Showing papers in "Clinical Otolaryngology in 1982"
TL;DR: A retrospective clinico-pathological study has been carried out in patients with squamous cell carcinoma of the head and neck who underwent a total of 484 radical neck dissections, finding histological extra-nodal spread to be the most important single prognostic factor.
Abstract: A retrospective clinico-pathological study has been carried out in a series of 405 patients with squamous cell carcinoma of the head and neck who underwent a total of 484 radical neck dissections. The recurrence rate in the neck in 327 patients who had histological positive nodes was 21.1%. Recurrence in the neck after a standard radical neck dissection almost invariably proved fatal. A statistical analysis has been carried out to evaluate the clinical and pathological factors which are of importance in regards to recurrence in the neck. Histological factors such as extra-nodal spread and the number of histological positive nodes have been shown to be of much more prognostic importance than clinical parameters. When corrections are made for interdependencies between variables, histological extra-nodal spread proved to be the most important single prognostic factor (P less than 10(-7)).
444 citations
TL;DR: Patients with hyperplasia, keratosis, dysplasia and carcinoma in situ should be carefully followed up, as invasive carcinoma may develop many years after the initial diagnosis.
Abstract: Comparison of reported series of laryngeal lesions is complicated by the inconsistency in the terminology. The classification of these lesions should logically be based on the degrees of dysplasia, as this has a bearing on the prognosis. The material for this study consisted of 193 patients with hyperplasia and/or keratosis, with or without mild dysplasia (Group I), moderate dysplasia (Group II), and severe dysplasia and carcinoma in situ (Group III). They were treated over a 14-year period (1966-1979) at Linkoping University Hospital. Of the 98 patients in Group I available for follow-up, 23 had repeat excisions. Moderate dysplasia developed in 3 patients, severe dysplasia in 2, and invasive carcinoma in another 2 within 3 and 3.5 years; they both underwent laryngectomy. Among the 24 patients in Group II available for follow-up, severe dysplasia developed in 3 and invasive carcinoma in 3 up to 13 years after the initial diagnosis, all but one (with severe dysplasia) received a full course of radiotherapy, on one case total laryngectomy was subsequently performed for recurrent carcinoma. Of the 39 patients with severe dysplasia and carcinoma in situ 16 were given primary radiotherapy; 4 of these developed invasive carcinoma; 3 of them underwent total laryngectomy and one partial laryngectomy. Excision or stripping of the vocal cords was the primary treatment in 23 cases; 5 of these developed invasive carcinoma; 2 of them underwent total laryngectomy. Diffuse lesions and well differentiated forms of severe dysplasia caused most problems and had the highest incidence of invasive carcinoma irrespective of the form of treatment. Patients with hyperplasia, keratosis, dysplasia and carcinoma in situ should be carefully followed up, as invasive carcinoma may develop many years after the initial diagnosis.
170 citations
156 citations
TL;DR: Ear, nose and throat symptoms and signs were studied in 15 patients with Kartagener's syndrome: a triad consisting of chronic rhinosinusitis, chronic bronchitis with bronchiectasis, and situs inversus, causing primary ciliary dyskinesia.
Abstract: Ear, nose and throat symptoms and signs were studied in 15 patients with Kartagener's syndrome: a triad consisting of chronic rhinosinusitis, chronic bronchitis with bronchiectasis, and situs inversus. The triad is caused by primary ciliary dyskinesia and characterized by absent or considerably reduced mucociliary transport. Daily accumulation of secretions in the nose, chronic recurrent secretory otitis media and sinusitis occurred in all subjects. Characteristically, nasal discharge started at birth or was first detected in early childhood. Apparently, the frequency of common colds and of acute purulent otitis media was not increased. As primary ciliary dyskinesia can occur without situs inversus, knowledge of the typical ENT symptoms is essential for making an early diagnosis, which is important for the correct management of the disease. While a conservative surgical approach to treatment of the ENT symptoms is recommended, early and active treatment of the bronchial symptoms is probably important for prevention of further lung damage and development of bronchiectasis.
