bluuebunny/crossref_metadata_2025 huggingface dataset:
Pseudoaneurysm of the carotid artery with haemorrhage into the hypopharynx
Authors: Tanaka Saichiro , Kimura Yasuyuki , Furukawa Mitsuru
Published: November 2007

Pseudoaneurysms of the extracranial carotid arteries are rarely seen following irradiation for cancers of the head and neck. We present a patient with a pseudoaneurysm of the common carotid artery following a radical neck dissection and irradiation for thyroid carcinoma 20 years earlier. Following oesophagoscopical examination, a pseudoaneurysm of the right common carotid artery ruptured into the piriform sinus. The common carotid artery was embolized with multiple coils and the bleeding was halted. The relationship between the carotid artery aneurysm and irradiation, and the treatment of carotid artery aneurysm, is discussed.
Is central hyperacusis a symptom of 5-hydroxytryptamine (5-HT) dysfunction?
Authors: Marriage Josephine , Barnes N. M.
Published: November 2007

The subjective symptom of hyperacusis is described. The terms ‘hyperacusis’ and ‘phonophobia’ are considered to be synonymous as there is no recognized distinction between these two descriptions. Peripheral auditory pathologies with associated hearing sensitivity are reviewed and the likely mechanisms underlying the hyperacusis are listed. The neurological conditions, which have been reported to occur with hyperacusis, are reviewed. A separate aetiology of central hyperacusis is therefore proposed, with a symptom profile distinct from the peripheral hyperacusis

A common factor to neurological conditions with hyperacusis, is disturbance of 5-HT (5-hydroxytryptamine) or serotonin function. The research literature on the role of 5-HT in sensory modulation (specifically auditory startle) in animals is presented. It is proposed that 5-HT dysfunction is a probable cause of increased auditory sensitivity manifested as central hyperacusis or phonophobia
Hearing impairment in association with distal renal tubular acidosis among Saudi children
Authors: Zakzouk Siraj M. , Sobki Samia H. , Mansour Faizeh , Al Anazy Fatma H.
Published: November 2007

A follow-up of seven patients with the autosomal recessive inherited syndrome of distal renal tubular acidosis (RTA) and sensorineural hearing loss is described. Five patients were diagnosed as having primary distal renal tubular acidosis and rickets, four were found to have severe sensorineural hearing loss of over 80 dB: two of which are brothers. Two patients were diagnosed as having secondary distal renal acidosis due to a genetic disorder called osteopetrosis; they are brothers and their audiograms showed a mild conductive hearing loss of an average 35 dB bilaterally. All patients had growth retardation with improvement due to alkaline therapy but their hearing loss was not affected by the medication. The pedigrees of two families with half sibs showed the familial incidence for consanguineous marriage. Consanguinity was found to be positive in five out of the seven patients. The tribal tradition in Saudi Arabia fosters consanguineous marriages for cultural and social reasons and pre-arranged marriages are still seen.
Effect of Beconase nasal spray on olfactory function in post-nasal polypectomy patients: a prospective controlled trial
Authors: Naggar Mohammed El , Kale Savita , Aldren Chris , Martin Frank
Published: November 2007

Numerous studies have postulated the possible benefit of corticosteroids on olfaction in patients with nasal/sinus disease. Twenty-nine patients with bilateral nasal polyps were included in our study using strict selection criteria to reduce other aetiologies of olfactory dysfunction. The University of Pennsylvania Smell Identification Test (UPSIT) was performed pre-operatively on the right and left nostrils separately. Following intranasal polypectomy the patients received a six-week course of beclomethasone nasal spray (Beconase) to one nostril only, with the other acting as a control. The UPSIT scores were again obtained for each nostril separately. Wilcoxon Signed Rank test revealed no statistically significant difference in UPSIT scores between treated and untreated nostrils (p= 0.31; power 70 per cent; ES = 0.47). We conclude that topical beclomethasone does not improve olfaction following nasal polypectomy.
Renal cell carcinoma presenting as a solitary paranasal sinus metastasis
Authors: Homer J. J. , Jones N. S.
Published: November 2007

We present an unusual case of renal cell carcinoma presenting as a periorbital mass. The presenting symptom was a supraorbital swelling which proved to be a mucocoele which had arisen secondary to a solitary metastasis in the ethmoidal sinuses. We discuss the management strategy including the place of endoscopic biopsy, the choice of investigations and craniofacial resection.
A case of submandibular teratoma
Authors: McKiernan D. C. , Koay B. , Vinayak B. , Gould S. , Freeland A. P.
Published: November 2007

A rare case of benign teratoma arising in the submandibular gland is presented.
Bone pate repair of the eroded incus–five years on
Authors: Snow D. G. , Robinson J. M. , Peters J.
Published: November 2007

Seventy-four patients undergoing bone pate repair of the long process of the incus as part of a tympanoplasty are presented. Mean follow-up time was 66 months (range 12–143 months). Hearing results are averaged over the frequencies 500, 1000, 2000 and 4000 Hz. Thirty-two per cent of the patients had hearing thresholds better than 30 dB pre-operatively. A significant improvement in hearing was seen (p<O.OO1). The data were also analysed to assess the effect of the pre-operative state of the tympanic membrane on the final result. The pre-operative condition of the tympanic membrane was either perforated (35 ears) or atrophic (33 ears). Six tympanic membranes were intact but these were excluded from the final results. No difference in hearing result was found between patients who had an ossicular repair in combination with either a perforated tympanic membrane repair or an atrophic membrane repair. Average hearing gain in the perforated group was 13 dB, in the atrophic group 9 dB and in the intact group 7 dB.
Intracranial complications of sinusitis: the need for aggressive management
Authors: Jones R. L. , Violaris N. S. , Chavda S. V. , Pahor A. L.
Published: November 2007

