bluuebunny/crossref_metadata_2025 huggingface dataset:
Leeches in the larynx
Authors: Labadi Monther H. , Jamal Musa N.
Published: November 2007

This is a report of two patients with leech inhalation. The first patient presented with severe attacks of inspiratory stridor, cyanosis and cough of five days duration. He had no fever. Indirect laryngoscopy revealed a black, smooth foreign body between the vocal folds. Lateral soft tissue X-ray of the neck revealed shadow involving the glottic and the subglottic areas of the larynx. Laryngoscopy under general anaesthesia showed a living leech. This was removed and the patient improved.

The second patient presented with difficulty of breathing, dysphagia, and spitting of blood of two weeks duration. Indirect laryngoscopy revealed a brown foreign body in the larynx. Laryngoscopy under general anaesthesia showed a living leech. This was removed by forceps.
Recurrent canalicular adenoma of the minor salivary glands in the upper lip
Authors: Harmse J. L. , Saleh H. A. , Odutoye T. , Alsanjari N. A. , Mountain R. E.
Published: November 2007

Canalicular adenoma is a recently classified uncommon salivary gland neoplasm. This biologically benign growth tends to be multifocal and occurs most often in the upper lips of elderly people. Histologically and clinically it differs from the basal cell adenoma, for which it may be mistaken, in a number of ways. Its clinical importance lies in the fact that it may be confused with malignancy. Little information is available regarding the recurrence and long-term follow-up of these tumours, and where available it covers only relatively short periods.

We report the recurrence of a canalicular adenoma after an 11.2 year disease-free period.
Contribution to the pathogenesis of radiation-induced injury to large arteries
Authors: Zidar Nina , Ferluga Dušan , Hvala Asta , Popovć Mara , Šoba Erika
Published: November 2007

We report a case of a 35-year-old man who died of a brain infarct 20 months after radiotherapy for carcinoma of the tonsil with metastases to the cervical lymph nodes. Histology revealed mild atherosclerosis, necrotizing vasculitis, and occlusive thrombosis of the internal carotid artery. Significant changes were observed in the vasa vasorum: swelling and detachment of the endothelium, subendothelial oedema, hyaline change, fibrinoid necrosis of the vessel walls with mononuclear cellular infiltration, accompanied by focal haemorrhages and chronic inflammation in the periadventitial soft tissue. We believe that these changes of the vasa vasorum and necrotizing vasculitis are causally related and that vasculitis represents focal ischaemic necroses with inflammatory reaction. Our findings support the hypothesis, based on experimental studies, that injury to the vasa vasorum is an important mechanism in the development of radiation-induced vasculopathy of large arteries. They also suggest an evolution of the injury to the vasa vasorum and periadventitial tissue from the early lesions described in our patient, to late stages resulting in dense periadventitial fibrosis as reported previously. We suggest that injury to the vasa vasorum and the consequent ischaemic lesions of the arterial wall are morphological features distinguishing radiation-induced arterial injury from spontaneous atherosclerosis.
Audio-vestibular findings in meningioma of the cerebello-pontine angle: a retrospective review
Authors: Baguley David M. , Beynon Graham J. , Greyf Philip L. , Hardya David G. , Moffat David A.
Published: November 2007

The aim of this study was the determination of the incidence of symptoms of audio-vestibular dysfunction and of abnormalities on audio-vestibular testing in patients found to have a unilateral meningioma of the cerebello-pontine angle (CPA). The case notes of 25 patients diagnosed with unilateral, sporadic and histologically proven CPA meningioma were retrospectively reviewed. The age range of this series was 31–71 years, with a mean age of 50 years. Two patients were male (eight per cent) and 23 were female (92 per cent). The mean length of history was 44.7 months. The distribution of tumour size was skewed toward larger tumours, with 15 cases (60 per cent) having tumours with a maximum diameter greater than 3.5 cm on imaging. Pure tone audiometry was normal in five cases (20 per cent), and no patients exhibited the high frequency sensorineural hearing loss that is characteristic of vestibular schwannoma. Speech audiometry was normal in 50 per cent of cases. Caloric testing was abnormal in 77 per cent of the 18 cases tested, whilst auditory brainstem responses (ABR) were abnormal in 100 per cent of the 18 cases who had sufficient hearing for this test to be possible. The presence of normal audiometry in patients with a proven CPA lesion indicates that, if in a protocol for investigation, asymmetry of hearing is mandatory then some pathology will be missed. Any suspicion of a CPA lesion warrants investigation even in the absence of hearing loss.

The investigation of choice for the identification of CPA lesions has become magnetic resonance imaging (MRI). If this technique is not available then this study indicates that ABR is a suitable and sensitive investigation. It should be borne in mind however that the data in this study has been derived from a series of predominantly large tumours, and the sensitivity of ABR to smaller CPA meningiomata may fall, as is the case for vestibular schwannoma.
Treatment of hereditary haemorrhagic telangiectasia by the pulsed dye laser
Authors: Harries P. G. , Brockbank M. J. , Shakespeare P. G. , Carruth J. A. S.
Published: November 2007

Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu syndrome, Osier's disease) is an inherited abnormality of the vasculature characterized by abnormal subepithelial vessels. Treatment has included repeated intranasal cautery, intra-arterial embolization and arterial ligation.

Treatment has included repeated intranasal cautery, intra-arterial embolization and arterial ligation. Historically, the operation of septodermoplasty and the use of systemic/topical oestrogens have been the most effective and lasting treatments, but over time the telangiectasias recur. There is increasing interest in the use of a variety of lasers for intranasal photocoagulation.

