Superglue in otology.

BACKGROUND: The use of stitches and staples for the closure of surgical wounds is associated with complications for both the surgeon and the patient. Histoacryl (butyl1-2cyanoacrylate glue) is widely used for wound closure in Accident and Emergency departments, in particular for facial and scalp wounds. METHOD: We have used Histoacryl for closure of various surgical incisions in a series of 50 cases and assessed the cosmetic outcome at three to four weeks. RESULTS: There were no wound related complications in the form of infection or dehiscence. In one case however, there was formation of synechiae in the external auditory meatus following an endaural incision. CONCLUSION: We recommend the use of Histoacryl over traditional closure using skin suture material in otological surgery. Our experience was also successful in parotid cases.

Smoking and middle ear ciliary beat frequency in otitis media with effusion.

The middle ear mucociliary system has been shown to play an important role in clearing middle ear effusions. There is conflicting epidemiological evidence, however, as to whether exposure to tobacco smoke plays a significant role in persistence of middle ear effusion in patients with otherwise normal mucociliary function. Samples of middle ear mucosa from 33 patients with persistent otitis media with effusion (OME) were taken at myringotomy, together with corresponding nasal brushings. The aim of this study was to observe the mean ear ciliary beat frequency (CBF) and to compare it with nasal ciliary activity. Nasal brushings were collected from 33 age and sex matched non-smoking controls with no history of nasal atopy or topical nasal treatment. Ear CBF in OME was significantly reduced in comparison to paired nasal samples (p < 0.001). Ear CBF in adult OME patients who smoked or in children who were passive smokers was significantly less than in patients who were not exposed to cigarette smoke (p < 0.01). This study indicates that impaired ciliary function due to tobacco smoke exposure is an aetiological factor in persistent OME.

Objective assessment of posterior choanae and subglottis.

The assessment of children with suspected stenosis of the posterior choanae and the subglottis can be arbitrary and subjective. A study was therefore undertaken to assess the normal size of both posterior choanae and subglottis in normal children and ascertain their relationship. The size of the posterior choanae in 72 children ranged from 3-9.3 mm (3-5.5 mm when less than one year old, and 6.1-9.3 mm when older than one year). The two sides were of equal size in 51 children (p < 0.001), in 16 children the right side was larger than the left (p < 0.01), and in 5 children the left was larger than the right side. The subglottic size in 52 children ranged between 4.2-9.3 mm (1.2-5.5 mm when less than one year old, and 6.1-9.3 mm, when older than one year). The size of the subglottis was of equal size or within 1.0 mm of the average size of the two posterior choanae in 41 children (p < 0.001), and of different sizes in 11 children. Accurate and objective assessment of either area can therefore be made by measuring and comparing the two sizes in the same child.

Antral washout with nasal polypectomy: should both be combined?

Two hundred and sixteen patients with nasal polyps were studied. All patients had antral washouts performed at the same time as nasal polypectomy. Two hundred and sixty aspirates were sent for culture and microscopy; bacteria were cultured from 58 of these specimens in 38 patients. One hundred and one patients had pre-operative sinus radiographs of which 94 were reported as abnormal with a 52% false-positive result. It is concluded that antral washouts should be routine in all patients having nasal polypectomy. Sinus radiographs are an unnecessary pre-operative investigation in patients with uncomplicated nasal polyps.

Does nasal septal deviation influence adult posterior choanal size?

Despite the development of modern imaging techniques, no study has been carried out to establish the normal size (particularly the area) of the adult posterior choanae. In this study we present our findings of the normal anatomical sizes of the adult posterior choanae and its relationship to septal deviation, by analysing MRI images of 70 patients. Coronal sections through the sphenoid rostrum and axial sections through the nasal septum were used. There were 32 males and 38 female patients. The age ranged between 18 and 73 years (mean 35.6). Our results show that the posterior choanal dimensions were as follows: right area: 1.35-6.1 cm2 (mean 2.7 cm2); left area: 1.4-5.9 cm2 (mean 2.7 cm2); right width: 0.9-2.1 cm (mean 1.5 cm); left width: 0.9-2.2 cm (mean 1.5 cm); right height: 2.5-4.0 cm (mean 2.6 cm); and left height: 1.5-4.0 cm (mean 2.5 cm). Chi-square analysis showed no statistically significant differences between left- and right-sided measurements. Twenty-three patients had a deviated septum towards the left side, 22 patients towards the right side, and 25 patients had no septal deviation. Chi-square analysis showed no statistical correlation between deviation of the nasal septum and any of the three dimensions of the posterior choanae studied.

The incidence of sinusitis in patients with multiple sclerosis.

A retrospective study was performed to assess the incidence of sinus disease in patients with MS. The MRI scans of 108 patients referred to a regional Neurosciences Unit with a diagnosis of multiple sclerosis were examined. There were 71 females and 37 males with an age range of 22 to 67 years (mean: 39.7 years). The sagittal and axial images were reviewed and the degree of sinus disease noted. This was graded as absent, minimal, polypoid and pansinus. Fifty-seven patients (53%) had disease, the most common sinus involved was the maxillary followed by the ethmoid, frontal and sphenoid. Thirty-six patients had bilateral disease affecting the ethmoid sinuses most commonly. Three patients had fluid levels and four patients had retention cysts. The incidence of sinus disease is higher than in some other studies of normal populations.

Pneumosinus dilatans: a discussion of four cases and the possible aetiology.