Sinus-induced intracranial sepsis can represent a genuine medical and surgical emergency. We review 12 cases presenting to our hospitals over a five-year period. Nine were male and three were female with an age range of 16 to 74 years (mean 35.5 years). Four patients had their sinusitis diagnosed prior to admission and eight did not. Nine patients had bilateral sinus disease, the most common sinus involved was the frontal followed by the ethmoid, maxillary and sphenoid. Neurosurgical drainage was via a craniotomy in seven cases and burr hole in three. Nine patients underwent sinus surgery and three did not. Of the nine who had sinus surgery three had frontal drainage, four fronto-ethmoidal and two transsphenoidal drainage. The most common organism was Streptococcus milleri. Our series confirms that sinus-induced intracranial sepsis is a serious problem needing early diagnosis and aggressive treatment. We would recommend a high index of suspicion of sinusitis in patients with intracranial infection.
Highly aggressive behaviour of occult papillary thyroid carcinoma
Authors: Hefer Tsila , Joachims Henry Zvi , Hashmonai Moshe , Ben-Arieh Yehudith , Brown Jacob
Published: November 2007

Occult papillary thyroid carcinoma is generally associated with an excellent prognosis. Distant metastasis of this tumour is extremely rare. A case of occult papillary thyroid carcinoma with metastases to the lungs, cervical lymph nodes, skeleton, and the brain is reported. The tumour expressed itself in extremely aggressive clinical behaviour and responded only partially to aggressive therapy. The controversial methods of treatment for occult papillary thyroid carcinoma are also discussed.
How we do it: use of a venous cannulation needle for endoscopic Teflon injection to the vocal folds
Authors: Strachan David , Kamath Basker , Wengraf Carol
Published: November 2007

Since its introduction in the 1960's the injection of Teflon into a paralysed vocal fold has become a standard treatment in laryngology. Although in recent years alternative treatments have been suggested, such as the injection of collagen or autogenous fat (Mikaelianet al., 1991), re-innervation procedures and thyroplasty (Crumley, 1990), the use of Teflon is still widespread (Rontal and Rontal, 1991; Dedo, 1992). Various instruments have been developed for the application of Teflon paste and these take the form of a gun-like syringe with a ratchet mechanism. For a number of years we have injected Teflon using a needle marketed for internal jugular vein cannulation along with a plastic 1 ml syringe thus making substantial savings to our department in terms of both time and cost.
Dysphonia as an atypical presentation of gastro-oesophageal reflux
Authors: Weiner Graeme M. , Batch A. J. G. , Radford K.
Published: November 2007

We present three cases of dysphonia in which gastro-oesophageal reflux (GOR) appeared to be a precipitating factor. In all cases reflux was clinically occult. We discuss the theory and implications of GOR presenting atypically with laryngeal symptoms, and outline our current approach to laryngeal symptoms of clinically evident or occult GOR.
Acute labyrinthitis associated with systemicCandida albicansinfection in ageing mice
Authors: Ashman Robert B. , Papadimitriou John M. , Fulurija Alma
Published: November 2007

The yeastCandida albicansis an important opportunistic pathogen that has been associated with disease of the inner ear. This study describes the histopathology of acute labyrinthitis caused by systemic infection with C.albicansin ageing inbred mice. Within four days after infection, yeast and hyphal forms of C.albicanswere found in the membranous labyrinth. The utricle and the adjacent parts of the ampullary regions of the semicircular canals were most severely affected, but damage was also seen in the scala media, the Scala tympani, the saccule, and the scala vestibuli. In the utricle, the lining epithelium of the membranous labyrinth was disrupted, and the lining cells of the vestibular membrane showed foci in which the membrane was disrupted. The data suggest that age may represent a risk factor for fungal labyrinthitis.
Relief of severe hyperacusis and diplacusis in a deafened ear by cochlear labyrinthectomy
Authors: Cherry John R. , Brown Michael J.
Published: November 2007

A professional musician with intolerable hyperacusis and dysharmonic diplacusis in a severely deafened ear was successfully relieved of his symptoms by deliberate destruction of the cochlea.
Cavernous sinus thrombosis following manipulation of fractured nasal bones
Authors: Ahmmed A. U. , Camilleri A. E. , Small M.
Published: November 2007

Septic cavernous sinus thrombosis is a serious infective condition with a high mortality and morbidity. We report the first case to our knowledge of septic cavernous sinus thrombosis following manipulation of fractured nasal bone under general anaesthesia. The patient later developed complications of pneumonia with pleural effusion, a vegetative lesion of the mitral valve, and blindness.
Retro- and para-pharyngeal ganglioneuroma
Authors: Walch C. , Anderhuber W. , Preidler K. , Humer U.
Published: November 2007

A patient with slight dysphagia and dyspnoea on exertion was referred to us. We diagnosed a large retro- and para-pharyngeal ganglioneuroma. The mass was surgically removed in toto. The case is presented and the features are discussed.
Primary lingual tuberculosis: a case report
Authors: Jawad Jamal , El-Zuebi Fouad
Published: November 2007

