bluuebunny/crossref_metadata_2025 huggingface dataset:
Relapsing polychondritis presented as inner ear involvement
Authors: Kimura Yasuyuki , Miwa Hiroko , Furukawa Mitsuru , Mizukami Yuji
Published: November 2007

We report a rare case of relapsing polychondritis with an initial symptom of inner ear involvement. This 53-year-old Japanese man experienced a hearing difficulty, tinnitus in both ears, and dizziness of sudden onset, but lacked auricular chondritis at that time, which is the most frequent finding in relapsing polychondritis. Thus it was difficult to reach a correct diagnosis. Steroid therapy, with oral prednisolone 15 mg daily, was effective. Almost two months after we began the steroid therapy, the patient complained of losing interest in his work and reported a hallucination vision on the TV screen, so the dose of prednisolone was decreased to 10 mg. The hallucinations then disappeared, but the serum level of C-reactive protein increased highly. To reduce the dose of prednisolone, we tried low-dose oral methotrexate. However, we had to discontinue it when the patient experienced severe vomiting and diarrhoea. As adjuvant therapy, we then administered Sho-saiko-to, Chinese herbal medicines with few side effects. Symptoms and laboratory abnormalities then improved markedly.
Mediastinitis - a rare complication of a peritonsillar abscess
Authors: Nielsen T. R. , Clement F. , Andreassen U. K.
Published: November 2007

We report a case of mediastinitis, in an otherwise healthy 25-year-old man, resulting from a peritonsillar abscess with extension through the parapharyngeal and retropharyngeal spaces.

In our case the patient was primarily treated with needle aspiration, a method described in many publications as a safe alternative to incision and drainage.

We emphasize that for peritonsillar abscesses a tonsillectomy or wide incision and drainage, instead of needle aspiration, might prevent the extension of the condition, thus preventing serious complications.
Thrombosed jugular vein presenting as a hard neck mass
Authors: Quinn S. James , Bleach Nigel R. , Ong Poh S. , Mackay Ian S.
Published: November 2007

We report an unusual case of thrombosis of a dilated external jugular vein presenting as a hard neck mass of sudden onset. The lesion's presentation, investigation, treatment and pathology are discussed.
Paraganglioma: an unusual tumour of the parathyroid gland
Authors: McCluggage W. G. , Cameron C. H. S. , Brooker D. , O'Hara M. D.
Published: November 2007

A case of paraganglioma arising within a parathyroid gland is reported. The lesion was an incidental finding in a block dissection of neck performed for squamous carcinoma of the pharynx. A well-circumscribed lesion, exhibiting the characteristic pathological features of a paraganglioma, was embedded within the right inferior parathyroid gland. Due to its location, the chief histological differential diagnosis was an unusual variant of parathyroid adenoma. Immunohistochemistry and electron microscopy assisted in reaching a diagnosis. This, as far as we are aware, is the first reported case of a paraganglioma of the parathyroid gland.
Vestibular neurectomy: A histological and clinical study of results
Authors: Kitamura Ken , Miyata Mamoru , Wanamaker Hayes H. , Silverstein Herbert , Seidman Michael
Published: November 2007

Posterior fossa vistibular neurectomy has become one of the most effective surgincal procedures for control of vertigo symptoms in Menière's disease. A small group patients continue to have vertigo and demonstratablke vestibular function by electronystagmography (ENG) post-operatively. Another group of patients may have also. In an effort to correlate hitological findings with clinical outcome, nerve biopsies were comapared with clinical, audiometric and ENG results. Results of this study demonstratge that complete reduction of vestibylar response (on calorica testing) and clinical cure of vertigo can be obtained despite a variable number of nerve fibres at vestibular neurectomy.
Proptosis following nasal tamponade
Authors: Oluwole M. O. , Hanif J.
Published: November 2007

A fracture of the lamina papyracea as a result of nasal packing, though plausible is undocumented. A case is presented, with a cautionary note to avoid the use of excessive pressure in packs and balloons when attempting to control epistaxis in elderly patients.
Surgical bone wax causing epistaxis
Authors: Tay H. L. , Tan L. K. S.
Published: November 2007

A case of recurrent epistaxis caused by bone wax in the nasal cavity is reported. This is the first reported case of a nasal complication due to surgical bone wax.
Nasopharyngeal lipoma – a rare clinico-pathological entity
Authors: Fagan J. J. , Learmonth G. M. , Garb M. , Bowen R. M.
Published: November 2007

A lipoma situated within the posterior wall of the nasopharynx is reported. Only three lipomas of the nasopharynx in adults have previously been reported. The value of CT scan and cytology in making the preoperative diagnosis of a lipoma at this location is discussed.
Vestibular schwannoma and the only hearing ear
Authors: Bhatia Sanjaya , Karmarkar Sandeep , Taibah Abdelkader , Russo Alessandra , Sanna Mario
Published: November 2007

With the recent advances in the management of vestibular schwannomas, it is possible not only to save the facial nerve function but also preserve hearing in a small percentage of cases. Difficulties arise while managing patients with vestibular schwannoma in their only hearing ear. In this article we summarize our experience in managing seven of these patients. We recommend a watch and wait policy with a regular follow-up with audiometric testing and gadolinium-enhanced magnetic resonance imaging (MRI). Gamma knife radiosurgery is advised in cases with deterioration of hearing or increase in tumour size. Surgery is usually avoided unless there are brainstem compression symptoms.
The role of MIBG scintigraphy in the management of a case of metastatic glomus jugulare tumour
Authors: Nilssen E. , Wormald P. J.
Published: November 2007

Glomus jugulare tumours with metastases are rare as the diagnosis of metastases in this condition can be difficult.