59 citations
TL;DR: One hundred and nine congenital nasal masses which presented to two children's hospitals over a 20 year period are reviewed and a management protocol is advocated.
Abstract: One hundred and nine congenital nasal masses which presented to two children's hospitals over a 20 year period are reviewed. The diagnosis of the nasal mass is discussed with respect to age, mode of presentation, and site of the lesion, and a management protocol is advocated.
57 citations
55 citations
TL;DR: During a 10 year period (1969-1978) 922 patients with facial fractures were hospitalized at the Department of Otolaryngology, Jönköping Central County Hospital, Sweden, and eighty percent were men.
Abstract: During a 10 year period (1969-1978) 922 patients with facial fractures were hospitalized at the Department of Otolaryngology, Jonkoping Central County Hospital, Sweden. Eighty percent were men. The peak incidence occurred at the age of 21-30 years. The yearly number of facial fractures was doubled between 1969 and 1974, after which no marked increase was noted. The aetiologies of the fractures were fights (28%), traffic accidents (23.5%), sport activities (17.4%). There was a comparatively low number of work related facial fractures in this study (8.1%). Front seat passengers, car drivers and cyclists represented a great portion of the traffic injury group. The number of fractures caused by traffic accidents decreased after 1974, a fact that may be due to the safety-belt law. Language: en
45 citations
TL;DR: There was no significant difference between traditional Chinese acupuncture and placebo (Wilcoxon test, P greater than 0.05, one-tailed); there was no relation between the patients' subjective statements and the results of sound balance measurements as an objective standard of tinnitus (Spearman test).
Abstract: In a double-blind controlled trial the effect of traditional Chinese acupuncture versus placebo acupuncture was evaluated among 17 patients (8 females and 9 males, mean age 45.7 years) with chronic (mean disease duration 5.3 years) unilateral tinnitus. None of the patients had any treatable otological disease. All patients suffered from daily tinnitus, the intensity of which was recorded by the patients themselves every day during a period of 15 weeks. Each patient was treated by traditional Chinese acupuncture as well as placebo acupuncture following randomization (Figure 1). Each period of treatment comprised 2 treatments a week for 3 weeks. Throughout the whole investigation a period effect was recorded, insignificant in the acupuncture-placebo group, but significant in the placebo-acupuncture group (Friedman analysis of variance) (Table 4). There was no significant difference between traditional Chinese acupuncture and placebo (Wilcoxon test, P greater than 0.05, one-tailed). There was no relation between the patients' subjective statements and the results of sound balance measurements as an objective standard of tinnitus (Spearman test).
44 citations
TL;DR: Patients who were free of tumour 5 months to 14 years after total laryngectomy or a commando procedure were given questionnaires designed to obtain the patient's assessment of their resulting disability.
Abstract: Forty-nine patients who were free of tumour 5 months to 14 years (mean 30 months) after total laryngectomy or a commando procedure were given questionnaires designed to obtain the patient's assessment of their resulting disability. Sixteen areas of disability were studied grouped under five main headings: speech, eating, cosmetic, employment and social. Following laryngectomy more than half of the patients achieved successful communication by oesophageal speech. Success in this was usually associated with minimal problems in other areas. The disabilities after commando procedures were more varied and complex. More patients reported severe disability in more than one area. Difficulties with chewing and swallowing were prominent. The results are illustrated with patients' comments. Ways in which rehabilitation might be improved are considered.
39 citations
TL;DR: It is concluded that salivary calculus is the most important indication for removal of submandibular gland, for reasons other than neoplasia, during 1960-1975 at Karolinska sjukhuset, Stockholm.