A case of primary tuberculosis of the tongue in a 45-year-old male patient is presented. The clinical manifestation, diagnosis and the response to the antituberculosis treatment are considered. The previous literature is reviewed.
Obstruction of the nasal valve
Authors: Elwany Samy , Thabet Hossam
Published: November 2007

Obstruction of the nasal valve is an important cause of chronic nasal obstruction in adults. In a series of 500 patients, obstruction at the level of the nasal valve was diagnosed in 65 of them (13 per cent). The obstruction was unilateral in 57 patients (88 per cent). Forty-seven patients (72 per cent) had history of previous nasal surgery of accidental trauma. Causes of obstruction of the nasal valve included high septal deviations, a weak or deformed upper lateral cartilage, adhesions, and alar collapse. All patients underwent corrective nasal surgery and the surgical procedures were tailored according to the existing pathology. Post-operatively, the mean nasal patency score increased from 2.9 to 8.6, the mean nasal airflow increased from 579.5 to 727 cm/sec (at 150 Pa), and the mean nasal resistance decreased from 0.31 to 0.23 Pa/cm3sec-1.
Modifications of the Caldwell-Luc procedure for the prevention of post-operative sensitivity disorders
Authors: Ferekidis E. , Tzounakos P. , Kandiloros D. , Kaberos A. , Adamopoulos G.
Published: November 2007

The effectiveness of some modifications of the Caldwell-Luc standard procedure in the prevention of postoperative mid-facial sensitivity disorders was investigated in a prospective comparative study at the ENT Department, Faculty of Medicine, University of Athens, Greece, from 1986–1992. Sixty-nine maxillary sinuses were operated on in 61 patients suffering from benign pathological conditions. The modifications concerned the type of mucoperiosteal incision and the site and size of the created anterior antrostomy. Only 8.7 per cent of the sinuses operated on by the modified technique presented with post-operative disorders whereas among those operated on by the classical technique, the ratio climbed to 33 per cent. In view of the findings of this study, the modifications applied can be valuable in treating non-extensive maxillary sinus disease with minimal post-operative sensitivity disorders.
Candida – ‘the cancer of silastic’
Authors: Ell S. R.
Published: November 2007

Candida species have the propensity to colonize and erode into the surface of silastic causing a loss of function. Colonization of silastic tracheo-oesophageal speaking-valves is an important cause of valve failure post-laryngectomy: the exact nature of the colonization is unknown and light microscopic studies have not been reported previously.

Microbiological examination of scrapings taken from the colonized oesophageal surface of failed speaking valves was arranged before sectioning for light microscopy. Conventional ultrathin sectioning of silastic was difficult, therefore 15 micrometre sections were cut after cooling the material to −30°C. These sections were then stained with toluidine blue; Candida species taking up the stain.

Microbiological examination of the colonies confirmed the predominance of Candida species in the biofilm. Light microscopy of the 15 micrometer sections revealed that the Candida colonies had invaded the silastic.

This work demonstrates that the colonization of the silastic valve prosthesis in the oesophageal area is due predominantly to Candida species which actively invade the structure of the silastic. This is an important cause of speaking-valve failure post-laryngectomy.
Mucoepidermoid carcinoma of the middle ear – a case report
Authors: Soh K. B. K. , Tan H. K. K. , Sinniah R.
Published: November 2007

We report a case of mucoepidermoid carcinoma of the middle ear, a site which does not appear to have been previously described. A discussion of four possible theories of pathogenesis are presented.
Bilateral antrochoanal polyps in a child: a case report
Authors: Myatt H. M. , Cabrera M.
Published: November 2007

In this paper we present the first ever reported case of simultaneously occurring bilateral antrochoanal polyps in a fit 12-year-old child. The antrochoanal polyps (ACP) were removed using functional endoscopic sinus surgery (FESS) which achieved complete cure. Histological analysis of the polyps showed them to be of benign inflammatory origin.
Clinical and biochemical studies of bone destruction in cholesteatoma
Authors: Amar Mohamed S. , Wishahi Hussein F. , Zakhary Madeha M.
Published: November 2007

The exact causative factor(s) of bone erosion in cholesteatoma are not known. In recent years, the possible role of cytokines has drawn attention. Since the studies on cytokines in cholesteatoma are limited and depend on histopathological methods, the present work approached this subject by biochemical determination of TNF-α lysosomal enzymes, acid phosphatase (total and tartrate resistant), cathepsin B, leucyl aminopeptidase lysozyme together with non-lysosomal enzymes calpain I and II in 50 cholesteatoma samples (epithelial and subepithelial tissues) in comparison with 14 normal skin samples from the external ear canal. The study revealed significantly increased levels of all previous indices in cholesteatoma epithelium and subepithelial tissues compared with healthy skin. The levels of these indices reflected the clinical severity of the disease as reflected by their significant increase in cases with erosion of two or three ossicles, erosion of dural plate, sinus plate and facial canal and more extensive cholesteatoma. It is likely that TNF-α acts both directly by causing bone erosion and indirectly by stimulating the release of lysosomal enzymes. The latter mechanism is supported by the significant correlations observed between TNF-α and lysosomal enzymes. The non-lysosomal enzymes calpain I and II seem to participate in the bone erosion associated with cholesteatoma by their involvement in collagen destruction. Due to the suggested role of TNF-α in bone destruction associated with cholesteatoma the use of anti-inflammatory drugs should be taken into consideration in otitis media to diminish bone destruction. Similarly, antibiotics should be used to prevent the deleterious effects of bacterial endotoxin.
Case of ageusia from a variety of causes
Authors: Deguchi K. , Furuta S. , Imakiire T. , Ohyama M.
Published: November 2007

