Bilateral multicystic parotid masses in primary Sjögren syndrome.

We report the case of a 48-year-old woman who presented with bilateral parotid gland enlargement as the initial manifestation of primary Sjögren syndrome. Magnetic resonance imaging demonstrated multiple areas of low-intensity signal mixed with foci of high-intensity signal, a finding suggestive of Sjögren syndrome. Autoimmune blood tests for Sjögren syndrome were positive, and a sublabial biopsy confirmed the diagnosis. Investigations for other conditions, including human immunodeficiency virus infection, were negative. After 5 years of follow-up, the parotid swellings remained essentially unchanged. We discuss the etiology of multicystic parotid gland pathology, its involvement in Sjögren syndrome, and the risk of lymphoma.

Contralateral deafness post head injury without temporal bone fractures.

We report an unusual case of contralateral deafness in a 31-year-old man after an uncomplicated blunt force head injury. The patient was presented with a left-sided head injury and complained of profound deafness in his right ear, dysequilibrium, and vertigo. Pure tone audiogram revealed total sensorineural deafness in the right ear. A high-definition computed tomography scan demonstrated no radiological evidence of bony injuries or a fistula. His dysequilibrium had improved 2 months later, but his vertigo and hearing loss persisted. We will discuss several possible mechanisms of injury that may result in deafness after head injury without bony fractures. The literature has been reviewed. Although deafness is not an uncommon complication of head injuries, its presentation in the contralateral ear in the absence of temporal bone fractures following head injury has not been reported before in the medical literature.

Indications for tonsillectomy: are we documenting them?

INTRODUCTION: Tonsillectomy is one of the most frequently performed operations in the UK. Documentation of the indications for tonsillectomy is vital, and should fulfil evidence-based guidelines where possible. We present a completed audit, evaluating the documentation of our department's practice in meeting the recommendations made by the Scottish Intercollegiate Guideline Network (SIGN) on indications for tonsillectomy. PATIENTS AND METHODS: A prospective audit of 100 children undergoing tonsillectomy for recurrent tonsillitis at a university hospital during two time periods: October 2007 to January 2008 and March to September 2008. Interventions including the production of posters and rubber stamps were agreed and implemented between the two audit periods. RESULTS: Following the implementation of simple changes, significant improvements were seen in documentation relating to the SIGN guidelines for tonsillectomy. Overall, the number of children meeting all four SIGN criteria for tonsillectomy rose from 12% to 44% (chi(2) = 57.8; P < 0.001). Furthermore, a significant reduction was seen in the number of children below the age of 5 years undergoing tonsillectomy for recurrent tonsillitis (chi(2) = 14.66; P < 0.001). CONCLUSIONS: With increasing scrutiny on tonsillectomy, it is important to ensure that the reasons for performing tonsillectomy are documented clearly and adhere to evidence-based guidance where possible. We have demonstrated that, with only simple and low-cost interventions, significant improvements in the documentation of tonsillectomy indications can be achieved.

Spontaneous cerebrospinal fluid otorrhoea presenting as otitis externa.

A case of spontaneous cerebrospinal fluid (CSF) otorrhoea in a 59-year-old lady is reported. The patient was initially diagnosed and treated for chronic otitis externa. Following the referral by her GP, it was found that her symptom of otorrhoea was secondary to cerebrospinal fluid leak with middle ear encephalocoele. The CSF leak was repaired using a transmastoid approach with fascia, bone paté and fibrin glue. In this paper, we describe an unusual case of spontaneous CSF otorrhoea presenting as otitis externa. We review the pathophysiology of spontaneous CSF otorrhoea, and discuss the pitfalls in the diagnosis of CSF otorrhoea.