Abstract: During 1960-1975, 115 submandibular glands were removed for reasons other than neoplasia at the Ear, Nose and Throat department, Karolinska sjukhuset, Stockholm. The material was retrospectively analysed with regard to clinical and histopathological findings. The patients, 62 men and 52 women aged 13-77 years, exhibited in all cases but one a chronic sialadenitis. Salivary calculi were found in 82% of the patients. In one patient a mucous retention cyst was found. Microscopically some cases exhibited only a slight periductal inflammation, while others showed a complete destruction of the gland architecture. The duration of symptoms of the whole group before surgery varied from 1 week to 55 years but with a median value of almost 1 year. The conclusion of this study is that salivary calculus is the most important indication for removal of submandibular gland, for reasons other than neoplasia.
32 citations
TL;DR: Every attempt should be exerted to spare the involved nerve even on the expense of leaving behind a part of the tumour which is definitely benign and having practically no tendency for malignant change.
Abstract: Sixteen cases of schwannomata of the neck were included in this study. Clinical and pathological features were analysed. Pre-operative diagnosis was always difficult and was achieved in only three cases. The lesion should be suspected whenever examining the neck for a solitary swelling of long standing. Schwannomata of the cervical vagus or sympathetic chain usually bulge into the pharynx and present as parapharyngeal tumours. Neurological deficits were absolutely absent in our cases. Every attempt should be exerted to spare the involved nerve even on the expense of leaving behind a part of the tumour which is definitely benign and having practically no tendency for malignant change.
TL;DR: The main cause of the fracture was violence, followed by traffic accidents, fall and sport, and in more than 25% of the cases, the fractures were accompanied by another fracture of the facial skeleton, viz maxillary, mandibular and nasal fractures.
Abstract: One hundred and five patients with zygomatic fractures are presented. The main cause of the fracture was violence, followed by traffic accidents, fall and sport. In more than 25% of the cases, the fractures were accompanied by another fracture of the facial skeleton, viz maxillary, mandibular and nasal fractures. In severe cases of traffic accidents there were associated fractures in more than half of the cases. The follow-up study showed visible asymmetry of the face in 17 patients and sensory disturbances in 37 patients. We did not find the X-ray subdivision by Knight & North useful in the evaluation of the stability of the fractures. As a method of choice in cases of dislocated zygomatic fractures, we used reposition by the method of Gillies and in cases of instability this reposition was combined with internal wiring, reconstruction of the orbital floor and antral packing. An active attitude towards reconstruction of the orbital floor is recommended.
TL;DR: Hypertension proved to be the most important single discriminating variable in a group of patients with Bell's palsy.
Abstract: The purpose of this study was to assess the frequency of risk factors for vascular disease like hypertension, lipid disturbances and diabetes mellitus in a group of patients with Bell's palsy. These patients were compared to patients with a peripheral facial paralysis of known origin. We did find a statistically significant difference between the Bell's palsy patients and their controls for cardio-vascular variables only. Hypertension proved to be by far the most important single discriminating variable.
TL;DR: No significant difference in the size of the adenoid was found in a series of children with middle ear fluid compared with children who had sustained a head injury, casting doubt on the role of enlarged adenoids in the aetiology of serous otitis media.
Abstract: The size of the adenoid in a series of children with middle ear fluid was compared radiologically with the size of the adenoid in a series of age and sex-matched children who had sustained a head injury. There was no significant difference in the size of the adenoid in the 2 series of children. This therefore casts doubt on the role of enlarged adenoids in the aetiology of serous otitis media in the majority of children with this condition.
TL;DR: It is shown that patients treated primarily by surgery achieve worse results than those treated by radiotherapy.
Abstract: In the treatment of glottic T3 carcinoma there are four possible methods (1) primary radical surgery, (2) primary radical radiotherapy, (3) radical surgery with preoperative irradiation or (4) partial surgery. This study shows that patients treated primarily by surgery achieve worse results than those treated by radiotherapy.
TL;DR: Empirical findings in the two groups of lesions can be used as clinico-pathological definitions of "branchial cysts' and "brachial sinuses and fistula' respectively" and should be given other names.