We report a case of a 31-year-old woman with ageusia. Her ageusia was related to a variety of causes including an unbalanced diet, administration of the anti-epileptic drug, carbamazepine and psychological factors. Her taste function recovered after stopping the carbamazepine and treatment with liver extracts and zinc sulphate.
A silver tattoo of the nasal mucosa after silver nitrate cautery
Authors: Mayall Frederick , Wild David
Published: November 2007

We report a silver tattoo of the nasal mucosa that occurred after silver nitrate cautery for nasal bleeding. Ths type of tattoo is a very rare potential mimic of melanoma and appears not to have been described before. It has similar features to an amalgam tattoo of the oral mucosa on histology and energy dispersive X-ray analysis (EDAX).
Metastatic osteosarcoma of the ethmoid: an unusual cause of recurrent epistaxis and proptosis
Authors: Sharma H. S. , Reddy S. C. , Mohamad Abdul , Meor Kamal M. Z. , Halder Dinesh
Published: November 2007

Osteosarcoma is the most common primary malignant tumour of bone and it usually metastasises to the lung. In the nasal cavity metastatic disease is extremely rare. We describe a case of osteosarcoma presenting with recurrent epistaxis, and proptosis due to secondaries in the nasal cavity. To our knowledge such a case has not been reported previously in the available English literature.
Treatment of acute auricular haematoma
Authors: Quine S. M. , Roblin D. G. , Cuddihy P. J. , Tomkinson A.
Published: November 2007

Auricular haematoma is a problem frequently complicated by recurrence due to failure to apply adequate pressure over the pinna following simple drainage. We describe a simple method of splinting the pinna using silicone putty which overcomes this problem.
Explanatation of a nucleus multichannel cochlear implant and re-implantation into the contralateral ear. A case report of a new strategy
Authors: Maas Stefan , Bance Manohar , O'Driscoll Martin , Mawman Deborah , Ramsden Richard T.
Published: November 2007

We present a unique case in which a multichannel cochlear implant device was explanted and the same device was re-implanted into the contralateral ear. A patient with bilateral total deafness secondary to head injury received an implant in his left ear but developed severe facial nerve stimulation. Because this stimulation could not be eliminated effectively with change of programming, it was decided to implant the contralateral ear. Since the device itself was functioning well, it was explanted from the left ear and re-implanted successfully into the right ear. Facial nerve stimulation was minimal in this ear and the patient demonstrated very good speech discrimination. To our knowledge, this is the first description of this strategy.
Acrokeratosis paraneoplastica: Bazex syndrome
Authors: Wareing Michael J. , Vaughan-Jones Samantha A. , McGibbon David H.
Published: November 2007

Bazex syndrome, or acrokeratosis paraneoplastica, is a cutaneous paraneoplastic syndrome characterized by psoriasiform lesions associated with, usually, a squamous cell carcinoma of the upper aerodigestive tract. We present a case of Bazex syndrome associated with metastatic cervical squamous cell carcinoma with an unknown primary. The features of the condition are discussed in the light of current knowledge.
Otorhinolaryngological diseases in Byzantium (A.D. 324–1453): information from non-medical literary sources
Authors: Lascaratos J.
Published: November 2007

The knowledge of the Byzantine physicians in the field of otorhinolaryngology and especially of the eminent ones, Oribasius, Aetius of Ameda, Paul of Aegina and Alexander of Tralles is noteworthy. They knew an adequate number of diseases of the ear, nose and throat and treated them with a plethora of drugs and some of them, especially tonsillitis and tonsillar abscess, with operations. The writer, based on the texts of the Byzantine historians and chroniclers, presents information previously unknown. This includes analysis of cases of an epidemic of angina, speech defects, instances of otitis, epistaxis, ulcer of the mouth, acute laryngitis or pharyngitis and psychogenic aphonia. Most cases concern emperors and other prominent figures of the State and Church. This information complements, from the historical point of view, the scientific knowledge of the medical writersin the field of otorhinolaryngology.
Impaired specific cellular immunity to the varicella-zoster virus in patients with herpes zoster oticus
Authors: Ikeda Minoru , Hiroshige Kouichi , Abiko Yuzuru , Onoda Keiko
Published: November 2007

The possible involvement of depression on cellular immunity in reactivation of varicella-zoster virus (VZV) in herpes zoster oticus was investigated. The subjects comprised 59 cases of herpes zoster oticus, 33 cases of herpes zoster sine herpete (ZSH) with facial paralysis, and 205 cases of Bell's palsy. The transformation rate of lymphocytes to phytohaemagglutinin in herpes zoster oticus tended to be lower than that in Bell's palsy. In skin tests with purified protein derivatives of tuberculin, the positivity rate in herpes zoster oticus was significantly lower than that in Bell's palsy (p<0.015). In skin tests using VZV antigen, the positivity rate in herpes zoster oticus and ZSH were significantly lower than that of Bell's palsy (p<0.001 andp<0.015, respectively). Thus, it was noted that cellular immunity, especially specific cellular immunity against VZV, was significantly depressed in herpes zoster oticus and ZSH. We consider that depression of specific cellular immunity plays an important role in triggering reactivation of VZV and onset of these diseases.
Laryngeal carcinoma in younger patients
Authors: Petrović Z. , Stojčić G. , Ješić S.
Published: November 2007

During the period 1976–1988, 988 patients were treated surgically for laryngeal cancer of whom 61 were below the age of 40 years.

