Fifty years of woodworkers' nasal adenocarcinoma in High Wycombe.

BACKGROUND: Since adenocarcinoma of the ethmoid sinuses was first described as an occupational disease in the woodworkers of High Wycombe, over the 50 subsequent years there has been a gradual decrease in the numbers to none over the last 12 years. Although this mirrored the decline in local industry, it seems the causative factor was first seen and then disappears over a 50-year period. METHODS: A total of 146 cases have been traced historically over this time as well as personal experience of 33 cases; these cases are reviewed and success with a new modality of treatment is discussed. CONCLUSION: This paper outlines how the disease was initially recognised, both its diagnosis and treatment development. It also describes how both the appearance and disappearance were seemingly caused by changes in manufacturing practice.

Esme Hadfield (1921-92) and the Wycombe woodworkers.

This paper reflects on the life and work of Esme Hadfield, an otolaryngologist based at Wycombe General Hospital and, in particular, on her discovery of the link between adenocarcinoma of the paranasal sinuses and wood dust exposure from those in the furniture industry. The paper also explores the woodworking industry that forms the backdrop to her discovery.

Mucous membrane pemphigoid: nasal and laryngeal manifestations.

Mucous membrane pemphigoid (MMP) is a sub-epithelial blistering disease that primarily involves mucosal surfaces but may also involve the skin. Clinically, it appears as vesiculobullous lesions of the oral cavity and eyes, but other tissues such as the nasopharyngeal and laryngeal mucosa can also be affected. Ultimately, scarring and airway stenosis may occur. The condition should be managed by a multidisciplinary team led by a dermatologist. Immunosuppressive therapy forms the mainstay of treatment, with surgery having both a diagnostic role and a use in the treatment of complications such as airway obstruction. There must be a low threshold of suspicion for laryngeal involvement in this group of patients, so that prompt action can be taken. Once laryngeal stenosis has occurred repeated endoscopic laser excision of scar tissue can be used to maintain an adequate airway. Adjuvant use of mitomycin-C can be used beneficially in the treatment of laryngeal complications of MMP.

External auditory canal pH in chronic otitis externa.

Several risk factors have been postulated to play a part in the progression of acute into chronic otitis externa, including changes towards alkalinity of the skin pH of the external auditory canal. These changes have been previously reported to occur in the acute stage, and their persistence may predispose to a chronic status of this condition. This prospective control study was designed to look at this possible relationship in more depth, by comparing the external auditory canal pH of individuals with chronic otitis externa, but with no current exacerbation, with an age-/sex-matched control group. Analysis of the data revealed a significantly higher external auditory canal pH in the chronic otitis externa group (P < 0.004) when compared with the controls, with no concomitant difference in body skin pH. Within this chronic otitis externa cohort, a statistically significant correlation was found between external auditory canal pH and the severity of the condition, as assessed using a multiparameter scoring system (r = 0.562; P < 0.02). Importantly, the pH was not related to the length of time since the last exacerbation. There was a significant age relationship present within our sample. Younger patients displayed more severe chronic otitis externa(r = -0.813; P < 0.001), with correspondingly higher external auditory canal pH values (r = -0.550; P < 0.02). The results suggest that alkaline ear canal skin is a local risk factor for the progression into chronic otitis externa, occurring, in this study, with greater severity in younger individuals.

Adenocarcinoma of the ethmoid sinuses: a case of two primary tumours.

The authors present a case report of a retired furniture worker who initially presented with a mucin-secreting adenocarcinoma of the right ethmoid sinus. He underwent surgical resection, leaving the nasal septum intact, and topical treatment with 5-fluorouracil. He remained disease free. Three years after his initial presentation he was found to have a left nasal polyp on routine examination. This subsequently proved to be a second primary adenocarcinoma. A review of the literature has not shown any other cases of a second primary adenocarcinoma of the ethmoid sinuses.

Fluctuating hearing loss in West African and West Indian racial groups: yaws, syphilis or Meniere's disease ?

Four cases of fluctuating hearing loss in West African and West Indian racial groups are presented. Two are Meniere's disease, and the authors are unaware of any report in English publications describing Meniere's disease in these racial groups. One is late syphilitic hearing loss and the other is idiopathic. The possible role of yaws is presented and long-held beliefs questioned (Summary)