Superglue in otology.

BACKGROUND: The use of stitches and staples for the closure of surgical wounds is associated with complications for both the surgeon and the patient. Histoacryl (butyl1-2cyanoacrylate glue) is widely used for wound closure in Accident and Emergency departments, in particular for facial and scalp wounds. METHOD: We have used Histoacryl for closure of various surgical incisions in a series of 50 cases and assessed the cosmetic outcome at three to four weeks. RESULTS: There were no wound related complications in the form of infection or dehiscence. In one case however, there was formation of synechiae in the external auditory meatus following an endaural incision. CONCLUSION: We recommend the use of Histoacryl over traditional closure using skin suture material in otological surgery. Our experience was also successful in parotid cases.

Anterior inferior cerebellar artery syndrome: fact or fiction.

A prospective analysis of patients referred by Otolaryngologists from a tertiary hospital for detailed assessment of the posterior cranial fossa was undertaken. The objectives were to evaluate radiological characteristics of the anterior inferior cerebellar artery (AICA) within the cerebellopontine angle (CPA) and the internal auditory canal (IAC), and to correlate these characteristics with ipsilateral auditory symptoms. Three hundred and thirty-two consecutive adult patients who presented with unilateral auditory symptoms were studied. All patients were referred by the Department of Otolaryngology at City Hospital, Birmingham, from October 1999 to October 2001. Magnetic resonance imaging (MRI) with three-dimensional Fourier Transformation Constructive Interference in Steady State (3D FT-CISS) was the imaging strategy used to investigate each patient. Six hundred and sixty-four sides were studied and the AICA loop was identified in all patients. Using a simple anatomical classification to type the loops: there were 412 type I loops (within the CPA), 202 type II loops (at the porus acousticus, extending up to 50% of IAC) and 50 type III loops (extending beyond 50% of IAC). There was a statistically significant association with unilateral hearing loss and type II and III AICA loops (P = 0.016 and P = 0.006 respectively). An association between the presence of a large diameter vascular loop in the CPA and unilateral auditory symptoms was not found to be significant (P > 0.05).

Minimum dataset for recording myringotomy and ventilation tube insertion.

A minimum dataset for recording of findings during myringotomy and ventilation tube insertion for cases of otitis media with effusion is presented. With increasing pressures on surgeons to audit existing practices and hence improve standards of health care, it is appropriate to produce such a set of guidelines for a surgery that is frequently performed world-wide. We believe that the data presented is not too exhaustive and can be readily incorporated into the operative notes.

Mandibular advancement prosthesis: first-line alternative to surgery in snoring.

Mandibular advancement prosthesis (MAP) is infrequently used in the UK at present for snoring. First-line measures include dietary and weight modification for those that require it. Where such measures are unlikely to be useful or have already failed, surgery is sometimes utilized as a second-line treatment modality. We evaluate the use of MAP as an adjunct to first-line measures, with emphasis on efficacy, side-effects and patient compliance. Case notes of 30 snorers were reviewed and followed up with a questionnaire. Despite being useful in alleviating snoring, the prosthesis was poorly tolerated. Side-effects include increased salivation, temporomandibular joint pain, intra-oral and myofacial discomfort. Patients who persevered with the prosthesis found the early side-effects resolved after a few weeks and snoring reduced. MAP can be used in the initial management of snorers but patients need to be educated and encouraged, especially in the first few weeks.

Otitis media with effusion: the role of Alloiococcus otitidis.

Otitis media with effusion (OME) is a common condition that can cause deafness as well as speech and behavioural disturbance. It has long been considered to be a noninfective process resulting from Eustachian tube dysfunction; however, molecular biological techniques have implicated bacteria in the aetiology of this condition. One such organism is Alloiococcus otitidis, which has been detected in middle ear fluid of patients with OME which has not yielded micro-organisms with conventional microbiological culture methods. The exact role of this infectious agent in the pathogenesis of otitis media has yet to be elucidated.

Long-term results of tympanic neurectomy for chronic parotid sialectasis.

