Objective: To investigate the incidence and clinical significance of deranged clotting results among patients with juvenile (nasopharyngeal) angiofibroma.

Methods: Twenty consecutive patients treated for juvenile angiofibroma between March 1998 and July 2002 in whom preoperative coagulation tests were performed were selected. Results were compared with normal laboratory values, and clinical and histological records were retrospectively analysed.

Results: Four out of 20 patients were found to have abnormal tests, consistent with concurrent consumptive coagulopathies. One patient was found to have a raised D-dimer level. This resolved following removal of the lesion.

Conclusions:The association between larger arterio-venous malformations and disseminated intravascular coagulopathy is well described (Kasabach–Merritt syndrome). Our findings suggest that low-grade consumptive coagulopathies may also complicate smaller juvenile angiofibromas, implying that preoperative coagulation screening tests may have a role in ensuring optimal perioperative haemostasis.

Background: The cause of ossicular prosthesis extrusion remains an issue of interest to many otologists. This study evaluated the change in material surfaces and chemical elements of extruded total ossicular replacement prostheses (TORPs) and partial ossicular replacement prostheses (PORPs).

Methods: A total of nine extruded Polycel® ossicular prostheses (four TORPs, five PORPs) from nine patients was investigated using scanning electron microscope and energy dispersive X-ray spectrometry (EDX). Three prostheses (TORPs) obtained during revision surgery for hearing restoration were used as control subjects for EDX study.

Results: All subjects from the study group showed loss of fibrous capsule at both platform and shaft in the extruded prostheses. In comparison with the control group, the extruded prostheses had a lower level of carbon element (Wilcoxon signed-rank test, p < 0.05).

Conclusion: Loss of fibrous capsule and micro-degradation are probably two of the many factors that contribute to the extrusion of ossicular prostheses.

Background: Patients with gastroesophageal reflux disease may suffer from a variety of symptoms from the upper aerodigestive tract. The objective of this study was to determine the impact of dual-probe 24-hr pH monitoring in the diagnosis of reflux-related otolaryngological disorders.

Methods: Twenty-two patients with symptoms such as chronic cough, globus pharyngeus, heartburn,dysphonia and burning sensation of the tongue underwent a complete ear, nose and throat examination, 24-hr dual-probe pH monitoring, and oesophago-gastro-duodenoscopy.

Results: pH monitoring revealed gastroesophageal (distal) reflux in all patients and pharyngeal (proximal) reflux in 21 patients. Treatment consisted of a proton pump inhibitor (esomeprazole). Within 4 weeks 68 per cent of patients had no laryngopharyngeal symptoms; within 8 weeks 95 per cent of patients were symptom-free.

Conclusions: Patients with atypical reflux symptoms such as hoarseness, globus sensation or throat-clearing responded well to anti-reflux treatment.

A retrospective analysis of 10 patients was performed to evaluate navigation systems in extranasal frontal skull base surgery. When performing a craniotomy following a bicoronal skin incision, the surgeon has to calculate the extent of the frontal sinus to avoid unnecessary damage to the dura or mucoceles later. Due to surgical morbidity including compression of the frontal lobe, many skull base surgeons have refused to use such an approach. Malformation or bone-destruction complicates the identification of the borders and increases the risk ofside-effects. Navigation systems can be an alternative for calculating the frontal sinus outlines during surgery. In the authors’ surgical procedure two different navigation systems were used. Conventional surgery using the transfrontal, transbasal or subcranial approach consisting of trepanation and craniotomy were performed, while the navigated surgical procedure was evaluated.

The analysis showed that computer-assisted surgery (CAS) is applicable to extranasal frontalskull base surgery. In comparison to X-ray beam-controlled craniotomy, CAS is beneficial as it constitutes a noninvasive instrument of quality management. Furthermore, the analysis indicatedthat under the guidance of a navigation system a precise pre-surgical simulation is available in order to perform an optimal craniotomy and reconstruction of the frontal skull base.

A growing body of evidence suggests that a variety of upper respiratory symptoms (URS) are associated with gastro-oesophageal reflux (GORD). The aim of this study was to determine the prevalence of endoscopic erosive, and non-erosive, oesophagitis among patients complaining of persistent URS, in the absence of typical GORD symptoms, and to compare them with a comparison group of similar age. A group of 110 patients aged 18–75, presenting with persistent URS with no suspicion of GORD symptoms, underwent upper flexible endoscopy, with biopsy sampling for histology, and was compared with a group of 117 patients of similar age undergoing endoscopy for reasons other than GORD. Patients affected with upper airway disorders, such as posterior laryngitis, chronic sinusitis and vocal fold nodules, had a significantly higher prevalence of oesophagitis of varying degrees (31 per cent) compared to the comparison population(15.4 per cent) (p < 0.01). These data suggest that in many patients with chronic URS occult gastro-oesophageal diseases are present.

Objectives: We studied the experimental use of Seprafilm, a sheet-like filmform of hyaluronic acid, in the repair of subtotal perforations of the tympanic membrane (TM), and the durability of such repairs.

Method: The research was conducted on 42 Sprague–Dawley rats. Right TMs of all rats were subtotally and thermally perforated in the same fashion. Seprafilm was applied to the perforated TMs of the 21 rats comprising the experiment group. The perforated TMs of the remaining 21rats, the control group, were left to heal spontaneously.

