Cochlear implantation in Malawi: report of the first four cases.

OBJECTIVE: This paper reports on the first four cochlear implant cases in Malawi. CASE REPORTS: Three patients were deafened from infectious diseases and one from an unknown cause. They all had post-lingual deafness. Six months after the last implant, they are all progressing well. CONCLUSION: Despite significant practical difficulties, it has proved possible, with the right support, to carry out cochlear implantation in one of the world's poorest countries. The project has also raised awareness of deafness in Malawi and highlighted significant public health issues relating to the aetiology of deafness in developing countries.

Improving paranasal sinus computed tomography reporting prior to functional endoscopic sinus surgery - an ENT-UK panel perspective.

BACKGROUND: Functional endoscopic sinus surgery is recognised to have a significant complication profile (e.g. blindness, cerebrospinal fluid leak and intracranial sepsis). Pre-operative computed tomography imaging is considered mandatory for surgical planning to reduce intra-operative risk. A radiological report is the 'gold standard' in image interpretation; however, because of a lack of otolaryngological or radiological guidance, its contents may be variable. By surveying practising otolaryngologists, this study aimed to provide some guidance which may be used by radiologists to produce more surgically relevant radiological reports. METHOD: A prospective questionnaire was distributed to the ENT-UK panel. RESULTS: A total of 117 consultant members of the panel completed the survey. Twenty-nine per cent indicated that they were uncomfortable interpreting all areas of the computed tomography scan. Greatest importance was given to areas including the ethmoid roof (dehiscence, asymmetry and angle), lamina papyracea (dehiscence) and sphenoid sinus (carotid canal dehiscence and optic nerve relationships). CONCLUSION: Functional endoscopic sinus surgery is commonly performed by non-subspecialist rhinologists. The information obtained from this study can be used by radiologists to improve report relevance, particularly for the generalist ENT surgeon. This contributes to improving patient safety and helps avoid medicolegal litigation when complications arise.

Factors affecting myringoplasty success.

OBJECTIVE: To identify factors that significantly influence myringoplasty success. METHODS: A retrospective study was performed of all adults and children who underwent myringoplasty from January 2005 to January 2010 in a teaching hospital. Outcome measures were tympanic membrane perforation closure and air-bone gap closure to within 20 dB HL. The factors assessed were the surgeon grade, pre-operative condition of the ipsilateral and contralateral middle ears, perforation site, perforation size, graft material, and whether simultaneous cortical mastoidectomy was performed. Factors with statistically significant effects were determined by logistic regression analysis. RESULTS: In the adult group, the perforation site significantly influenced tympanic membrane closure (p = 0.016): anterior (p = 0.008) and subtotal (p = 0.017) sites had the greatest influence. None of the factors proved to have a significant influence on tympanic membrane closure in the paediatric group. CONCLUSION: There was a significant association between perforation site and tympanic membrane perforation closure in adults. Anterior and subtotal perforations had a significantly reduced closure rate.

Memristive switching of single-component metallic nanowires.

Memristors have recently generated significant interest due to their potential use in nanoscale logic and memory devices. Of the four passive circuit elements, the memristor (a two-terminal hysteretic switch) has so far proved hard to fabricate out of a single material. Here we employ electromigration to create a reversible passive electrical switch, a memristive device, from a single-component metallic nanowire. To achieve resistive switching in a single-component structure we introduce a new class of memristors, devices in which the state variable of resistance is the system's physical geometry. By exploiting electromigration to reversibly alter the geometry, we repeatedly switch the resistance of single-component metallic nanowires between low and high states over many cycles. The reversible electromigration causes the nanowire to be cyclically narrowed to approximately 10 nm in width, resulting in a change in resistance by a factor of two. As a result, this work represents a potential route to the creation of nanoscale circuits from a single metallic element.

Use of Rubens pillow in functional endoscopic sinus surgery.

Functional endoscopic sinus surgery is a common procedure in almost all ENT departments. Commonly, a head ring is used for head support during this procedure. We believe that the Rubens pillow enables better head stability and provides a better operating surface for surgical instruments.

Duplication of internal jugular veins: case report.

OBJECTIVES: We report a rare case of internal jugular vein duplications, in order to raise the level of awareness of this anomaly amongst ENT surgeons, radiologists and intensive care practitioners. We briefly review and discuss the related literature. CASE REPORT: Duplicated internal jugular veins are a rare anatomical finding. They may be subclinical, or may present with neck swellings that may be mistaken for laryngocoeles or branchial cysts. We present a case of bilateral internal jugular vein duplication in a young adult. The referral was made on the basis of intermittent neck swelling, dyspnoea and dysphagia. Conservative treatment was instigated, and symptoms improved without surgical intervention. CONCLUSIONS: Only a handful of cases of duplicated internal jugular veins have been reported. The current case is unique, as no previously reported cases have presented with dyspnoea and dysphagia. We suggest a conservative approach, as there is currently no evidence that duplicated internal jugular veins cause any adverse health outcomes.