A report of nine patients suffering from hereditary haemorrhagic telangiectasia who have undergone laser treatment with the Chromos pulsed dye laser is presented. This laser produces light energy at a wavelength of 585 nm and causes localized thermal damage to the blood vessel wall.

Initially, no patient saw an improvement in their symptoms, but following an average of approximately three courses of treatment, all have reported a measurable reduction in the number of epistaxes suffered.

Although no treatment completely resolves the epistaxis associated with this condition, we have found the pulsed dye laser to be effective at treating telangiectasias within the anterior nasal cavity.
Endoscopic holmium: YAG laser dacryocystorhinostomy-safe and effective as a day-case procedure
Authors: Hehar S. S. , Jones N. S. , Sadiq S. A. , Downes R. N.
Published: November 2007

Endoscopic holmium laser dacryocystorhinostomy can be used safely and efficiently to relieve symptoms of distal nasolacrimal duct obstruction. It has great advantages over the conventional external approach as it can be done as a day-case procedure under local anaesthesia. The excellent ablation of bone and soft tissue using this type of laser contribute to the fact that the procedure can be performed in a mean time of 20 minutes. We report on the results of our first 50 patients and review the literature on the subject.
Metastatic renal cell carcinoma presenting as an aural polyp
Authors: Ingelaere P. P. C. , Simpson R. H. W. , Garth R. J. N.
Published: November 2007

Renal cell carcinoma may metastasize to the head and neck region at different stages of its evolution. We present a case of an undiagnosed renal cell carcinoma presenting as an ear polyp, and discuss the difficulties of the diagnosis and the management of these tumours.
Isolated laryngotracheal separation following blunt trauma to the neck
Authors: Offiah C. J. , Endres D.
Published: November 2007

Isolated laryngotracheal separation following blunt trauma to the neck is a very rare subset of laryngeal trauma and has not been previously well characterized. A ‘clothes-line’ type injury is one way in which such an injury may occur in which a cyclist rides into a rope or cable. A case of this kind is presented, followed by a discussion of the relevant clinical symptoms and signs as well as the difficulties in making a diagnosis. The critical role of fibre-optic subglottoscopy and tracheoscopy in reaching this diagnosis is also examined.
Ancient schwannoma masquerading as parotid pleomorphic adenoma
Authors: Jayaraj Samuel M. , Levine Tanya , Frosh Adam C. , Almeyda John S.
Published: November 2007

Pleomorphic adenoma of the parotid gland is common. We report a typical case of a parotid gland swelling which clinically, radiologically and cytologically represented a pleomorphic adenoma. Only following surgical excision and histological examination however, was the true diagnosis of ancient schwannoma made.

Benign peripheral nerve sheath tumours should always be considered in the differential diagnosis of parotid gland tumours.
Performance of ionomeric cement (Ionocem®) in the reconstruction of the posterior meatal wall after curative middle-ear surgery
Authors: Geyer G. , Dazert S. , Helms J.
Published: November 2007

The hybrid bone-substitute ionomeric cement is suitable for restoring the original anatomy of the posterior canal wall. During a four-year period the posterior meatal wall was rebuilt with ionomeric cement in 74 patients. The canal wall was totally rebuilt in38 patients, two-thirds rebuilt in 22 cases, and one-third rebuilt in14 cases. On the meatal side, the canal wall was covered by a musculo-periosteal (Palva) flap. In the majority of cases, the drum was closed with (cartilage)-perichondrium. Revisions were performed in 27 patients (due partially to cholesteatoma, and/or poor visualization of radical mastoidectomy cavities). The ears were non-infected at thetime of operation.

Permanent epithelialization of the bone replacement material was achieved in 57 cases, with secondary closure of a cutaneous defect of the meatal wall being required in six cases. The auditory canal wall had to be removed in 17 patients owing to deficient soft-tissue coverage, persistent inflammation, and/or partial adhesive processes with development of cholesteatoma. In terms of surgical technique, utilization of the material over a follow-up period of maximally seven years proved it to be a sophisticated procedure for reconstructing themeatal wall. Despite the finesse of the surgical technique employed, the overall failure rate of 31 per cent was inadmissibly high. Implantation of the material should therefore be restricted to middle ears with permanent ventilation and no trace of infection.
Middle-ear lipoma as a cause of otomastoiditis
Authors: Edmonds Joseph L. , Woodroof Janet M. , Ator Gregory A.
Published: November 2007

We present a case report which describes a rare cause of a common clinical problem; eustachian tube dysfunction. A seven-year-old child presented with a history of chronic draining ears, despite rigorous medical therapy and multiple ventilation tubes. At myringotomy a mass was noted in the middle ear, and she was taken to the operating room for exploration. The patient was found to have a pedunculated lipoma arising from the anterior medial aspect of the middle-ear cleft producing intermittent obstruction of the eustachian tube orifice. This case represents the fourth case of a middle-ear lipoma in the world literature. We present a review of the literature and an exploration of possible aetiologies of this unusual entity in the differential diagnosis of eustachian tube dysfunction.
Severe laryngeal injury caused by blunt trauma to the neck: a case report
Authors: Goldenberg D. , Golz A. , Flax-Goldenberg R. , Joachims H. Z.
Published: November 2007

