suffering from a fracture of the hyoid bone. The fracture was fixed using the modern technique of tension band wiring. There was subsequent relief of the symptoms. A review of the literature and our perspective is included.
Parenchymal pulmonary endometriosis
Authors: Svendstrup F. , Husby H.
Published: November 2007

Parenchymal pulmonary endometriosis is an extremely rare but well described condition. We present four new cases, and discuss the examination and treatment of these patients. We conclude that the condition may be underdiagnozed, and that it is a relatively harmless disorder. We propose treatment with progesterone as the first choice of treatment. None of our patients needed surgical treatment.
Prevalence and natural history of otitis media with perforation in Maori school children
Authors: Giles M. , Asher I.
Published: November 2007

New Zealand Maoris are one of five ethnic groups in developed countries known to have a high rate of ear disease, including perforation of the eardrum (CSOM). It is a strongly held belief by otolaryngologists whose practice dates back to the 1960's that the prevalence of CSOM in Maori children is gradually falling. Despite the obvious practical implications this change has not yet been documented.

The aim of the study was to compare the prevalence of CSOM in two surveys conducted in 1978 and 1987 of children living in a North Island Maori community. A second aim was to examine the natural history of CSOM in these children.

The raw data from the 1978 study were reviewed. Of 134 children aged 4–13,12 had CSOM. In 1987 the same age group yielded 12 children out of 250 with CSOM. The prevalence of CSOM fell from 9 per cent to 4 per cent. The incidence of new perforations in 1987 was 1.3 per cent per child per year. It is concluded there has been a fall in the rate of CSOM, although otitis media remains a significant problem for these children.

The probability of a perforation healing was influenced by whether or not the perforation had been observed before: at least 35 per cent of perforations seen for the first time healed, but none of the perforations seen on two occsaions healed spontaneously. It was concluded that perforation of the eardrum can be managed conservatively at first.
Information leaflets in the rhinitis clinic?
Authors: Camilleri A. E.
Published: November 2007

Failure to get relief from topical steroid nasal spray is often blamed on poor administration knowledge. In a population of patients referred to the rhinitis clinic who have failed to get relief from topical steroid nasal spray when prescribed by the general practitioner, lack of patient education only accounts for 28 per cent of patient treatment failures and other factors e.g. poor compliance, erroneous diagnosis or severity of rhinitis will be responsible for the rest. Information leaflets are considered to be a good idea by nearly all patients but this study demonstrates that they would only be of therapeutic benefit to a minority of patients.
Prospective study of the complications of endoscopic laryngeal surgery
Authors: Robinson P. M.
Published: November 2007

Patients undergoing 204 endoscopic laryngeal operations were studied prospectively to determine the incidence of complications. Twelve patients were considered to be at high risk of postoperative airway obstruction. Two of these patients had an elective tracheostomy. One required temporary reintubation in the recovery room. No case of respiratory obstruction occurred in a patient not considered to be in the high risk group. Mucosal haemorrhage or oedema was seen on postoperative indirect laryngoscopy in 31 per cent of patients. The commonest abnormality found was mucosal haemorrhage in the oropharynx.
The feeding pharyngostomy: an alternative approach to enteral feeding
Authors: John D. G. , Fielder C. P.
Published: November 2007

We present a six-year retrospective review of feeding pharyngostomies as performed in this department. The indications, technique and complications of this procedure are discussed.
The limited accuracy of bone-conduction audiometry: its significance in medicolegal assessments
Authors: Coles R. R. A. , Lutman M. E. , Robinson D. W.
Published: November 2007

Accurate bone-conduction testing with masking is always difficult, but for clinical purposes limited accuracy suffices. However, when assessing claimants for compensation, extreme care is needed since even small apparent air-bone gaps are sometimes translated into financial abatement. This paper sets out the stringent test conditions required to achieve adequate precision. It also indicates the inaccuracies inherent in such tests, and recommends procedures for interpreting the significance of bone-conduction thresholds.
Unusually placed oesophageal foreign body
Authors: Quraishi M. S. , O'Halpin D. R.
Published: November 2007

Oesophageal foreign bodies are common occurrences. A variety of cases have been reported in the past. We present here a unique case of an unusually placed foreign body.
Prospective study of the use of vasoconstrictor and saline in septal surgery for infiltration
Authors: Vanniasegaram I
Published: November 2007