In the past this diagnosis has been made on histology of the metastatic lesions which were identified on clinical grounds. This is one of the reasons why there have been only 20 reported cases in the literature up to 1990 (Johnstone et al., 1990). This case report examines the role of meta-iodobenzylguanidine (MIBG) scintigraphy in the diagnosis of metastases. MIBG scintigraphy is an injected radionucleotide isotope scanning technique which is cheap, non-invasive, sensitive as well as being a specific investigation for identifying sites of ectopic neuroendocrine tissue. It may also have a role in the treatment of these tumours.
Heterotopic pleomorphic adenoma of the external nose
Authors: Badia Lydia , Weir Justin N. , Robinson Anthony C.
Published: November 2007

Pleomorphic adenomas arising from sites other than the major or minor salivary glands are uncommon. We describe a case of pleomorphic adenoma in the subcutaneous tissue of the nasomaxillary crease. An identical tumour was previously excised from the right nasal cavity. The possible aetiology of these heterotopic salivary gland tumours is discussed.
Trans-nasal endoscopic holmium: YAG laser correction of choanal atresia
Authors: Panwar S. S. , Martin F. W.
Published: November 2007

Five patients with choanal atresia were treated, using a trans-nasal endoscopic Holmium:YAG laser. The age of patients ranged from 15 months to 53 years. The nasal endoscope provides excellent visualization. The advantage of the Holmium:YAG laser is its fibre-optic delivery, allowing the laser to be hand-held, giving greater precision. Good nasal airways were achieved in four out of five cases with a single treatment. The procedure was found to be safe, quick, with minimal morbidity and a shorter in-patient stay.
Acute laryngeal trauma: a comparison between peace time and war injuries
Authors: Đanić Davorin , Miličić Damir , Prgomet Drago , Leović Dinko
Published: November 2007

Thirty-six patients with acute laryngeal trauma are presented. Sixteen patients had peace-time and 20 had war injuries. Peace-time injuries were mostly due to car accidents, violence and suicide using a knife, whereas the war injuries were caused by shell and mine fragments.

Nine patients were treated conservatively (eight peace-time and one war-time) and 27 by surgery (eight peace-time and 19 war-time).

Surgical experience showed that acute laryngeal trauma must be treated within the first 24 hours after injury. Primary treatment must be a definite one. In that way complications and uncontrolled healing can be successfully avoided.
Tympanic thermometry and minor ear surgery
Authors: Tomkinson A. , Roblin D. G. , Quine S. M. , Flanagan P.
Published: November 2007

Infra-red tympanic thermometry is a relatively new technique for measuring body temperature which requires the minimum of co-operation and is quick and easy to use. It is therefore ideal for use in children. Its use is becoming more widespread and as it is theoretically possible that minor ear surgery may interfere with function its reliability in these patients may be in question.

Twenty-two children (mean age 5.3 years) who underwent myringotomy ± grommet insertion had the tympanic temperature of each ear measured immediately before, and 15 minutes after, surgery on the recovery ward. No difference was found between the pre- and post-operative temperatures (mean difference – 0.1°C, p>0.1, paired t-test, hypothesized difference of 0).

This thermometer appears to be a reliable way of monitoring body temperature on a paediatric ENT recovery ward in patients who have undergone minor ear surgery.
Early diagnosis of Wegener's granulomatosis presenting with facial nerve palsy
Authors: Hern J. D. , Hollis L. J. , Mochloulis G. , Montgomery P. Q. , Tolley N. S.
Published: November 2007

Wegener's granulomatosis is a multi-system disease characterized by granuloma formation and a necrotizing vasculitis. It classically presents with involvement of the upper and lower respiratory and renal systems. However locoregional disease is common and may include otological manifestations. Facial nerve palsy has been reported during the course of the disease process but it is extremely rare for it to be the presenting feature. Previously reported cases have involved a protracted diagnostic process including exploratory tympanotomy, mastoidectomy and facial nerve decompression. We report a case of Wegener's granulomatosis which presented with a facial nerve palsy. An early diagnosis was achieved by measurement of the erythrocyte sedimentation rate (ESR), followed by serological assay of cytoplasmic anti-neutrophil cytoplasmic antibody (cANCA). Histological examination of nasal mucosal biopsies confirmed granuloma formation consistent with a diagnosis of Wegener's granulomatosis. This allowed early treatment with immunosuppressive therapy and avoided unnecessary and potentially hazardous middle ear surgery.
Drug induced otalgia due to mesalazine and sulphasalazine
Authors: Wareing Michael , Mitchell David
Published: November 2007

A case of left otalgia in a patient suffering from longstanding ulcerative colitis is reported. The patient was treated for an exacerbation of his disease with courses of mesalazine and sulphasalazine during which time he developed otalgia. The otalgia disappeared with cessation of the drugs. It is concluded that in the absence of any other head and neck cause that the otalgia was a complication of the drug therapy.
Giant hamartoma of the oropharynx
Authors: Santana-Hernandez D. J. , Ell S. R. , Da Costa P. , Macklin C. P. , Hussain S. S. M.
Published: November 2007

