Middle-ear damage caused by a defective portable headphone.

We report a case in which a defective portable headphone caused ablation of the malleus and removal of the drum. In addition to the warnings already given against the risk of noise-induced hearing loss, a warning should be given against the use of headphones of poor quality. Alternatively, headphones consisting of ear-plugs and electric wire without a metal holder should be recommended.

Laryngeal papillomas with adult onset. An epidemiological study from the Copenhagen region.

All patients treated for laryngeal papillomas with adult onset in the Copenhagen region during a 4-year period were identified for this epidemiological study. The incidence was 0.8/100,000 among the population at risk and the prevalence was 2.3/100,000. It is concluded that papillomas with juvenile and adult onset are one and the same disease and that single papillomas versus multiple papillomas cannot be considered different entities. As is the case with juvenile laryngeal papillomas, the prognosis is good and the morbidity low in most cases of adult onset papillomas, but malignant degeneration must be considered a risk factor.

Juvenile laryngeal papillomatosis. An epidemiological study from the Copenhagen region.

All 23 patients treated for juvenile laryngeal papillomatosis (JLP) in the Copenhagen region during a 4-year-period were identified for this epidemiological study. The incidence of JLP was 0.6/100,000 among the population at risk, children aged 0-14 years, and the prevalence was 0.8/100,000. It is concluded that the condition in most cases has a good prognosis, i.e., short duration and low morbidity. Only in a few cases JLP will take a long-lasting course. Regression before or during puberty does not in all cases ensure complete recovery. Thus, 7 of 12 adult patients experienced a quiescent period of 21 years (median). Spread of papillomas to the bronchogenic system seems to be a serious prognostic sign.

Acute laryngeal obstruction in a patient with chronic bronchitis.

An unusual case of acute respiratory obstruction due to a laryngeal cyst is described. The mixed inspiratory and expiratory nature of this obstruction is discussed, and its implications for diagnosis and anaesthetic management. Alternative forms of management, especially those of transtracheal insufflation and transtracheal ventilation, and their possible complications are considered.

Lightmicroscopical features of interferon-alpha-treated laryngeal papillomatosis in adults.

Papillomatous tissue samples from 12 adult patients with laryngeal papillomatosis were examined by light microscopy before and after interferon-alpha (IFN) treatment. Increased atypia, a change in intra-epithelial differentiation, sclerosis of the underlying stroma and infiltration of especially plasma cells were found in tumour tissue removed after 3 weeks of IFN treatment. These morphological findings do not explain the effects exerted by IFN on the growth pattern of adult laryngeal papillomatosis, but provide a basis for further studies.

Ultrastructural features of the interferon-treated adult laryngeal papilloma.

The ultrastructural features of the interferon-treated adult laryngeal papillomas are described. Compared with untreated papillomas, no differences in ultrastructure were found by transmission electron microscopy. By scanning electron microscopy, significant alterations comprising a smooth and oedematous surface with a uniform microvilli pattern of the superficial cells were observed after interferon therapy. Our observations suggest an increased cell adhesion and maturation of epithelial cells caused by interferon.

Ultrastructural features of the adult laryngeal papilloma.

The ultrastructural features of nine laryngeal papillomas of the adult type were examined by transmission and scanning electron microscopy. The surface was covered by numerous microvilli varying in size and shape and often arranged in parallel cords. Although we did not find virus-like particles, the ultrastructural characteristics of the adult type of laryngeal papilloma did not differ from those previously found on the juvenile type. The two types may in nature be one and the same lesion, differing in behaviour because of the different environments.

Facial palsy in lymphocytic meningoradiculitis (Bannwarth's syndrome).

Four patients had unilateral or bilateral facial palsy associated with lymphocytic meningoradiculitis (Bannwarth's syndrome). Diagnosis depends on a lumbar puncture, and if the characteristic CSF changes, ie, pleocytosis and elevated protein level, are found, more comprehensive investigations can be restricted in view of the favorable prognosis.

Interferon therapy for laryngeal papillomatosis in adults.

Eight patients with recurrent laryngeal papillomatosis were treated with exogenous leukocyte interferon alpha, 1 to 4 X 10(6) IU daily or every second day for 150 days. During an initial three-week period of low-dose treatment, tumor size was reduced in five patients. After three weeks of treatment, microsurgical removal was performed, followed by increased dosage of interferon. At the end of the five-month treatment, recurrence of small papillomas was found in one of the patients. During the posttreatment period (seven to 11 months), recurrences occurred in four patients. We conclude from this pilot study that exogenous leukocyte interferon changes the pattern of recurrences of laryngeal papillomas in adults and may supplement surgical treatment.

Profound sensorineural hearing loss in polyarteritis nodosa. An atypical case of Cogan's syndrome.

Parameters of importance for the development of thrombosis were investigated in a patient with polyarteritis nodosa (PAN) and profound sensorineural hearing loss. During the acute phase, platelet hyperaggregability, shortened platelet survival, and decreased fibrinolytic activity were found. The possibility is discussed that the etiology of the acoustico-vestibular symptoms in this patient could be an inner ear thromboembolic disorder. It is suggested that platelet functions and fibrinolytic activity should be investigated in patients with acoustico-vestibular symptoms and PAN or other systemic diseases. If abnormalities are found, specific platelet inhibitory and/or fibrinolysis-increasing treatment should be considered as an addition to the conventional medical treatment.

Hypofibrinolysis in Menière's disease. Preliminary report.

Hypofibrinolysis was found in five patients with Menière's disease that all started with sudden hearing loss. A connection between hypofibrinolysis and Menière's disease is proposed. The possibility that the symptoms of Menière's disease and endolymphatic hydrops is due to an inner ear vascular disorder, is discussed. It is concluded that, if the hypothesis is correct, it can lead to a causal therapy in some cases of Menière's disease.

Fibrinolytic activity in patients with sudden sensorineural hearing loss.

Fibrinolytic activity and capacity were studied in a group of 18 patients with sudden sensorineural hearing loss of unknown etiology. The fibrinolytic activity and capacity were found reduced in 12 patients. No distinct changes in platelet aggregation in vitro could be demonstrated. Further, repeated studies in this category of patients should be performed.

Platelet hyperaggregability in young patients with completed stroke.

In a consecutive series of 11 young patients with clinical evidence of cerebral infarction, platelet function and plasma lipid levels were examined. The results show that increased platelet aggregability characterizes the patient group as a whole. Hyperlipidemia was frequently found, and the number of heavy smokers was high. It is suggested that all younger patients with cerebrovascular disease are examined with regard to these presumed risk factors.