Vasoconstrictor agents are often used to reduce bleeding and hence improvethe operative field in surgery. These agents are potentially dangerous. A trial was undertaken to compare the use of adrenaline 1:80,000 with saline alone as an infiltrating agent in 30 consecutive patients undergoing septoplasty under general anaesthesia. This study, based on a small number of patients can draw no firm conclusions. There are no really dramatic differences between 1:80,000 adrenaline and saline, in terms of blood loss, operative time and the condition of the operative field between the two groups. However, there is a possibility that there are substantial differences, which, because of the variability of these outcomes, could not be detected in a study as small as this. It is recommended that a randomized trial involving patients is used to answer the question.
The fate of bone grafts in deep oval windows
Authors: kapur T. R.
Published: November 2007

The use of bone grafts for total ossicular chain reconstructions in patients with deep oval windows may result in varying degrees of absorption of the segment of the bone graft in the fossula fenestra vestibuli. The mechanism of bone absorption is described—a condition not described before.
Mast cell numbers in the mucosa of the inferior turbinate in patients with perennial allergic rhinitis: a light microscopic study
Authors: Drake-Lee A. B. , Moriarty B. , Smallman Lesley A.
Published: November 2007

The number of mast cells in the inferior turbinate from patients with perennial allergy due to house dust mite were compared with ten normal controls. Ten random high powered fields were counted in the epithelium and the submucosa in samples which had been divided into two and fixed either in aqueous formaim or Carnoy's fixative. The sections from each block were stained with either Azure A or Chloroacetate esterase technique. No statistical differences were found. The lack of increase in mast cell numbers was attributed to degranulation since numbers have been shown to be increased in perennial allergy when sections are examined ultrastructurally.
Management of peritonsillar abscess
Authors: Maharaj D. , Rajah V. , Hemsley S.
Published: November 2007

A prospective, randomized clinical trial was conducted on 60 patients with confirmed peritonsillar abscess to: (1) compare the safety and efficacy of permucosal needle aspiration with that of incision and drainage; (2) assess whether admission to hospital and treatment with intravenous antibiotics is necessary; (3) culture the pus obtained, in order to decide on a rational antibiotic regime.

Of the 60 patients, 30 were randomized to the needle aspiration group, and 30 to the incision and drainage group. The initial success rate was 87 per cent (26 of 30 patients) with needle aspiration, and 90 per cent (27 of 30 patients) with incision and drainage. Two patients required hospital admission, for rehydration and intravenous antibiotics. The commonest organisms cultured were streptococci (62 per cent); 97 per cent of all patients responded to penicillin. This study indicates that most patients with peritonsillar abscess may successfully and safely be treated by permucosal needle aspiration, and oral penicillin, on an outpatient basis.
Retrograde intubation of the trachea
Authors: Stern Yoram , Spitzer Thomas
Published: November 2007

Successful intubation can be accomplished in the majority of patients via direct laryngoscopy. However, situations frequently arise in which simple orotracheal intubation is contraindicated or impossible. In these situations retrograde tracheal intubation may be of particular use. This technique has been performed by novice physicians in cadavers, without difficulty or major complications. It has proved to be a quick, efficient and simple method to establish an endotracheal airway and should be a valuable adjunct for airway control.
Nasopharynggeal carcinoma with spinal secondaries
Authors: Elango S. , Kareem B. A. , Chandrasekaran S. , Azman N.
Published: November 2007

Nasopharyngeal carcinoma hs been reported to have a higher incidence of distant metastases as compared to other head and neck cancers. Distant metastases of nasopharyngeal catcinoma has been reported in the bones, lungs, liver, distant lymph nodes, brain and porta hepatis. This report presents a case of nasopharyngeal carcinoma with secondaries in the extradural space at the thoracic level of the spinal cord which hitherto has been an unreported site.
Acute bacterial thyroiditis presenting as otalgia
Authors: Stevenson James
Published: November 2007

A case of acute bacterial thyroiditis due toHaemophilus influenzaeinfection presenting as otalgia is reported. The features of this condition and the differential diagnosis from subacute (DeQuervains) thyroiditis are discussed.
Giant cell tumour of the sphenoid sinus: An unusual skull base tumour
Authors: Uttley David , Archer Daniel J.
Published: November 2007

An unusual skull base tumour is presented. Intraoperative smears made the diagnosis and dictated a change in surgical strategy. Giant-cell tumours of the sphenoid bone are discussed, together with current management.
Emergency cricothyrotomy
Authors: Milner S. M. , Bennett J. D. C.
Published: November 2007

The indications for the ruling for the Gulf Forces that emergency cricothyrotomy is to be performed where the airway is thought to be compromised are reviewed. The advantages of this procedure are outlined and some of the likely consequences regarding the incidence of complications and their management predicted.
Calcifying and keratinizing ameloblastoma of the maxilla
Authors: Siar Chong Huat , Han Ng Kok
Published: November 2007

