Biomedical subjects
B J Bingham
Publications and source records attributed to B J Bingham.
A comparison of performance of Shepard and Sheehy collar button ventilation tubes.
This study was designed to confirm the longer in situ life of the Sheehy collar button compared with the Shepard tube and to assess the complication rates associated with the two tubes. Cases of bilateral otitis media with effusion had a Shepard tube inserted in one ear and a Sheehy contralaterally. The insertion position was allocated randomly. The patients were then assessed at three-monthly intervals for two years. In 71 per cent of those in whom at least one tube had extruded, the Sheehy remained in situ longer. The antero-inferior tube remained longer than the postero-inferior whichever type was used. There was no significant difference between complication rates, or recurrence rates of middle ear effusion after tube extrusion, for the two types. We conclude that use of a Sheehy rather than a Shepard tube carries no increased risk of complications and the patient may require further surgery less often in total.
Aspirating middle ear effusions when inserting ventilation tubes: does it influence post-operative otorrhoea, tube obstruction or the development of tympanosclerosis?
This prospective study examined the influence of aspirating middle ear effusions, immediately prior to ventilation tube insertion, upon the subsequent development of otorrhoea and tympanosclerosis. 50 children were studied and aspiration of effusions did not influence the incidence of purulent otorrhoea or ventilation tube obstruction within 1 month of surgery. The development of tympanosclerosis did not correlate with effusion aspiration, but in those ears which had an effusion aspirated there was a relation between operative bleeding and the development of tympanosclerosis.
Granular cell tumour of the larynx.
A granular cell tumour may present as clinically innocuous lesions on the vocal cords and the diagnosis is usually made by histopathology. However, the granular cells characteristic of this tumour may not be obvious and accompanying epithelial hyperplasia may be interpreted by the pathologist as invasive squamous cell carcinoma. Good communication between pathologist and surgeon is required to ensure that clinically benign lesions on the vocal cords are not misdiagnosed. The diagnosis of granular cell tumour can be confirmed by immunocytochemical staining for S100 antigen.
Episodic macroglossia in Down's syndrome.
We report a unique case of recurrent gross enlargement of the tongue associated with lymphangiectasia and tongue protrusion in an adult male with Down's syndrome. There were three episodes of acute macroglossia with no clinically identifiable cause. Spontaneous resolution always occurred after five to six days. Histological examination of the tongue, at post mortem, revealed a primary lesion of the lingual lymphatics. The possible mechanisms of acute macroglossia and the surgical techniques which could have been used to reduce the tongue bulk are discussed.
Sublabial rhinotomy with septal transfixion as an approach to the nasal fossa, paranasal sinuses and nasopharynx.
A sublabial incision with septal transfixion and mid-face degloving is described as an approach to the nasal cavity, paranasal sinuses and nasopharynx. A brief history of the development of the technique is given. The results of nine cases are presented. These cases have had good tumour clearance, excellent cosmetic results and the minimum of complications. The sublabial approach is most useful in children and women, particularly those with intermediate grade tumours. The advantages of the approach compared to the lateral rhinotomy incision include: superior access to the floor of the nose, inferior turbinate and anterior nasal septum; access to both sides of the nasal septum and the absence of a facial scar. The limitations of the sublabial technique are the poor access to frontal sinus and the cribriform plate.
The histological appearance of the tympanic edge in contact with an indwelling ventilation tube (grommet).
This study describes the histological features of the tympanic membrane which has been in contact with an indwelling ventilation tube and considers the factors of tube type, time in situ, persistent aural discharge and the comparison to perforations residual to grommet extrusion. The specimens were obtained at the time of operative removal of a grommet. The 21 margins examined were characteristically hyperplastic and hyperkeratotic with a prominent granular layer. The squamous epithelium was from 8 to 25 cell layers thick and the connective tissue core was increased. Chronic inflammation was common. Features of chronic otitis media (respiratory epithelium, goblet cells and glandular tissue) were found in 7 margins (2 perforations and 5 grommet specimens). A theory of grommet extrusion is presented in this paper in the light of the histological findings.
Tympanic membrane perforation following the removal of ventilation tubes in the presence of persistent aural discharge.
This study considers the effect of the removal of a ventilation tube from the tympanic membrane of an ear which has been affected with persistent mucopurulent discharge for at least 3 months. The records of 332 patients were reviewed. Thirty-three patients with 34 ears satisfied the entry criteria. Tube removal cured 27 out of 34 ears (79%) of aural discharge within 1 month. The tympanic membrane healing rates were: at 1 month, 14 (41%); at 3 months, 23 (68%); at 6 months, 24 (71%); and at 1 year, 28 (82%). A table is presented comparing perforation rates from different ventilation tube studies.
Water contamination and swimming with the open mastoid cavity.
The aim of this study was to assess whether patients with open mastoid cavities should be advised to avoid water contaminating the ear in order to avoid aural discharge. A detailed history and clinical examination was performed on 53 patients with a unilateral modified radical mastoid cavity of more than 5 years duration. The results showed that it is possible to identify reliably the well-designed trouble-free cavity by the features of its skin lining and the ability to visualize the entire cavity through a size 4 Siegle speculum. A patient with this form of cavity very rarely develops aural discharge following water exposure and need not protect the ear during washing but should do so when swimming because of caloric effects.
The swallowed foreign body: is it in the nasopharynx?
Children with a history of a suspected swallowed radio-opaque foreign body should undergo radiographic examination of the nasopharynx even in the absence of symptoms and signs. Failure to identify and remove an object at this site can result in potentially fatal consequences.
The prevention of tympanic membrane perforation following the removal of long-term Paparella type II ventilation tubes.
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The prevention of tympanic membrane perforation following the removal of long-term Paparella type II ventilation tubes.
Residual perforation following the extrusion or removal of a long-term ventilation tube may occur in between 8.5% and 25% of cases. This prospective clinical trial concerns Paparella II ventilation tubes and demonstrated that (a) extracting (pulling) a tube from the tympanic membrane gives a 6-month perforation rate of 20%, (b) excising (freshening) the edge of the defect at the time of removal decreases the 6-month perforation rate to 3%, and (c) excising the edge significantly accelerates the healing of the tympanic membrane. There was no correlation in this study between the incidence of perforation and age, sex, ear affected, tympanosclerosis, ventilation tube position, tube in situ time or discharge. The study confirmed a high rate of tympanosclerosis (76%) to be associated with ventilation tubes. Long-term discharge (68%) was identified as a problem of Paparella II ventilation tubes.