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OBJECTIVES: This study aimed to evaluate the prevalence of normal variations of temporal bone anatomy on high-resolution computed tomography imaging and report their clinical importance. METHODS: A retrospective review was conducted of high-resolution temporal bone computed tomography imaging performed at NHS Greater Glasgow and Clyde over an eight-year period. The presence of five variants was determined. These variants were: a high dehiscent jugular bulb, an anteriorly located sigmoid sinus, a deep sinus tympani, an enlarged cochlear aqueduct and a large internal auditory meatus. RESULTS: A total of 339 temporal bones were examined. The incidences of a high dehiscent jugular bulb, anteriorly located sigmoid sinus, deep sinus tympani, enlarged cochlear aqueduct and an enlarged internal auditory meatus were 2.76 per cent, 2.94 per cent, 5.01 per cent, 0.58 per cent and 1.76 per cent respectively. CONCLUSION: Anatomical variations of the temporal bone are not uncommon and it is important for the investigating otologist to be aware of such variations prior to undertaking surgery.
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Hueso Temporal/anatomía & histología , Hueso Temporal/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Acueducto Coclear/anatomía & histología , Humanos , Venas Yugulares/anatomía & histología , Prevalencia , Estudios RetrospectivosRESUMEN
BACKGROUND: Branchial cleft cysts occur because of a failure of involution of the second branchial cleft. However, as well-differentiated squamous cell carcinoma can mimic branchial cleft cysts, there is a lack of consensus on the appropriate management of cystic neck lumps. OBJECTIVE: To report our experience of fine needle aspiration cytology and frozen section examination in the management of cystic neck lumps. METHOD: Retrospective case note review of patients managed in the Southern General Hospital, Scotland, UK. RESULTS: The sensitivity of fine needle aspiration cytology and frozen section for detecting branchial cleft cysts was 75 per cent and 100 per cent respectively. Two patients who did not undergo intra-operative frozen section examination were either over- or under-treated, which is discussed. CONCLUSION: Adult patients subjected to surgical excision of a suspected branchial cyst should undergo intra-operative frozen section analysis regardless of clinical suspicion for malignancy. This part of management is critical to ensure patients are offered appropriate treatment.
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Biopsia con Aguja Fina/métodos , Branquioma/patología , Secciones por Congelación/métodos , Adulto , Anciano , Anciano de 80 o más Años , Branquioma/diagnóstico , Branquioma/terapia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Diagnóstico Diferencial , Femenino , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/terapia , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y Especificidad , Carcinoma de Células Escamosas de Cabeza y Cuello , Adulto JovenRESUMEN
OBJECTIVE: Neurenteric cysts are rare lesions that account for 0.7-1.3% of all spinal cord tumours. We report the first ever case of a neurenteric cyst presenting with stridor and dysphagia. A literature review on the presentation and management of these lesions is also included. METHODS: A MEDLINE search of articles using the terms 'neurenteric cyst', 'intraspinal cyst', 'enterogenous cyst', 'intramedullary cyst' along with diagnosis, presentation and management was performed. Suitable references from these articles were also reviewed. RESULTS: All published evidence on neurenteric cysts are either case series or case reports (level IV/V) with the largest case series reporting 23 patients from a single institution. CONCLUSION: Neurenteric cysts are rare spinal cord lesions that usually present with focal neurological signs and managed within neurosurgical units. This is the first reported case of a neurenteric cyst presenting with upper aerodigestive tract symptoms warranting specialist ear, nose and throat input.
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Trastornos de Deglución/etiología , Defectos del Tubo Neural/complicaciones , Defectos del Tubo Neural/diagnóstico , Radioterapia Guiada por Imagen/métodos , Ruidos Respiratorios/etiología , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Defectos del Tubo Neural/terapia , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
OBJECTIVES: We examined our experience of image guidance surgery in rhinology, and compared image guidance surgery cases with non-image guidance cases. We also audited our practice against the American Academy of Otolaryngology-Head and Neck Surgery image guidance surgery guidelines. METHOD: The study employed a single institution retrospective approach comprising 174 image guidance surgery patients (106 males and 68 females) and 134 non-image guidance surgery patients (75 males and 59 females). RESULTS: In the image guidance surgery group, tumour operations represented 45 per cent of cases (55 per cent were non-neoplastic). Basic, intermediate and advanced (structured classification) procedures represented 19 per cent, 24 per cent and 61 per cent, respectively. Five minor complications were recorded. In non-image guidance surgery, tumour operations represented 8 per cent of cases (92 per cent were non-neoplastic). Basic, intermediate and advanced procedures represented 73 per cent, 12 per cent and 15 per cent, respectively. One minor complication was observed. CONCLUSION: We report the largest series of image-guided ENT surgical procedures in the UK. In the cases we examined, image guidance surgery was predominantly used in advanced procedures and tumour surgery.