A case is described of ameloblastoma of maxilla presenting with numerous calcified keratin pearls. The significance of cellular variation in relation to the behavioural potential of the ameloblastoma in general is briefly discussed.
Ultrastructure of nasal mast cells in normal subjects and patients with perennial allergic rhinitis
Authors: Drake-Lee A. B. , Price Jaqueline
Published: November 2007

The ultrastructure of mast cells from the nine normal inferior turbinates were compared with those found in eight patients with perennial allergic rhinitis due to house dust mite allergy. Forty-six mast cells from normal patients were found in forty blocks and eighty cells were found in thirty-three blocks in patients with perennial allergy suggesting an increase of mast cell numbers in perennial allergy. There were no basophils outside the blood vessels and whole mast cells were found only in the submucosa. There was no difference in the morphology of cells of different sizes. Mast cells were more degranulated in the allergic mucosa. Degranulation, irrespective of cell size was found at all depths of the mucosa. A review of the literature covered thein vivoandin vitrodescriptions of the ultrastructural morphology of human mast cells in the respiratory tract.
An unusual case of traumatic haematoma of soft palate
Authors: Gray Peter
Published: November 2007

Ingestion of small bones often causes oropharyngeal trauma. I present an unusual case of a potentially lifethreatening haematoma of the soft palate caused by a chicken bone. To my knowledge, this is the only case reported in the English literature.
An unusual oronasal foreign body
Authors: Harun S. , Montgomery P. , Ajulo S. O.
Published: November 2007

An unusual case of oronasal foreign body in a child is reported. A plain lateral X-ray of the head was carried out to show the shape and position of the foreign body; it was also useful in planning removal.

Ribbon gauze impregnated with vaseline was packed around the sharp end of the metal in the nostril to protect the nasal mucosa from further trauma while removing it. We recommend this technique.
Studies on mucocoeles of the ethmoid and sphenoid sinuses: Analysis of 47 cases
Authors: Moriyama Hiroshi , Nakajima Tsuneya , Honda Yoshio
Published: November 2007

Forty-seven mucocoeles of the ethmoid and/or sphenoid sinuses (33 males, 14 females) were operated on during the 10-years period from 1980 through 1989. Thirty-seven cases were post-operative mucocoele, while the remaining 10 were so-called primary mucocoeles. None of the cases had a history of facial trauma. In the majority of post-operative cases, the mucocoele develops 15–24 years after initial surgery. Paranasal sinus surgery in young patients (teenagers) may lead to a mucocoele due to post-operative scarring in the surgical wound. The principal symptoms include globe displacement, double vision, headache, deep orbital pain, a mass in the supero-medial quadrant of the orbit, visual disturbance, etc. Sufficient opening of the mucocoele wall by the endonasal approach is recommended for surgical treatment of ethmoidal and sphenoidal mucocoeles
Pre-operative nasal preparation—nasal packing and spraying compared
Authors: Sharma R. K. , Paulose K. O. , Al-Khalifa Salman , Shenoy P.
Published: November 2007

Fifty patients were included in a single blind study to evaluate the effectiveness of ephedrine-naphazoline (0.5 and 0.125 per cent respectively) nasal spray as against nasal packing with lignocaine (4 per cent) and adrenaline solution (1:50,000).
Ventilatory monitoring during microlaryngeal surgery using jet insufflation anaesthesia
Authors: Drysdale A. J. , Fawcett W. J. , Hollway T. E. , Moore-Gillon V.
Published: November 2007

We describe a method for continuous measurement of end-tidal carbon dioxide concentration during jet insufflation anaesthesia for microlaryngeal surgery. This increases the safety of the technique by allowing closer monitoring of inspired and expired gases during anaesthesia
Primary gingival leiomyosarcoma
Authors: Sözeri Bülent , Önerci Metin , Hosal Sefik , Ruacan Sevket
Published: November 2007

A case of primary gingival leiomyosarcoma in a 64-year-old woman is presented. The treatment modalities are discussed and the previous literature is reviewed.
Bacterial attachmentin vivoto epithelial cells of the nasopharynx during otitis media with effusion
Authors: Stenfors Lars-Eric , Räisänen Simo
Published: November 2007