Acute blunt laryngeal trauma can be a life-threatening event and often poses a difficult airway management problem. Patients may be unable to supply important anemnestic facts because of aphonia or intubation as a result of their injury. Therefore the immediate recognition and appropriate initial assessment and treatment are vital for a successful outcome. The first step is assuring an appropriate airway, either by careful intubation or temporary tracheotomy. An assessment of potential vascular and oesophageal injuries must be undertaken. The use of computerized tomography (CT) with contrast material is especially useful in identifying and localizing fhe damage caused by blunt neck injuries. Laryngeal fractures, air in the soft tissues and the extravasation of contrast material in the neck are all helpful in assessing the injuries before surgical intervention. Immediate initial surgery is aimed at stabilizing the cartilaginous framework and repairing the mucosa. We present a case of severe laryngeal injury caused by blunt trauma to the neck; our evaluation, treatment and the outcome.
Dissection tonsillectomy: pattern of post-operative pain, medication and resumption of normal activity
Authors: Murthy P. , Laing M. R.
Published: November 2007

A prospective study of 99 adults undergoing tonsillectomy was carried out to determine the pattern of post-operative pain, intake of medication and timing of return to work and normal swallowing. The differences in the pain scores, as measured by a visual analogue scale, between every third consecutive day following post-operative day four were found to be highly significant (p<0.001). Sixty-six patients (66.6 per cent) required medication in the form of analgesics and/or antibiotics after the first post-operative day. Sixty-four out of a total of 82 patients (78.2 per cent) returned to work within 14 days of surgery. Ninety-six patients (97 per cent) reported normal swallowing within 14 days of surgery. These results suggest that the majority of adult patients undergoing tonsillectomy can be appropriately advised pre-operatively regarding the probable pattern and duration of post-operative pain and the timescales they can expect to return to work and normal swallowing.
A clinical and videostroboscopic evaluation of laryngeal tuberculosis
Authors: Agarwal Pinky , Bais Arvind S.
Published: November 2007

A series of 31 cases of tuberculous laryngitis is reviewed to assess the diagnostic features of the disease.

The condition generally presents in males of late middle age who have pulmonary tuberculosis. It presents in a manner similar to laryngeal carcinoma except that painful dysphagia is a prominent symptom. Histological examination of biopsy material is usually the diagnostic procedure.

Stroboscopy was able to document a number of abnormalities which included abnormalities of laryngeal configuration, vibratory asymmetry, reduction of amplitude and mucosal wave. Symptoms responded well to antituberculous chemotherapy.
Hoarseness and gastroesophageal reflux in children
Authors: Gumpert Louise , Kalach Nicolas , Dupont Christophe , Contencin Philippe
Published: November 2007

The importance of a hoarse voice or voice change in children has not been stressed in the literature in the same way as it has been in adults. We present 21 children who had been suffering from chronic hoarseness for more than three months and had on fibre-optic laryngoscopy findings suggestive of gastroesophageal reflux. None of them had complained of gastroesophageal symptoms. Twenty-four hour pH monitoring revealed that 13 (62 per cent) of these children had gastroesophageal reflux, seven (33 per cent) having gastroesophageal reflux more than three times the upper limit of normal. The pH graphs highlighted frequent refluxes, ranging from 0.4 to 37.4 refluxes per hour (median of 7.3 refluxes/hour). The majority of these refluxes occurred when the child was awake as opposed to asleep, with a median of 14.8 refluxes/hour and 0.9 refluxes/hour respectively (p = 0.0009). The refluxes were classically of short duration. This study suggests that gastroesophageal reflux plays a direct role in the pathogenesis of chronic laryngitis and hoarseness in children.
J incision in neck dissections
Authors: Acar Aydin , Dursun Gürsel , Aydin Ömer , Akbaş Yücel
Published: November 2007

Metastasis in the neck lymph system of primary tumours of the head and neck is frequently seen. In order to prevent this metastasis, neck dissection is carried out by various types of skin incisions. In this study, types of skin incision used in neck dissections were defined, and the advantages, disadvantages and results of J incisions, which have been performed on 320 radical neck dissection patients in our clinic between 1985–1996, were compared with those of other incision types.
Melanotic neuroectodermal tumour of infancy arising in the maxilla
Authors: el-Saggan Ahmed , Bang Gisle , Olofsson Jan
Published: November 2007

Melanotic neuroectodermal tumour of infancy is an uncommon neoplasm that usually occurs in children aged one year or less. Difficulty in deciding the cellular origin of this tumour has led to numerous names, including congenital melanocarcinoma, melanotic epithelial odontoma, melanotic ameloblastoma, and retinal anlage tumour. Electron microscopy and histochemical studies, however, have now established the neural crest origin. The most frequent site of occurrence is the maxilla followed by the skull, the brain and the mandible. The genital organs are the most frequent extracranial site.

We present two cases of melanotic neuroectodermal tumour of infancy arising in the maxilla.
Acquired medial canal fibrosis
Authors: El-Sayed Yousry
Published: November 2007

Acquired medial canal fibrosis is a discrete clinicopathological entity characterized by formation of fibrous tissue in the bony external auditory meatus.

Over a seven-year period, a total of 14 operative procedures were performed on 12 ears involving 10 patients. Four cases had followed otitis externa, two were complications of suppurative otitis media, and three cases were iatrogenic. The cause could not be identified in three ears involving two patients.

