Connection between the inner ear and the lymphatic system.

OBJECTIVE: The aim of this study was to identify the lymphatic drainage of the inner ear in guinea pigs. STUDY DESIGN: Prospective study. METHODS: The prospective study was performed in guinea pigs by injection of keyhole limpet hemocyanin (KLH) into either the right-side scala tympani or the middle ear cavity. The left side was not injected and served as a control. Fifteen minutes after injection, the animals were killed by intracardiac perfusion with paraformaldehyde and tissue specimens (right and left temporal bones, cervical lymph nodes, and the spleen) were collected. The presence of KLH in each specimen was determined by immunohistochemical assay of frozen sections using polyclonal mouse anti-KLH antibodies. RESULTS: After injection into the middle ear, labeled cells were identified in the parotid, superficial ventral, mandibular, and deep cranial cervical lymph nodes. However, after inner ear injections KLH was present in only the parotid and superficial ventral cervical nodes. The spleen contained KLH-positive cells following injection into either the middle or inner ear, but not all animals contained labeled spleen cells. CONCLUSIONS: The inner ear has a connection to the lymphatic drainage system. Because fewer lymph nodes contained labeled cells after inner ear injection than after middle ear injection, it is concluded that the inner ear does not simply drain to the middle ear and subsequently to the lymph nodes but seems likely to have its own connections.

Distribution of minor salivary glands in the peritonsillar space.

Minor salivary glands can usually be found along the mucous membrane of the upper aerodigestive tract. Their presence in the peritonsillar space was of little interest until it was postulated that infection of Weber's gland (minor salivary gland at the superior pole of the peritonsillar space) might be the possible cause of peritonsillar abscess. This study was designed to examine the distribution of minor salivary glands in the peritonsillar space and their role in pathogenesis of peritonsillar abscess. Tonsillectomy specimens from fifty-five patients who were suffering from repeated tonsillitis, obstructive sleep apnea, tonsillar mass and peritonsillar abscess at Srinagarind Hospital from September 1995 to November 1996 were histologically examined. The locations of these minor salivary glands were found at the upper, middle, and lower portions of the peritonsillar space. This small sample study precludes any definitive statement regarding the association of Weber's gland and the pathogenesis of peritonsillar abscess.

Idiopathic sudden sensorineural hearing loss.

BACKGROUND: Sudden sensorineural hearing loss is one of the most controversial unsolved mysteries in Otolaryngology. Lack of a universally accepted definition of sudden sensorineural hearing loss, insufficient knowledge of pathogenesis, lack of a standard method for evaluating the patients, in addition to a high spontaneous recovery rate, all complicate the study of sensorineural hearing loss and the investigation of different treatment modalities. OBJECTIVE: To study the clinical manifestation and prognostic factors, which influence the recovery of hearing in sudden sensorineural hearing loss. PATIENTS AND METHOD: Patients with idiopathic sudden sensorineural hearing loss who were admitted to Srinagarind Hospital from January 1994 to December 1998 were included. The clinical manifestations, audiograms and investigations of these patients were analysed. RESULTS: Of the fifty-six patients, who met the criterion, 34 were females and 22 males. The average age of onset was 43.7 years (SD = 13.46, range = 13-66 years). The onset of hearing loss was sudden in 50 per cent of cases, whereas, 46.4 per cent of cases were noted on awakening in the morning and the remainder had rapidly progressive hearing loss. The hearing loss was unilateral in 92.9 per cent of cases. 96.4 per cent of the patients had tinnitus and 66.1 per cent of the patients had vertigo. 64.3 per cent of the patients had some degree of recovery (complete recovery in 28.6% and partial recovery in 35.7%). The severity of hearing loss significantly influenced the outcome of the patients. CONCLUSION: Approximately two-thirds of the patients with idiopathic sudden hearing loss had some degree of recovery. Among contributing factors, only the severity of hearing loss significantly influenced the prognosis.

Dislodge of T-tube into the bronchus, an unusual complication of the Montgomery T-tube: a case report.

Laryngotracheal stenosis is a sequel of laryngeal trauma. Many surgical techniques have been developed to correct this problem. Sometimes it requires a tracheal T-tube after the surgical correction. Here the authors report an unusual complication of tracheal T-tube and suggest a method for the management of this complication.

Treatment of benign paroxysmal positional vertigo by canalith repositioning procedure: experience from Srinagarind Hospital.

INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo. The diagnosis is confirmed by observing a classical response during the Dix-Hallpike maneuver. The cause of BPPV is usually idiopathic. There are two popular hypotheses described regarding the pathogenesis of BPPV. The first one is the "cupulolithiasis" hypothesis, and the second hypothesis, the so-called "canalithiasis" hypothesis. The clinical course of BPPV is spontaneous recovery in weeks or months. Treatments for BPPV have ranged from no intervention to surgical treatment. The new treatment, "Canalith-repositioning procedure (CRP)" which was introduced by Epley in 1992 produces a very high rate of success. This treatment has caused interest and has been modified and studied worldwide in recent years. OBJECTIVE: To study the efficacy of the canalith-repositioning procedure that we modified from Epley's maneuver in the treatment of BPPV patients. DESIGN: A descriptive study. The BPPV patients, who came to the neurotologic clinic at Srinagarind Hospital from January 1997 to December 1998, were treated with our technique that was modified from Epley's maneuver. We neither used pre-medication, a mastoid oscillator, nor post-treatment instruction. RESULTS: The total number of patients included in this study was 19. The efficacy of this procedure for curing nystagmus and vertigo was 89.5 per cent. One patient did not follow-up and one patient did not respond to the CRP. Complication such as vago-vagal reflex, lateral canalithiasis, occurred in 5.3 per cent of the patients. The recurrence of BPPV in our study was 26.3 per cent. However, CRP was also effective in treatment of both patients with recurrence as well as those without recurrence. CONCLUSION: The canalith-repositioning procedure that is modified from Epley is effective in the treatment of BPPV.