Pneumosinus dilatans is an abnormal dilatation of the paranasal sinuses, which contains only air and is lined by normal mucosa. It is a rare condition, the aetiology of which is unclear. We describe four patients who presented to our department with pneumosinus dilatans. The aetiology was either developmental hydrocephalus (n = 1), post-traumatic (n = 1) or idiopathic (n = 2). Two patients underwent surgery, and follow-up is at least 12 months to date. The radiological aspects of this rare condition and the possible aetiologies are discussed.

The ENT problems following the Birmingham bombings.

The ENT problems following the Birmingham bombings of 1974 are presented. It is during the positive phase of bomb blast that the tympanic membrane ruptures. Spalling is a likely explanation for the mechanism of rupture of the tympanic membrane specially in large perforations. Tympanic membrane defects involving 80 per cent of the surface area of the drumhead or more persisted, whereas those involving less than 80 per cent healed with conservative treatment. The majority of perforations (81.4 per cent) healed spontaneously, with a three-layered membrane. A month should be allowed for the healing of every 10 per cent loss of the surface area of the drumhead. During surgical repair of persistent perforations, the malleus handle was found to be on a deeper plain than the long process of the incus. Tympanic membrane perforations did not protect the inner ear, the sensorineural deafness producing either a high tone or a flat loss. One in four of the victims seen in the hospital complained of deafness. A patient who suffered blast injuries to the lung also developed cord palsy.

Enterogenic cyst of the nasopharynx.

An 'enterogenic cyst' of the nasopharynx is presented. The term 'enterogenic' is preferred to the currently used term 'cyst of the bursa pharyngea embryonalis'.

Extramedullary plasmacytoma of the head and neck, parotid and submandibular salivary glands.

Twenty-two cases of extramedullary plasmacytomas (EMP) were diagnosed in the Birmingham region during 1962-1973. Five cases of EMP of the head and neck are discussed, including cases involving the parotid and submandibular salivary glands. Comparative data on incidence, age, sex, and survival is presented. A multidisciplinary approach is important for diagnosis, treatment and follow-up. It is mandatory to carry out investigations to exclude multiple myeloma. Radiotherapy is the treatment of choice; clinical, radiological and pathological evidence are cited. However, a residuum may be left after an initial response to radiotherapy which may require surgical removal. Chemotherapy has a place in multiple site lesions. A proportion of cases proceed to multiple myeloma after a variable period of time and thus follow-up should be life-long.

Herpes zoster of the larynx--how common?

Herpes zoster of the larynx is considered to be rare, but on reviewing the literature it is noted that some authors considered it to be more common than already acclaimed. Herpes may prove to be a common cause of cord palsies presently labelled as idiopathic and serological tests for herpes should be asked for. Of note is the fact that the cord palsy of a herpetic lesion can be short-lived and that earache is a common symptom. In this paper four cases of herpes laryngis are presented. It is advised that the larynx should be examined in all cases of herpes zoster of the head and neck.

Intratympanic keratoma following grommet insertion.

An intratympanic keratoma following myringotomy and multiple Shepard's grommet insertions is presented.

Rhabdomyosarcoma of the middle ear and mastoid.

A case of embryonal rhabdomyosarcoma of the middle ear and mastoid is presented. The patient was treated by irradiation and Actinomycin D, and survived 4-5 months.

Plasmacytoma of the larynx.

Plasmacytoma of the larynx is rare; thirty-one cases are reported in the literature and in this paper a further case is presented. The difficulty in diagnosing plasmacytoma is mentioned. Investigations to exclude multiple myeloma are mandatory to be sure that the disease is a localized lesion. Treatment of a localized lesion is essentially by radiotherapy but in the case of widespread or systemic disease, chemotherapy is recommended. A scoring system utilizing different parameters is suggested to decide whether the case has passed the borderline between local and systemic disease, a line which is invariably difficult to define.

The Birmingham mummy: the first torticollis in history.

The Birmingham Mummy is of a warrior, 25-35 years of age, from the Graeco-Roman period. He was struck from the front by an arrow, which penetrated the soft tissues of the neck to some depth and lodged in the right infratemporal fossa. It is suggested that the wound became infected and that muscle spasm induced the torticollis which was not fully corrected on mummification.

A variation of first branchial cleft anomalies.

First branchial cleft anomalies are considered to be duplications of the external auditory meatus (EAM) and pinna with a sinus that runs parallel to the EAM (Type 1) or with a sinus that runs from an opening in the neck and ends blindly near the cartilaginous EAM (Type 2). In this paper we discuss a young patient that presented with an infected sinus that did not resemble either of the two known types of first branchial cleft anomalies.

Tuberculous nasopharyngeal cyst: diagnostic aspiration using the nasendoscope.

A case of tuberculous lymphadenitis with a nasopharyngeal tuberculoma is presented where a novel use of the flexible nasendoscope to provide a diagnostic aspiration biopsy avoided an examination and biopsy under general anaesthesia. The use of this approach is discussed.

Retropharyngeal myxoma: a case report.

Myxomas are rare tumours which may occur in the head and neck region. About 60 cases have been reported in the literature so far. We describe a retropharyngeal myxoma in this paper.

Leiomyosarcoma of the larynx: emergency laryngectomy.

Leiomyosarcoma of the larynx is extremely rare. A patient with respiratory obstruction due to such a tumour is presented. This was originally misdiagnosed as hysteria. The treatment of choice was an emergency laryngectomy.

Persistent stapedial artery.

Persistence of the stapedial artery is rare. A case is presented in which the stapedial artery was found over the footplate during stapes surgery. The technical problems encountered are discussed. A wire prosthesis has previously been used in the presence of a persistent stapedial artery and we describe the use of an all Teflon prosthesis. A subsequent CT scan demonstrated the vessel in the middle ear. An outline of the embryology of the stapedial artery is given and the literature reviewed.