Treatment entails excision of all the fibrous tissue and involved skin, a wide canaloplasty, a meatoplasty, and then reconstruction by split skin graft. Two cases of canal cholesteatoma were encountered. Average follow-up of two years showed hearing improvement in all patients. The only complication was a recurrence of the stenosis in two ears. The paper discusses terminology, aetiology, pathophysiology, diagnosis, and principles of treatment of this condition.
Stapedectomy for far-advanced otosclerosis
Authors: Khalifa A. , El-Guindy A. , Erfan F.
Published: November 2007

Patients with far-advanced otosclerosis (FAO) may appear to be suffering from profound sensorineural hearing loss and are frequently directed to cochlear implantation programmes. In order to avoid such misdiagnosis, FAO should be considered in patients with non-measurable bone-conduction levels and airconduction levels exceeding 85 dB. Specific clues can lead the clinician to suspect otosclerosis as the aetiology of hearing loss. A review of eight patients (nine ears) with FAO who underwent stapedectomy from 1985–1995 reveals that six of the eight (75 per cent) who had been unable to use a hearing aid preoperatively obtained serviceable hearing with a hearing aid after surgery. This confirms that cochlear implantation is not the best treatment for all profoundly deaf patients; some are better off with stapedectomy.
Hypersensitive allergic reactions to bismuth-iodoform-paraffin paste following ear surgery
Authors: Lim P. V. M. , Hughes R. G. M. , Oates J.
Published: November 2007

The case notes of 185 patients who had bismuth-iodoform-paraffin paste (BIPP) impregnated ribbon gauze used for packing following ear surgery were analysed retrospectively. The incidence of hypersensitive allergic reactions to BIPP was 5.9 per cent and a five-fold increase risk of developing allergic reactions was found in those with previous exposure to BIPP. Where temporalis fascia was used to repair tympanic membrane defects, the incidence of tympanic membrane graft perforations was higher when allergic reactions to BIPP developed post-operatively, compared to non-allergic cases.
The case of the missing carotid artery – a well aimed knife!
Authors: Mehanna Hesham M. , MacGregor Fiona B.
Published: November 2007

A 20-year-old male presented with a small stab wound to the neck and with haemodynamic signs of significant haemorrhage, but no signs of local bleeding. On exploration, an intact vagus nerve and internal jugular vein were found, but the common carotid artery was not immediately apparent. Careful dissection confirmed a completely transected common carotid artery with the two ends contracted and retracted. A primary repair was performed and post-operatively the patient recovered completely and had no neurological deficit.
Verrucous carcinoma of the maxillary antrum
Authors: Ram B. , Saleh H. A. , Baird A. R. , Mountain R. E.
Published: November 2007

Verrucous carcinoma is a distinct variant of well differentiated squamous cell carcinoma. Its occurrence in the maxillary antrum is rare. Only three cases have previously been documented. We present a case report of verrucous carcinoma in the maxillary antrum and a review of the literature.
Interpretation of the dilated pupil during endoscopic sinus surgery
Authors: Mason J. D. T. , Haynes R. J. , Jones N. S.
Published: November 2007

This article describes the anatomy of the visual pathways and how they should be assessed under anaesthesia. The differential diagnosis of asymmetrical pupils is illustrated with clinical examples and a strategy as to how they should be examined.
Oro-nasal transfer of nasogastric tube following endoscopic placement
Authors: Alderson D. J. , O'Sullivan D. G.
Published: November 2007

After placement of a nasogastric tube through a rigid oesophagoscope it is necessary to transfer the proximal end from the mouth to the nose. Observation of surgeons performing this apparently simple task has indicated that many find it somewhat difficult. We describe a simple solution to the problem.
Unusual lesions of the internal auditory canal
Authors: Ajal Mohammad , Roche James , Turner Jennifer , Fagan Paul
Published: November 2007

Acoustic neuromata (AN) account for nearly 90 per cent of internal auditory canal (IAC) and cerebello-pontine angle (CPA) tumours. The second most common tumour is meningioma. Rare lesions include primary cholesteatoma, facial neuroma, lipoma, angioma and various cysts.

Two cases of IAC tumour are presented, one of hamartoma in which smooth muscle was prominent and the other of lymphangioma. Of interest are the specific clinical and radiological features associated with these lesions.
Laryngeal rhabdomyosarcoma in adults
Authors: Ruske D. R. , Glassford N. , Costello S. , Stewart I. A.
Published: November 2007

Laryngeal rhabdomyosarcoma is a rare disease. Only nine of these tumours have been adequately described in world literature in the adult population. Adult patients with laryngeal rhabdomyosarcoma often present at a later stage than other laryngeal tumours, including squamous cell carcinoma. Diagnosis is made by identification of cross-striations histochemically or cytoplasmic myoglobin by immunohistological methods. We present a 66-year-old woman with pleomorphic rhabdomyosarcoma of her larynx. This is the first female in the adult age group to be presented. Surgical treatment with adjuvant radiotherapy is currently the treatment of choice for this disease. We provide a review of the literature on laryngeal rhabdomyosarcoma, including presentation, pathology and management of this rare disease.
Focal myositis of the sternocleidomastoid muscle
Authors: Cain A. J. , Michie B. A. , Davis B. C. , Ram B.
Published: November 2007

Focal myositis is an unusual inflammatory lesion of skeletal muscle. It usually affects the extremities, but can present rarely in the head and neck region. We present a case of an elderly woman with focal myositis of the sternocleidomastoid muscle and review of the previous literature on this subject.
Bilateral sudden sensorineural hearing loss following non-otologic surgery
Authors: de la Cruz Mel , Bance Manohar
Published: November 2007