In 29 patients the tumour was localized in the supraglottis, and in 32 in the glottis. T1tumour was present in 32 (52.46 per cent), and T2tumour in six (9.84 percent) patients. Advanced T3and T4tumours were present in 13 (21.31 per cent), and (16.39 per cent) patients respectively. The majority had clinically negative findings in the neck (N0). Conservative or reconstructive surgery was applied in 39 (63.93 per cent), and radical in 22 (36.07 per cent) patients. Planned post-operative radiotherapy was carried out in 28 (45. 90 per cent) patients.

The five-year survival rate of the studied patients was 83.61 per cent (51/61). The five-year survival rate of the patients with laryngeal carcinomas within the same period was 68.32 per cent (675/988). There was no significant difference in survival rate: X2= 0.018, DF = 1,p>0.05.
Pulsed dye laser lithotripsy of submandibular gland salivary calculus
Authors: Ito Hirotaka , Baba Shunkichi
Published: November 2007

An in vivo study was performed to evaluate the use of pulsed-dye laser beam for the fragmentation of salivary calculus. In accordance with the absorption and reflection spectra of sections of salivary stones, optimal fragmentation was achieved with a pulsed-dye laser with a pulse width of 1.4 μm and tuned to a wavelength of 504 nm. Further studies on particle size were conducted, and a new “sialoendoscope” technique was developed. Fifteen patients with sialolithiasis of the submandibular gland were treated. Under continuous endoscopic monitoring laser-induced shock wave lithotripsy was performed. In six patients complete fragmentation and removal of the salivary stones was achieved and in another patient 50 per cent fragmentation was sufficient to restore salivary flow. Laser lithotripsy of salivary stones with endoscopic monitoring permits treatment on an outpatient basis with little inconvenience to the patient, and this is a breakthrough in otolaryngology.
Use of pre-reduced swabs in bacteriology of chronic suppurative otitis media
Authors: Indudharan R. , Haq J. Ashraful
Published: November 2007

A simple, safe and effective procedure for improving the bacterial isolation in chronic suppurative otitis media (CSOM) is described. It is most useful for the isolation of aerobes as well as anaerobes from the middle ear.
Transnasal endoscopic surgery in juvenile nasopharyngeal angiofibroma
Authors: Kamel Reda H.
Published: November 2007

A case of angiofibroma limited to the right posterior nasal cavity, nasopharynx, and pterygopalatine fossa was operated upon transnasally under endoscopic control. The tumour was completely excised without complications. Endoscopic follow-up for the next two years and contrast computed tomography (CT) excluded any residual tumour or recurrence. The advantages, limitations and possible complications of this approach are discussed. It seems that in limited lesions of angiofibroma, the option of a transnasal endoscopic approach could be cautiously considered by experienced surgeons.
Unusual anterior course of the sigmoid sinus: report of a case and review of the literature
Authors: Gangopadhyay K. , McArthur P. D. , Larsson S. G.
Published: November 2007

The position and dimensions of the jugular bulb and the venous dural sinuses vary considerably. While the anatomical variations of the jugular bulb have been extensively reported in the literature, that of the sigmoid sinus have been reported only rarely. We report a case of unusual anterior course of the vertical segment of the sigmoid sinus which was encountered during an attempted myringoplasty. Anomalies of the jugular bulb in general are also described.
Audio-vestibular manifestations of Chiari malformation and outcome of surgical decompression: A case report
Authors: Ahmmed A. U. , Mackenzie I. , Das V. K. , Chatterjee S. , Lye R. H.
Published: November 2007

Sensorineural hearing loss, tinnitus, dizziness and ataxia are recognised symptoms associated with Chiari malformations but they are rarely the presenting complaints. Patients with such symptoms are frequently referred to otolaryngologists and audiological physicians. We report a case of a 13-year-old girl who presented complaining of tinnitus and impaired hearing, and was subsequently diagnosed as having a type I Chiari malformation. Pure tone audiogram showed a mild hearing impairment on the left side and the speech audiogram was normal. Auditory brain stem responses and the electronystagmography were abnormal. The patient underwent posterior fossa decompression following which her tinnitus disappeared, the hearing problem recovered and some of the abnormal electrophysiological parameters were corrected.
Fractured tracheostomy tube: an overlooked foreign body
Authors: Gupta S. C. , Ahluwalia Hemant
Published: November 2007

A rare case of an overlooked fractured metallic Fuller's tracheostomy tube in the posterior basal segment of the left lung is reported along with a review of the literature. Incidence, aetiology, delay in diagnosis, complications and management of overlooked foreign bodies are discussed. Various factors contributing to the fracture of tracheostomy tubes are reviewed.
A cost effective screening protocol for vestibular schwannoma in the late 90s
Authors: Ravi K. V. , Wells S. C.
Published: November 2007