Abstract: In a study of 57 lateral cervical lesions, 46 cysts were found to form a homogeneous group and four sinuses and fistulae formed another homogeneous group. The cysts lay behind the angle of the mandible, and were lined by stratified squamous epithelium resting on lymphoid tissue, with part of the wall resembling a lymph node. The sinuses and fistulae had life-long external openings and were muscular tubes lined by respiratory-type epithelium. The other seven lesions had some other structure. Such uniformity of clinico-pathological features of supposed branchial lesions has not been demonstrated before and no explicit definition of them has ever been published. We suggest that our empirical findings in the two groups of lesions can be used as clinico-pathological definitions of ‘branchial cysts’ and ‘brachial sinuses and fistulae’ respectively. Lesions with other features should be given other names.
TL;DR: Until the masking procedures in audiometry are standardized, hearing gain may be regarded as the most satisfactory alternative for describing hearing results as it is based on the air conduction thresholds only.
Abstract: At present there is no universally accepted method for calculating hearing results after chronic ear surgery. In this study the methods most frequently used have been applied to a material of 105 tympanoplasties and compared to each other. In addition a comparison between pre- and post-operative bone conductions (BC) thresholds for calculating post-operative air-bone gaps has been performed using multiple regression analysis. The results lend support to the conclusion that BC thresholds will improve with surgery in successful cases and that the post-operative BC threshold is a closer approximation of the cochlear function than the pre-operative one and consequently should be used for gap calculations. However, until the masking procedures in audiometry are standardized, hearing gain may be regarded as the most satisfactory alternative for describing hearing results as it is based on the air conduction thresholds only. This method requires a careful description of pre-operative air and bone conduction thresholds.
TL;DR: Fusion of cilia, the growth of clumps of fused cilia and giant cilium formation have been studied in the normal human organ of Corti using the scanning electron microscope and are discussed in the light of recent experimental work on cell fusion.
Abstract: Fusion of cilia, the growth of clumps of fused cilia and giant cilium formation have been studied in the normal human organ of Corti using the scanning electron microscope. These unusual forms are found mainly in the apical portions of the cochlea and appear to precede the loss of normal apical cilia which increases and extends in a basal direction with age. These changes may be due to low frequency noise damage or be a phenomenom of ageing. The mechanism of their formation is discussed in the light of recent experimental work on cell fusion.
TL;DR: From a review of the literature and personal assessment of the cases presented here it would appear that local conservative endoscopic treatment with careful follow-up may be the treatment of choice for certain verrucous carcinomata.
Abstract: Verrucous carcinmoma of the larynx is an uncommon but distinct variety of well differentiated squamous carcinoma and accounts for 1–2% of all laryngeal squamous carcinomata. Awareness of the condition both by clinician and histopathologist is essential otherwise the diagnosis may not be made. From a review of the literature and personal assessment of the cases presented here it would appear that local conservative endoscopic treatment with careful follow-up may be the treatment of choice for certain verrucous carcinomata. Such treatment may be either suction diathermy or cryosurgery or laser surgery. Anaplastic transformation has been said to occur following irradiation of these tumours, though this view is not held by all clinicians, some of whom recommend radiotherapy for selected cases.
TL;DR: It has been concluded that the size of the footplate fenestration plays a major role in the outcome, both immediately, and in the long term, of protection of cochlear function following stapedectomy.
Abstract: The protection of cochlear function following stapedectomy has emerged as the major problem in the surgical treatment of otosclerosis. Both immediate and delayed sensorineural losses continue to occur in spite of refinements of technique. The frequency and extent of these complications has been investigated by prospective and retrospective studies of the author's patients. It has been concluded that the size of the footplate fenestration plays a major role in the outcome, both immediately, and in the long term. Revision operations are necessary when initially good results rapidly deteriorate, both to resolve complications such as perilymphatic fistulae and also to restore function. Although second ear operations are usually worthwhile, they should be performed only when certain specific criteria have been met. The expected duration of unaided hearing gain, although often adequate when a standard large fenestra operation is performed, is considerably prolonged by restricting the size of the footplate to less than half its total area. For reasons unknown, bone conduction thresholds appear to be better, eventually, in operated as compared to unoperated ears.
