[Neonatal submandibular sialadenitis]. / Neonatal submandibulaer sialoadenitis.

Submandibular sialadenitis is very rare in the neonatal period. Only a few cases have been reported of isolated submandibular gland infection without the involvement of the parotid gland. In the present case, a premature boy, fourteen days old, developed clinical signs of infection and bilateral submandibular erythematous swelling. Pus was expressed from the submandibular ducts. Culture yielded Staphylococcus aureus. He was treated with intravenous netilmicin and cefuroxin. The infection resolved after antibiotic therapy.

Unpredictable hearing loss after intratympanic gentamicin treatment for vertigo. A new theory.

A new hypothesis is advanced suggesting that unpredictable cases of profound hearing loss after intratympanic gentamicin treatment (IGT) may be caused by decreased patency of the communication routes between the inner ear and the cerebrospinal fluid, primarily of the cochlear aqueduct. A tympanic displacement analyzer, which can indirectly analyze inner ear and intracranial pressure changes and can also evaluate the efficiency of communication between these two compartments, was used. Two cases are presented: in the first, a patient who became deaf after IGT showed signs of decreased patency of the communication routes with the tympanic membrane displacement (TMD) test; in the second, a patient without hearing damage after IGT had efficient communication evaluated by the TMD test. These preliminary findings are in accordance with the proposed pathophysiology. If future clinical studies confirm the present theory and findings, it may prove possible to predict and prevent deafness after IGT and possibly also after systemic aminoglycoside treatment.

Postural-induced changes in intracranial pressure evaluated non-invasively using the MMS-10 tympanic displacement analyser in healthy volunteers.

Inner ear pressure reflects intracranial pressure (ICP) primarily because of the direct communication of perilymph and cerebrospinal fluid (CSF) through the cochlear aqueduct (CA). The MMS-10 tympanic displacement analyser (TDA) is a relatively new device for measuring perilymphatic pressure non-invasively, and thereby also indirectly measuring intracranial pressure. The aim of the present study was to evaluate the use of the TDA in a daily clinical setting. Other aims were to investigate changes in perilymphatic pressure from sitting to lying position in healthy volunteers in two age groups (mean age: 33 years and 50 years) and to compare the patency of the CA in these groups using the MMS-10 TDA. Tympanic membrane displacement (TMD) analyses were performed in the test subjects initially twice in sitting position (test-retest) and then in sitting and supine positions. We found that the MMS-10 TDA is easy to use, and that it gives reproducible values in repeated tests, but with large inter-subject differences. The TMD test showed curves, which, in the whole test group, were more negative in supine position, in accordance with an increasing intracranial and inner ear pressure when lying down. The change from sitting to lying position was larger in the younger group than in the older group. In 11% of the younger group (males) and in 30% of the older group (females), the CA was considered to be non-patent, although the difference was not statistically significant. However, the finding is in keeping with the hypothesis of a greater proportion of patent CA in younger than in older individuals.

Effects of cerebrospinal fluid loss on hearing.

There is a direct communication between the cerebrospinal fluid (CSF) and the perilymph through the cochlear aqueduct (CA). Perilymph depletion due to perilymphatic fistulas has been demonstrated to influence inner ear function, with signs and symptoms similar in many ways to those of Meniere's disease. A leakage of CSF could also theoretically affect the inner ear. The present study was conducted to investigate whether hearing was affected in patients submitted to a leakage of CSF and, if so, to what extent, in which frequency range, which time course and incidence. The study comprised 126 patients who were exposed to different surgical procedures that involved puncture or incision of the dura, and a control group of 32 patients without such leakage. Hearing was reversibly affected only in patients with leak of CSF. The size of the hearing loss, the number of affected patients and the number of frequencies involved increased with increasing amount of CSF lost. Changes in the constituent cochlear fluids due to a transitory reduction in the CSF and the perilymphatic volume with a compensatory endolymphatic expansion may be responsible for the observed findings.

Hearing loss after cardiopulmonary bypass surgery.

Hearing loss (HL) is a rare complication following cardiac surgery with extracorporal circulation (CSWEC) or other non-otologic surgery under general anesthesia, as is HL caused by loss of cerebrospinal fluid during neurosurgery or spinal anesthesia. The incidence of HL after CSWEC is not known since preoperative hearing testing is not commonly done and a perioperative HL may occur unnoticed. We present four cases of profound sensorineural hearing loss following CSWEC for coronary artery bypass or cardiac valve surgery. The hearing loss was noticed immediately on waking from anesthesia in three of the patients, whereas the fourth patient noticed decreased hearing during the first postoperative week. In all patients audiological investigation suggested a cochlear etiology of the HL. The possible mechanisms for HL are discussed. HL after CSWEC is most likely caused by a microembolism generated by atheromatous material.