Epithelial cells were obtained by swabbing the posterior wall of the nasopharynx (NPH) of 15 patients (age one to 6 8/12; years; eight males, seven females) undergoing ENT-surgery under general anaesthesia for otitis media with effusion (OME). Individually matched, ear healthy children served as controls. Bacteria attached to the non-ciliated cells were calculated according to a method described. Furthermore, quantitative and qualitative bacteriological analyses were performed on samples obtained from mucoid middle ear effusion material as well as from the NPH. All patients and controls harboured middle ear pathogens (S. pneumoniae,H. influenzae,B. catarrhalis, orS. aureus) in the NPH. Only 33 per cent of the patients harboured middle ear pathogens in the middle ear effusion and the same pathogen was invariably found in the corresponding NPH Attachment of bacteria to the non-ciliated cells of the NPH diminished significantly with growing age in the ear healthy control group but not in the OME group. OME is closely correlated tothe presence of middle ear pathogens in the NPH and to attachment of bacteria to the epithelial cells in the NPH.
Major surgery of oral and oropharyngeal carcinoma
Authors: Jones T. Alun , Gallow I. , Sellars S. L. , Kranold D. H. , Sealy G. R.
Published: November 2007

Thirty-two composite resections were carried out in the Department of Otolaryngology at Groote Schuur Hospital for oral and oro-pharyngeal squamous carcinoma over the 10-year period, 1977–1986. Three patients were lost to review but all others were followed up to death or to five years. Twenty-seven patients underwent surgery as their primary procedure and five for recurrence after primary radiotherapy. The overall survival was 16 patients at three years and eight at five years. Only one of the five patients who underwent salvage surgery after failed radiotherapy was alive at five years and all five experienced serious postoperative complications. All thosesurviving over five years had had either N0 or N1, disease at the time of presentation for surgery.
AIDS-like disproportion of minor T-cell subsets in Japanese patients with Wegener's granulomatosis
Authors: Ikeda Makoto , Katsura Yoshiya , Tsuru Sumiaki , Inouye Tetsuzo , Healy Gerald B.
Published: November 2007

Fifteen Japanese patients with Wegener's granulomatosis (WG) were evaluated according to their lymphocyte subset abnormalities. Two colour immunofluorescent flow cytometry was used to distinguish the lymphocyte subset alterations. WG group showed a decrease in the percentage of CD4+ cells and the increase of CD8+cells. Within the NK cell family, the functionally unidentified CD8+57+cells were markedly elevated. The disproportion of thelymphocyte subsets (CD4+↓ CD8+57+↑) were similar to those of Acquired Immunodeficiency Syndrome (AIDS) and AIDS relating complexes (ARC). To assesssilent infection of Human immunodeficiency virus (HIV), the polymerase chain reaction (PCR) wasdone for all patients to selectively amplify specific HIV proviral DNA sequences in peripheral blood mononuclear cells, HIV-1 proviral DNA was not found in any patients but these changes of WG might suggest a possible adaptive response to unknown viral infection.
The paranasal sinuses and other enigmas: an aquatic evolutionary theory
Authors: Rhŷs Evans Peter H.
Published: November 2007

The functional role of the paranasal sinuses in man has long been in dispute and as yet no satisfactory explanation has been offered for these ‘unwanted’ spaces. An answer may be found by study of the comparative evolutionary development of the sinuses in man and other higher primates.

Several unique physical characteristics of man not seen elsewhere in the ape family, or indeed in other terrestrial mammals, including some relating to the upper aerodigestive tract, are not satisfactorily explained by the traditionally held theory of evolutionary development of early man directly from the arboreal ape.

It is argued that these developmental differences are much more logically explained by a period of aquatic adaptation at a crucial period in the evolution of pre-hominid man. A new theory is proposed which might explain the importance of the sinus air cavities as buoyancy aids for protection of the upper airway tract in such an aquatic environment.

Further evidence is offered relating to a pathological condition of the external ear canal which supports this theory that man at some stage in his early development acquired an affinity for an aquatic environment.

Explanation of these unique hominid characteristics in terms of an aquatic evolutionary theory may help to resolve some of the enigmatic inconsistencies between man and other higher primates, and may account for man's eventual emergence as the dominant extant species, and perhaps an explanation for the ‘missing link’.
Chondrosarcoma of the hyoid
Authors: Hasan Suhel , Kannan V. , Shenoy Ashok M. , Nanjundappa  , Naresh K. N.
Published: November 2007

Two cases of chondrosarcoma of the hyoid bone are described. They were managed with surgical resection and postoperative radiotherapy. These patients are disease free at 26 months and 15 months respectively.
Tumours of the nose and maxillary sinus. Ten year survey from Kenya
Authors: Bjerregaard B. , Okoth-Olende C. A. , Gatei D. , Bal I. S. , Jensen H.
Published: November 2007

Between 1976–1985,127 cases of malignant tumours of the nose and maxillary sinus were seen at the Department of Human Pathology, Kenyatta National Hospital, Nairobi, Kenya. Cancer of the nose and maxillary sinus was a common diagnosis accounting for 0.8 per cent of all malignancies. Despite this, the incidence was low probably because the rural Kenyans have difficulty in gaining access to the oncology facilities in Nairobi. Incidence rates standardized to world population per 100,000 persons–years were 0.16 for males and 0.12 for females.