Giant polypoidal hamartomas of the pharynx and oesophagus are rare benign tumours of unknown origin, exceptionally arising from the oropharynx. We report the case of a 74-year-old man who developed sudden nausea and a foreign body sensation. Shortly afterwards he regurgitated a 25 × 3 × 1.5 cm pedunculated fleshy mass, still attached to the inside of his throat. The patient was anaesthetised, the mass traced to the right tonsillar fossa and adjacent oropharyngeal wall. The pedicle was clamped and the lesion excised. Histology was consistent with a giant oropharyngeal hamartoma. We discuss the pathogenesis and potential complications of this condition. The literature is reviewed.
Retropharyngeal abscess – an unusual complication of anorexia nervosa
Authors: Delap Thomas G. , Grant William E. , Dick Robert , Quiney Robert E.
Published: November 2007

An unusual case of an adult female with anorexia nervosa, who developed a retropharyngeal abscess, is presented. This case is reported both because of the paucity of reports on retropharyngeal abscess and because of the dramatic unusual aetiology.
The detection of clinically occult nasopharyngeal carcinoma in patients following radiotherapy – an analysis of 69 patients
Authors: Nicholls John M. , Chua Daniel , Chiu Pui Man , Kwong Dora L. W.
Published: November 2007

A prospective analysis of 69 patients who had been treated for nasopharyngeal carcinoma (NPC) by external radiotherapy was carried out. Biopsies from the posterior nasopharynx were performed and analyzed by in situ hybridization using an antisense Epstein-Barr Early RNA (EBER) radio-labelled riboprobe. None of the patients had evidence of disease in the nasopharynx. One patient was found to have nasopharyngeal carcinoma detected only by in situ hybridization. In the subsequent 18-month follow-up of these clinically- and biopsynegative patients, only one patient developed relapse in the nasopharynx. In situ hybridization is a valuable tool for the detection of NPC and should be routinely available in histopathology laboratories where NPC is regularly diagnosed.
Adenoid cystic carcinoma of the maxilla – the value of histopathology in diagnosing a second primary
Authors: Hadfield P. J. , Fisher C. , Archer D. J.
Published: November 2007

Adenoid cystic carcinoma is the commonest tumour of minor salivary glands. In the case described here a pulmonary mass was found. This was likely to be a distant metastasis, particularly as the primary tumour was of cribriform subtype with perineural invasion and resection was microscopically incomplete. However, surgical excision of the pulmonary mass enabled histopathological studies to be carried out which found it to be an unrelated bronchioloalveolar carcinoma.
A cost-benefit analysis of the post-operative use of antibiotic ear drops following grommet insertion
Authors: Pearson C. R. , Thomas M. R. , Cox H. J. , Garth R. J. N.
Published: November 2007

A prospective randomized controlled study was carried out to investigate the effect of prophylactic antibiotic ear drops used for five days after bilateral grommet insertion. The average improvement in the hearing threshold was significantly better in ears in which there was an effusion (16 dB) compared with no effusion (9 dB). The drops had no significant effect upon grommet function at three months measured by blockage rates, extrusion rates or improvement in pure tone audiometry whether or not there was an effusion. The drops were not therefore cost-effective.
Local anaesthesia in flexible nasendoscopy. A comparison between cocaine and co-phenylcaine
Authors: Lennox P. , Hern J. , Birchall M. , Lund V.
Published: November 2007

Flexible nasendoscopy is now an integral part of the diagnostic process in Otorhinolaryngology. Topical local anaesthesia is generally recommended and cocaine is usually the drug of choice in view of its concurrent vasoconstrictor action. However, it is expensive, a controlled drug and serious side effects have been reported. Co-phenylcaine forte is a new preparation which also has both local anaesthetic and vasoconstrictor properties. This study compares the efficacy of cocaine and Co-phenylcaine in flexible nasendoscopy and concludes that they provide similar local anaesthesia and vasoconstriction of the nasal mucosa. Co-phenylcaine forte can therefore be used as an alternative to cocaine in flexible nasendoscopy.
Correlation between clinical response and injection quality in treatment of spasmodic dysphonia
Authors: Tewary A. K.
Published: November 2007

Botulinum toxin injection is an effective treatment for spasmodic dysphonia. There are ethical difficulties in performing a controlled placebo trial to assess the effectiveness of this treatment. This paper shows a significantly decreased clinical response following technically poor injections given to patients who respond well to good quality injections.
Surgical management of the plunging ranula: a review of seven cases
Authors: Ichimura Keiichi , Ohta Yasushi , Tayama Niro
Published: November 2007

We have treated seven patients with a plunging ranula during the past 10 years. All patients underwent surgery via a cervical approach. In two, the ranula reached the anterior neck by passing through a dehiscence in the mylohyoid muscle, while in the other five the plunging ranula passed posteriorly to the mylohyoid muscle. A pseudocyst was extirpated in each patient. Although total sublingual gland excision was not performed in two patients, no recurrence was observed in any patient. Incision of the pseudocyst facilitated subsequent procedures and decreased the incidence of transient facial paralysis. In the presence of a cervical mass without swelling of the oral floor, a cervical approach may still be the method of choice either for the first operation or for salvage surgery after recurrence subsequent to intraoral procedures. It is based on the fact that there may be ectopic sublingual glands residing on the inferior surface of the mylohyoid muscle.
Incidence of previously undetected disease in routine paediatric otolaryngology admissions
Authors: Zeitoun H. , Robinson P.
Published: November 2007

The process of clerking routine pre-operative admissions involves the house officer taking a full medical history and performing a full physical examination. The diagnostic yield is thought to be low, and the educational value to the house officer is also small. This study addresses the question as to whether routine physical examination is always indicated.