Hearing loss as a complication of non-otological surgery is rare. The majority of described cases have followed cardiac bypass surgery. To date there have been only 25 reported cases of non-otological surgery associated earing loss (NOSAHL) which have not involved cardiopulmonary bypass. Only two cases of bilateral NOSAHL have been previously described, and neither resulted in permanent severe bilateral hearing deficit. We describe a case of permanent bilateral severe hearing loss following metatarsal pinning in a patient with preexisting non-operated otosclerosis.
Mycotic aneurysm of the external carotid artery
Authors: Worley G. A. , Hern J. D. , O'Sullivan G. J. , Tassone P. , Hinton A. E.
Published: November 2007

Mycotic aneurysms of the extracranial carotid arteries are extremely rare. A case is reported of a false aneurysm of the left external carotid artery. This developed secondary to cervical lymphadenitis which did not settle with high dose antibiotic therapy. The diagnosis was made on investigation with carotid doppler ultrasound and confirmed with computerized tomography. Digital subtraction angiography was performed to highlight the vascular anatomy. In addition percutaneous balloon catheter control of blood flow in the external carotid artery was used as an adjunct to surgical management.
Kikuchi's disease of the neck (histiocytic necrotizing lymphadenitis)
Authors: Bhat N. A. , Hock Ye Lim , Turner N. O. , Gupta A. R. Das
Published: November 2007

Histocytic necrotizing lymphadenitis (HNL), also known as Kikuchi's disease is a benign self limiting disease of unknown origin. It effects cervical lymph nodes, predominantly in young females. It is well described in the pathology literature, but little is written about this in the ENT literature, as few clinicians are probably aware of this condition. Five cases of cervical Kikuchi's disease are presented with a brief review of the literature.
Temporal bone fracture following blunt trauma caused by a flying fish
Authors: Goldenberg David , Karam Marwan , Danino Joshua , Flax-Goldenberg Renee , Joachims Henry Zvi
Published: November 2007

Blunt trauma to the temporal region can cause fracture of the skull base, loss of hearing, vestibular symptoms and otorrhoea. The most common causes of blunt trauma to the ear and surrounding area are motor vehicle accidents, violent encounters, and sports-related accidents.

We present an obscure case of a man who was struck in the ear by a flying fish while wading in the sea with resulting temporal bone fracture, sudden deafness, vertigo, cerebrospinal fluid otorrhoea, and pneumocephalus.
Non-Hodgkin's lymphoma of the lacrimal sac and concomitant pansinusitis
Authors: El-Hakim H. , Nunez D. A.
Published: November 2007

Paranasal sinus disease has an established propensity to breach anatomical barriers and present with orbital clinical features. Lacrimal sac lymphomas on the other hand are rare, usually present in males in the sixth decade and 50 per cent of cases have systemic rymphoma/leukaemia. Atypical presentations of lymphomas at this and other sites are reported in patients with acquired immunodeficiency syndrome (AIDS). The clinical features, investigations and treatment of a young human immunodeficiency virus (HIV) sero-negative woman with a non-Hodgkin's lymphoma localized to the lacrimal sac and presenting with a concomitant ipsilateral pan-sinusitis is described. The importance of submitting surgical material for pathological investigation is stressed.
Study of ethmoid sinus involvement in multibacillary leprosy
Authors: Srinivasan S. , Nehru V. I. , Mann S. B. S. , Sharma V. K. , Bapuraj J. R. , Das A.
Published: November 2007

The nasal mucosal involvement in lepromatous leprosy is well recognized. Currently interest has centred around the involvement of paranasal sinuses in leprosy. They act as a reservoir and constant source of reinfection to the nasal mucosa. In the present prospective study 25 untreated patients with multi-bacillary leprosy were included. Clinical examination, computed tomography (CT) scan of paranasal sinuses, ethmoid sinus endoscopy and biopsy were carried out in all patients, to investigate the involvement of the paranasal sinuses in leprosy.

Ethmoid sinus involvement was noted in 20 patients on CT scan. Bilateral involvement was more common (65 per cent). Anterior ethmoids were more commonly affected (65 per cent). On ethmoid sinus endoscopy abnormal mucosa was noted in 17 patients (68 per cent). Ethmoid sinus biopsy was confirmative in 16 patients (64 per cent). Statistically significant correlation was found between CT findings, sinus endoscopy and sinus biopsy findings.
An unusual cause of obstructive sleep apnoea presenting during pregnancy
Authors: Taibah Khalid , Ahmed Mohammad , Baessa Ebtessam , Saleem Muhammad , Rifai Ayman , Al-Arifi Abdullah
Published: November 2007

We describe a case of lingual thyroid (LT) with primary hypothyroidism, presenting during pregnancy and continuing beyond it with oropharyngeal obstructive symptoms and sleep apnoea syndrome (SAS) of mixed type. Although SAS of a combined obstructive and central type should not be too surprising in a case of LT with hypothyroidism, we were unable to find such a documentation previously. Only four weeks of L-thyroxin treatment resulted in a dramatic improvement in dysphagia, disturbed phonation, haemoptysis, arterial desaturation, sleep apnoea and overall sleep efficiency, in conjunction with a regression in the size of the lingual mass. This case highlights the vagaries confronted in the management of such a case and focuses on efforts towards accurate diagnosis and treatment.
Bilateral and multicystic major salivary gland disease: a rare presentation of primary Sjögren's syndrome
Authors: Ahmad Ijaz , Ray J. , Cullen R. J. , Shortridge R. T. J.
Published: November 2007

