Cervical tuberculous lymphadenitis: diagnosis and demographics, a five-year case series in the UK.

Introduction Cervical tuberculous lymphadenitis is a low-volume condition in the UK with a potential for delayed diagnosis. This study describes typical demographic and clinical features of patients diagnosed with cervical tuberculous lymphadenitis in a UK population. The utility of cytological, histological and microbiological investigations is reviewed with comparison between fine-needle aspiration and open biopsy. This information can facilitate recognition of new cases and guide initial management. Methods Patients diagnosed with cervical tuberculous lymphadenitis between January 2009 and December 2013 at two district general hospitals were identified from local infectious disease databases. Retrospective case-note review was undertaken to collect demographic and diagnostic data and associated complications. Results Full data were available for 51 patients aged 19-70 years (mean 32.4 years) with mean follow-up of 370 days; 49/51 patients were immigrants to the UK with a wide geographic spread in the countries of origin and time since arrival; 42/51 had no significant comorbidities, although two patients had coexistent HIV infection. The clinical presentation was most frequently without constitutional symptoms (39/51) and often with no history of tuberculosis contact. Posterior triangle neck nodes were most commonly involved (26/51). Conclusion The 'typical' patient with cervical tuberculous lymphadenitis in our region is a young healthy individual who came to the UK from a high-risk country several years earlier. Diagnosis by fine-needle aspiration is as effective as open biopsy if fluid/pus is aspirated. Open biopsy is potentially associated with complications but does not appear to increase chronic wound discharge rates in our series.

Managing chondrosarcoma of the epiglottis: a case report.

Laryngeal chondrosarcomas are a very rare malignancy with less than 150 cases reported in the literature. Of these, the epiglottis is the most unusual primary neoplastic subsite. Uncertainties arise owing to the extremely rare nature of the condition with regard to treatment and investigation for metastases in overtly low grade cases. We present the case of a 62-year-old woman with a low grade chondrosarcoma, arising from the tip of the epiglottis, presenting with dysphagia but no other symptoms.

Tenosynovial giant cell tumour of the neck.

We report the case of a diffuse tenosynovial giant cell tumour to be found adjacent to the thyroid gland. These tumours, also known as extra-articular pigmented villonodular synovitis, are found more commonly in the fingers, wrist, knee thigh and foot, rarely in the head and neck. These tumours are prone to local recurrence, require a high clinical index of suspicion and if they have atypical features may be extremely difficult to obtain a histological diagnosis.

Detection of fungi in sinus fluid of patients with allergic fungal rhinosinusitis.

We aim to develop a rapid, accurate and sensitive diagnostic assay with which to detect the surface antigens of fungi thought to be involved in allergic fungal rhinosinusitis (AFRS), by assessing the usefulness of immunofluorescence microscopy (IMF) and enzyme linked immuno-absorbent assays (ELISA). The age, sex, clinical symptoms and signs, imaging (CT and/or MRI), microbiological subculture data, sinus contents, blood eosinophilia, aspergillosis precipitins, radioallergoabsorbent technology (RAST) for fungal allergens and histopathology were performed on individuals undergoing endoscopic sinus surgery for suspected AFRS. Thirteen patients were examined, and five monoclonal antibodies raised to the surface washings of various fungi were found to recognize and differentiate between fungal species implicated in sinus disease, i.e. Aspergillus niger, Alternaria alternata, Cochliobolus lunata, Penicillium expansum and Cladosporium species. The IMF microscopy proved to be a useful assay to distinguish visually between the cultured fungi, but was less useful for visualization of fungi in the patient samples. However, ELISA assays with 5 monoclonal antibodies gave clear and unambiguous data as to the presence of certain fungi within the patient samples. There is good correlation between the ELISA data and the pathology findings. This preliminary study suggests that both IMF and ELISA techniques may offer an important advance in this area.

Otomycosis: the detection of fungi in ears by immunofluorescence microscopy.

The procedure currently used to diagnose infection in otitis externa has several limitations: it is slow to culture organisms on growth media, fungal infections are often missed, and extensive laboratory facilities and mycological expertise are required. A rapid, accurate and sensitive assay would greatly improve patient care by initiating appropriate antifungal treatment at the onset of disease. We report the development of a rapid detection assay for otomycosis using fungal-specific monoclonal antibodies to detect fungi in ear swabs by immunofluorescence microscopy. This assay could form the basis of a detection assay for fungal infections of the head and neck.

Acoustic rhinometry of the Indian and Anglo-Saxon nose.

The internal and external geometry of the nose has previously been shown to differ between Anglo-Saxon, Chinese, and Negro noses. It is therefore important to define the normal geometric nasal parameters of a given race, so as to detect the abnormal nose. We present acoustic rhinometric data, with height-adjusted figures, examining the nasal minimum cross-sectional area (MCA), the distance to the nostril from the MCA, and the MCA between 0-6 cm. These data show no significant differences between Indian and Anglo-Saxon noses.

The detection of Mycoplasma pneumoniae in nasal polyps.