Magnetic resonance imaging (MRI) is the imaging modality of choice in diagnosing vestibular schwannoma (VS). Perceived high costs have prevented clinicians from using it as a screening investigation, although MR scanners are now widely available in the United Kingdon. In a retrospective study, the clinical records of all the patients who presented to the ENT department of Taunton and Someerset NHS Trust with suspected symptoms of VS during the year 1994 were analysed. The cost of confirming or refuting the diagnosis of VS in each patient ranged from £220.72 to £580.31 depending on the number of hospital visits and investigations performed. This study shows that the routine use of MR scanning for detection of VS is cost effective and more effective than the use of conventional tests.
Nonspecific vertigo with normal otoneurological examination. The role of vestibular laboratory tests
Authors: Gordon Carlos R. , Shupak Avi , Spitzer Orna , Doweck Ilana , Melamed Yehuda
Published: November 2007

Vestibular larobatory tests are not general necessary in the diagnosis of patients with a clear description of vertigo accompanied by positive otoneurological examination findings. The purpose of the study was to inverstigate the role of conventional vestibular laboratory tests in the diagnosis of patients compaining of hnonspecific vertigo, despite their having a documented normal otoneurological examination. The results patients referred for ambulatory vestibular laroratory testes due to a nonspecific illusion of movement, but with nornal otoneurological examination, were reviewed. Abnormalities were found in the vestibular tests of 35 patients (67 per cent), 22 of whom (63 per cent) were finally diagnosed as having a unilateral perpheral vestibular lesion, and 13(37 per cent) benign positional vertigo. These results suggests that a high percentage of patients with nonspecific vertigo and a normal otoneurologica examination probably suffer from peripheral vestibular dusfunction, which can be objectively documented by the ENG and SHA tests.
Thyroid carcinoma causing fatal laryngeal occlusion
Authors: Carter N. , Milroy C. M.
Published: November 2007

Pure squamous carcinoma of the thyroid gland is an uncommon tumour and is thought to arise in glands containing metaplastic squamous epithelium. Extrinsic compression or tumour invasion of the larynx causing fatal respiratory obstruction are recognized complications. We report a case of primary squamous carcinoma of the thyroid gland where obstruction of laryngeal mucous gland outflow resulted in fatal laryngeal compression. This appears to be the first description of such a sequence of events.
The bone anchored hearing aid (BAHA) in chronic suppurative otitis media (CSOM)
Authors: Macnamara Marcelle , Phillips David , Proops David W.
Published: November 2007

Bone anchored hearing aids are gaining wide acceptability in the treatment of patients with congenital ear problems, chronic suppurative otitis media (CSOM) and in some cases otosclerosis. To date little information on the effect of the bone anchored hearing aid on the symptoms of chronic suppurative otitis is available. This retrospective study based on notes review and telephone interviews was to assess the outcome of bone anchored hearing aid surgery in patients with CSOM in terms of: ear discharge; surgical techniques and complications; the number of hours the aid is worn compared with the previous aid.

One hundred and forty-two patients were fitted with bone anchored hearing aids without additional prostheses in Birmingham between 1989 and 1995. Sixty-nine (48.5 per cent) of these were for chronic suppurative otitis media, 45 of these were female and 24 were male with a mean age of 58 years. Most (85 per cent) had undergone previous ear surgery with 65 per cent having mastoid surgery. Ninety-eight per cent of this patient group had undergone single stage surgery and 65 per cent under local anaesthetic as a day case. A variety of techniques for soft tissue reduction were employed.

The mean follow-up time for these patients was 24 months (range one month to seven years). No patients experienced worse discharge following their BAHA and 84 per cent had significantly reduced discharge, 16 per cent had no change. Complications included skin reactions, 15; failure to integrate, one; late loss of fixture, three. Seventy-three per cent wore their bone anchored hearing aid more than eight hours per day and 58 per cent were more satisfied with their bone anchored hearing aid than their previous aid.
Self-inflicted traumatic macroglossia
Authors: Alvi Aijaz , Theodoropoulos Philip A.
Published: November 2007

Macroglossia is a potentially life-threatening problem. The multiple aetiologies responsible for this condition include cysts, tumours, amyloidosis, angioedema, and infections. Although injuries to the oral cavity are common, self-inflicted traumatic macroglossia is not common. We report a case of a comatose patient with limb contractures and severe trismus who developed entrapment of the tongue with progressive macroglossia and near auto-amputation of the tongue. The importance of early recognition and treatment of tongue entrapment in comatose patients is emphasised since this is a potentially reversible condition.
Atypical carcinoid of larynx: presentation with scalp metastases
Authors: Ereño Cosme , Lopez Jose I. , Sanchez Jose M.
Published: November 2007

A case of atypical carcinoid tumour of the larynx in a 72-year-old woman is presented. The neoplasm was located in the supraglottic region and was first manifest by metastases to the scalp. The presence of amyloid-like material and calcitonin-positive cells were features that resembled medullary carcinoma of the thyroid. Clinically, it pursued an aggressive course that led to death 58 months after diagnosis. The literature is reviewed, particularly that regarding the differential diagnosis.
Cochlear implantation in the presence of chronic suppurative otitis media
Authors: Axon P. R. , Mawman D. J. , Upile T. , Ramsden R. T.
Published: November 2007