We present a case of a 15-year-old girl with bilateral parotid and sub-mandibular salivary gland enlargement as the sole presentation of primary Sjögren's syndrome. The clinical, radiological, immunological and pathological features have been discussed. The relevant literature has been reviewed. To our knowledge this is the only reported case of Sjögren's syndrome presenting as multicystic disease with bilateral major salivary gland involvement.
Intramuscular haemangioma of head and neck region
Authors: Chaudhary Neena , Jain Anurag , Gudwani Sanjay , Kapoor Rajeev , Motwani Gul
Published: November 2007

Intramuscular haemangiomas are rare benign haemangiomas occurring within the skeletal muscle. These are uncommon tumours in the head and neck region and occur most frequently on the trunk and extremities. Fewer than 80 cases of intra-muscular haemangioma in the head and neck region have been reported in the literature.

A case of intramuscular haemangioma of the sternocleidomastoid muscle is presented. The review of occurrence and natural history of such tumours is described and clinical and radiological presentation, histological classifications and treatment modalities are discussed.
Fibrous histiocytoma of the larynx
Authors: Saleem M. , McArthur P. D. , Hainau B. , Velagapudi S. B.
Published: November 2007

We present a case of fibrous histiocytoma of the larynx in a young female who presented eight years ago and is still alive and well with no evidence of any regional invasion or distant metastasis. This rare lesion has been described in 30 cases previously of which 26 were malignant and four benign. Our case is unusual in a sense that histologically it has not been possible to determine its exact biological behaviour and growth potential. However, clinically it behaved as a low-grade malignant tumour.
Evaluation of the dizzy patient: experience from a multidisciplinary neurotology clinic
Authors: Heaton Judith M. , Barton Jason , Ranalli Paul , Tyndel Felix , Mai Ryan , Rutka John A.
Published: November 2007

In 1993 a multidisciplinary neurotology clinic was established at the Toronto Hospital, University of Toronto, Where patients with symptoms of dizziness were assessed by both otolaryngologists and neurologists. The results from the first 400 patients seen in consultation are described. The disease pathologies identified in this patient population with dizziness showed some significant differences from other published series, which we believe reflects the specialized tertiary nature of referrals to this clinic. A model for the collaborative investigation of the dizzy patient is provided consistent with the current trend towards multidisciplinary approaches in medicine.
Microbiology of the middle meatus in children requiring adenotonsillectomy
Authors: Gordts Frans , Nasser Ibrahim Abu , Pierard Denis , Meyvisch Paul , Clement Peter A. R.
Published: November 2007

Middle meatus samples were cultured in 120 children undergoing adenotonsillectomy with, or without, insertion of ventilation tubes. Every child (except one) had positive cultures. Haemophilus influenzae (62 per cent of the children), Moraxella catarrhalis (53 per cent) and Streptococcus pneumoniae (48 per cent) were the most commonly isolated bacteria. The presence of Moraxella catarrhalis and (to a lesser extent) Streptococcus pneumoniae was higher in younger children, while Haemophilus influenzae was cultured independently of age.

Culture results of these middle meatal samples, carefully taken in order to avoid any contamination, probably reflect some ongoing sinus infection in these children requiring adenotonsillectomy. The problems inherent in the interpretation of surface cultures are addressed.
Acoustic evaluation of Isshiki type III thyroplasty for treatment of mutational voice disorders
Authors: Li Guo-Dong , Mu Liancai , Yang Shilin
Published: November 2007

The goal of this study was to determine if there are acoustical differences between pre- and post-surgical voices and to evaluate the effectiveness of Isshiki type III thyroplasty in 11 male patients with mutational voice disorders. Acoustic measures were obtained both pre- and post-operatively. A comparison of pre-and post-operative fundamental frequency (Fo), voice frequencies, and vocal intensity obtained from a sustained vowel /i/ during different phonatory tasks was made. The results from the present study demonstrated that after operation the voice frequencies were significantly decreased (p<0.05). The vocal intensity tended to reduce slightly as the voice frequency lowered. However, there were no statistically significant differences in the pre- and post-operative measures of vocal intensity (p>0.5). The preoperative high pitched voices of all the male patients were lowered up to the normal value by the type III thyroplasty.
Update on paediatric tracheostomy tubes
Authors: Wyatt M. E. , Bailey C. M. , Whiteside J. C.
Published: November 2007

In the recent past there has been a significant expansion in the range of paediatric tracheostomy tubes available. This has mainly been in response to clinicians' requests. This article reviews those now available and the situations in which they are useful. A sizing chart is included for easy reference.
Access to the traumatized vertebral artery: an unusual approach
Authors: Lloyd R. V. , O'Flynn P. E. , Jones N. S.
Published: November 2007

Although injuries to the vertebral arteries are relatively uncommon, there are several different methods used to gain access to these vessels, and to control any bleeding arising from them. We describe a case of torrential oropharyngeal bleeding following a stab wound to the neck in which rapid access to the vertebral artery was gained using a paramedian mandibulotomy; this approach has not previously been documented. The other approaches are discussed.
Auditory rehabilitation in neurofibromatosis type 2: a case for cochlear implantation
Authors: Temple Robert H. , Axon Patrick R. , Ramsden Richard T. , Keles Nesil , Deger Kemal , Yücel Emre
Published: November 2007

