Biomedical subjects
Publications and source records attributed to D I Choa.
Peritonsillar abscesses may be treated by needle aspiration, incision and drainage, or abscess tonsillectomy. A modification of the technique of needle aspiration is described. This technique minimizes the risk of vascular damage during needle aspiration and is more reassuring to the patient.
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We describe the first case of allergic fungal sinusitis (AFS) associated with Schizophyllum commune. Histological diagnosis was made on the mucinous material from the sinus which contained eosinophils, fungal hyphae and Charcot-Leyden crystals. The fungal isolate was identified as S. commune on the basis of its colonial morphology and minute peg-like outgrowths from vegetative hyphae and clamp connections. The optimal treatment of AFS is not known but may involve surgical debridement followed by systemic corticosteroids, gradually reduced, with the patient being maintained on inhaled corticosteroids. Oral itraconazole could be added to the regimen of those patients in whom frequent recurrences occur after debridement or when there is histological evidence of severe pressure erosion.
After resolution of conditions necessitating tracheostomy in children, decannulation may be extremely difficult and associated with significant morbidity. Endoscopy and radiography can identify anatomical abnormalities preventing decannulation. Physiological abnormalities are, however, more difficult to assess. A system has been developed whereby functional upper airway resistance can be calculated in children with a tracheostomy. The instrument used was a modified Mercury Electronics rhinomanometer. A probe was placed through the tracheostome and another probe was situated in an occluding anaesthetic face mask. Upper airway resistance was derived from the differential pressure and flow changes recorded in anaesthetized children who were breathing spontaneously. Studies in 26 children have revealed low airway resistance in all those successfully decannulated. Further studies will hopefully allow identification in advance of children who will have decannulation difficulties.
Computed tomography is replacing contrast radiography as the method of choice in evaluating congenital posterior choanal atresia. Careful preparation of the patient, however, is necessary prior to the examination in order to obtain the maximum of information pre-operatively. We present patients with inadequate preparation and illustrate their misleading scans. The proper method of examination is discussed, with a review of the literature; it is essential to remove nasal secretions by suction and instill vasoconstrictor nose drops, shortly before scanning.
Jugulotympanic glomus tumors have been called many things, but "paraganglioma of the temporal bone" is perhaps a more suitable term. This tumor is generally described as benign with a predilection for middle-aged women. Herein we report the case of an 11-month-old female infant with this condition. The extensiveness of the tumor with intracranial involvement at presentation suggests that the lesion might have been present for some time and raises the question of it being congenital in origin. We emphasize the overall importance of including paraganglioma of the temporal bone in the differential diagnosis of a "bleeding polyp" of the ear.
Our experience with the treatment of 23 cases of subglottic haemangioma in children at the Hospital for Sick Children is presented. Different modalities of treatment are mentioned, with particular emphasis on excision with laryngo-tracheoplasty and the use of CO2 surgical laser. In a self-limiting lesion, our present policy is to use the CO2 laser to accelerate the rate of regression while minimizing morbidity and mortality.
This paper describes experience with a transtympanic facial nerve needling operation in 62 patients with hemifacial spasm, over a 15-year period. The procedure is simple and effective, but unfortunately it is usually marred by recurrence of the spasm. Repeat operations are easy to perform, and usually valuable the first time. Despite recurrence, most patients are finally less troubled than before operation. A small number have proved very resistant to treatment, and the aetiological implications of this are presented. Other operative options are also discussed, together with our experience in a small number treated by facial nerve needling at other sites.