Nine patients are presented who underwent cochlear implantation in the presence of chronic suppurative otitis media. Four had a simple tympanic membrane perforation, four had a pre-existing mastoid cavity and one had cholesteatoma in the ear chosen for implantation. Patients with a simple perforation had a staged procedure with myringoplasty followed by cochlear implantation after an interval of three months. Patients with cholesteatoma or with an unstable mastoid cavity were also staged. A mastoidectomy or revision mastoidectomy was performed with obliteration of the middle ear and mastoid using a superiorly pedicled temporalis muscle flap and blind sac closure of the external meatal skin. After a further six months a second stage procedure was performed to confirm that the middle-ear cleft was healthyand to insert the implant. Patients presenting with a stable mastoid cavity underwent obliteration of the cavity and implantation of the electrode as a one-staged procedure. To date there have been no serious problems such as graft breakdown, recurrence of disease or implant extrusion, and all patients are performing well.
CT assessment of jugular foramen dominance and its association with hand preference
Authors: Adams W. M. , Jones R. L. , Chavda S. V. , Pahor A. L.
Published: November 2007

Three hundred and seven normal CT scans of the head were prospectively analysed to assess jugular foramen dominance. After assessment, hand preference was elicited. Of these, 276 were right-handed and 31 were left-handed. Of the right-handed patients: 180 had a larger jugular foramen on the right; 63 had a larger jugular foramen on the left; and in 33 no difference could be discerned. Of the left-handed patients: 11 had a larger jugular foramen on the right; 16 hada larger jugular foramen on the left; and in four no difference couldbe discerned. The results suggested a significant association betweenjugular foramen dominance and hand preference.
Anatomical considerations of high jugular bulb in lateral skull base surgery
Authors: Aslan Asim , Falcioni Maurizio , Russo Alessandra , Donato Giuseppe De , Balyan Fatih Ridvan , Taibah Abdelkader , Sanna Mario
Published: November 2007

In order to study high jugular bulb management in lateral skull base surgery, an anatomical study was conducted on 30 temporal bones by examining the relationship between the internal auditory canal (IAC) and the jugular bulb. The following parameters were measured: 1) Height of the jugular bulb (H) … distance between the level of the jugular bulb dome and the line passing through the confluence of the sigmoid sinus with the jugular bulb (SS-JB), 2) Mastoid length (ML) … distance between the mastoid process and middle cranial fossa dura, 3) Distance between the most inferior part of the porus acousticus and jugular bulb dome (A), 4) Distance between the porus acousticus and SS-JB (B). The jugular bulb was defined as high when it occupied more than two thirds of (B). The incidence of a high jugular bulb was 23 per cent in this study. When the jugular bulb was high, the mean (H) and (A) were 9.4 ± 1.9 mm and 2.7 ± 0.5 mm, respectively. (H) was higher on the right side than on the left side. No statistically significant difference was found between small and large mastoids (t-test: p>0.05). It was concluded that when a high jugular bulb was encountered during lateral skull base surgery, the jugular bulb position allows a very small working area inferior to the IAC. In these cases, a 3 or 4 mm depression of the jugular bulb is necessary in order to expose the lower cranial nerves. This can be accomplished by lowering the jugular bulb with the technique already described.
Mast cell ultrastructure in the inferior turbinate and stroma of nasal polyps
Authors: Drake-Lee Adrian , Price Jacqueline
Published: November 2007

Fourteen unselected adult patients with nasal polyps had ultrastructural examination of mast cells from matching biopsies of the polyp and inferior turbinate. Between three and 10 blocks were examined for each patient in both tissues and every mast cell that had a nucleus was photographed for study. Fifty-three mast cells were found within the stroma of nasal polyps and 54 in the submucosa of the inferior turbinate biopsies. The number of granules ranged between 13 and 167 (mean 60) for polyps and 18 and 148 (mean 61) in the inferior turbinate. The mast cells appeared essentially normal in the inferior turbinate of four patients. The degree of degranulation of the mast cells was calculated as in previous studies and then averaged for both the polyp and the inferior turbinate of each patient. There was greater degranulation in the nasal polyp compared to inferior turbinate (p= 0.03). These results were compared with mast cell degranulation found in the normal nose and in the inferior turbinate of patients with perennial allergic rhinitis which we previously published. The inferior turbinates in these patients were more degranulated than the normal nose (p= 0.0001) but were similar to that found in patients with perennial allergic rhinitis. This suggested that some degree of degranulation may occur throughout the nose in two thirds of the patients with nasal polyps which supports the theory that mast cell reactions are not limited to the polyps in a proportion of patients.
Snoring and oral submucous fibrosis
Authors: Soni N. K.
Published: November 2007

Forty patients above the age of 40 years with oral submucous fibrosis were studied to determine the frequency and severity of snoring. The results were compared with a controlled group of similar sex and age for presence of snoring. The present study indicates that patients with oral submucous fibrosis having a short and fixed uvula and scarred soft palate are less likely to develop snoring. Thus it is suggested that in laser surgery or in classical uvulopalatopharyngeal surgery, the uvula and soft palate should be reduced in size and volume to the extent of that found in oral submucous fibrosis.
Treatment of recurrent respiratory papillomatosis with argon plasma coagulation
Authors: Bergler W. , Hönig M. , Götte K. , Petroianu G. , Hörmann K.
Published: November 2007

Extension of recurrent respiratory papillomatosis (RRP) to the lower airway in children is life-threatening and an extremely difficult condition to treat. We present the case of a seven-year-old girl with progressive RRP since the age of two. Repeated CO2 laser treatment and interferon-alpha treatment could not prevent tracheotomy and spread to the trachea. We used argon plasma coagulation (APC) with flexible endoscopy for the first time for the treatment of RRP. APC gives a controlled limited penetration into the tissue and good control of bleeding. There is no carbonization or vaporization which makes it a suitable method for the treatment of lower airway RRP. After a few treatments with APC, we gained very good control of the disease with no side-effects or complications. The described application of APC seems to be a promising way to treat lower airway RRP.
Tracheoesophageal puncture using a flexible gastroscope and a percutaneous endoscopic gastrostomy set
Authors: Singh V. , Brockbank M. J. , Flower N. , Frost R. A.
Published: November 2007