Cochlear implantation has a limited but definite role in the rehabilitation of certain neurofibromatosis type 2 (NF2) patients. The presence of a dead ear either before, or after, tumour removal does not necessarily imply loss of function in the eighth nerve; in some instances the hearing loss will be cochlear. Promontory or round window electrical stimulation may help to identify those individuals with surviving eighth nerve function. In such patients multichannel cochlear implantation promises a better level of audition than the auditory brain stem implant. This paper highlights such a case and the management problems are discussed.
Pharyngo-oesophageal haemangioma with a positive cough impulse
Authors: Hollis L. J. , El-Alami M. , Pyke R.
Published: November 2007

Benign tumours of both the pharynx and oesophagus are rarely seen, cavernous haemangiomas even less so. We present a case in which a large lesion was the cause of non-specific symptoms but which only appeared intermittently on nasendoscopic examination of the pharynx.
Tympanostomy in young children with recurrent otitis media. A long-term follow-up study
Authors: Valtonen Hannu , Qvarnberg Yrjö , Nuutinen Juhani
Published: November 2007

A total of 305 children, five to 16 months of age, were treated from 1983–1984 with ventilation tubes – Shah vent Teflon tube – inserted under local anaesthesia for recurrent acute otitis media (RAOM) or otitis media with effusion (OME). The final study group comprised 281 children (92.1 per cent) monitored prospectively for five years, 185 in the OME-group and 96 in the RAOM-group. For the first insertion of tubes the average ventilation period was 15.4 months. Re-tympanostomy, with adenoidectomy simultaneously at the first time was performed in 99 ears (35.2 per cent); once in 27.0 per cent, twice in five per cent, and three times in 3.2 per cent. Mastoidectomy due to otorrhoea was performed in three ears (1.1 per cent). The children in the OME-group were at higher risk of repeated post-tympanostomy otorrhoea episodes than children in the RAOM-group. These episodes of otorrhoea during the first insertion of ventilation tubes significantly increased both the tube extrusion rate and the need for subsequent re-tympanostomies. No major complications were caused by the tympanostomy procedure as such. It is concluded that early tympanostomy is a safe procedure in young children with RAOM or OME. However, parents should be carefully informed of risks of post-tympanostomy otorrhoea and recurrent disease after insertion of ventilation tubes necessitating subsequent tube insertion, especially in children with OME.
Temporal bone tumours in patients irradiated for nasopharyngeal neoplasm
Authors: Goh Yau Hong , Chong Vincent F. H. , Low Wong Kein
Published: November 2007

Radiation-associated tumours are rare complications of radiotherapy. This study seeks to highlight and discuss the clinically challenging problem of radiation-associated tumours (RATs) in the temporal bones of seven patients previously irradiated for nasopharyngeal neoplasm.

Seven patients (six males and one female) with radiation-associated temporal bone tumours are presented (five squamous cell carcinomas, one osteogenic sarcoma and one chondrosarcoma). The initial nasopharyngeal disease for which radiotherapy was indicated was nasopharyngeal carcinoma (six patients) and nasopharyngeal lymphoma (one patient). The latency period between radiotherapy and presentation of temporal bone tumours ranged from five years to 30 years with a mean of 12.9 years. All the patients underwent surgical tumour resection. Three patients had post-operative radiotherapy and one patient underwent pre- and post-perative chemotherapy. Two patients died from the disease within three months of treatment with one patient surviving 36 months at the time of writing. One patient died from an unrelated medical condition three months after surgery.

With refinement in radiotherapy techniques and the resultant increase in patient survival, there may be more patients with radiation-associated tumours in the future. It remains imperative for clinicians to be vigilant when patients previously irradiated for nasopharyngeal carcinoma present with otological symptoms as the key to the successful management of this condition lies in the early detection and expedient treatment of this difficult disease.
Diagnosis of peritonsillar infections: a prospective study of ultrasound, computerized tomography and clinical diagnosis
Authors: Scott P. M. J. , Loftus W. K. , Kew J. , Ahuja A. , Yue V. , Van Hasselt C. A.
Published: November 2007

Peritonsillar infections include cellulitis and abscess (quinsy). Clinical diagnosis is often supplemented by diagnostic drainage (aspiration or incision) in an effort to distinguish abscess from cellulitis. In a prospective study of 14 patients we have shown that clinical impression alone is unreliable (sensitivity 78 per cent, specificity 50 per cent). Computerized tomography (CT) (sensitivity 100 per cent, specificity 75 per cent) and intraoral ultrasound (sensitivity 89 per cent, specificity 100 per cent) are much more reliable. We propose that intraoral ultrasound could play a useful role in the clinical assessment of peritonsillar infections helping to improve accuracy in distinguishing abscesses from cellulitis.
A third decade's experience with the gastric pull-up operation for hypopharyngeal carcinoma: changing patterns of use
Authors: Hartley B. E. J. , Bottrill I. D. , Howard D. J.
Published: November 2007

Gastric transposition has been used extensively in this department since 1965 for reconstruction following pharyngolaryngoesophagectomy (PLO). A previous report by Harrison and Thompson in 1986 detailed our experience with 101 cases dating back to 1965. Here we review our experience between 1986–1996.

Medical records of 41 cases were examined. The primary site and stage of tumour and associated lymph nodes, patient demographics, complications, in-patient mortality and survival as demonstrated by the Kaplan-Meier method were recorded.