One hundred and nine children admitted for routine Otolaryngology procedures were prospectively studied to identify the importance of examination in the pre-operative assessment of patients.

The results showed that 51 per cent of the children admitted had risk factors. The medical history was sufficient to identify these risk factors in all patients with the exception of one cardiac condition.

This study concludes that a suitable alternative to the current process of clerking such as a standardized nurse history could be safely and efficiently undertaken. Eliminating the tiny percentage of previously unrecognized disease would be a prerequisite for such a change.
Solitary fibrous tumour of the infratemporal fossa
Authors: Rayappa C. S. , McArthur P. D. , Gangopadhyay K. , Antonius J. I.
Published: November 2007

Solitary fibrous tumour was first described as a pleural tumour. It has been reported in a number of extrapleural sites including the head and neck. We present the first case of solitary fibrous tumour of the infratemporal fossa described in the English literature. Complete excision was achieved using the orbitozygomatic infratemporal craniotomy approach.
Configuration of experimentally produced cholesteatoma by transplantation of a free skin graft
Authors: Gyo Kiyofumi , Sasaki Yasushi , Hinohira Yasuyuki
Published: November 2007

Residual cholesteatoma was experimentally produced in guinea pigs by transplanting a free skin graft into the middle ear bulla. In group A, the graft was placed on the mucosa after scratching the surface with a pick, while in group B, it was placed on the bone surface following removal of the mucosa and drilling with a diamond burr. The group A procedure was conducted on the left ear and the group B procedure on the right ear in 12 guinea pigs. The animals were sacrificed at two, four and eight weeks after transplantation. In all 12 ears of group A, the graft kept its original flat shape, resembling an open type residue. In eight of 12 ears of group B, the graft grew forming a squamous pearl, while in the remaining four ears it retained a flat shape. The difference in configuration is thought to be due to the amount of granulation around the graft.
Chondroblastoma – an unusual site in a young patient
Authors: Al-Sader M. H. , Tait R. , Leader M.
Published: November 2007

We report a case of primary chondroblastoma presenting as a submucosal lump on the nasal bridge of a 15-yearold female. The lesion was curetted and the patient remains well after one year follow-up. This case report describes a primary chondroblastoma arising in an unusual site and in an unusual age group.
The history of percutaneous tracheotomy
Authors: Ernest van Heurn L. W. , Brink Peter R. G.
Published: November 2007

Percutaneous tracheotomy is a surgical procedure for inserting a tracheal cannula into the tracheal lumen without a large incision, without extensive dissection of pretracheal tissue and without exposure of the trachea. Ciaglia's report on the procedure a decade ago led to this technique gaining popularity, although its origin is much older.
Maxillary antral lavage using inferior meatal cannula anaesthesia
Authors: Mochloulis G. , Hern J. D. , Hollis L. J. , Tolley N. S.
Published: November 2007

Antral puncture and lavage through the inferior meatus is a minor but common otolaryngological procedure, usually performed under local anaesthesia. We describe a new method of introducing local anaesthetic into the inferior meatus, via the use of a soft intravenous cannula connected to a syringe containing 10 per cent cocaine paste. We have called this new technique inferior meatal cannula anaesthesia (IMCA).
Electrodissection tracheotomy
Authors: Alvi Aijaz , Stegnjajic Arsen
Published: November 2007

The acquired immune deficiency syndrome (AIDS) epidemic and other potentially fatal blood-borne infectious diseases have produced a heightened awareness for preventing accidental inoculation of surgeons and operating theatre staff. It is incumbent upon the head and neck surgeon to use safe and effective surgical technique in these patients to prevent such an event. We are seeing an increasing number of patients with AIDS and hepatitis undergoing tracheotomy. We present a sharps-free technique for tracheotomy which is safe for the hospital staff and the patient.
Bilingual hearing acquisition in Welsh and English following cochlear implantation
Authors: Osborne Jonathan , Jenkins Janet , Sparkes Clive
Published: November 2007

A post lingually deafened adult equilingual in Welsh and English, received rehabilitation in both languages following cochlear implantation.

Hearing acquisition was very similar in both languages, indicating that there is no need to vary the electrode coding strategy for different languages of Indo-European origin. The situation may be difficult for tonal languages such as Chinese.
Facial paralysis caused by a lymphoepithelial cyst located in the parotid gland
Authors: Watts S. J. , Turner N. O. , Juan J. San , Rockley T. J.
Published: November 2007

We report the case of an acute onset facial paralysis which was caused by a benign lymphoepithelial cyst found in the parotid, an association which is a rarity in the literature. The diagnosis and surgical management is discussed. This report emphasises the clinical principle that parotid masses causing an acute facial palsy are not necessarily malignant in nature. Intra-operative frozen section histology is helpful in saving the patient from unnecessarily radical surgery.
Isolated sphenoid sinus changes – history, CT and endoscopic finding
Authors: Hadar Tuvia , Yaniv Eitan , Shvero Jacob
Published: November 2007

This study reviews the records of 21 patients with isolated sphenoid sinus disease who were treated by rigid endoscopic sphenoidotomy at the Nose and Sinus Unit, Department of Otolaryngology of Beilinson Medical Center, Israel.