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Nariz/cirugía , Senos Paranasales/cirugía , Base del Cráneo/cirugía , Cirugía Asistida por Computador/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nariz/diagnóstico por imagen , Otolaringología , Senos Paranasales/diagnóstico por imagen , Radiografía , Estudios Retrospectivos , Cirugía Asistida por Computador/efectos adversos , Reino Unido , Adulto JovenAsunto(s)
Endoscopios , Endoscopía/métodos , Osteoma/cirugía , Neoplasias de los Senos Paranasales/cirugía , Neoplasias de la Base del Cráneo/cirugía , Senos Etmoidales , Seno Frontal , Humanos , Masculino , Persona de Mediana Edad , Osteoma/diagnóstico por imagen , Neoplasias de los Senos Paranasales/diagnóstico por imagen , Radiografía , Neoplasias de la Base del Cráneo/diagnóstico por imagenRESUMEN
OBJECTIVE: To review outcomes following paediatric cholesteatoma surgery performed between 1999 and 2009 in a tertiary paediatric ENT unit. STUDY DESIGN: Retrospective case note review. RESULTS: A total of 137 mastoid procedures were recorded. Fifty-four per cent of children were observed to have disease involving the entire middle-ear cleft and mastoid complex. The revision rate was 25 per cent. Time to recurrence was one to three years in 17 patients, three to six years in five patients, and six to nine years in three cases. Eight of 25 revision cases demonstrated spontaneous improvement in air conduction thresholds following primary surgery. A high facial ridge and inadequate meatoplasty correlated highly with disease recurrence. CONCLUSION: Children tend to present with aggressive disease. Disease extent and ossicular chain involvement are associated with a higher risk of recurrent disease. Spontaneous improvement in hearing thresholds following cholesteatoma surgery should alert the clinician to recurrent disease.
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Colesteatoma del Oído Medio/cirugía , Pérdida Auditiva/rehabilitación , Apófisis Mastoides/cirugía , Procedimientos Quirúrgicos Otológicos/estadística & datos numéricos , Adolescente , Umbral Auditivo/fisiología , Conducción Ósea/fisiología , Niño , Preescolar , Colesteatoma del Oído Medio/epidemiología , Colesteatoma del Oído Medio/fisiopatología , Osículos del Oído/patología , Femenino , Humanos , Masculino , Recurrencia , Remisión Espontánea , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
AIMS: To determine (1) the accuracy of positron emission tomography - computed tomography in the diagnosis of head and neck cancer, (2) the learning curve involved, and (3) whether its use alters patient management. MATERIALS AND METHODS: A retrospective study including 80 patients with head and neck cancer who underwent positron emission tomography - computed tomography image fusion at Blackpool Victoria Hospital. RESULTS: Fifty-three patients underwent positron emission tomography - computed tomography for staging (32 for detection of a primary tumour and 21 for detection of distant metastasis) and 27 for detection of loco-regional recurrence. Ten primary tumours and 20 recurrences were accurately diagnosed by this method. Eighteen patients had their tumour stage and management modified as a result of this method of imaging. The effect of the learning curve resulted in better true positive detection rates, one year after introduction (81 versus 61 per cent). The sensitivity and specificity of this method in detecting head and neck cancer were 70 and 42 per cent, respectively, whereas those of conventional imaging were 73 and 51 per cent, respectively. CONCLUSION: Compared with magnetic resonance imaging, the benefits of positron emission tomography - computed tomography may be limited to diagnosis of recurrence, as it is less hindered by tissue fibrosis, radiotherapy-related oedema, scarring and inflammation.
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Carcinoma/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Imagen Multimodal , Recurrencia Local de Neoplasia/diagnóstico por imagen , Neoplasias Primarias Desconocidas/diagnóstico por imagen , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Biopsia , Carcinoma/patología , Carcinoma/secundario , Competencia Clínica , Fluorodesoxiglucosa F18 , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/secundario , Humanos , Hallazgos Incidentales , Metástasis Linfática , Estadificación de Neoplasias/métodos , Variaciones Dependientes del Observador , Valor Predictivo de las Pruebas , Radiofármacos , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
INTRODUCTION: Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of neonatal upper airway obstruction. This study is to review the presentation and management of this uncommon condition in a tertiary paediatric ENT centre in Scotland, United Kingdom. METHODS: Retrospective case note review between 2003 and 2011. A literature search was performed using MEDLINE and EMBASE between April and June 2011 using search terms 'pyriform aperture' in combination with diagnosis and treatment. Suitable references were also selected and reviewed. RESULTS: A total of 10 cases were identified and 50% of cases were managed surgically. Surgical widening of the pyriform aperture was performed at an average of 14 days at birth. Associated malformations include holoprosencephaly, hypopituitarism, cardiac and urogenital malformations. CONCLUSION: CNPAS is a treatable cause of upper airway obstruction. Early recognition is vital to appropriate management. Treatment is either conservative or surgical and depends on the severity of symptoms.