BACKGROUND: Chronic parotid sialectasis presents as troublesome recurrent swellings of the parotid salivary gland during swallowing and mastication. The main treatment options are parotidectomy with its associated high morbidity and tympanic neurectomy. AIM: The aim of this study is to present the long-term results of our experience about tympanic neurectomy for chronic parotid sialectasis. PATIENTS AND METHODS: Twenty two patients underwent tympanic neurectomy (14 males; 8 females) between 1983 and 1999 with an mean follow up of over six years. The hallmark of our surgery is to interrupt as many branches of the tympanic nerve as possible by extensively drilling in the hypotympanum and below the basal turn of cochlea, with removal of the anterior and posterior branches. RESULTS: 17 of the 22 patients had a marked to total reduction in symptoms on follow-up. Four patients were troubled enough to go on to undergo a superficial parotidectomy. There was no significant morbidity associated with the procedure. CONCLUSION: Tympanic neurectomy performed by an experienced otologist should be the preferred surgical option for chronic parotid sialectasis, with parotidectomy being reserved for those patients who fail to improve.

Computed tomography evidence of dental restoration as aetiological factor for maxillary sinusitis.

Maxillary sinusitis due to dental causes is usually secondary to periodontal disease or periapical infection and is commonly associated with mucosal thickening of the floor of the maxillary antrum. Computed tomography (CT) is currently the modality of choice for evaluating the extent of disease and any predisposing factors in patients with symptoms of chronic maxillary sinusitis, but it is unable to diagnose dental disease reliably. The presence of restorative dentistry is, however, easily seen at CT and is associated with both periapical and periodontal disease. We aimed to determine whether its presence at CT may predispose to maxillary sinusitis, and in particular to focal mucosal thickening of the sinus floor characteristic of dental origin. Three hundred and thirty maxillary sinus CT images in 165 patients were reviewed for the presence of restorative dentistry in the adjacent teeth, focal maxillary sinus floor mucosal thickening, any maxillary sinus disease (including complete opacification, air fluid levels, diffuse mucosal thickening, focal mucosal thickening) and evidence of a rhinogenic aetiology (osteomeatal complex pathology, mucosal thickening in other sinuses). One hundred and ninety two sinuses adjacent to restorative dentistry and 178 sinuses not adjacent to restorative dentistry were analysed. Focal floor thickening both with, and without, evidence of a rhinogenic aetiology, was significantly more common adjacent to restorative dentistry. Maxillary sinus disease overall was no more common adjacent to restorative dentistry. This work demonstrated that the presence of restorative dentistry predisposes to focal mucosal thickening in the floor of the maxillary sinus and its presence should prompt clinical and radiographical assessment to exclude dental disease as a source of chronic maxillary sinusitis.

Herpes and the head and neck: the difficulties in diagnosis.

A case of primary herpes of the head and neck is presented. The exact source of infection and the precise diagnosis proved difficult to establish, but evidence tended to support a diagnosis of varicella zoster infection as opposed to a herpes simplex infection, though a dual infection was not ruled out. Herpes simplex has specific clinical features which usually make its distinction from varicella zoster clear cut. In this case we relied heavily on laboratory investigations to improve the accuracy of our diagnosis since the clinical characteristics were blurred. Unlike varicella zoster there has been little written about herpes simplex infections specifically affecting the ear, face and neck.

Detection of Alloiococcus otitis in mixed bacterial populations from middle-ear effusions of patients with otitis media.

BACKGROUND: Otitis media is a potentially serious disorder, since there is a risk of permanent hearing loss. Culture methods are not useful in characterisation of populations of bacteria in the middle ear. We have used a PCR-based method that does not depend on prior knowledge of the bacteria identified by culture. METHODS: Middle-ear effusion fluid was obtained from 12 patients with chronic otitis media with effusion. Total DNA was extracted from the samples, and the hypervariable regions of bacterial 16S rRNA genes were amplified by means of broad-range PCR primers. Individual PCR products were segregated by cloning to allow analysis of mixed bacterial populations. FINDINGS: Many bacterial species were detected by PCR, whereas with culture-based approaches, no bacterial growth was detected for ten of the 12 patients. The gram-positive bacterium Alloiococcus otitis (A. otitidis) was detected by 16S rDNA amplification in six of the twelve samples, but not by culture techniques. Interpretation The method may have general usefulness in characterising bacterial populations at the site of infection and may indicate, from small sample numbers, organisms that are candidates for further investigation.

An unusual cause of nasal septum perforation.

We present a case where the use of magnetically held earring clips in the nose led to an unfortunate series of events resulting in perforation of the nasal septum.

Age, smoking and nasal ciliary beat frequency.

