The maturation of balance in children.

BACKGROUND: Balance function is known to change with age during infancy and childhood. However, the relative contributions of the three primary inputs to position sense are not fully understood. METHODS: In this paper we report the computerised dynamic posturography findings in a group of 60 healthy children from the age of five to 17. RESULTS: The results confirm that there is a progressive improvement in balance function with age. The EquiTest system that was used gave indications of the relative contributions of the three principal contributors to overall balance function and showed that somatosensory function was intact throughout the age range tested and that there are significant increases in vestibular function with age and visual contribution with height. The technique used was found to be reliable and repeatable in this paediatric sample. CONCLUSIONS: It is hoped that a better understanding of the normal age related development of balance will be helpful in dealing with children presenting with disequilibrium and vertigo.

Orbital and skin metastases in a polymorphous low grade adenocarcinoma of the salivary gland.

We report the previously undocumented development of an orbital metastasis and skin metastases in a patient with polymorphous low grade adenocarcinoma (PLGA) 15 years after initial presentation. The clinical course, treatment and changing histological features are discussed.

Endoscopic fenestration of choanal atresia.

We report two cases of unilateral choanal atresia and one of choanal stenosis treated successfully by endoscopic fenestration, with no recurrence at a mean follow-up of 18 months. Rigid endoscopy and axial CT scanning confirm the clinical diagnosis and this technique avoids the need for stenting or prolonged post-operative stay.

Mycobacterium avium-intracellulare cervical lymphadenitis in siblings: a case report and review.

We report two cases of cervical mycobacterium avium-intracellulare lymphadenitis in siblings which developed within one month of each other. There was no underlying immunodeficiency but the children lived in close proximity to a pigeon loft.

Major complications of functional endoscopic sinus surgery.

The results of a postal questionnaire indicate an exponential rise in the practice of functional endoscopic sinus surgery (FESS) in the UK and a major complication rate of 0.23%. Cerebrospinal fluid leak was the most common serious complication accounting for 24 of the 36 reports.

Pneumatization of the uncinate process.

We report one case of extensive and two of partial pneumatization of the uncinate process from a consecutive series of 250 CT scans of the paranasal sinuses. The CT findings are illustrated and the literature reviewed.

Pneumoparotitis.

Pneumoparotitis is a rare cause of parotid enlargement. It is due to a reflux of air through Stensen's duct into the acini of the parotid gland with subsequent dilatation. We report a case which followed a long history of autoinflation of the middle ears by the Valsalva manoeuvre. The plain radiographic, sialographic and ultrasound findings are presented.

Prospective study of two management strategies for epistaxis.

Two different management strategies were applied prospectively and consecutively for 12 months each for epistaxes requiring hospital admission. Patients who did not respond to 48 h nasal packing were treated more successfully and more economically by submucous resection of the nasal septum than by delayed arterial ligation.

Hazards of ear-piercing procedures which traverse cartilage: a report of Pseudomonas perichondritis and review of other complications.

A case of severe Pseudomonas perichondritis following a 'fashionable' ear-piercing procedure, performed high on the pinna, is reported. The current vogue for such 'high' ear-piercing, which traverses cartilage rather than the fatty tissue of the ear lobe as in 'traditional' ear-piercing, increases the risk of infection which may produce severe cosmetic deformity.

Endolymphatic hydrops precipitated by haemodialysis.

We report a case of endolymphatic hydrops preceded by haemodialysis in the contralateral ear of a patient with known Menière's disease, and discuss the possible mechanism. It is suggested that the sudden decrease of plasma osmolality during haemodialysis acts as a reverse glycerol test. The audiometric and electrophysiological recordings pre- and post-dialysis and the induction of the Menière's triad of symptoms during dialysis, were strongly indicative of the presence of endolymphatic hydrops.

Atypical thyroglossal duct cyst.

Thyroglossal duct cysts most frequently present in childhood as a painless midline swelling of the neck. Uncommonly, these embryonal remnant cysts present clinically in adult life. The majority of adults with thyroglossal duct cysts present with a swelling at the level of the thyrohyoid membrane. On rare occasions, a thyroglossal duct cyst can present with more sinister symptoms, such as hoarseness, dysphagia and dyspnoea. On these occasions, the pre-operative clinical and investigative diagnosis remains in doubt until histology is available.

Mucoepidermoid carcinoma of the larynx.

We report two cases of poorly differentiated mucoepidermoid carcinoma of the larynx which both remain well after surgical management. The first underwent a radical neck dissection for recurrent disease following radiotherapy and the second a total laryngectomy with elective post-operative radiotherapy. Although well differentiated ('low grade') mucoepidermoid tumors of the larynx may respond to radiotherapy surgical management is generally recommended for all grades of such tumours especially for poorly differentiated ('high grade') tumours. Elective post-operative radiotherapy is often advocated for high grade tumours; radical neck dissection is generally undertaken only in the presence of lymphadenopathy, although elective radical neck dissection has been proposed for high grade tumours. These cases emphasise the value of comprehensive surgical management for this condition. Such laryngeal tumours are difficult to diagnose histologically from biopsy and are often initially reported as squamous cell carcinoma.