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Cavidad Nasal/anomalías , Obstrucción Nasal/congénito , Obstrucción Nasal/cirugía , Preescolar , Constricción Patológica/congénito , Constricción Patológica/cirugía , Diagnóstico Precoz , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Cavidad Nasal/diagnóstico por imagen , Cavidad Nasal/cirugía , Obstrucción Nasal/terapia , Seno Piriforme/anomalías , Seno Piriforme/diagnóstico por imagen , Estudios Retrospectivos , Medición de Riesgo , Muestreo , Índice de Severidad de la Enfermedad , Stents , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: Otalgia is a common presenting symptom to the ENT clinic. The aetiology of otalgia can be divided into otological and referred depending on its underlying pathology. This article aims to provide a systematic and evidence-based method of managing a patient with referred otalgia. METHODS: The data in this article are based on a literature review performed on MEDLINE and EMBASE in January 2010. The keywords used included otalgia in combination with diagnosis, management, investigations and treatment. Articles in the English language were selected and reviewed. Suitable references from these articles were also reviewed. RESULTS: The majority of published literature on the management of diseases causing referred otalgia is level III/IV evidence. CONCLUSIONS: An understanding of the different causes of referred otalgia is essential as it can be multifactorial in origin. The main concern in a patient with referred otalgia is overlooking a malignant lesion in the upper aerodigestive tract or base of skull/infratemporal fossae. A thorough history followed by a systematic examination usually helps to arrive at a diagnosis. Treatment should be directed towards the underlying pathology.
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Dolor de Oído/diagnóstico , Dolor de Oído/terapia , Algoritmos , Diagnóstico Diferencial , Dolor de Oído/etiología , Medicina Basada en la Evidencia , Humanos , Factores de RiesgoRESUMEN
OBJECTIVES: To determine the accuracy of fine needle aspiration cytology conducted within a standard ENT out-patients service (rather than a one-stop neck lump clinic), and also to assess the value of ultrasound guidance during fine needle aspiration cytology. DESIGN: Retrospective study of all patients undergoing fine needle aspiration cytology of a neck lump, from 2005 to 2008 in Leeds teaching hospitals. MAIN OUTCOME MEASURES: Accuracy of fine needle aspiration cytology, compared with the corresponding histology report of the original surgical specimen, and non-diagnostic fine needle aspiration cytology rates with and without ultrasound. RESULTS: Fine needle aspiration cytology yielded the following respective sensitivity, specificity and accuracy rates: 85, 91 and 87 per cent for lymph nodes; 80, 93 and 89 for salivary glands; and 52, 80 and 69 for thyroid. The proportion of non-diagnostic procedures was 28 per cent, both with and without ultrasound guidance. CONCLUSION: Cytologist-led fine needle aspiration cytology would have reduced the time to diagnosis and the number of clinic visits per patient. Fine needle aspiration cytology was accurate for predicting malignancy in salivary gland and lymph node lesions, and for diagnosing lymph node pathology. Study results did not support the use of ultrasound guidance during fine needle aspiration cytology.
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Biopsia con Aguja Fina/métodos , Neoplasias de Cabeza y Cuello/patología , Biopsia con Aguja Fina/normas , Humanos , Ganglios Linfáticos/patología , Estudios Retrospectivos , Glándulas Salivales/patología , Glándula Tiroides/patología , Ultrasonografía Intervencional , Reino UnidoRESUMEN
A 17-year-old male presented with a 10-day history of symptoms of upper respiratory tract infection, headaches, photophobia and progressive swelling around both eyes. Clinical examination revealed a temperature of 39 °C and bilateral periorbital swelling which was worse on the left side. Initial ophthalmological examination revealed a dilated non-reactive pupil on the left side and a sluggish pupillary reflex on the right side. The patient also had a lateral rectus palsy of the left eye. Fundoscopy showed bilateral papilloedema, and visual acuity on admission was 6/12 in the right and 6/18 in the left eye. Ear, nose and throat examination revealed a rhinitic nasal mucosa with thick mucopus in the left middle meatus. The patient required surgical intervention to drain his sinuses followed by long-term intravenous antibiotic therapy and anticoagulation. After 6 weeks of therapy and close observation, he recovered with minimal sequelae.