The nasal ciliary beat frequency of 120 individuals in a British urban population was determined from nasal brushings. These individuals formed part of a previous study which looked at nasal and middle ear ciliary beat frequency in 60 patients with middle ear disease and compared it to nasal ciliary beat frequency in 60 matched controls. The present study intended to investigate any changes in nasal ciliary beat frequency with age. Comparison was also made between patients who were habitually exposed to tobacco smoke and non-exposed individuals. Nasal brushings were taken from the inferior turbinate using a cytology brush and the beat frequency was determined using a computerized photometric technique. In the population studied ages ranged from 2 to 69 years (mean 10.9 +/- 19.7 years). The mean beat frequency of 120 individuals was 11.5 +/- 2.5 Hz (SD), range 5.5-19.2 Hz. There was no particular trend observed with regards to beat frequency and advancing age. Nasal ciliary beat frequency in tobacco smoke-exposed patients (whether active or passive smokers) was significantly less than that in non-smoke exposed controls (P = 0.02, Student's t-test).

Pneumosinus dilatans: a discussion of four cases and the possible aetiology.

Pneumosinus dilatans is an abnormal dilatation of the paranasal sinuses, which contains only air and is lined by normal mucosa. It is a rare condition, the aetiology of which is unclear. We describe four patients who presented to our department with pneumosinus dilatans. The aetiology was either developmental hydrocephalus (n = 1), post-traumatic (n = 1) or idiopathic (n = 2). Two patients underwent surgery, and follow-up is at least 12 months to date. The radiological aspects of this rare condition and the possible aetiologies are discussed.

The incidence of sinusitis in patients with multiple sclerosis.

A retrospective study was performed to assess the incidence of sinus disease in patients with MS. The MRI scans of 108 patients referred to a regional Neurosciences Unit with a diagnosis of multiple sclerosis were examined. There were 71 females and 37 males with an age range of 22 to 67 years (mean: 39.7 years). The sagittal and axial images were reviewed and the degree of sinus disease noted. This was graded as absent, minimal, polypoid and pansinus. Fifty-seven patients (53%) had disease, the most common sinus involved was the maxillary followed by the ethmoid, frontal and sphenoid. Thirty-six patients had bilateral disease affecting the ethmoid sinuses most commonly. Three patients had fluid levels and four patients had retention cysts. The incidence of sinus disease is higher than in some other studies of normal populations.

The role of surgery in tuberculous mastoiditis: appropriate chemotherapy is not always enough.

We present a case of tuberculous otitis media in which a facial palsy occurred after the start of appropriate chemotherapy. To our knowledge this circumstance has not been described previously. It has been argued that radical surgery is completely unnecessary if chemotherapy is commenced early in the disease. We would suggest that this is not always the case, and would advocate a more measured approach.

CT assessment of jugular foramen dominance and its association with hand preference.

Three hundred and seven normal CT scans of the head were prospectively analysed to assess jugular foramen dominance. After assessment, hand preference was elicited. Of these, 276 were right-handed and 31 were left-handed. Of the right-handed patients: 180 had a larger jugular foramen on the right; 63 had a larger jugular foramen on the left; and in 33 no difference could be discerned. Of the left-handed patients: 11 had a larger jugular foramen on the right; 16 had a larger jugular foramen on the left; and in four no difference could be discerned. The results suggested a significant association between jugular foramen dominance and hand preference.

Parapharyngeal abscess secondary to an external auditory meatus foreign body.

Parapharyngeal abscess is not an uncommon condition and may be due to spread of infection from acute tonsillitis or dental disease or secondary to perforating injury of the pharynx. We present a case report of a patient with an external auditory meatus foreign body who developed a parapharyngeal abscess.

The Midland Institute of Otology and its founder: William Stirk Adams (1896-1978).

To celebrate the 50th Anniversary of the establishment of the Midland Institute of Otology (MIO) a meeting was held in the Belfry Hotel, West Midlands, 19-21 September 1997. The meeting comprised an excellent academic conference, social events and a golf tournament. A report on the academic conference has been published (Stansbie and Pahor, 1997). The MIO has been established to further the cause of ENT in the Midlands and it has succeeded in its aim to a great extent. An historical overview of the Institute is of interest and would serve perhaps as a model for similar organizations, especially in the provinces. The Institute was the brainchild of William Stirk Adams. He remained the President from the conception of the Institute till his death. It is befitting to present a biography of such a dedicated personality.