The importance of petrous apex and peri-carotid pneumatisation in subtotal petrosectomy and blind sac closure: a radiological study.

OBJECTIVE: To ascertain in what proportion the vertical segment of the intratemporal carotid artery on its medial aspect anatomically separates the peri-tubal cells and Eustachian tube from the remainder of the pneumatised spaces of the temporal bone. METHOD: A retrospective review was conducted of 222 adult and 29 paediatric consecutive computed tomography scans of petrous temporal bones from a single tertiary referral centre. RESULTS: In 96 per cent of temporal bones, the carotid artery formed a lateral barrier (with no communication pathway medially) between air spaces anterior and posterior to it. This equated to 94 per cent when chronic otitis media cases were excluded. CONCLUSION: The degree of separation of middle-ear air cells from the Eustachian tube or nasopharynx, and the relevant anatomy, are reviewed. This knowledge helps to optimise the outcome of subtotal petrosectomy and blind sac closure. The frequency and process of pneumatisation of the petrous apex, and its connections with the middle ear, have been radiologically confirmed.

Quality of life after vestibular schwannoma surgery: does hearing preservation make a difference?

OBJECTIVE: Surgery for vestibular schwannoma may reduce patients' quality of life, but the effect of hearing preservation on this process is not fully understood. Our aim was to determine whether hearing preservation makes a difference to patients' quality of life in this clinical setting. STUDY DESIGN: Retrospective questionnaire and cross-sectional survey. METHODS: The study included 104 consecutive patients who had undergone surgery for vestibular schwannoma between 1998 and 2004. Surgery was via a middle cranial fossa route in 24 patients and a translabyrinthine route in 79. Quality of life was assessed using the SF-36 questionnaire and the Glasgow Benefit Inventory. RESULTS: Quality of life was reduced in both patient groups, with a mean Glasgow Benefit Inventory score of -7.5 (confidence interval (CI) -13 to -2.5) in the translabyrinthine patients and -4 (confidence interval -13.5 to 5.5) in the middle fossa patients. The SF-36 scores did not show any statistically significant difference between the two groups, except for social function (p = 0.01). CONCLUSIONS: Surgery for vestibular schwannoma reduces patients' quality of life, and the preservation of hearing, achieved by using a middle fossa surgical approach, does not significantly alter this result.

The management of multiple paraganglioma of the head and neck.

During the years 1984 to 1991, of 32 patients who had one large glomus or carotid body tumour, six were found to have other paragangliomas. Excluded from the above total of 32 are patients whose only lesion was a solitary glomus tympanicum. No two patients had identical problems and no pattern emerged on which patient management in any particular case could be based. The major problems associated with the tumours themselves and their treatment is the risk to hearing and the lower cranial nerves. Individual cases and their treatment are discussed.

Incidence of 'unsuspected' extranodal head and neck lymphoma.

A series of 100 consecutive patients presenting with non-Hodgkin's lymphoma in the head and neck region was reviewed. An examination of the contribution made to the staging classification by an otolaryngological examination showed that one-third of patients presenting with cervical nodes had unsuspected extranodal disease in Waldeyer's ring. Overall 14% of patients undergoing an otolaryngological examination had their disease upstaged because of that examination.

Evaluation of an enzyme-linked immunosorbent assay (ELISA) for serodiagnosis of infectious bovine rhinotracheitis infection, with results of a preliminary survey.

An indirect enzyme linked immunosorbent assay (ELISA) procedure was evaluated against the serum neutralisation test (SNT) for the detection of antibodies to infectious bovine rhinotracheitis virus (bovine herpesvirus type l), using 2028 sera from 166 dairy and 172 beef cattle herds. The results showed the ELISA to give high levels of agreement with the SNT in classifying positive and negative sera (98% and 97% respectively). Such disagreements as did occur involved weakly reactive sera with SNT titres of % or less. A number of sera (n=123) with trace neutralising activity of doubtful diagnostic significance were found to give marginal reactivity with ELISA. ELISA absorbance values were found to be highly correlated with SNT titres (r=0.909) on an overall basis, though agreements were lower with individual sera. The ELISA procedure was quicker, cheaper, and detected more reactors than the SNT. It also allowed results to be obtained with a number of sera which were unsuitable for testing by SNT because of their cytotoxic nature. Analysis of ELISA results showed reactors to be present in 57% of tested sera, representing 81% of cattle herds. Reactor rates for sera and herds in the South Island, (37% and 58%), were significantly lower than for those in the North Island (64% and 88%). Antibody prevalence was also found to be significantly lower in districts having a low annual rainfall (<850 mm), and to be lower in beef cattle than in dairy cattle. A surprising exception to the latter occurred in low rainfall districts, where dairy cattle showed significantly lower reactor rates than local beef animals.

Comparison of the enzyme-linked immunosorbent assay (ELISA) and serum neutralisation test for the serodiagnosis of Aujeszky's disease.

The serum neutralisation test (SNT) and the indirect enzyme-linked immunosorbent assay (ELISA) for Aujeszky's disease were compared, utilising 3202 sera from Aujeszky's disease free pig herds, and 304 SNT reactor and 245 non-reactor sera from Aujeszky's disease infected piggeries. ELISA was found to give good discrimination between positive and negative sera, results showing 96.9% and 99.7% agreement with the SNT in classifying positive and negative reactor pigs respectively. The ELISA appeared to detect a slightly higher proportion of reactors than did the SNT. Absorbance values obtained with ELISA showed a high degree of overall correlation with SW titres (r = 0.916), though correlations were lower when applied to individual sera. The ELISA was considered to be a rapid and convenient procedure, offering many advantages over the SNT for routine use.

Levels of antibody against Legionella pneumophila serotype 1 in healthy populations in five areas in New Zealand.

Levels of antibody to Legionella pneumophila serogroup 1 in five areas of New Zealand were determined by indirect immunofluorescence. Both immunoglobulin G (IgG) and IgM levels were separately assessed. Of the 500 people studied, 2.8% had IgG titers of greater than or equal to 1:128 and 4.0% had IgM titers of greater than or equal to 1:128. Higher levels of IgG reactivity were noted in the southern part of New Zealand, but neither age nor sex appeared to be related to variations in antibody levels.

Antibodies to Legionella pneumophila serotype 1 among the healthy New Zealand population.

The antibody levels to Legionella pneumophila, serotype 1 in two groups of healthy New Zealanders have been determined by the indirect fluorescent antibody test. These have been compared with antibody levels obtained from patients' sera submitted for L. pneumophila antibody levels. Significant levels of antibody have been found among the healthy people. The lower age groups demonstrated greater levels of immunity than those of patients suspected of having the disease.