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Trombosis del Seno Cavernoso/diagnóstico , Oftalmopatías/etiología , Adolescente , Trombosis del Seno Cavernoso/complicaciones , Oftalmopatías/diagnóstico , Humanos , MasculinoRESUMEN
OBJECTIVE: Inverted papilloma is a rare but locally aggressive tumour with the potential for malignant transformation. Intracranial extension or complications secondary to inverted papilloma are extremely rare. We report a case of inverted papilloma with a large frontal sinus mucocele eroding the frontal sinus, which presented with sudden neurological compromise. A literature review on intracranial extension of such tumours is also included. METHODS: A Medline search of articles, using the terms 'inverted papilloma', 'Ringertz tumour', 'intracranial extension' and 'complication'. Suitable references from the collected articles were also reviewed. Articles published in English were selected and reviewed. RESULTS: A total of 10 cases was identified. Intracranial spread was more commonly seen in recurrent cases, especially if the recurrence involved the cribriform plate, fovea ethmoidalis or orbits. Cases with extradural disease seemed to have a better prognosis than those with intradural spread. CONCLUSIONS: Intracranial involvement of inverted papilloma is extremely rare, and is usually seen in recurrent cases. This case report highlights an unusual but serious case of inverted papilloma presenting with acute neurological deterioration secondary to a large frontal sinus mucocele eroding the frontal sinus. A literature review on intracranial extension of inverted papilloma indicated that common sites of intracranial spread include the cribriform plate, fovea ethmoidalis and orbits. The prognosis for patients with such tumours depends on the type of dural involvement, with intradural extension carrying a poorer prognosis.
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Epilepsia/etiología , Seno Frontal , Mucocele/complicaciones , Papiloma Invertido/complicaciones , Neoplasias de los Senos Paranasales/complicaciones , Adulto , Humanos , Masculino , Invasividad Neoplásica , Papiloma Invertido/cirugía , Neoplasias de los Senos Paranasales/cirugía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
AIMS: Patients complaining of a dry mouth can present themselves to various clinicians such as the primary care physician, dentists, otolaryngologists and/or oral surgeons. The aim of our review is to provide a systematic method of assessing and managing these patients based on current best evidence published in the literature. METHODS: A literature search was performed on 20th April 2009 using MEDLINE and EMBASE using the terms dry mouth and xerostomia in combination with diagnosis, management, investigations and treatment. RESULTS: There appears to be little correlation between patient symptoms and objectives tests of salivary flow. Therefore clinical management should be based on patient symptoms. There is good evidence to support that xerostomia is commonly associated with anticholinergic drugs, and altering such agents plays an important role in the management of these patients. In patients with residual salivary gland function, the use of salivary stimulants appears to be more beneficial than salivary substitutes. CONCLUSION: Xerostomia can be debilitating and primarily affects the middle aged and elderly population. The most common causes of xerostomia include medications with anticholinergic properties, dehydration, diabetes and radiotherapy for head and neck cancer. Treatment of xerostomia essentially involves addressing the cause followed by salivary substitutes and/or salivary stimulants.
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Xerostomía/terapia , Terapia por Acupuntura , Ácido Ascórbico/uso terapéutico , Goma de Mascar , Humanos , Malatos/uso terapéutico , Anamnesis , Agonistas Muscarínicos/uso terapéutico , Parasimpaticomiméticos/uso terapéutico , Examen Físico , Pilocarpina/uso terapéutico , Protectores contra Radiación/uso terapéutico , Derivación y Consulta , Saliva Artificial/uso terapéutico , Xerostomía/etiologíaRESUMEN
AIM: To survey antibiotics prescribed for patients admitted with acute tonsillitis and peritonsillar abscess to UK ENT departments. MATERIALS AND METHODS: An anonymous postal questionnaire was sent to UK ENT consultants. RESULTS: Intravenous benzylpenicillin alone was preferred significantly more often for acute tonsillitis (n = 175) than for peritonsillar abscess (83) (p < 0.001). A combination of benzylpenicillin and metronidazole was preferred significantly more often for peritonsillar abscess (n = 131) than for tonsillitis (62) (p < 0.001). CONCLUSIONS: In this survey, penicillin was the commonest antibiotic choice for tonsillitis; this is in accordance with published guidelines. For cases of peritonsillar abscess, benzylpenicillin with metronidazole was the most common antibiotic combination chosen. However, the high resolution rate of peritonsillar abscess following drainage and treatment with penicillin alone suggests that multiple antibiotics are unnecessary and inappropriate in this setting.