Biomedical subjects
Publications and source records attributed to C J Woodhead.
Achalasia is a motility disorder of the oesophagus that typically presents with dysphagia, regurgitation and chest pain. A rare presenting symptom is stridor. A case of previously treated achalasia re-presenting with stridor is described and associated imaging presented.
Internal jugular vein thrombosis is a rare but treatable disorder with most of the reports in the literature related to the adult population. The most common reported cause is iatrogenic trauma to the internal jugular vein and only a few cases have been reported in the paediatric population. We present a case of bilateral internal jugular venous thrombosis with pulmonary and cerebral complications in a 14-year-old girl with protein S deficiency. This problem has not been previously reported in the world literature.
The association of Kallmann's syndrome with conductive hearing loss has not previously been described. We report the findings at tympanotomy in three ears of patients with Kallmann's syndrome and conductive deafness. The literature related to this topic is reviewed, and the treatment of these patients is discussed.
Primary amyloidosis localized to the sinonasal tract is extremely rare with only 20 reported cases in the English literature. We describe a further case and review the literature.
A case of oculostapedial synkinesis occurring after Bell's palsy is described. This rare phenomenon has not previously been reported following Bell's palsy. The authors discuss the method of objectively proving the diagnosis, which can be difficult. The patient was successfully treated by stapedius tendon section under local anaesthesia.
The technique of long-term middle ear ventilation using a tympanotomy technique is presented. This has proved successful in the management of persistent middle ear effusion despite numerous previous short- and intermediate-term tympanic membrane ventilation tubes. The technique is particularly appropriate in the presence of severe tympanosclerosis as a result of previous tympanostomy tubes, posterior tympanic membrane collapse and adhesion, and atelectasis.
The region of maximum resistance in the respiratory tract is in the anterior part of the nose, and this area has been termed the nasal valve. Inspiratory narrowing of this area, known as alar or nasal valve collapse can produce the symptom of obstruction, and may be very difficult to correct. The anatomy and physiology of the nasal valve are discussed followed by the author's technique for correction of a common problem leading to alar collapse; a narrow piriform aperture, which is often associated with a prominent web at the muco-cutaneous junction.
Snoring is a common disorder usually presenting to otolaryngologists. Most patients who have any nasal symptoms would normally be offered nasal surgery, but there is a significant incidence of failure to control the snoring (approximately 25%). We analysed a group of patients, all having nasal surgery for snoring, with the aim of assessing whether any pre-operative factors would predict success or failure of the surgery. We found symptoms of excessively loud snoring, witnessed apnoeic episodes and hypersomnolence, or obstructive sleep apnoea diagnosed by overnight oxygen saturation measurements to be statistically associated with failure of nasal surgery to improve snoring.
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We present a rare case of a transitional papilloma of the middle ear, occurring several years after excision of a similar lesion from the nose. There was no continuity between the two lesions suggesting that these tumours can be multicentric in origin.
The significance of the beta adrenergic system in the nasal mucosa is unclear. The authors have used the technique of autoradiography to localize and classify beta adrenoceptors in human nasal mucosa. The receptors have been found to be exclusively of the beta-2 subtype and the highest density is found in the glandular ducts. It is suggested that the beta-adrenergic system may have a physiologically important role in controlling the electrolyte composition of nasal secretions.
Snoring is a common disorder, and may be associated with obstructive sleep apnoea, although there is little published information on the incidence of apnoea in snorers. This study aimed to assess the upper airway and to relate the findings to sleep study data in a population of patients referred by their general practitioners with loud snoring. Each patient had a full history, weight and height measurements, nasal examination, rhinomanometry, peroral grading of the oropharyngeal features, and fibreoptic pharyngoscopy with a modified Muller manoeuvre, followed by a sleep study. The results in our group of 35 patients demonstrate a high incidence of obstructive sleep apnoea (46%). Factors which correlated well with apnoea were excessively loud snoring, a narrow oropharynx, and marked obesity; 94% of patients with one or more of these features had evidence of sleep apnoea.
Submucosal diathermy (SMD) of the inferior turbinates is widely used, although its effect histologically has not been well shown. We attempted to demonstrate the acute histological changes of SMD by performing it immediately prior to inferior turbinectomy. The results found help to explain the unpredictability of producing a clinical response.
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