Bilateral inverted papilloma: A report of two cases and review of the current literature.

Inverted papilloma is locally aggressive tumour which typically presents as a unilateral nasal polyp. Whilst it has a malignant potential it rarely transforms and in its benign form the main concern originates from its locally aggressive nature and substantial propensity to recur. Bilateral disease can also be due to inverted papilloma, sometimes due to direct extension of the tumour, but it can also occur as two distinct lesions. Here we report two cases of bilateral involvement, review the current literature and highlight some important issues on the management and follow-up of this well known neoplasm.

Cochlear implantation in Refsum's disease.

Refsum's disease is a rare disorder characterized by accumulation of phytanic acid in plasma and tissues. The main clinical features are retinitis pigmentosa, cerebellar ataxia and chronic polyneuropathy. Sensorineural hearing loss of varying severity can be an additional feature. This study reports our experience with two patients with Refsum's disease who underwent successful cochlear implantation. Both patients had good audiological outcomes after implantation and were overall very satisfied. Bilateral implantation should be considered with patients with severe dual sensory loss. One patient was implanted bilaterally the other unilaterally, primarily due to prolonged duration of unaided unilateral profound hearing loss.

Skin flap thickness in cochlear implant patients - a prospective study.

The thickness and quality of the skin overlying a cochlear implant is important for its integrity. It should be thick enough to protect the implant and prevent flap breakdown yet should not be so thick that it impedes the electronic signal or causes difficulty wearing the coil because of loss of the magnetic coupling. The principle of this study was to devise a method to assess the thickness of skin over a cochlear implant receiver stimulator package and prospectively measure this thickness during the first year following surgery. All patients studied were implanted with MED-EL COMBI 40+ implants. The first cohort consisted of 35 adults; the second 23 children. Various methods of measurement were assessed. In this study the principle of the Hall Effect electrode was used to measure the magnetic flux density of the magnet within the receiver stimulator package. Following standardization, results showed that skin thickness significantly thinned in the adult group before stabilizing. This was less obvious in children, probably due to the effect of the skin thickening as the child grows. Knowledge of skin thickness has implications relating to the functioning of an implant and avoiding potential flap related complications.

A clinical review of 128 cases of head and neck tuberculosis presenting over a 10-year period in Bradford, UK.

AIMS: To analyse the epidemiology, presentation and diagnosis of head and neck tuberculosis (TB). METHODS: We conducted a 10-year retrospective study of all cases of tuberculosis of the head and neck region occurring in Bradford, UK. RESULTS: Of a total of 1315 cases of TB, 128 presented with head and neck TB (12 per cent of which (15/128) were in children). Cervical lymph nodes were most commonly involved (87 per cent, 111/128), other sites being: salivary glands (five cases); larynx, oral cavity, eyes and ears (two cases each); and skin, thyroid, nasopharynx and retropharyngeal space (one case each). Patients' ethnic origins were Asian (89 per cent, 114/128), Caucasian (10 per cent, 13/128) and African (one case). Only 26 per cent (33/128) had constitutional symptoms, and 20 per cent (25/128) had a coexistent site of TB. Only 39 per cent (40/105) of surgical specimens were sent for culture. CONCLUSIONS: Isolated head and neck TB is not uncommon. Atypical presentations render diagnosis challenging, so awareness aids early diagnosis. Mycobacterial cultures should be performed, where possible, for diagnosis.

Size-dependent diffusion in an aging colloidal glass.

Colloidal dispersions of Laponite platelets are known to age slowly from viscous sols to colloidal glasses. We follow this aging process by monitoring the diffusion of probe particles embedded in the sample via dynamic light scattering. Our results show that the time-dependent diffusion of the probe particles scales with their size at early times and for the larger particles. This implies that within this regime the measurements can be used to investigate the generalized fluctuation-dissipation theorem for this out-of-equilibrium system, where the bath temperature is replaced with an effective temperature. Simultaneous dynamic rheological measurements reveal that this effective temperature increases as a function of aging time and frequency which suggests the existence of two measured time-scale regimes. In accord with recent work by Abou [Phys. Rev. Lett. 93, 160603 (2004)], our results suggest that at probed time scales longer than the characteristic relaxation time of the Laponite dispersion the system thermalizes with the bath, whereas at shorter time scales the system is out-of-equilibrium with an effective temperature greater than the bath temperature.