Diagnosis was made on the basis of history, rigid nasal endoscopy and computed tomography (CT) scan. The most frequent symptom was headache; no instances of ‘pathognomonic’ headache were found. Sphenoidotomy was performed through the area of the natural ostium. The pathological finding was infection in 11 patients, cyst in four patients, polyps in three patients, mucocoele in two, and inverted papilloma in one patient.

Surgical results were very good. Endoscopic sphenoidotomy proved to be safe, with minimal blood loss, reduced operating time, decreased morbidity, and short post-operative hospitalization.
Otoplasty: the problem of the deep conchal bowl
Authors: Beasley N. J. P. , Jones N. S.
Published: November 2007

The correction of prominent ears requires a logical approach to address each of the anatomical defects present while bearing in mind the overall shape of the ear. The two most common problems encountered are the lack of an antihelix and a deep conchal bowl.

We describe a method of reducing the depth of the conchal bowl which avoids some of the problems previously encountered such as occlusion of the external auditory meatus and visible irregularity on the external surface of the pinna. Resection of the inferomedial part of the conchal bowl and thinning of the ponticulus allow realignment of the ear and prevent prominence of the antitragus. The ear is then secured with concha-mastoid sutures and the scapha-conchal angle can then be corrected to form an antihelix if necessary.
Hodgkin's disease of middle ear and mastoid
Authors: Solanellas J. , Esteban F. , Soldado L. , López-Lacomba D. , Hierro C. , Jimenez J. M.
Published: November 2007

We present a case of Hodgkin's disease of the mastoid associated with upper cervical lymph node involvement without disseminated disease. This patient was treated with chemotherapy alone and lesions responded rapidly. At present the patient is well, with no evidence of recurrence or extension of this disease. Hodgkin's disease of the middle ear and mastoid is an extremely rare disease. After a wide search in the literature no cases of Hodgkin's disease arising in the middle ear and mastoid have been found.
Dural metastasis at medulla oblongata: a rare cause of vocal fold paralysis
Authors: Pak Martin Wai , Mak Henry Ka Fung , Ku Peter Ka Ming , van HasseltS Charles Andrew
Published: November 2007

Malignancy is a major cause of vocal fold paralysis. Nevertheless, metastatic disease at the brainstem leading to high vagal paralysis is rarely encountered. We illustrate an unusual case of unilateral vocal fold paralysis caused by dural metastasis directly compressing on the nucleus ambiguus. The median position of the paralysed vocal fold is inconsistent with the Wagner and Grossman theory predicting the location of the lesion.
Castleman's disease restricted to the infratemporal fossa
Authors: Rodrigo Juan P. , Fernandez Jose A. , Alvarez Juan C. , Gómez Justo , Suárez Carlos
Published: November 2007

Giant lymph node hyperplasia (Castleman's disease) is usually reported as a solitary mediastinal tumour, although involvement of other anatomical sites and a multicentric form have been reported. We describe a rare case of Castleman's disease due to its localisation (the left infratemporal fossa) and histology (plasma-cell variant). A brief review of the main clinico-histological characteristics of Castleman's disease is also presented.
Increase in epithelial mast cell numbers in the nasal mucosa of patients with perennial allergic rhinitis
Authors: Slater A. , Smallman L. A. , Drake-Lee A. B.
Published: November 2007

The aim of the study was to compare the numbers and distribution of mast cells in the nasal mucosa of perennial allergic rhinitis (PAR) patients and controls, as demonstrated by different staining methods for light microscopy.

Biopsies of inferior turbinate mucosa were taken from 10 patients with PAR and 10 patients undergoing septoplasty or septorhinoplasty (control group). Sections for light microscopy were stained with azure A, chloroacetate esterase and an ABC immunohistochemical technique using antibody to tryptase.

Three times more mast cells were found in the epithelium of PAR patients compared to controls using the immunohistochemical technique (p= 0.0074). This method demonstrated considerably more mast cells than the other stains.

The increase in epithelial mast cells is consistent with the migration of mast cells seen in seasonal allergic rhinitis, and this may be important in the phenomenon of nasal priming seen after repeated antigen exposure.
Tuberculous parotitis: a case report
Authors: Bhat N. A. , Stansbie J. M.
Published: November 2007

Tuberculosis of the parotid gland is rare. It cannot be distinguished from a parotid tumour by clinical examination alone, so surgical exploration has usually been required for diagnosis. We present a case with the same diagnostic dilemma.
Computer-assisted documentation and analysis of wound healing of the nasal and oesophageal mucosa
Authors: Weber R. , Keerl R. , Jaspersen D. , Huppmann A. , Schick B. , Draf W.
Published: November 2007

Our aim was to analyse the dynamics of healing processes in the nose and oesophagus by videoendoscopic examination and reconstruction of the natural dynamics and continuity of a process using modern computer technology and so-called morphing software. Thirteen patients were followed-up for six months after sinus surgery and three weeks after oesophagitis. Four overlapping and meshing phases of wound healing following sinus surgery with significant interindividual differences. Topical budesonide shortened the duration of wound healing phases. Healing of oesophagitis occurred approximately symmetrically from the wound edges to the centre with constant velocity. Computer-assisted morphing enables dynamic analysing of mucosal processes under the following preconditions: Availability of a valid imaging method for documentation and measurement with the generation of congruent images. The process under analysis must run without sudden leaps and there must be adequate choice of timing of single measurement procedures.
Arytenoidopexy for bilateral vocal fold paralysis in young children
Authors: Triglia Jean-Michel , Belus Jean-François , Nicollas Richard
Published: November 2007

