Monozygotic twins and cholesteatomas: nature or nuture?

PURPOSE: Cholesteatoma is a rare middle ear pathology. It can be classified into acquired and congenital forms. Although benign, cholesteatomas can cause significant morbidity including hearing loss, infection, facial palsy and thrombosis. Congenital cholesteatomas are incredibly rare and bilateral disease has not commonly been published in the literature. METHOD: We describe the case of female identical (monozygotic, monochorionic, diamniotic) twins who both developed congenital cholesteatomas. In this report, we review the aetiology, treatment, embryology and pathology of cholesteatoma. RESULTS: The patients have been followed up 15 years after their initial surgery with promising results - pure-tone audiometry and repeat scans have not illustrated any disease recurrence. CONCLUSION: This paper presents one of the only cases of female monozygotic twins presenting with unilateral and bilateral cholesteatomas.

Impact factor and study design: the Academic Value of Published Research (AVaRes) score.

INTRODUCTION: To compare the citation indices of original articles and case reports in otolaryngology journals and thereby determine whether case reports are of less interest and possibly of academically inferior value to original articles. MATERIALS AND METHODS: All articles in two reputable UK otolaryngology journals (Clinical Otolaryngology and Journal of Laryngology and Otology) for 2000 and 2001 were identified. Citation indices were obtained from ISI Web of Knowledge and compared. Statistical analysis was performed using Microsoft Office Excel 2003. RESULTS: Review articles were cited most frequently with a mean of 5.21 followed by original articles with 4.28 citations and case reports with 2.40 citations. The difference in citing between original articles and case reports was statistically significant (P < 0.0001). There was no statistically significant difference in citations between review articles and original articles. CONCLUSIONS: As case reports are clearly of lesser academic value than original and review articles, we suggest a scoring system incorporating journal impact factor and a scoring multiple taking into account study design. This facilitates easier comparison and recognition of publications in curricula vitae during job application.

Lymphocyte-white blood cell count ratio: a quickly available screening tool to differentiate acute purulent tonsillitis from glandular fever.

OBJECTIVE: To find a quickly available screening tool for the differentiation of patients with glandular fever from those with acute purulent tonsillitis. The null hypothesis was that there was no difference between the lymphocyte-white blood cell count (L/WCC) ratio between the 2 patient groups. DESIGN: Retrospective pilot study based on laboratory tests for lymphocyte counts, white blood cell counts, and the mononucleosis spot test. SETTING: Ear, Nose, and Throat Department, St George's Hospital, London, England. PATIENTS: One hundred twenty patients with glandular fever and 100 patients with bacterial tonsillitis. MAIN OUTCOME MEASURES: Results from the mononucleosis spot test in conjunction with the clinical picture and the L/WCC ratio were analyzed. Significant differences were evaluated using the Mann-Whitney test and Fisher exact test. RESULTS: The L/WCC ratio was significantly different in the 2 groups (P<.001). The mean L/WCC ratio in the glandular fever group was 0.54 and the mean L/WCC ratio in the bacterial tonsillitis group was 0.10. A ratio higher than 0.35 had a specificity of 100% and a sensitivity of 90% for the detection of glandular fever. CONCLUSIONS: We recommend that the L/WCC ratio should be used as an indicator to decide whether mononucleosis spot tests should be requested. A ratio higher than 0.35 had a high specificity in our study group.