Periorbital swelling: the important distinction between allergy and infection.

Orbital cellulitis and abscess formation are rare complications of sinusitis, however acute orbital inflammation is secondary to sinusitis in about 70% of cases. Delay in diagnosis must not occur to avoid serious complications such as blindness and life threatening intracranial sepsis. A case is reported in which despite late referral, emergency surgical intervention was sight saving.

Long-term ventilation of the middle ear using a subannular tympanotomy technique: a follow-up study.

The results of a nine-year series of patients who underwent long-term middle ear ventilation using a tympanotomy technique are presented. The original series of 26 cases was published in 1995. The same series has now expanded to 37 cases, which form the basis of this follow-up study. In contrast to the original series we found a high spontaneous extrusion rate (68 per cent) and in 27 per cent of cases complications necessitated removal of the subannular T tube. In favour of the technique was a low perforation rate after extrusion or removal (eight per cent). Although only nine per cent underwent re-ventilation this is unlikely to represent resolution of the middle ear effusion in the remaining cases. We conclude that the adverse effects of the subannular tympanotomy technique for long-term ventilation of the middle ear outweigh the benefits when compared with the traditional technique of placing a T tube through a myringotomy incision.

Intermittent self-nasal packing for intractable epistaxis in a patient with Ehlers-Danlos syndrome.

Intractable epistaxis is a difficult problem to manage, particularly in a case complicated by Ehlers-Danlos syndrome. This is the first report describing intermittent self-packing of the nasal cavities at home to reduce hospital admissions and control symptoms. Some of the potential problems and complications are highlighted.

Dentures may be radiolucent.

Diagnosing ingested dental prostheses can be difficult and delays in treatment may result in serious complications. Patients often present with a vague history and very few reliable clinical signs. In addition, the fact that dental plates are often radiolucent may lead to the diagnosis being overlooked with disastrous consequences. A case of successful diagnosis and treatment is presented, and the importance of a high index of clinical suspicion to avoid the morbidity and mortality associated with missed impacted dentures is discussed.

How we do it: using a surgical navigation system in the management of the ossified cochlea.

The ossified cochlea poses both concerns and challenges to any implant team. One of the surgical aims is to implant as many of an implant system's electrodes into the cochlea as close to the modiolus as possible, thus facilitating stimulation of the surviving cell bodies in the spiral ganglion. Within the field of otorhinolaryngology various surgical navigation systems have been introduced to facilitate surgical orientation during endoscopic sinus and skull-base surgery. The principle behind such systems is that specialized software uses high-resolution computerized tomography and magnetic resonance imaging scans to create a 3D image of the patient's anatomy. This 'virtual patient model' is then 'registered' with the patient's anatomical landmarks. Surgical instruments registered into, or linked with, the system can then be tracked within the 3D model. This is the first time this system has been described for surgery of the inner ear, and we describe how the technique allows more precise control of the bur tip while drilling tunnels that approximate with the apical and distal parts of the basal coil of the ossified cochlea.

Allergic otitis externa.

Chronic otitis externa is a common condition, which is usually successfully treated by topical medications and aural toilet. In cases that persist despite conventional treatment, a diagnosis of allergic otitis externa should be considered. Sensitization to otic medications (secondary contact otitis) is not uncommon. Topical aminoglycosides are the most common sensitizers although many components of topical preparations can cause sensitization. Patients who may have developed allergic otitis externa should undergo patch testing. Otolaryngologists should consider using topical antibiotics with a low allergenic potential and avoiding neomycin when treating patients with otitis externa. Primary contact otitis may occur to metals used in earrings and also to hearing aid moulds. Treatment of both primary and secondary contact otitis consists of identifying the allergen, avoiding further contact and use of simple preparations avoiding common sensitizers.

Allergy to Merocel nasal packs causing septal perforation and inferior turbinate necrosis.

We present a case of a patient with an allergy to Merocel nasal tampons and the subsequent complications and implications of this.

Do superconductors have zero resistance in a magnetic field?

We show that dc voltage versus current measurements of a YBa(2)Cu(3)O(7-delta) film in a magnetic field can be collapsed onto scaling functions proposed by Fisher et al. [Phys. Rev. B 43, 130 (1991)] as is widely reported in the literature. We find, however, that good data collapse is achieved for a wide range of critical exponents and temperatures. These results strongly suggest that agreement with scaling alone does not prove the existence of a phase transition. We propose a criterion to determine if the data collapse is valid, and thus if a phase transition occurs. To our knowledge, none of the data reported in the literature meet our criterion.