The purpose of this retrospective study was to describe and evaluate the results of arytenoidopexy performed by the external laterocervical approach in 15 consecutive children presenting bilateral vocal fold paralysis causing life-threatening airway compromise. Mean age at the time of surgery was 20 months and mean follow-up was 42 months. At the end of follow-up all patients were in good health and did not need special care for breathing. No abduction movement has been observed on the opposite vocal fold since arytenoidopexy. One failure subsequently required arytenoidectomy. The findings of this study suggest that arytenoidopexy is an effective surgical treatment for life-threatening bilateral vocal fold paralysis in young children.
Are laryngeal papilloma virus-infected cells viable in the plume derived from a continuous mode carbon dioxide laser, and are they infectious? A preliminary report on one laser mode
Authors: Kunachak Somyos , Slthisarn Pranee , Kulapaditharom Boonchu
Published: November 2007

The purpose of this study was to determine the potential risk of transmitting viable viral infected cells as well as viral infectivity of laryngeal papilloma in the plume derived from a continuous mode carbon dioxide laser. Each of 10 juvenile recurrent laryngeal papilloma specimens was divided into two equal parts, and one part was irradiated with a carbon dioxide laser employing a continuous mode at the power setting of 10 watts with 0.5 mm spot size and a power density of 1667 W/cm2. The resultant laser plume was trapped and was cultured simultaneously with the other part of the specimen which served as the control. All irradiated specimens tested yielded negative culture results while all the control counterparts revealed viable cell growth. To detect the viral infectivity, laser plume was cultured with two separate cellsystems, one was the porcine PS clone D cell line and the other normal mucosal cells obtained from the same patient, and to control these systems both cell lines were also designed to be infected with polio virus. Both cell lines in the viral infectivity testing systems revealed no sign of viral infection. The results suggest that papilloma virus-infected cells cannot survive the continuous mode of carbon dioxide laser irradiation. We primarily conclude that, to avoid airborne transmission of plume containing laryngeal papilloma viral-infected cells and infectious viral particles, the carbon dioxide laser parameters should be in a continuous mode with the power density equal to, or more than, 1667 W/cm2.
Menière's disease: evolution of a definition
Authors: Beasley N. J. P. , Jones N. S.
Published: November 2007

In 1861 Prosper Menière separated patients with episodic vertigo, hearing loss and tinnitus from a group previously described as having apoplectiform cerebral congestion. He suggested the cause was disease within the semicircular canals (Menière, 1861). Over the years it becoame apparent that within this group there were a number of patients with characteristic signs and symptoms and in 1938 a pathological correlate was found in the form of endolympatic hydrops. Descriptions scuh as Menière's ‘Menière's ‘disease’, Menière's ‘syndrome’ and Menière' ‘symptom complex’ led to a confusing array of terms for this condition and monotoring of treatment results became difficult. In response to this in 1972 the American Academy of Ophthalmology and Otolaryngology and Otolaryngoly Committee on Hearing and Equillibrium published a clear definition of Menière's disease and criteria for the reporting of treatment results, it was updated in 1985 and again in 1995. We described the changes that have taken place as the definition of Menière's disease has evolved.
Nuclear DNA content using computerized image cytometry of squamous cell carcinomas of the head and neck
Authors: Sarker S. K. , Ghufoor K. , Patel K. S. , Tolley N. S. , Coleman D. V.
Published: November 2007

Ploidy status using flow cytometry of head and neck cancers may be of prognostic value. We describe the use of image cytometry in ploidy measurement of squamous cell carcinomas of the head and neck (SCCHN). This technique allows only tumour cells to be measured, thereby rejecting debris, artefact and benign cells. Tissue sections were cut from tumours and then Feulgen stained. A total of 60 patients were included in this study, 23 females and 37 males. The data reveals a relationship between ploidy status and the histological differentiation. However, the ploidy status and histological differentiation do not appear to correlate to the clinical stage of the disease. This method of measuring ploidy may be more accurate than flow cytometry and may have a prognostic role in head and neck cancer patients. A study comparing both methods may demonstrate this and we aim to evaluate this in the future.
Primary branchial cleft carcinoma – a case report
Authors: Ohri A. K. , Makins R. , Smith C. E. T. , Leopold P. W.
Published: November 2007

Primary branchial cleft carcinoma is a diagnostic challenge. The majority of cases have been shown, following the application of rigid criteria, to have developed from an occult metastasis elsewhere.