TL;DR: Cases presenting to the Royal National Throat, Nose and Ear Hospital, London, over the previous 10 years are described to illustrate the difficulties in management.
Abstract: The term ‘ranula’ implies a transparent cystic swelling in the floor of the mouth which is usually unilateral. The current aetiological theory is that these cysts arise from the sublingual salivary glands and present as two clinical types: (1) the simple ranula (which has an epithelial lining) or (2) the plunging ranula (which is an extravasation pseudocyst). This is poorly understood and 8 cases presenting to the Royal National Throat, Nose and Ear Hospital, London, over the previous 10 years are described to illustrate the difficulties in management. Treatment consists of excision of the associated sublingual glands which are the origin of these lesions.
TL;DR: The test protocol developed and revised at the University of Washington provides a differential diagnostic means of identifying endolymphatic hydrops which is a specific and practical test which is easily available as a routine office procedure.
Abstract: The response of patients with suspected Meniere's disease to the glycerin test was reviewed in a prospective evaluation covering a 10 year period. Three hundred and eightly three patients with 495 suspect ears were tested and were classified as to hearing improvement 3 h post-orally administered glycerin. Two hundred twenty-five patients (265 ears) were diagnosed as Meniere's disease. Sixty-six percent of these ears showed significant hearing improvement by pure tone threshold and/or speech discrimination measurements with the glycerin test. The test protocol developed and revised at the University of Washington provides a differential diagnostic means of identifying endolymphatic hydrops which is a specific and practical test. It is easily available as a routine office procedure.
TL;DR: The histopathology of the right temporal bone of a 47 year old deaf woman with Turner's Syndrome (gonadal dysgenesis) is described and the appearances are of the Mondini deformity, the cochlea consisting of a single basal turn with a bulbous apical dilatation.
Abstract: The histopathology of the right temporal bone of a 47 year old deaf woman with Turner's Syndrome (gonadal dysgenesis) is described. The appearances are of the Mondini deformity, the cochlea consisting of a single basal turn with a bulbous apical dilatation. The organ of Corti was absent. The remainder of the bony labyrinth save for the cochlear aqueduct was normal. The patient's death was due to a cerebral astrocytoma. Previous reports concerning the co-existence of gonadal dysgenesis, congenital deafness and non-gonadal neoplasia are discussed.
TL;DR: A series of 76 cases of laryngeal carcinoma was examined in transverse slices using a motorized slicing machine and eleven cases of ventriculosaccular carcinoma were detected and the topography and gross appearances of the tumours in the larynges are described.
Abstract: A series of 76 cases of laryngeal carcinoma was examined in transverse slices using a motorized slicing machine. Eleven cases of ventriculosaccular carcinoma were detected by this method and the topography and gross appearances of the tumours in the larynges are described. Microscopy of the tumour indicates a keratinizing squamous cell carcinoma the mode of growth of which seems to be by concentric expansion through the whole margin rather than by invading tongues of tumour. In no case was there invasion of laryngeal cartilages or extension to the surgical cut surface of the specimen. The clinical, radiological and biopsy features in 10 of the 11 patients are described. In follow-up studies, which were 12 years or longer in five patients, none had lymph node metastases or recurrences of the laryngeal carcinoma of any sort. The following features may suggest the diagnosis of ventriculosaccular carcinoma before laryngectomy: (1) a ventricular tumour, (2) a supraglottic bulge above it, (3) a paraglottic swelling on CT scan radiology covered by a smooth laryngeal lining and (4) biopsy appearances of a well differentiated 'folded carcinoma'.
TL;DR: The results suggest that pre-operative irradiation has an adverse effect on nerve regeneration, using the rat sciatic nerve as an experimental model.
