Diagnosis and treatment of ear disease among children in the Ellisras district. An outreach programme.

Audiologists and ENT registrars examined 2,036 children aged 10 years or younger by means of pure-tone audiometry, tympanometry and otoscopic examinations. Twenty per cent of these children had ear pathology and 7.5% had impaired hearing. Forty-three pus swabs taken from patients with suppurative otitis media most often cultured Proteus mirabilis and Pseudomonas species. The prevalence of otitis media with effusion was twice as high in white children as in black children, resulting in a much higher prevalence of hearing loss in the first group. The black children had 7 times more dry perforations of the tympanic membrane and 11 times more wet perforations. A hundred and thirty-six patients were treated by the team and 137 were referred for further treatment. Sixteen operations were performed at a later stage. Further programmes are needed to diagnose and treat ear disease in rural communities.

Xanthomatous lesion of the mandible. Report of a case.

Xanthomatous lesions of the jawbone are rare and ill-defined. In the case presented, infiltration of the mandibular bone marrow by abundant foam cells was combined with extensive reactive bone formation.

[Lipoidproteinosis. A report of four cases]. / Lipoïed-proteïnose 'n bespreking van 4 gevalle.

Four cases of lipoid proteinosis (Urbach-Wiethe disease) are presented. The incidence, clinical features, relevant special investigations and possible treatment of the disease are reviewed. These patients present with hoarseness and lesions of the skin and mucosa. The condition is often misdiagnosed by general practitioners and otolaryngologists.

The Rapp-Hodgkin syndrome.

We report on a family with the Rapp-Hodgkin ectodermal dysplasia syndrome. Four affected family members are described and a review of the literature is given.

The aqueductus vestibuli--a morphological study.

The morphology of the aqueductus vestibuli enjoys considerable attention as it may possibly play a role in the cause of Ménière's disease. In this study, silicone rubber casts of human temporal bones were used, and the aqueductus vestibuli was then measured by means of a reflection microscope. By this method the morphometry of the aqueductus vestibuli was determined accurately.

Motion sickness--vestibular habituation with the centrifuge.

People who are prone to motion sickness have a directional preponderance of nystagmus to the left. Centrifuging will change this preponderance to the right in most people, and at the same time reduce their tendency towards motion sickness but only with regard to air travel.

The significance of Pseudomonas aeruginosa in chronic otitis media.

Fifteen patients with chronic otitis media, where the organism cultured was Pseudomonas aeruginosa, had previously been treated with a variety of antibiotics, ear drops and surgical procedures. In 8 patients the discharge persisted. Between October 1986 and August 1987 these patients were treated with a combination of antibiotics (including piperacillin, ceftriaxone, amikacin and tobramycin) specific for Pseudomonas administered intravenously. In 7 patients the infection cleared completely. Follow-up ranged from 1 month to 1 year (average 4.5 months). The regimen described could be of value in patients who do not respond to standard methods of treatment.

Dental aspects of hypophosphatasia: a case report, family study, and literature review.

The classic oral features of hypophosphatasia, namely, premature tooth loss and large pulp spaces, were found in a young adult woman with bone and joint pains. A study of 22 family members revealed several with dental abnormalities such as abnormal enamel, dentin, or cementum formation, decreased mandibular bone density, and abnormally large pulp spaces. Only the propositus' sister fulfilled the biochemical criteria for hypophosphatasia. Biochemical examination of an extracted tooth from this sister showed phosphate and alkaline phosphatase values that were 7 to 10 times lower than normal and reduced concentrations of the essential cofactors Zn++ and Co++. The spectrum of dental abnormalities is reviewed. This family study reveals that enamel hypoplasia, increased pulp spaces, and premature tooth loss are present not only in the deciduous but also in the permanent dentition. These findings should draw the dentist's attention to this condition.

Long-term effects of destruction of the endolymphatic sac in a primate species.

The endolymphatic sacs of ten vervet monkeys were surgically ablated unilaterally, and the animals were assigned predetermined survival times ranging from 6 months to 5 years. The left and right ears were prepared in anatomical continuity for light microscopic study. Four experimental ears had openings in their membranous labyrinths of unknown etiology and were not considered acceptable for correlative studies. The remaining five experimental ears showed mild cochlear endolymphatic hydrops, which was localized to the apical regions or was more severe in the apical regions than elsewhere. Four ears also showed saccular endolymphatic hydrops. The sensory and neural structures in both experimental and control ears were normal, and none of the control ears showed endolymphatic hydrops. None of the animals developed severe endolymphatic hydrops or the cochleovestibular symptoms that occur in human subjects with Meniere's disease. The results of this experiment indicate that dysfunction of the endolymphatic sac may be a contributing factor, but probably is not the sole cause of Meniere's disease.

Profile analysis of pupils at a school for black deaf children. A pilot study.

The pupils at a school for black hearing-disabled children were clinically investigated and the findings were analysed with regard to age, sex, and nature and possible cause of deafness. A total of 169 children were examined. The majority were boys, and 95% were hearing-disabled before the age of 3 years. One-tenth of the children had a positive family history. An apparent cause could be established with a degree of certainty in only 30% of cases.

Aspergillus fumigatus infection of the maxillary sinus. A case report.

The diagnosis and radiological findings in a 48-year-old woman with paranasal sinus Aspergillus fumigatus infection is described. The patient had had chronic post-nasal discharge and sinusitis for 7 years. She was treated by total removal of all infected material.

Autologous versus homologous bone grafting in osteotomies, secondary cleft repairs and ridge augmentations: a clinical study.

To compare the clinical results, complications and morbidity of osteotomies, secondary cleft repairs and ridge augmentations in which frozen femoral head homologous bone or autologous bone was used, a series of 61 patients with follow-up periods of 1 to 6 years has been reviewed. Long-term clinical observation shows that, with a correct indication and surgical technique, frozen homologous bone is a good alternative to autologous bone in clinical grafting procedures.

Histologically detected extrapulmonary tuberculosis in the head and neck region. A review of 222 cases.

During the 11-year period from 1974 to 1984, 222 cases of non-meningitic extrapulmonary tuberculosis in the head and neck region were seen at the ear, nose and throat departments of the academic hospitals of the University of Pretoria. A retrospective analysis revealed that three structures were mainly involved--the cervical lymph nodes, larynx and middle ear. The diagnoses were all confirmed on histological examination, revealing a positive biopsy rate for tuberculosis of 5% (222) of the total number of specimens submitted for the same period (4,357). Females had more cervical node involvement than males. Ninety per cent of all patients were black and the largest group was under 10 years old. A high index of suspicion of tuberculosis is important in the differential diagnosis of neck swellings, hoarseness and otorrhoea.

Subperiosteal onlay augmentation of the mandible: a clinical and radiographic survey.

A five-year follow-up study of 26 patients who underwent subperiosteal onlay augmentation of the mandible using corticocancellous bone from the iliac crest is presented. An overall postoperative reduction in mandibular height of 44% was found. The different rates of resorption between the various suggested augmentation methods are discussed, and suggestions are given to prevent the rapid resorption that occurs during the immediate postoperative period.