Epstein-Barr virus in exfoliated cells from the postnasal space. Viral detection by polymerase chain reaction is not a useful means of screening for nasopharyngeal carcinoma in high-risk populations.

There is a high incidence of undifferentiated nasopharyngeal carcinoma (NCP) in certain populations, including Greenland Eskimos. The cancer appears to have a causal association with Epstein-Barr virus (EBV), which is regularly found in NPC epithelial cells. With the aim of developing a method of screening or facilitating early diagnosis of NPC, we used the polymerase chain reaction to examine exfoliated nasopharyngeal cells for EBV in 54 Greenland and 17 white Danish subjects, none of whom was suspected of having NPC. EBV DNA was found in 81% of Greenland and 35% of Danish subjects. These findings support the concept of EBV infection leading in most cases to a chronic carrier state. It is concluded that EBV detection in nasopharyngeal cells is not at present a suitable method for identification of individuals at increased risk of developing NPC.

Spindle cell carcinoma of the larynx.

Histology, histogenesis, biology and treatment of the rare spindle cell carcinoma of the larynx are presented. The histogenesis of spindle cell tumours has been much debated, but electron microscopic investigations have shown that most of the laryngeal lesions are squamous epithelial carcinomas that have undergone transformation to a spindle cell pattern. As confusion with supporting tissue neoplasms may occur in the light microscope, the use of the electron microscope in differential diagnostics is recommended.

Otolaryngological complications in infectious mononucleosis.

Otolaryngological complications occurred in 5 per cent of 467 patients with infectious mononucleosis admitted consecutively to the ENT-department during the period 1 April 1969 to 30 June 1981. Four patients had peritonsillar abscess and five patients developed potentially lethal obstruction of the upper airway. Such complications require intervention and, as the latter condition probably is the most frequent fatal complication of IM, we find it important that patients with even slight respiratory embarassment in infectious mononucleosis should be observed and treated in an ENT-department.

Bilateral sudden deafness and acute acquired toxoplasmosis.

An 18-year-old woman, while suffering from acute acquired toxoplasmosis, experienced sudden deafness and a total loss of vestibular function first in the right ear and three months later also in the left. Following treatment with sulphadiazine and pyrimethamine, hearing was retrieved to such a degree that the patient was enabled to communicate by means of a body-worn hearing aid and lip-reading. Taking the differential diagnostic possibilities into account, we believe that toxoplasmosis was the cause of the severe hearing loss. Since effective treatment seems to be available, we recommend that patients with acute bilateral sensorineural hearing loss of unknown origin are examined for acute toxoplasmosis with a view to instituting chemotherapy.

Carcinoid tumor of the middle ear.

Carcinoid tumor of the middle ear is a very rare benign neoplasm, which may be mistaken for a malignant tumor. We present two new cases together with a review of 28 previously reported cases. Nearly all patients had progressive hearing loss, most often of the conductive type. About half of the patients complained of tinnitus and fullness of the ear. The typical otoscopic picture was erythema or lateral bulging of the tympanic membrane, which was intact in most patients. The tumor was most often localized to the middle ear with varying degree of extensions into neighboring areas. It often encapsulated the ossicles, which sometimes were eroded. Systemic symptoms were only reported in two cases. The tumor is clinically benign and total excision of the tumor and affected ossicles is an adequate treatment. The correct diagnosis, which should be considered in case of any adenomatous tumor of the middle ear, requires immunohistochemical and ultrastructural procedures.

On prediction of hearing disability.

The present investigation was performed in order to evaluate the pure-tone frequency and/or averages of frequencies best correlated with speech intelligibility measured by the discrimination score (DS) in quiet and in background noise, and, in addition, indicate a valid low fence of the DS when correlated to a self-assessment procedure. The material comprises 158 male subjects with a median age of 60 years, range 52-72 years, drawn from an ongoing longitudinal epidemiological investigation. By self-assessment 36% indicated hearing disability in noisy backgrounds, while 64% had no hearing problems. The pure-tone frequency that correlated best with the speech intelligibility in quiet was the 2-kHz pure-tone frequency. In background noise the best correlation was found with the 3-kHz pure-tone frequency. In the group of subjects with complaints of hearing problems, the median discrimination score in background noise was 84% (IQR 72-92), while in the group of subjects with no complaints the median discrimination score in noise was 92% (IQR 88-96). Based on the results it is concluded that DS in background noise is a valuable measure in the assessment of hearing disability, but no low fence value can be indicated on the basis of the present results.

Epidemiology of hearing impairment in male subjects: a follow-up investigation.

As part of a longitudinal study 158 male subjects, with a median age of 60 years, range 52-72 years, were re-examined after a 3-year interval. No significant deterioration in their hearing sensitivity was demonstrated when measured by pure-tone or speech audiometry. The prevalence of hearing impairment is 39% based on the criterion greater than or equal to 20 dB HL averaged over 0.5, 1, 2, 3, and 4 kHz. This is similar to the prevalence of 36% experiencing hearing problems in daily listening situations.

Malignant Warthin's tumour: a case study.

Malignant transformation of a benign Warthin's tumour (adenolymphoma) is extremely rare. The light microscopic and ultrastructural features of an adenocarcinoma arising in a Warthin's tumour in the parotid gland are described. Light microscopy demonstrated a transition zone from the benign to the malignant component, and the malignant cells revealed oncocytic features by both light- and electronmicroscopy.