[Laryngeal carcinomas and precancerous lesions. Incidence and course in a local area]. / Larynxkarcinomer og praekankroser. Forekomst og forløb i et lokalområde.

Out of 464 laryngoscopies, 23 patients with premalignant and 55 with malignant laryngeal biopsies were followed-up ten years later. Thirteen of the precancerous became malignant, ten within three months, and three after years. All with severe dysplasia later developed a carcinoma. Most male patients (66%) had glottic carcinomas while most female patients (88%) had supraglottic carcinomas. The incidence of larynx carcinomas was significantly higher and the disease specific survival lower in our area than in the rest of Denmark. Crude survival for glottic and supraglottic carcinomas was nearly equal after ten years (36%), but patients with glottic carcinomas had a higher death rate due to other causes. Social factors are suggested to be responsible for this. In 1994-1996 a smaller proportion of patients with glottic carcinomas were diagnosed in stage I, but the overall incidence was a little lower.

[Parapharyngeal Burkitt lymphoma in a seven-year-old boy]. / Parafaryngealt Burkitts lymfom hos en syvårig dreng.

The case describes a seven year-old Danish boy who was referred with a short history of nasal obstruction and enlargement of the lymph nodes on the left side of the neck. The ENT examination demonstrated a large parapharyngeal tumour, which was shown by CT-scanning to extend from the level of the zygomatic arch to the superior thoracic aperture. The histological diagnosis was a Burkitt's lymphoma.

Cerebrospinal fluid loss and threshold changes. 1. Hearing loss in the contralateral ear after operation for acoustic neuroma: an analysis of the incidence, time course, frequency range, size and pathophysiological considerations.

In a prospective study, 60 patients who underwent surgery for unilateral acoustic neuromas had the hearing on the contralateral ear tested before and several times after surgery. In 40 patients, a threshold increase was found during the following 9 days. The changes were greatest in the low frequencies immediately after surgery, but after 1 week the treble also became involved. After 3 months, the hearing was normalized. The elder patients more than 50 years of age were more often affected, whereas sex, tumor size, surgical approach or duration of surgery had no influence. The pathophysiological mechanisms are discussed and an intracochlear fluid dysfunction caused by the loss of cerebrospinal fluid is suggested.

Cerebrospinal fluid loss and threshold changes. 2. Electrocochleographic changes of the compound action potential after CSF aspiration: an experimental study.

Hearing loss has been reported following leakage of cerebrospinal fluid (CSF). The etiology has been attributed to an induced imbalance in the intracochlear hydrodynamics. The present study reports a guinea pig model with surgically induced loss of CSF. In 18 anesthetized animals, CSF was drained by a suboccipital incision in the dura: Eighteen animals were used as controls. The compound action potentials were recorded by an ear canal silver electrode. The animals with CSF loss showed a small increase in threshold and latency, while the control group was unchanged. The concept of an induced inner ear fluid dysfunction after CSF leak is supported by these findings.

Effect of craniotomy and cerebrospinal fluid loss on the inner ear. An experimental study.

Craniotomy with cerebrospinal fluid (CSF) suction was performed on 18 guinea pigs to determine the effects on the inner ear morphology. Six control animals received anaesthesia only and 12 were operated on with a postoperative survival time of 1 or 24 h. The histologic examinations showed no signs of endolymphatic hydrops or injury to other structures in any of the animals. In 11 of the operated animals, red blood corpuscles were demonstrated in the perilymphatic space of the cochlea, the subarachnoid space, and the cochlear aqueduct (CA). After 1 h survival time blood had entered primarily the basal part of the scala tympani, but in the animals of 24 h survival time the blood was more abundant in both the scala tympani and the scala vestibuli indicating flow within the inner ear. The CA thus provides a pathway between the CSF and the whole of the perilymph through which noxious effects could take place.

Hearing loss after neurosurgery. The influence of low cerebrospinal fluid pressure.

A prospective study was performed to investigate the effect of neurosurgery on hearing. Thirty-two patients underwent neurosurgery while 32 patients who had surgical procedures not involving puncture or drainage of the subdural space, served as a control group. In the neurosurgical group, a significant loss of hearing was observed in the immediate post-operative period, with recovery over one week. No average threshold shift was observed in the control group. It is suggested that following neurosurgery the mechanism of hearing loss results directly from a decrease in pressure and/or volume of the cerebrospinal fluid, which is reflected within the perilymphatic fluid, comparable to a transitory endolymphatic hydrops.

[Hearing loss after spinal anesthesia. An audiological controlled trial]. / Hørenedsaettelse efter spinalanaestesi. En audiologisk kontrolleret undersøgelse.

