Tuberculosis with secondary vasculitis presenting as a nasal septal perforation.

A 45 years old man with tuberculosis (TB) and secondary vasculitis presented with perforation of the nasal septum, involving skin and cranial nerves. Vasculitis is a recognized, tough rare complication of tuberculosis and has not been previously described in the literature as a cause of nasal septal perforation. It presents a diagnostic dilemma.

Spontaneous retropharyngeal haematoma: a case report.

Introduction: Spontaneous retropharyngeal haematoma is an unusual condition. It has multiple aetiological factors and can present to a number of specialists including the otolaryngologist.

Case Presentation: We describe a case of spontaneous retropharyngeal haematoma which demonstrates the dramatic presentation and emphasises the need for a conservative approach.

The maturation of balance in children.

Background: Balance function is known to change with age during infancy and childhood. However, the relative contributions of the three primary inputs to position sense are not fully understood.

Methods: In this paper we report the computerised dynamic posturography findings in a group of 60 healthy children from the age of five to 17.

Submandibular neurilemmoma; a diagnostic dilemma.

Neurilemmomas are slow growing, benign neoplasms of neural crest Schwann cell origin. They arise from any peripheral, spinal or cranial nerve except the olfactory and optic. Presentation is usually asymptomatic but focal neurological signs and symptoms may be associated with nerve compression.

Orbital and skin metastases in a polymorphous low grade adenocarcinoma of the salivary gland.

We report the previously undocumented development of an orbital metastasis and skin metastases in a patient with polymorphous low grade adenocarcinoma (PLGA) 15 years after initial presentation. The clinical course, treatment and changing histological features are discussed.

Mycobacterium avium-intracellulare cervical lymphadenitis in siblings: a case report and review.

We report two cases of cervical mycobacterium avium-intracellulare lymphadenitis in siblings which developed within one month of each other. There was no underlying immunodeficiency but the children lived in close proximity to a pigeon loft.

Endoscopic fenestration of choanal atresia.

We report two cases of unilateral choanal atresia and one of choanal stenosis treated successfully by endoscopic fenestration, with no recurrence at a mean follow-up of 18 months. Rigid endoscopy and axial CT scanning confirm the clinical diagnosis and this technique avoids the need for stenting or prolonged post-operative stay.

Major complications of functional endoscopic sinus surgery.

The results of a postal questionnaire indicate an exponential rise in the practice of functional endoscopic sinus surgery (FESS) in the UK and a major complication rate of 0.23%. Cerebrospinal fluid leak was the most common serious complication accounting for 24 of the 36 reports.

Rhinitis, sinusitis and the yellow nail syndrome: a review of symptoms and response to treatment in 17 patients.

A total of 17 patients with yellow nail syndrome are described. Their symptoms, age of onset and severity are examined with particular reference to the presence of rhinosinusitis. Fourteen of the patients (83%) suffered severe rhinosinusitis, which pre-dated nail changes in four, coincided with yellow nails in six, and occurred later in the remaining patients.

Apparent massive tongue swelling. A complication of orotracheal intubation on the Intensive Care Unit.

The trachea of an 81-year-old woman was intubated with an orotracheal tube for emergency abdominal surgery and the tube was left in place for postoperative management on the Intensive Care Unit. After 36 h, she developed apparent massive tongue swelling. On closer examination, a normal sized tongue was found to be displayed by oedema of the floor of the mouth and submandibular space, secondary to purulent sialadenitis from right submandibular duct obstruction by the tracheal tube.

Transnasal electrocoagulation of the vidian nerve.

Vidian neurectomy has previously been reported as having a high success rate in alleviating secreto-motor rhinopathies. We report a prospective study of 24 consecutive patients who underwent transnasal vidian electrocoagulation. An overall improvement in symptoms was found in 59.

Pneumatization of the uncinate process.

We report one case of extensive and two of partial pneumatization of the uncinate process from a consecutive series of 250 CT scans of the paranasal sinuses. The CT findings are illustrated and the literature reviewed.

Immunohistology of the nasal mucosa in seasonal allergic rhinitis: increases in activated eosinophils and epithelial mast cells.

The immunohistology of the nasal mucosa was examined in 13 grass pollen-sensitive patients and in seven normal nonatopic control subjects before and during the pollen season. Cryostat sections (6 microns) of biopsy specimens from the inferior turbinate were immunostained with the alkaline-phosphatase antialkaline-phosphatase method and a panel of monoclonal antibodies. Mast cell subtypes were measured with a double sequential immunostaining method.

Pneumoparotitis.

Pneumoparotitis is a rare cause of parotid enlargement. It is due to a reflux of air through Stensen's duct into the acini of the parotid gland with subsequent dilatation. We report a case which followed a long history of autoinflation of the middle ears by the Valsalva manoeuvre.

Prospective study of two management strategies for epistaxis.

Two different management strategies were applied prospectively and consecutively for 12 months each for epistaxes requiring hospital admission. Patients who did not respond to 48 h nasal packing were treated more successfully and more economically by submucous resection of the nasal septum than by delayed arterial ligation.

Hazards of ear-piercing procedures which traverse cartilage: a report of Pseudomonas perichondritis and review of other complications.

A case of severe Pseudomonas perichondritis following a 'fashionable' ear-piercing procedure, performed high on the pinna, is reported. The current vogue for such 'high' ear-piercing, which traverses cartilage rather than the fatty tissue of the ear lobe as in 'traditional' ear-piercing, increases the risk of infection which may produce severe cosmetic deformity.

Endolymphatic hydrops precipitated by haemodialysis.

We report a case of endolymphatic hydrops preceded by haemodialysis in the contralateral ear of a patient with known Menière's disease, and discuss the possible mechanism. It is suggested that the sudden decrease of plasma osmolality during haemodialysis acts as a reverse glycerol test. The audiometric and electrophysiological recordings pre- and post-dialysis and the induction of the Menière's triad of symptoms during dialysis, were strongly indicative of the presence of endolymphatic hydrops.

Atypical thyroglossal duct cyst.

Thyroglossal duct cysts most frequently present in childhood as a painless midline swelling of the neck. Uncommonly, these embryonal remnant cysts present clinically in adult life. The majority of adults with thyroglossal duct cysts present with a swelling at the level of the thyrohyoid membrane.

Mucoepidermoid carcinoma of the larynx.

We report two cases of poorly differentiated mucoepidermoid carcinoma of the larynx which both remain well after surgical management. The first underwent a radical neck dissection for recurrent disease following radiotherapy and the second a total laryngectomy with elective post-operative radiotherapy. Although well differentiated ('low grade') mucoepidermoid tumors of the larynx may respond to radiotherapy surgical management is generally recommended for all grades of such tumours especially for poorly differentiated ('high grade') tumours.