Tracheoesophageal puncture is an established procedure for voice restoration following laryngectomy. A method using a flexible gastroscope and a percutaneous endoscopic gastrostomy (PEG) set is described. This overcomes a number of problems and complications which may be encountered when using a rigid endoscope.
Luc's abscess - a rare complication of middle-ear infection
Authors: Knappe M. V. , Gregor R. T.
Published: November 2007

A case of subperiosteal temporal abscess of otitic origin is presented. This is an unusual complication of otitis media. The pathogenesis of Luc's abscess is different from other extracranial complications of middle-ear infections in that it is notassociated with mastoid infection which results in subperiosteal pus formation. Based on our experience and the reports from the turn of the century. we present the presumptive pathogenesis and clinical features. We contend that these patients run an unexpectedly benign course, and require concomitantly more conservative treatment than other otitic abscesses.
Revision myringoplasty
Authors: Berger Gilead , Ophir Dov , Berco Eliezer , Sadé Jacob
Published: November 2007

This retrospective study was undertaken to review the short- and long-term results of 70 revision and 16 re-revision myringoplasty operations. Of the former, 43 cases (61.4 per cent) had initial success, six weeks following surgery. The leading causes of immediate failure (27 cases) were associated with a complete no- take of thegraft, infection with graft necrosis and poor anterior adaptation of the graft in decreasing order. Six out of the 43 patients developed late re-perforations during the follow-up period, thus reducing the success rate of revision myringoplasty to 52.8 per cent. Late re-perforations were attributed to insidious atrophy of the tympanic membrane or episodes of acute otitis media. Sixteen patients underwent re-revision myringoplasty and their success rate was 62.5 per cent. The overall success rate of revision and re-revision myringoplasty was 54.7 per cent. It has been concluded that results of revision myringoplastywere independent of patients' age, location and size of perforation and the seniority of the surgeon.
The evaluation of salivary gland tumours using proliferating cell nuclear antigen
Authors: Trendell-Smith N. J. , Oates J. , Crocker J.
Published: November 2007

In order to assess its discriminating and prognostic value, we studied the immunoreactivity for proliferating cell nuclear antigen (PCNA) in tissue from 52 human salivary gland tumours using the murine monoclonal antibody PC10.

The PCNA percentage count, namely, the average number of positive nuclei counted per 100 randomly selected tumour cells was recorded for each tumour. Anaplastic carcinoma was used as a positive control and histologically ‘normal’ salivary gland and tonsil served as a negative control.

A PCNA count of 30 per cent was postulated to predict malignancy within a given salivary gland tumour i.e. a PCNA count of 30 per cent or above would indicate malignant potential. This gave a sensitivity of 96.9 per cent and a specificity of 95.2 per cent and a positive predictive value of determining malignancy of 96.8 per cent.

We conclude that PCNA immunoreactivity is useful in discriminating between benign and malignant salivary gland tumours and that it may have prognostic value in this diverse group of neoplasms.
Aspergillus mastoiditis in a patient with acquired immunodeficiency syndrome
Authors: Yates P. D. , Upile T. , Axon P. R. , de Carpentier J.
Published: November 2007

We present the case history of a patient who was severely immunocompromised due to infection with the human immunodeficiency virus (HIV), and who subsequently developed acute mastoiditis due to Aspergillus fumigatus. Fungal otomastoiditis is a rarely reported complication of HIV infection. A high index of suspicion is required in these patients to facilitate early diagnosis and appropriate therapy.
Parapharyngeal abscess: a rare complication of elective tonsillectomy
Authors: McEwan J. A. , Dhingra J. , Rowe-Jones J. , Bleach N. R.
Published: November 2007

We report a case of parapharyngeal abscess complicating an elective tonsillectomy in a healthy thirty-three- year-old woman. The clinical features and management of this very rare complication are discussed. In addition, we review the possible aetiology and pathogenesis of this potentially life-threatening condition.
Laryngeal tuberculosis at the end of the 20th century
Authors: Kandiloros D. C. , Nikolopoulos T. P. , Ferekidis E. A. , Tsangaroulakis A. , Yiotakis J. E. , Davilis D. , Adamopoulos G. K.
Published: November 2007

Despite the dramatic reduction in the incidence of laryngeal tuberculosis after the 1950s, the topic has now gained new interest due to claims that the disease has changed its clinical pattern. In the past, the typical patient was 20–40 years old with ulcerated laryngeal lesions, perichondritis, and advanced cavitary lung disease. We studied nine cases of laryngeal tuberculosis confirmed by histological examination. The microlaryngoscopy revealed tumour-like lesions and/or chronic non-specific laryngitis. There were no significant ulcerations or signs of perichondritis. The patients' ages ranged from 48.5 years to 69.3 years (mean, 59.4 years). In three of our patients (33 per cent) we did not find any pulmonary involvement, thus suggesting primary laryngeal tuberculosis or haematogenous spread. In conclusion, the numerous physicians who deal with the various laryngeal symptoms and diseases should be aware of the existence of laryngeal tuberculosis and the changing patterns of the disease (at least in the developed countries).