We describe what we believe to be only the second reported case in a patient who fulfils all of the established criteria.
Malignant vagal paraganglioma
Authors: Walsh R. M. , Leen E. J. , Gleeson M. J. , Shaheen O. H.
Published: November 2007

Vagal paraganglioma is a rare usually benign tumour of neural crest origin. The malignant form of this tumour i s very uncommon and the diagnosis is made on the basis of its clinical behaviour rather than its histological appearance. We report a case of vagal paraganglioma metastatic to adjacent cervical nodes and discuss the diagnosis and management of this tumour.
A transpalatal approach to the parapharyngeal space
Authors: Myatt H. M. , Remedios D.
Published: November 2007

The case of a 75-year-old lady with a large parapharyngeal pleomorphic adenoma excised via a transpalatal peroral technique is presented. This is a new approach to the parapharyngeal space not previously described. A laterally placed full thickness soft palate split from the superior pole of the tonsil to 1 cm proximal to the pterygoid hamulus provided good surgical access to the whole length of the parapharyngeal space and allowed complete tumour excision with minimal morbidity.
Acute non-tuberculous retropharyngeal abscess in an adult. A case report and review of the literature
Authors: Karkanevatos A. , Beasley N. J. P. , Swift A. C.
Published: November 2007

Retropharyngeal abscesses in adults are very rare and usually secondary to chronic tuberculous cervical spine osteomyelitis. We report a case of Staphylococcus aureus septicaemia with multifocal abscesses and osteomyelitis of the cervical spine causing a retropharyngeal abscess. This presented as neck pain and dysphagia following a fall. In addition, we have reviewed related cases.
Evaluation of hearing loss with auditory brainstem responses in the early and late period of bacterial meningitis in children
Authors: Külahli İsmail , Öztürk Mustafa , Bilen Çaǧatay , Cüreoglu Sebahattin , Merhametsiz Atilla , Çaǧil Nurullah
Published: November 2007

The hearing function of 50 children with bacterial meningitis was evaluated at the second and 10th days, and eight weeks after admission with auditory brain system responses (ABR) to investigate whether meningitis causes hearing loss. Normal values were obtained in all tests from both ears of 24 patients (48 per cent). Twelve patients (24 per cent) had temporary, and seven (14 per cent) patients had persistent mild degree hearing loss. Severe hearing loss was detected bilaterally in five (10 per cent) patients and unilaterally in two (four per cent) patients. Patients with other complications such as subdural effusion, convulsion, brain oedema and paralysis were found to have a higher incidence of hearing loss. We observed that patients treated with dexamethasone had 7.7 per cent persistent hearing loss, 11.6 per cent mild hearing loss, 34.6 per cent transient hearing loss, but in the group who did not receive dexamethasone there was 19.2 per cent persistent hearing loss, 15.3 per cent mild hearing loss and 11.6 per cent transient hearing loss. There were other signficant differences between the two groups in restoration of normal body temperature, the CSF/plasma glucose concentration ratio was elevated, CSF (cerebro-spinal fluid) protein concentration was decreased and the cell count in the CSF was decreased in the dexamethasone group, significantly more than the group who were not receiving dexamethasone. The hearing loss tended to be more frequent among younger children.
Cochlear implantation in otosclerosis: a unique positioning and programming problem
Authors: Ramsden Richard , Bance Manohar , Giles Ellen , Mawman Deborah
Published: November 2007

A case is reported in which a Nucleus 22 channel cochlear implant was inserted into the basal turn of the cochlea of a patient with advanced otosclerosis. It then passed out of the anterior end of the basal turn into an otospongiotic cavity related to the cochlea. Seven electrodes were located in the basal turn and it was possible to map them sufficiently well for the patient to derive considerable benefit from the implant. The problem of implant induced facial nerve stimulation in otospongiosis is also discussed.
Bilateral otogenic temporal lobe and post-aural abscesses
Authors: Gupta A. K. , Nagarkar N. M. , Mann S. B.S. , Gupta S. K.
Published: November 2007

A rare case of bilateral unsafe CSOM with bilateral post aural and temporal lobe abscesses is reported with a relevant review of literature.
A valuable device in the management of epistaxis
Authors: Shehab Zaid , Pahor Ahmes
Published: November 2007

A suction end for use in epistaxis is presented. It has advantages over commonly used devices in offering a comfortable length for handling and adequate diameter for effective control of severe haemorrhage. It is also disposable which reduces the risk of blood borne transmission of diseases.
Occupational otitis externa in chicken catchers
Authors: Rossiter Anne
Published: November 2007

Otitis externa is only occasionally occupational in origin and infestations of the ear are even less common. Two cases of occupational otitis externa due to infestation with Dermanyssus gallinae, the red poultry mite, are reported occurring in poultry workers.
Chondrosarcoma of the petrous apex. Dilemmas in diagnosis and treatment
Authors: Lau D. P. C. , Wharton S. B. , Antoun N. M. , Bottrill I. D. , Moffat D. A.
Published: November 2007

A case of chrondrosarcoma of the petrous temporal bone is presented. Chondrosarcomas rarely occur intracranially and typically present as a petrous apex mass. The dilemmas faced in the diagnosis and treatment of petrous apex chondrosarcomas are discussed. This case also gives interesting insight into the natural history of this tumour.
Fronto-ethmoid osteoma: the place of surgery
Authors: Hehar S. S. , Jones N. S.
Published: November 2007

Osteomas of the paranasal sinuses are common. Most are, however, asymptomatic and a chance radiographic finding. We describe four case histories which help to illustrate the benefits and hazards of surgery, and highlight the importance of patient selection. A review of the literature is presented.
Direct microscopy of effusions obtained from peritonsillar abscesses as a complement to bacterial culturing
Authors: Lilja Markus , Räisänen Simo , Jokinen Kalevi , Stenfors Lars-Eric
Published: November 2007

