Tumour-associated tissue eosinophilia in head and neck squamous-cell carcinoma.

The possible role of tumour-associated tissue eosinophilia (TATE) as a prognostic factor in epithelial tumours has been investigated before. TATE is supposed to be associated with good prognosis. In this study concerning 63 patients with laryngeal and/or pharyngeal squamous-cell carcinoma, we tried to verify this hypothesis. Of the 25 patients with TATE, 17 (68%) had a good outcome opposed to 8 (32%) with a poor outcome. This numerically better chance for a good outcome in case of TATE was however not statistically significant. Uniformity of research material, staining and classification of TATE together with more representative and larger series of patients should ascertain the real value of TATE as a valid prognostic factor in head and neck squamous-cell carcinoma.

Clinical approach to the dysphagic patient.

Dysphagia is a symptom of disease reflecting either structural or neuromuscular disorders of the oropharynx or esophagus. Dysphagia should be distinguished from globus sensation and odynophagia. The clinical evaluation of the dysphagia patient by the otolaryngologist requires taking a detailed history of the complaint, extended ENT physical examination, fiberoptic nasopharyngolaryngoscopy, to assess the oral and pharyngeal phases of swallowing. Special investigations including radiography, esophageal endoscopy, ultrasonography, pH metry, manometry may be needed for the full diagnosis. It is essential for the otolaryngologist to develop a close working relationship with the radiologist, gastroenterologist, neurologist and swallowing therapist. This team approach will allow in most of the patients with dysphagia not only to identify the cause of the complaint but also to implement an effective treatment.

Surgical treatment of oropharyngeal swallowing disorders.

The objectives of the surgical treatment of oro-pharyngeal swallowing disorders is (1) to improve the impaired transport of the bolus, and (2) to prevent aspiration or control it to safe levels. In this overview the common surgical procedures to improve the specific oro-pharyngeal swallowing disorders are presented. The indications, advantages and disadvantages of each surgical technique are discussed.

Fluctuating hearing loss in sarcoidosis.

Sarcoidosis is a systemic granulomatous disease, which can affect the vestibulo-acoustic system at any level, causing vertigo and/or hearing loss. The main mechanism could be vasculitis. One patient with fluctuating hearing loss as the first manifestation of a systemic sarcoidosis is presented. Diagnostic modalities, especially different sites of biopsy or needle aspiration are discussed. The treatment is steroid therapy. Hearing will be restored provided no irreversible changes of the VIIIth nerve and/or the inner ear have occurred.

[Premalignant lesions of the laryngeal epithelium]. / Premaligne lesies van het larynxepitheel.

At the Academic Hospital of the Free University of Brussels 243 patients underwent microlaryngoscopy over a period of 11 years (1978-1989). Histologic examination disclosed premalignant lesions in 55 patients. 26 patients had a follow-up (mean follow-up time was 5 years) and were selected for this study. The patients with premalignant lesions were divided into 3 groups: group 1 = hyperplasia and/or keratosis with or without mild dysplasia (11 patients); group 2 = mild dysplasia (7 patients); group 3 = severe dysplasia and carcinoma in situ (8 patients). In group 1 no malignant transformation was seen. In group 2 one invasive carcinoma developed after a period of 5 years (14%) and in group 3 two malignant transformations appeared 14 and 15 months after the initial diagnosis (25%). The treatment of choice was a total excision biopsy or stripping. A life time follow-up with an interval period of 6 months is recommended. The patients were also motivated to change their smoking habits.

[Laryngeal amyloidosis]. / Laryngeale amyloidose.

Laryngeal amyloidosis is a rare, benign disease of the larynx. An update on the pathology and clinical implications of this affection, along with the actual treatment modalities are discussed.

Ototoxicity of an ototopic preparation--experimental results and clinical facts.

The ototoxicity of "Cortisporin Otic Suspension" containing 3.5 ml neomycin base, 10,000 units/ml polymyxin B was studied using the baboon (papio ursinus) as an experimental animal. Inner and outer hair cell loss occurred in all cochleas of the ears which received cortisporin. Most lesions were confined to the basal turn of the organ of Corti. Separate evaluation of polymyxin B and neomycin at the same concentration as in cortisporin showed that polymyxin B produced greater cochlear damage. The results of this study and clinical reports of sensorineural hearing loss due to commercially available ear drops indicate that ototopical preparations must be used with caution in clinical situations in which they may reach the middle ear.