Gastric transposition is now used for more extensive tumours: 70 per cent T4 (83 per cent pathologically T4) compared to 21 per cent in the previous report. A high proportion of ‘radiation failures’ remains (54 per cent). The in-hospital mortality has fallen from 11 per cent to seven per cent. The five-year-survival calculated using the Kaplan-Meier method is 11 per cent.

This procedure is increasingly being used as a palliative procedure aiming to restore swallowing in the relatively young patient who has very extensive hypopharyngeal carcinoma. Long-term survival rates specific to this operation have fallen. This is attributed to patient selection for the procedure with the vast majority having disease extending into bone, cartilage or soft tissues (T4). The defect created by the resection of less extensive tumours are now increasingly reconstructed with jejunal free flaps and musculocutaneous flaps.
Infantile fibromatosis
Authors: Janahi Waleed M. , Darwish Abdulla , Paulose K. O. , Al-Khalifa Salman
Published: November 2007

A case of infantile fibromatosis involving the cheek of a three-year-old Sudanese girl is described. The tumour was resected through a sublabial approach.
Bilateral synchronous tonsillar carcinoma
Authors: Rajenderkumar D. , Chan K. K. K. , Hayward K. A. , McRae R. D. R.
Published: November 2007

Synchronous cancers occur in four per cent of patients with head and neck malignancies but no bilateral synchronous tonsillar carcinomas have been described in the English literature. We describe the first such case and discuss the prognostic aspect of this carcinoma. In the presence of contralateral neck nodes in patients with head and neck malignancies, a careful search should be made for a second head and neck primary.
A review of heterotopia and associated salivary gland neoplasms of the head and neck
Authors: Ferlito Alfio , Bertino Giulia , Rinaldo Alessandra , Mannarà Giacinto M. , Devaney Kenneth O.
Published: November 2007

Salivary tissue neoplasms may involve normal, accessory and heterotopic salivary gland tissue. A case of Warthin's tumour originating from heterotopic salivary gland tissue of the upper neck is reported. The radioactive uptake of131I, evidenced in the neck mass in its pre-diagnostic assessment, suggested a diagnosis of cervical node involvement from a primary malignant thyroid neoplasm. A critical review of the literature on heterotopic salivary gland tissue neoplasms of the head and neck is also presented.
Clarion® cochlear implants: surgical implications
Authors: Filipo R. , Barbara M. , Monini S. , Mancini P.
Published: November 2007

The surgical aspects of 34 Clarion® cochlear implants, positioned during a five-year period on 31 profoundly-deaf subjects as primary (11 children, 20 adults) and revision surgery (one child, three adults) were taken into consideration. Intra-and post-operative complications related to the specific structure of this device were considered along with the benefits obtained by update of the hardware and surgical approach. A smaller thickness of the internal receiver as well as the shifting from a retro-auricular/subtemporal (RA-ST) to an endaural-retromastoid (EA-RM) approach have contributed to a dramatic drop in post-operative complications, such as skin defect or device extrusion. Special care should, however, be taken when cochlear implantation is planned in ears with chronic otitis or its surgical sequelae. From the two revised cases (hardware failure, electrode displacement) in whom re-implantation in the same side was performed, it has been demonstrated that the helicoidal shape of the electrode carrier is not inducing any additional trauma to the cohlear structure.
An unusual presentation of an encephalocele to the otolaryngologist
Authors: Hari C. K. , Roblin D. G. , Brown M. J. K. M. , Thompson I.
Published: November 2007

An unusual case of encephalocele causing obstruction of the upper airway in a neonate is described. The patient presented with a large mass in the neck, which extended from the base of the skull to the level of the larynx. Although there was no evidence of a defect of the skull base, subsequent excision and histological examination confirmed an encephalocele.
Primary osteogenic sarcoma of the tongue
Authors: Dubey S. P. , Murthy D. P. , Cooke R. A. , Chaudhuri D.
Published: November 2007

A 56-year-old man presented with the difficulty of swallowing and respiratory distress due to a large tumour arising from the tongue and occupying the entire oral cavity. Histological examination revealed it to be an extraskeletal osteogenic sarcoma. The tumour was excised. After six weeks, he came back with massive local recurrence and bleeding from the tumour, but died despite chemotherapy. Review of the literature revealed only four other such cases of this rare tumour. A brief review of these four cases is also made.
Factors affecting hearing results after stapes surgery
Authors: Ueda Hiromi , Miyazawa Takashi , Asahi Kiyomitsu , Yanagita Noriyuki
Published: November 2007

Factors affecting auditory improvement after stapes surgery were investigated retrospectively on a study group of 106 otosclerotic ears (86 subjects). While the closure of the air-bone (A-B) gap after surgery was good at 2 kHz and 4 kHz, it was poor at 8 kHz and at frequencies lower than 1 kHz. Under 1 kHz, the lower the frequency, the worse the A-B gap after surgery. Stapedotomy and partial stapedectomy showed better post-operative hearing gain at 4 kHz than total stapedectomy. Total stapedectomy scored significantly better at 250 Hz and 500 Hz than stapedotomy. There was a close relationship between the pre-operative and post-operative A-B gap at frequencies under 1 kHz. The smaller the pre-operative A-B gap, the better the closure of the post-operative A-B gap at frequencies under 1 kHz. The smaller the pre-operative A-B gap, the better the closure of the post-operative A-B gap at these frequencies. It was speculated that otosclerotic ears with a larger pre-operative airbone gap might have another lesion in the middle ear other than the oval window.