Diagnosing maxillary sinusitis.
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Diagnosis, Differential↗
Biomedical subjects
N S Jones
Publications and source records attributed to N S Jones.
ENT manifestations of Fraser syndrome.
Fraser Syndrome is a rare autosomal recessive disorder (Gupta and Saxena, 1962; Smith, 1982). The most consistent feature is cryptophthalmos (hidden eye), but frequently abnormalities of the ears (meatal stenosis, dysplastic pinna), nose (hypoplastic notched nares, choanal stenosis or atresia), and larynx (glottic web, subglottic stenosis), as well as numerous other anomalies are encountered. We present four cases that have been treated at the Hospital for Sick Children in the last ten years, and describe the various ENT anomalies characteristic of this syndrome.
Abnormalities, Multiple↗
Photometrics: a new method of measuring the cross-sectional area of the subglottis.
A new endoscopic method of measuring the cross-sectional area of a subglottic stenosis is presented. The method was tested against existing techniques using a model. By standardizing the distance from the objective of the endoscope to the stenotic area we were able to measure the cross-sectional area using a graduated grid held against the video screen. This technique was then compared with the standard one of estimating the diameter of a stenosis from the external diameter of the bronchoscope which can be passed through the stenosis. The methods were found to be equally accurate in measuring the lumen diameter. However, when measuring the minimum cross-sectional area, three of five observers were significantly better (P less than 0.01) using the photometric method rather than the standard method (Wilcoxon's rank sum test for paired data). The photometric technique of measuring the cross-sectional area of the subglottis is easily performed, non-traumatic, and allows a visual record to be kept.
Bronchoscopes↗
Cerebrospinal fluid otorrhea at myringotomy. A meningocele through a defect in the tegmen.
Spontaneous cerebrospinal fistulae can simulate secretory otitis media or be discovered at myringotomy, but the diagnosis is frequently made after one or more episodes of meningitis. Congenital perilabyrinthine fistulae are extremely rare, and unlike translabyrinthine fistulae there is usually no sensorineural hearing loss. This is the first reported case of a congenital meningocele through the tegmen in a child. An 11-year-old boy presented with signs and symptoms which mimicked serous otitis media. A cerebrospinal fistula was produced at myringotomy and this was closed surgically via an endaural approach. A CT scan defined a defect in the tegmen tympani anterior to the superior semicircular canal.
Cerebrospinal Fluid Otorrhea↗
Foreign bodies in the throat: a prospective study of 388 cases.
We present the results of a prospective study of 388 patients presenting with a history of swallowing a foreign body. We indicate whether the patients' symptoms and signs were associated with a retained foreign body. While tenderness on palpation was an unreliable sign, pooling at indirect laryngoscopy invariably predicted a retained object. In many patients, initial careful examination of the oropharynx by casualty officers would have shown a retained fishbone in the tonsil or tongue and would have resulted in 16 per cent fewer radiographs and 17 per cent fewer referrals to the ENT department. Radiography only improved management in a small minority and 35 per cent of films were interpreted incorrectly by casualty officers. A follow-up barium swallow disclosed a pathological lesion in a significant proportion of patients with bolus obstruction, whether or not this was passed spontaneously.
Emergencies↗
Tuberous sclerosis with primary meningioma of the maxillary antrum.
Primary extracranial meningiomas are uncommon; they have been documented in the ear, skin, orbit, parapharyngeal space, parotid gland, mediastinum, and rarely the paranasal sinuses. Tuberous sclerosis is an autosomal dominant neurocutaneous syndrome characterized by multiple connective tissue tumours. We report the first case of a tuberous sclerosis patient with a maxillary antral meningioma.
Adolescent↗
CT and MR imaging in lateral sinus thrombosis.
Establishing a pre-operative diagnosis of lateral sinus thrombosis can be difficult, as the clinical features are non-specific and laboratory tests unhelpful. CT may demonstrate abnormal high density of the lumen of the sinus, which does not enhance after intravenous contrast medium. Enhancement of the dura surrounding the sinus may be prominent, causing the 'empty triangle' or 'delta sign' which may suggest the diagnosis. Magnetic resonance (MR) imaging may show both lack of flow and abnormal signal from the sinus, thus providing definitive evidence of thrombosis.
Adolescent↗
A guide to the selection of paediatric tracheostomy tubes.
A large range of tracheostomy tube types and sizes are available for use in children. Regional preference, rather than individual patient assessment, tends to determine selection. We present a table designed to assist with appropriate size selection, and discuss the relative merits and shortcomings of the tubes currently available.
Adolescent↗
Evaluation of a new method of neural anastomosis using nitrocellulose paper.
