Rhabdomyosarcoma of the middle ear cavity presenting with Horner's syndrome.

Rhabdomyosarcoma is a rare malignant tumour of striated muscle accounting for 3% of all primary soft tissue tumours of the middle ear cavity. We describe a unique case of a rhabdomyosarcoma of the middle ear cavity in a four-year-old boy, presenting as an otherwise asymptomatic ipsilateral Horner's syndrome. This case involved tumour erosion through the tensor tympani semicanal, accessing the carotid canal and the sympathetic plexus running through it. This child was treated successfully with chemotherapy and proton beam therapy, and remains disease free at six years of follow-up. This case highlights the importance of investigating patients with non-resolving ear infections, polyps or granulation tissue.

Use of magnetic resonance imaging as the primary imaging modality in the diagnosis and follow-up of malignant external otitis.

Malignant external otitis (MEO) is a severe infection of the external auditory meatus caused by Pseudomonas aeruginosa. Classical features include unrelenting deep otalgia, otorrhoea and granulations in the floor of the ear canal. Treatment is generally protracted antibiotic therapy and monitoring of inflammatory markers; the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Traditionally computed tomography (CT) has been the imaging modality of choice. The authors present a case where magnetic resonance imaging (MRI) has been crucial in the diagnosis and follow up of a patient with MEO.

Functional and morphological response of the stria vascularis following a sensorineural hearing loss.

Cochlear endolymph is maintained at a potential of (+)80 mV by an active transport mechanism involving the stria vascularis (SV). This so-called endocochlear potential (EP) is integral to hair cell transduction. We compared the EP with changes in SV area and Na(+),K(+)-ATPase expression following a sensorineural hearing loss. Guinea pigs were deafened using kanamycin and a loop diuretic, and the EP was measured at two, 14, 56, 112 or 224 days following deafening. Auditory brainstem responses were used to confirm that each animal had a severe-profound hearing loss. There was a significant reduction in EP following two days of deafness (normal, 73.5 mV S.E.M.=2.4; deaf, 42.1 mV, S.E.M.=2.8; P<0.0001, t-test). In animals deafened for 14 days the EP had partially recovered (65.2 mV, S.E.M.=5.08), while animals deafened for longer periods exhibited a complete recovery (56 days 80.5 mV, S.E.M.=5.36; 112 days 75.7 mV, S.E.M.=2.71; 224 days 81.0 mV; S.E.M.=6.0). Despite this recovery, there was a systematic reduction in SV area with duration of deafness over the first 112 days of deafness. Significant reductions were localised to the basal turn in animals deafened for two days, but had extended to all turns in animals deafened for 112 days. While there was a significant reduction in strial area, the optical density of Na(+),K(+)-ATPase within the remaining SV was normal. Since the treated animals exhibited essentially a complete elimination of all hair cells, the total K(+) leakage current from the scala media would be expected to be significantly reduced. The large reduction in the extent of the SV after deafening suggests that a reduced strial volume is capable of maintaining a normal EP under conditions of reduced K(+) leakage current.

The treatment of snoring in the armed forces.

Snoring is a common problem, which may have widespread medical and social implications. This is particularly true in the setting of the armed forces where snoring may have significant effects in terms of personal performance, social interaction and security. This paper discusses the general management of snoring in the military environment and in particular the clinical effectiveness of one surgical procedure, uvulopalatopharyngoplasty. In this study, the procedure proves to be an effective surgical option in the management of snoring.

Day case paediatric tonsillectomy: a review of three years experience in a dedicated day case unit.

Tonsillectomy is one of the most common surgical procedures performed in children. Day case tonsillectomy is common in many parts of the USA but remains controversial in the UK. Day case tonsillectomy in children has been performed in a dedicated paediatric day care unit at the May day Hospital since 1994. The results for the years 1995-1997 were reviewed. In these years 928 true day case tonsillectomies were performed. Reactionary haemorrhage occurred in 0.97% (nine children) but only three children required a return to theatre. All bleeding occurred within the standard observation period. There were no deaths. The overall effective day case rate was 95.7%, only 31 children needing unplanned admission, mainly for postoperative vomiting. The results suggest that day case tonsillectomy can be safely and successfully performed, with a dedicated paediatric day case unit and a favourable population geography.

Extracapsular haemorrhage from a parathyroid adenoma presenting as a massive cervical haematoma.

Spontaneous massive haemorrhage from a parathyroid adenoma is rare. It can cause extensive cervical ecchymosis as well as compression of structures within the neck. We present a case, discuss the diagnostic features and review the literature.

Metastatic carcinoma of the temporal bone presenting as glomus jugulare and glomus tympanicum tumours: a description of two cases.

Two cases of metastatic carcinoma of the temporal bone, that simulated glomus tumours on thorough preoperative evaluation are described. Although rare, metastatic spread to this area is recognized, but presentation in this way is unique.

Grommets and patient satisfaction: an audit.

With the increasing role of evidence-based medicine we, as ENT surgeons, are being asked more and more to justify the practice of grommet insertion in children with glue ear. The audiological improvement which follows this operation is often only moderate at best. When judged solely in terms of hearing improvement, one may miss the often dramatic all-round improvement in a child which the parents frequently report to us postoperatively. We set out to confirm this clinical observation by using a retrospective questionnaire, seeking parental opinion after their children had undergone grommet insertion. We found a wide range of reported benefits as a result of grommet insertion; these include an improvement in hearing (92.1%), a reduced frequency of ear infections (74.1%), a reduction in postoperative GP visits (87%), less time missed from school (70.7%), as well as a variety of improvements in children's speech, education and general behaviour. Overall, we found that 96.7% of parents were satisfied that the decision to insert grommets in their child was correct. We feel that these non-audiological factors should be taken into account when judging the potential benefit to a child, or population of children, from grommet insertion.

Vestibular nerve dysfunction and decompression in Engelmann's disease.

Vestibular nerve dysfunction as the major neuro-otological symptom in one of the osteopetrosis group of bone disorders is unusual. We describe a patient with Engelmann's disease who presented in this manner and who benefited from an eighth nerve decompression procedure. Surgical decompression of the internal auditory meatus to relieve vertigo has to our knowledge not been previously reported in this condition.

A prospective randomized controlled trial comparing the use of merocel nasal tampons and BIPP in the control of acute epistaxis.

A prospective study was undertaken to compare the efficacy of Merocel nasal tampons to BIPP (Bismuth Subnitrate and Iodoform Paste) impregnated ribbon gauze in the control of acute epistaxis requiring hospital admission. A total of 50 patients presenting with severe epistaxis was treated with either merocel nasal tampons, or BIPP. The groups did not differ significantly in terms of age, sex distribution, aetiology or severity of the bleed. There was no significant difference in efficacy or patient tolerance of either treatment. It was concluded that Merocel nasal tampons should be considered effective in the first line treatment of severe epistaxis uncontrolled by simple measures. Their ease of insertion makes them suitable for use in the accident and emergency department or in general practice.

Stroke-induced cardiovascular changes: a rare cause of death from polyarteritis nodosa.

Polyarteritis nodosa (PAN) is an uncommon but well documented cause of subarachnoid haemorrhage (SAH). We report a case of SAH in a patient with PAN causing death indirectly from the effects of resultant cardiovascular changes upon other manifestations of PAN. Clinicians should be aware of the systemic effects of SAH in patients with known vasculitides.