Abstract: The purpose of this study was to investigate the effect of pre-operative radiotherapy on nerve grafting, using the rat sciatic nerve as an experimental model. Two groups of 10 rats were used, one group irradiated, the other not. In each rat a 5 mm section of one sciatic nerve was excised then replaced and sutured into position. Nerve regeneration was investigated by expressing the area of the mass action potential in the regenerated nerve as a percentage of the mass action potential in the contralateral intact nerve. A significant difference (P less than 0.01) in nerve regeneration was found between the irradiated and non-irradiated animals. In the irradiated group only two animals achieved more than 20% nerve fibre regeneration whilst in the non-irradiated group all but two animals achieved greater than 20% regeneration. These results suggest that pre-operative irradiation has an adverse effect on nerve regeneration.
TL;DR: The case for a regular and orderly pathological progression of the otosclerotic lesion through various patterns of severity from minor to major degrees of footplate pathology is not established by the data; nor is it convincingly refuted.
Abstract: One thousand and thirteen consecutive patients in South Australia with stapedial fixation from otosclerosis were classified by duration of deafness, age at onset and degree of footplate pathology to determine whether there is an orderly progression in severity of the oval window lesion with duration of symptoms. The conclusions drawn were as follows. (1)An early age of onset of clinical otosclerosis, during the period of skeletal growth, dramatically increases the chance of contracting a fulminating lesion with severe and diffuse involvement of the stapedial footplate or obliteration of the oval window niche. (2) A late age of onset of clinical otosclerosis tends to be associated with lesions of the stapes footplate that are limited to the anterior pole, and there is good evidence that the lesion tends to remain stable or to progress only very slowly. (3) The case for a regular and orderly pathological progression of the otosclerotic lesion through various patterns of severity from minor to major degrees of footplate pathology is not established by the data; nor is it convincingly refuted. It is clear that if a pathological progression of the lesion does take place it must be at vastly different rates for different individuals.
TL;DR: Thirty-one children between the ages of 6 and 16 years with otalgia but normal eardrums were investigated for temporomandibular joint dysfunction and the diagnosis was made when the child was seen in pain.
Abstract: Thirty-one children between the ages of 6 and 16 years with otalgia but normal eardrums were investigated for temporomandibular joint dysfunction. Ear disease was excluded by microscopic examination, pure tone audiometry and impedance tympanometry. Dental disease was excluded by clinical and radiographic examination. Temporomandibular joint dysfunction was diagnosed by finding tenderness of the joint or masticatory muscles in at least two separate sites at one examination. Twenty-one patients were assessed as having joint dysfunction and in 18 of these the diagnosis was made when the child was seen in pain. Tympanometry on painful ears did not reveal any abnormality or trend in the values for compliance or middle ear pressure. Simple methods of treatment were effective in all cases. Temporomandibular joint dysfunction should be suspected in any child who complains of recurrent otalgia in the absence of dental and otological disease.
TL;DR: The widespread cellular degeneration in the crypts suggested that the cells were being lost from the body and that they had no further immunological or phagocytic function, suggesting that the first level of defence mechanisms of the tonsil was in the epithelium, not in the Crypt lumen.
Abstract: The material lying within the crypts of 11 human palatine tonsils was studied by scanning and transmission electron microscopy. There was a mixture of desquamated epithelial cells and various non-epithelial cells, mainly lymphocytes, with some mononuclear pahgocytes and plasma cells, and a few erythrocytes, neutrophil leucocytes and mast cells. Many of the cells were degenerating and there was a great deal of cellular debris. The non-epithelial cells seemed to have entered the crypts from the lining epithelium, probably by being caught up between superficial squamous epithelial cells as they sloughed into the lumen. The widespread cellular degeneration in the crypts suggested that the cells were being lost from the body and that they had no further immunological or phagocytic function. This also suggested that the first level of defence mechanisms of the tonsil was in the epithelium, not in the crypt lumen.