Density of epithelial cells in the normal human nose and the paranasal sinus mucosa. A scanning electron microscopic study.

214 biopsies of mucosa from various sites of the nose and paranasal sinuses were obtained post-mortem and examined using the scanning electron microscope. The density of ciliated cells was increased in the nasal cavity, in the antero-posterior direction. In paranasal sinuses the density of these cells was high, except near the ostium of the maxillary sinus, where the density was decreased by half. Non-ciliated epithelial cells were found in relatively few areas: anterior aspect of the middle and lower turbinates, anterior septum. However, no uniform distribution of these cells was present. The density of goblet cells was significantly lower in the paranasal sinuses as compared to the nasal cavity, with the highest density being found near the ostium of the maxillary sinus.

Ototoxicity of neomycin and polymyxin B following middle ear application in the chinchilla and baboon.

Previous experimental studies have demonstrated structural damage of the organ of Corti and stria vascularis following application of combination antibiotic otic drops to the middle ear. In this investigation the ototoxic effects of neomycin and polymyxin B (two antibiotics often used together in ototopical preparations) were separately evaluated after administration of each agent to the middle ear cavities of chinchillas and baboons. The antibiotics were administered in saline solution at the same concentrations used in Cortisporin Otic Suspension (3.5 mg/ml neomycin base, 10,000 units/ml polymyxin B). In both the rodent and primate, polymyxin B consistently produced greater cochlear damage than did neomycin. In fact, the extent of hair cell loss and strial injury produced by polymyxin B alone was, in many cases, comparable to that previously observed after application of Cortisporin Otic Suspension itself. Hair cell loss in the baboon was markedly less severe than in the chinchilla. It is believed that differences in position and structure of the round window membrane are important factors in the differing levels of ototoxicity observed in the rodent and primate.

Prevalence of otitis media in a Venda village.

During mid-winter in 1985, 263 children and 217 adults from a remote rural community in Venda, were examined for the presence of middle ear lesions by: pneumatic otoscopic examination; tympanometry; and contralateral acoustic reflex. A diagnostic algorithm was applied to assess the findings. The prevalence of otitis media (OM) in children (less than or equal to 15 years) was 8.4% and in adults (greater than 15 years) 2.3%, with the highest figure in the 0-23 months age group. OM with effusion was found in 3.6% of the children. Our data suggest the existence of considerable differences in the prevalence of OM between comparable black rural communities.

Ototoxicity of an ototopical preparation in a primate.

Severe ototoxicity has been observed in laboratory rodents after middle ear application of ototopical preparations or their constituents. Owing to their relatively high susceptibility, these animals may not be ideal experimental models. In the present study the ototoxicity of Cortisporin Otic Suspension (neomycin, polymyxin B, hydrocortisone) was studied using the baboon as a primate model. Middle and inner ear pathologic changes were assessed after a single application of the suspension to the tympanic cavity. Inner and outer hair cell loss occurred in all the experimental animals; it was, however, confined to the basal turn of the organ of Corti. Relative to previously studied rodents, the thicker, more densely structured round window membrane of the primate appears to provide better protection against penetration of ototoxic agents. Nonetheless, the results of this study indicate that ototopical preparations must be used with caution in clinical situations in which they may reach the middle ear.

Prevalence of otitis media in children in a black rural community in Venda (South Africa).

During mid-winter in 1985, 480 residents from a remote rural community in Venda, South Africa, were examined for the presence of middle and external ear pathology. The children (less than 15 years) numbered 267. The otological examination consisted of (1) pneumatic otoscopic examination, (2) tympanometry, (3) contralateral acoustic reflex. A diagnostic algorithm as proposed by Cantekin et al. was applied to assess the findings. Our data showed the prevalence of otitis media in children to be 8.2%. The highest prevalence was found in the 0-23 months age group. Of 22 children with otitis media, only one had a perforation with otorrhea. Otitis media with effusion was found in 3.8% of the children. External otitis media as an independent variable was found in only 1.5% of the 267 children, while 6.7% presented with scarred tympanic membranes. Our data suggest the existence of considerable differences in the prevalence of otitis media in children between two comparable black rural communities from Nigeria and Venda.

Immittance screening in black preschool children attending day-care centres.

Immittance screening was performed on 736 black children between the age of 2 and 6 years attending four day-care centres. It was found that 14.9% of these children failed the immittance screening. Problems encountered when attempting to apply the available standard immittance screening pass/fail criteria to a specific black race group are discussed.