Clinical information showed that malignancy should be expected in patients with swelling of thecheek and involvement of the orbit. Compared with Denmark the proportion of undifferentiated carcinomas was significantly higher in Kenya. The well known fact that anaplastic carcinoma of the postnasal space is causally associated with the Epstein Barr virus makes it tempting to suggest that anaplastic carcinoma of the nose and maxillary sinus may also be of viral aetiology.
Is ‘lateral aberrant thyroid’ always metastatic tumour?
Authors: Watson M. G. , Birchall J. P. , Soames J. V.
Published: November 2007

It is now a widely held belief that so-called ‘lateral aberrant thyroid’ tissue actually represents a metastasis from a malignant tumour of the thyroid gland. A case is presented which suggests that this is not always true, and an extensive review of the relevant literature is discussed.
Detection Of recurrent cholesteatoma by computerized tomography after ‘closed cavity’ mastoid surgery
Authors: Wake M. , Robinson J. M. , Witcombe J. B. , Bazerbachi S. , Stansbie J. M. , Phelps P. D.
Published: November 2007

Pre-operative Computerized Tomography was performed prior to second look operations in 10 cases to check for cholesteatoma after combined approach tympanoplasty. Three independent opinions were obtained on the CT scans and compared with the operative findings.

This small series failed to demonstrate reliable pre-operative radiological detection of cholesteatoma. There was disappointing inter-observer agreement in interpretation of the CT scan
An ad hoc tympanocentesis apparatus
Authors: Witana Jaika S.
Published: November 2007

Myringotomy is one of the commonest procedures carried out by ENT surgeons. Analysis of middle ear aspirate is sometimes helpful in the management of ear disease. A simple method of constructing an apparatus for collection of middle ear aspirate is described.
Rhinosporidiosis
Authors: Mears T. , Amerasinghe C.
Published: November 2007

Rhinosporidiosis is the disease resulting from infection by Rhinosporidiosum seeberi, an organism endemic in the Indian sub-continent, but rarely seen in the United Kingdom.

We describe the clinio-pathological features of a case presenting in a 14-year-old female.
Management of posterior mesotympanic cholesteatoma
Authors: Brooker D. S. , Smyth G. D. L.
Published: November 2007

Contrary to previous practice, the eradication of posterior mesotympanic cholesteatoma can frequently be achieved using a transcanal approach and without the need for more major surgery. For success, certain specific steps are necessary. These are described and the results reported.
Criteria for hearing preservation in acoustic schwannoma surgery: The concept of useful hearing
Authors: Hinton A. E. , Ramsden R. T. , Lye R. H. , Dutton J. E. M.
Published: November 2007

In the quest for hearing preservation in patients with acoustic schwannomas it is essential that surgeons do not lose sight of the concept of ‘useful’ hearing. There is an important difference between hearing preservation which pleases the surgeon and that which will be appreciated by the patient.

Tumour size, pure tone audiogram average differences between ears and speech discrimination scores have been recorded in a series of 114 patients with unilateral acoustic schwannomas. Criteria for useful hearing are presented in terms of pure tone audiogram average difference and speech discrimination scores.

There were 11 patients (10 per cent) with a speech discrimination score of 50 per cent or more, a pure tone audiogram average difference of 30 dB or better and a tumour size of no more than 2 cm. Only one patient (0.9 per cent) had a speech discrimination score of 50 per cent or more, a pure tone audiogram average difference of 20 dB or better and a tumour size of no more than 1 cm.

It is concluded that hearing preservation techniques may be applicable to between 1 and 10 per cent of patients with unilateral acoustic schwannomas.
Leprosy of the larynx
Authors: Soni N. K.
Published: November 2007

The result of a study conducted on 30 patients of lepromatous leprosy regarding laryngeal involvement is presented. The incidence of leprous laryngitis is 36.6 per cent in this part of India in lepromatous leprosy patients. Leprosy is long standing disease so laryngeal lesions developed gradually and may be asymptomatic in some cases while others have been found to have variety of clinical manifestation in form of congestion, infiltration, nodulation, thickening and fibrosis. Anti-leprosy chemotherapy is equally effective on these lesions. A screening survey of laryngeal pathology in such cases should be done periodically.