The aetiology and microbial flora of nasal polyps is not well understood. No study in the literature has reported an association between the sub-bacterium Mycoplasma pneumoniae and nasal polyps. We have developed an assay method using the Polymerase Chain Reaction (PCR) to amplify a specific region of the M. pneumoniae DNA in extracts of clinical samples using species-specific primers designed to a region of the 16S rRNA. The presence of M. pneumoniae was detected in 13/14 (93%) nasal polyps, in 4/5 (80%) rhinosinusitis mucosal samples but only in 1/7 (14%) of control samples (obstructive turbinates). An epidemic of infections due to M. pneumoniae is expected to occur in 1995. We believe this assay could form the basis of a rapid technique for M. pneumoniae detection. We also propose that the presence of M. pneumoniae may be of importance in the aetiology of nasal polyps.

Laser-Doppler blood flowmetry measurement of nasal mucosa blood flow after injection of the greater palatine canal.

Laser-Doppler blood flowmetry was used to measure the mucosal blood flow of the inferior turbinate before and after injection of the greater palatine canal with 2 ml of a 0.5 per cent bupivicaine hydrochloride solution. Injection of the greater palatine canal is a useful technique in the control of posterior epistaxis. The arterial blood supply to the inferior turbinate is via a single descending branch of the sphenopalatine artery. We conjectured that injection of the pterygopalatine fossa, via the greater palatine canal, would result in a reduction of blood flow to the inferior turbinate. In this study injection of the pterygopalatine fossa caused only a 4.7 per cent decrease in blood flow to the inferior turbinate mucosa (p = 0.571). Elevation of the head by an angle of 20 degrees reduced nasal mucosal blood flow by 38.3 per cent (p < 0.0001). Depression of the head by an angle of 20 degrees increased nasal mucosal blood flow by 74.7 per cent (p < 0.0001). We conclude that there is an adequate collateral blood circulation to the anterior portion of the inferior turbinate.

Provox valve use for post-laryngectomy voice rehabilitation.

The Provox voice prosthesis has been used in our department since September 1992 for post-laryngectomy voice rehabilitation. This prosthesis is an indwelling low-resistance tracheoesophageal valve. The cohort consisted of 28 laryngectomes with a mean follow-up time of 352 days. The average valve life before failure was 148 days. Speech intelligibility of 85 per cent was achieved for complete sentences. No major surgical problems were associated with the valve insertion or its use. Replacement of the prosthesis as an outpatient procedure was accomplished without difficulty.

Day-case adenoidectomy, parental opinions and concerns.

Day-case surgery has been urged on the National Health Service by the Audit Commission in the last decade despite concerns about safety. A questionnaire was posted to the parents of 109 children who had recently undergone day-case adenoidectomy, addressing parental concerns and opinions. Eighty per cent of the questionnaires were returned. A high level of satisfaction with day-case adenoidectomy was expressed by the parents. All the children were observed for six hours after surgery prior to discharge. One child was visited at home by his general practitioner in the first 24 hours of discharge but there were no serious post-operative complications and none of the children required re-admission to hospital. Day-case adenoidectomy is safe, very acceptable to parents and does not result in a greatly increased workload for general practitioners.

Does the type of middle ear aspirate have any prognostic significance in otitis media with effusion in children?

Two hundred and twenty-two children with chronic, bilateral middle ear effusions were assessed during a 2 year follow-up period. At initial myringotomy the middle ear aspirate was found to be serous in 44 children and mucoid in 178 children. Evaluation at 1 and 2 years post-operatively showed no difference in otoscopic fluid clearance or mean hearing threshold at either follow-up time in relation to either type of fluid. There was no greater need for ventilation tube reinsertion in either group during the overall follow-up period. There was found to be no significant difference between the children with serous or mucoid effusions in relation to a range of pre-operative and operative variables. The study suggests that outcome in terms of fluid clearance and hearing thresholds is independent of the fluid type and there appears no greater need for revision ventilation tube insertion in relation to the findings at myringotomy. The type of effusion found on aspiration prior to ventilation tube insertion has no prognostic value. Children with serous fluid should be managed in an identical manner to those in which the fluid is thicker and mucoid in character.

Tinnitus in pregnancy.

The presence of tinnitus in pregnancy was investigated by a postal questionnaire survey. A group of pregnant women attending the ante-natal clinic and a control group of non-pregnant members of the nursing staff at the Royal United Hospital in Bath were studied. The prevalence of tinnitus in the pregnant and non-pregnant women was compared. Both groups were similar in age, previous noise exposure and the presence of ear disease or operations. Twenty-five per cent of the pregnant women reported tinnitus compared with 11% of the control group. Chi-square analysis of this data gives a value of chi 2 = 4.07, d.f. = 1, P < 0.05. The result of our survey shows that there is significantly increased prevalence of tinnitus in pregnant women compared with a similar non-pregnant control group. This association has not been previously reported.

Tympanic membrane perforation following the removal of ventilation tubes in the presence of persistent aural discharge.

This study considers the effect of the removal of a ventilation tube from the tympanic membrane of an ear which has been affected with persistent mucopurulent discharge for at least 3 months. The records of 332 patients were reviewed. Thirty-three patients with 34 ears satisfied the entry criteria. Tube removal cured 27 out of 34 ears (79%) of aural discharge within 1 month. The tympanic membrane healing rates were: at 1 month, 14 (41%); at 3 months, 23 (68%); at 6 months, 24 (71%); and at 1 year, 28 (82%). A table is presented comparing perforation rates from different ventilation tube studies.