Effusion material was aspirated from 51 consecutive peritonsillar abscesses (34 male, 17 female; age range eight to 46 years) and subjected to direct microscopy after staining with acridine orange. Bacteria were counted per ml effusion material and their morphology was analyzed. In addition, aerobic and anaerobic bacterial culturing was performed. Effusions containing β-haemolytic streptococci Group A, which appeared as a single species, contained fewer bacteria (8 × 106per ml, median value) than effusions harbouring a mixed flora (7 × 108bacteria per ml, median value). Direct microscopy of effusions obtained from peritonsillar abscesses makes possible rapid identification of a single or mixed flora, which is of importance for the antibiotic treatment of the disease.
Scleroma of the larynx
Authors: Soni N. K.
Published: November 2007

Twenty-two cases of rhinoscleroma were studied to determine the involvementof the larynx. The study revealed that scieroma affected the larynx in 40 per cent of cases. In the larynx, scleromatous lesions were found in the subglottic region and the disease was observed in stages i.e. atrophic, granulomatous (proliferative i.e. nodular) and afibrotic or sclerotic (scarring) stage as found in the nose. The role of laryngological examination is established in the diagnosis of asymptomatic and early laryngeal lesions and in assessing response to initial treatment. Extensive granulomatous lesions were treated by open excision by the laryngofissure approach which was found to be the best method resulting in a quick recovery without any evidence of subglottic stenosis. The disease as a whole is discussed in the light of available literature.
Distant metastases in terminal head and neck cancer patients
Authors: Talmi Yoav P. , Cotlear Daniel , Waller Alexander , Horowitz Zeev , Adunski Abraham , Roth Yehuda , Kronenberg Jona
Published: November 2007

With improved control of cancer above the clavicles, distant metastases (DM) are frequently more seen and are becoming a more common cause of morbidity and mortality. The present study defined the incidence of distant metastases in a cohort of terminal head and neck cancer patients (HNCP) and compared it to current reported data. The incidence of distant metastases in relation to the primary tumour was evaluated and their impact on survival was assessed. A retrospective survey of patient charts was made, based on the hospice database and original referring hospital charts. Data of 59 patients admitted to the hospice were evaluated. The incidence and location of locoregional and distant disease were studied and effects on survival analyzed.

The overall survival from diagnosis to demise was 42.7 months. Thyroid cancer was seen in 20.3 per cent of cases and squamous cell cancer was seen in 59.3 per cent. Distant metastases were found in 83 per cent and 48.6 per cent of patients respectively. Laryngeal cancer patients had a 54.5 per cent incidence of distant metastases. Locoregional disease was seen in 47 per cent of cases and 35.7 per cent of them had distant metastases while a 64.3 per cent incidence of distant metastases was found in cases without locoregional disease. Mean survival was 47.3 months with distant metastases vs 36.5 months without metastases. The difference was not statistically significant.

The incidence of distant metastases in squamous cell cancer in terminalHNCP was 48.6 per cent. This is the highest reported incidence of metastases in a clinical series. Patients without locoregional disease had almost a two-fold incidence of metastases. Survival was not affected by metastases in this series.
Oroantral fistula: a complication of transantral ligation of the internal maxillary artery for epistaxis
Authors: Morgan M. K. , Aldren C. P.
Published: November 2007

Transantral ligation of the internal maxillary artery (IMAX) is a well-described option for surgical management of posterior epistaxis not controlled by anterior and posterior packing. Advocates for this procedure argue that it reduces the morbidity, length of hospital stay and financial cost associated with prolonged nasal packing. The procedure is carried out through a Caldwell-Luc approach and the IMAX is clipped in the pterygomaxillary fossa. Fashioning of a nasoantral window is optional and its inclusion usually depends on the integrity of the sinus ostium. The commonest complications of transantral IMAX ligation occur when local structures including the inferior orbital and anterior superior alveolar nerves are damaged. The incidence of oroantral fistula following IMAX ligation is very low but those cases reported have been associated with the failure to create a nasoantral drainage window. We report two cases of persistent oroantral fistula complicating transantral internal maxillary artery ligation. No nasoantral window was fashioned in either of these cases.
Acute pulmonary oedema complicating laryngospasm
Authors: Ingrams Duncan , Burton Martin , Goodwin Alison , Graham John
Published: November 2007

Pulmonary oedema is an uncommon but important complication of laryngeal spasm which in turn occurs more commonly in ENT practice than in most other surgical specialities. A case is reported and the literature reviewed, with particular reference to the proposed pathophysiological mechanism of this phenomenon.
Septal, widely infiltrative and clinically occult adenoid cystic carcinoma of the parotid gland
Authors: Coup A. , Williamson J. M. S. , Curley J. W. A.
Published: November 2007

Most salivary gland tumours present with an obvious mass and are usually diagnosed clinically. We present a case of occult adenoid cystic carcinoma of the parotid which, due to its peculiar septal pattern of growth and complicated clinical setting. defied diagnosis for several years.
Visual evoked potentials in endoscopic and anterior skull base surgery: a review
Authors: Jones N. S.
Published: November 2007

The anterior visual pathway can be damaged during surgery of the anterior skull base, the sellar and parasellar area, the orbit, or the paranasal sinuses. Clinical per-operative monitoring of the visual pathway is difficult and damage to the optic nerve is oftenonly determined late. Visual evoked potentials may provide an early indication of reversible change to the visual system and various per-operative monitoring techniques have been used. These techniques show promise but at present they are too cumbersome and give results whichare too variable to be reliable in per-operative monitoring.