Audiological tests were conducted on 34 patients before and after undergoing an operation in spinal anaesthesia. One of these patients developed a considerable unilateral hearing loss in the low-frequency range, which persisted until an epidural blood-patch was given. Unexpectedly, we also found a general small but significant threshold shift at 500 Hz, which has never before been described in the literature. The biological mechanism is discussed, and the results suggest that the explanation of the hearing loss could be a condition similar to endolymphatic hydrops, resulting from perilymphatic hypotension due to loss of liquor during and after the spinal anaesthesia.

[Reversible hearing loss in the contralateral ear after surgery of acoustic neurinoma]. / Reversibel hørenedsaettelse på det raske øre efter operation for acusticusneurinom.

In a prospective study of 12 patients undergoing operation for acoustic neuromas, the hearing on the contralateral ear was tested before and systematically after operation. In 11 cases a perceptive loss of at least 20 dB was found at one or more frequencies during the first two postoperative weeks. The maximal average threshold decrease was 16.5 dB in the treble and 19.6 in the low frequencies. After three months the hearing had normalized in all cases. The loss of cerebrospinal fluid during operation diminishes the CSF pressure, which is then transmitted to the perilymph via the cochlear aqueduct, producing a transitory perilymphatic hypotonia and a relative endolymphatic hypertension mimicking an endolymphatic hydrops.

Hearing decrease after loss of cerebrospinal fluid. A new hydrops model?

In a prospective study of 12 patients undergoing operation for acoustic neuromas the hearing on the contralateral ear was tested before and systematically day by day after operation. In 11 cases a perceptive loss of at least 20 dB was found at one or more frequencies during the first 2 postoperative weeks. A maximal average threshold decrease of 16.5 dB was found in the treble (2.4, 8 kHz average), while a tendency of a more pronounced decrease of 19.6 dB was seen in the low frequencies (125, 250, 500 Hz average). After 3 months the hearing had normalized in all cases. The explanation for the transitional loss supports the present theory: The loss of cerebro-spinal fluid during operation diminishes the CSF pressure. This decrease is transmitted to the perilymph via the cochlear aqueduct producing a transitory perilymphatic hypotonia, which in turn hydromechanically results in a relative endolymphatic hypertension mimicking an endolymphatic hydrops thus representing a human hydrops model.

Low-frequency hearing loss after spinal anesthesia. Perilymphatic hypotonia?

Audiological tests were conducted on 34 patients before and after undergoing an operation under spinal anesthesia. One of these patients developed a considerable unilateral hearing loss in the low-frequency range, which persisted until an epidural blood-patch was given. Unexpectedly, we also found a general small significant threshold shift at 500 Hz, which has never before been described in the literature. The biological mechanism is discussed and the results suggest that the explanation of the hearing loss could be an endolymphatic hydrops resulting from perilymphatic hypotonia due to loss of liquor, during and after the spinal anesthesia.

[Surgical treatment of chronic maxillary sinusitis. Report of a new surgical technic and an evaluation of results of traditional surgery]. / Operativ behandling af kronisk kaebehulebetaendelse. Orientering om en ny operativ procedure og evaluering af resultater af traditionel kirurgi.

During recent years, a new operative procedure for treatment of chronic maxillary sinusitis has been strongly recommended as being more effective and more physiological than the traditional Caldwell-Luc operation. The principle of the method is endoscopically guided endonasal resection of the anterior ethmoid cells and enlargement of the natural ostium of the maxillary sinus in the middle meatus. In contrast, the principle in the Caldwell-Luc operation is opening into the sinus in the canine fossa, providing direct approach to the lumen, and finally creation of a fenester towards the inferior meatus. However, the publications hitherto presented have not documented clearly the efficiency of this new method, which also appears to have an increased risk of complications, some of which are serious. The present study elucidates the efficiency and side effects of the traditional Caldwell-Luc operation in 77 patients (107 maxillary sinuses). Four to nine years after the operation 73% of the patients had had satisfactory subjective effect of the operation. Consistency was present between the subjective estimation and the objective findings at follow-up. The effects included only slight disturbances of the sensibility in the infraorbital nerve (n = 9) or teeth (n = 6). However, only two patients (3%) had more troublesome change of the sensibility in the infraorbital nerve and in one patient only a subjectively "dead" tooth was also avital at vitality testing. The survival of the teeth was estimated roughly by comparison of the number of teeth on the operated side versus the non-operated side and was unimpaired.(ABSTRACT TRUNCATED AT 250 WORDS)

Two malignant melanomas in skin and tonsil during consecutive pregnancies.

A patient is described with two primary malignant melanomas which developed during consecutive pregnancies four years apart. The first melanoma was of the cutaneous nodular type located on the arm. The second, of the superficial spreading type, was located in the oral mucosa near the right tonsil. The influence of pregnancy on the development and outcome of malignant melanomas is discussed, and the risk of a subsequent pregnancy is emphasised.