Nerve regeneration was examined in 108 mouse sciatic nerves in a prospective morphometric study in which a new anastomotic technique using nitrocellulose paper was compared with conventional suturing and simple sectioning. Mice were randomly allocated to one of the three arms of the trial and sciatic nerves were examined following surgery at time intervals up to 8 weeks. Serial sections were taken for qualitative and quantitative morphometric analyses. Counts demonstrated that the rate of regeneration was faster in the nitrocellulose group than following nerve section alone, but that the suture group was even better. However, 8 weeks after surgery, there were no significant differences in myelinated axon counts 4mm distal to the site of section between any of the experimental groups. The superlative regenerative capacity of rodent axons may limit the applicability of this model to human nerve tissue.
Anastomosis, Surgical↗
Prevention of microvascular thrombosis with controlled-release transmural heparin.
The use of controlled local-release heparin was studied as a means to prevent thrombosis in microvascular surgery, using a rat arterial inversion graft as a model. Polyvinyl alcohol embedded with heparin was placed around the outside of inversion graft anastomoses in 16 animals. Results were compared with control group animals in which polyvinyl alcohol alone was placed around the graft or systemic heparin was given. Vessel patency rates were significantly higher for animals receiving either systemic or transmural heparin than for animals in the control group. Controlled local delivery of heparin did not cause measurable systemic anticoagulation. However, the complication of local hematoma formation occurred as frequently as in the systemic heparin group. Controlled transmural release of heparin has an effective local antithrombotic effect and may hold promise for use in clinical practice.
Anastomosis, Surgical↗
Unusual laryngeal cyst.
We report a lateral saccular cyst of the larynx with both an internal and external component. The patient had a four year history of a cervical swelling and hoarseness. He presented acutely with stridor. The cyst was resected successfully without tracheostomy.
Cysts↗
Imbalance and chronic secretory otitis media in children: effect of myringotomy and insertion of ventilation tubes on body sway.
We studied balance in 34 children with chronic secretory otitis media and compared them with 34 age- and sex-matched control children between the ages of 3 and 5 years. In addition to history and examination, objective measurements were obtained by use of a fixed force plate body sway platform in both the control group and the group with chronic secretory otitis media. We took measurements in both groups at an interval of 4 months to ensure that any improvement in body sway could not be attributed to normal maturation. Eight parameters of body sway were compared, including three new parameters not described elsewhere (mean squared velocity, the number of intersections, and velocity moment). Our study showed that balance is significantly worse in children with chronic secretory otitis media compared to a control group. Furthermore, the increased body sway of children with chronic secretory otitis media was returned to the normal range by myringotomy and insertion of ventilation tubes.
Child, Preschool↗
An avoidable occupational hazard during mastoid surgery.
Conjunctival innoculation is a previously unrecognized hazard for the otologist during mastoid surgery. This experiment assess the spread of droplet contamination during temporal bone dissection. The results suggest that otologists and assistants should wear eye protection during exposure of the mastoid antrum by drilling.
Acquired Immunodeficiency Syndrome↗
Late onset Cogan's syndrome.
Previous reports describe Cogan's syndrome occurring in young adults this case shows that it can be diagnosed in an older patient, and that prompt treatment is often successful, making it a worthwhile diagnosis to consider in patients with sudden hearing loss. The erythrocyte sedimentation rate was a useful marker for disease activity in this patient.
Deafness↗
An audit of the management of 250 patients with chest trauma in a regional thoracic surgical centre.
Two hundred and fifty patients with chest trauma admitted consecutively over a 6-year period to the Royal Surrey County Hospital were reviewed. This is a large series by British standards. The cause and nature of their chest and associated injuries were studied, together with the management, complications and outcome. The aim of this study was to find areas where diagnosis and treatment could be improved. It was found that where there was no lung contusion, flail chest injuries could be managed without ventilation. The review suggests that even small traumatically induced pneumothoraces should be drained. It illustrates the need for an awareness of the wide range of concurrent problems in patients with chest injuries and the variety of possible complications.
Accidents, Traffic↗
Topical nasal steroids in non-atopic perennial rhinitis; subjective symptom scores and objective measurement of nasal resistance by active anterior rhinomanometry.
We present a study of 22 patients with perennial non-atopic rhinitis who have been treated with a course of topical beclomethasone dipropionate (Beconase). All subjects were skin-test negative for the common inhaled allergens and had normal total and specific IgE levels. The results of treatment were assessed by symptom scoring and by active anterior rhinomanometry, and are compared to measurements of resistance made in 22 untreated controls and an equal number of normal volunteers.
Administration, Intranasal↗
Multiple myeloma in bony metaplasia of the cricoid cartilage (a rare cause of laryngeal obstruction).
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Aged↗
Osteomyelitis in a general hospital. A five-year study showing an increase in subacute osteomyelitis.
We have reviewed 60 patients with primary bone infections; 21 of these (35%) had subacute osteomyelitis, a figure which supports other recent observations that this variant of bone infection is becoming more widespread. In this group open culture and biopsy were necessary in order to exclude bony malignancy, and a raised erythrocyte sedimentation rate proved a useful diagnostic aid. All the patients with acute osteomyelitis or with vertebral infection responded to primary treatment, but five of those with subacute osteomyelitis had recurrences.
Anti-Bacterial Agents↗