Results: The mean healing times were recorded as 7.8 ± 0.6 days for the Seprafilm group and 14.9 ± 1.1 days for the control group (p < 0.001).

Conclusions: These results suggest that Seprafilm may be a possible first choice (before thedecision to operate) in subtotal perforations, considering its easy application and patient follow-up.

This study evaluates the efficacy and systemic tolerability of licensed doses of mometasone furoate (Nasonex®) and betamethasone sodium phosphate (Betnesol®) in allergic chronic rhinosinusitis patients. It also assesses the diagnostic accuracy of morning salivary cortisol (MSC) concentrations to screen for adrenal suppression inthese patients.

Forty-eight patients were prospectively randomized to two treatment limbs. Symptom scores and adrenal function assessments were performed immediately prior to commencement and at the end of treatment.

One (4 per cent) mometasone furoate and 14 (58 per cent) betamethasone sodium phosphate patients developed biochemical evidence of adrenal suppression. There were statistically significant (p < 0.005) reductions in symptom scores following treatment, but no significant difference (p > 0.05) between the drug groups regarding post-treatment symptom scores. As a screening tool for iatrogenic adrenal suppression, MSC had a sensitivity of 100 per cent and a specificity of 97 per cent.

This study demonstrates the high risk of developing adrenal suppression secondary to betamethasone sodium phosphate therapy. The salivary cortisol assay is an accurate tool for monitoringadrenal function and is ideally suited to the out-patient setting.

This study investigated the role of sudden sensorineural hearing loss (SSNHL) as a symptom in oral anticoagulant therapy with vitamin K antagonists (Phenprocoumon; Marcumar®, Falithrom®). Vascular compromise of the cochlea due to thrombosis, embolus, reduced blood flow or vasospasm is one of the four possible pathways that can lead to SSNHL. Oral anticoagulant therapy should prevent thrombosis; if it does not the question arises as to whether the anticoagulation is working, or the wrong hypothesis of vascular compromise has been made. Patients with SSNHL during oral anticoagulant therapy who were admitted tothe ENT Department of the University Hospital in Jena from 1998 to 2001 were included. The pure-tone audiograms and the prothrombin time (PT) values before and after the event of the SSNHL were evaluated. The study found 10 patients with SSNHL during oral anticoagulant therapy. Although the audiograms showed some improvement in the majority of cases, three cases showed almost no improvement in hearing. On admission, half of the patients showed a PT-value higher than 30 per cent and in nine cases a PT-value >30 per cent could be demonstrated at least once duringtesting. It was not possible to demonstrate a relationship between the SSNHL and oral anticoagulation. Vascular compromise cannot be excluded as a cause for sudden hearing loss in patients undergoing oral anticoagulant therapy. It is possible that oral anticoagulants influence the viscosity of the plasma leading to interference with the microcirculation in the inner ear. Further research into this area is currently being conducted.

Introduction: The volumes of the maxillary sinuses are of interest to surgeons operating endoscopically as variation in maxillary sinus volume may mean variation in anatomical landmarks. Other surgical disciplines, such as dentistry, maxillo-facial surgery and plastic surgery, may benefit from this information.

Objectives: To compare the maxillary sinus volumes of dried crania from cadavers of European and Zulu descent, with respect to ethnic group and gender.

Methodology: Helical, multislice computed tomography (CT) was performed using 1-mm coronal slices. The area for each slice was obtained by tracing the outline of each slice. The CT machine calculated a volume by totalling the slices for each sinus.

Results: Ethnic and gender variations were found in the different groups. It was found that European crania had significantly larger antral volumes than Zulu crania and men had larger volumes than women. Race and gender interaction was also assessed, as was maxillary sinus side.

Conclusion: A variation in maxillary sinus volume between different ethnic groups and genders exists, and surgeons operating in this region should be aware of this.

The flexible nasendoscope is now an integral tool in most otorhinolaryngology departments for visualizing the hypopharyngolarynx. A technique has been described using themodified Valsalva manoeuvre to improve visualization of the hypopharynx during flexible nasopharyngoscopy. The authors report an alternative technique for visualizing the upper oesophagus using the flexible nasendoscope, and highlight three cases where there was accurate visualization of an impacted oesophageal food bolus. Subsequently, these patients underwent flexible oesophagoscopy to dislodge the foreign body. The authors also describe three cases where the flexiblenasendoscope was successfully used to visualize and negotiate the impacted food bolus beyond the cricopharyngeus. This is a safe and simple procedure performed without any sedation and reduces the need for prolonged hospitalization.

A rare case of a smooth muscle tumour in the pharynx is reported, together with histopathological findings. The patient’s psychiatric background and recurrent complaint of a sensation of a lump in the throat all pointed to a psychogenic aetiology, and diagnosis was delayed. The importance of mirror or endoscopic examination of the pharynx is stressed in patients with globus pharyngeus symptoms.

The larynx functions as a protective valve of the upper airway. An end-tracheostomy represents a risk factor for foreign body aspiration. We describe a case of tracheostomy stoma button aspiration, leading to recurrent chest infection and irreversible lung damage, necessitating a pneumonectomy. This is the first reported case of this kind. This case also emphasizes the importance of patient education and of stoma button design.

Primary hyperparathyroidism during pregnancy carries significant risks to both mother and fetus. Parathyroidectomy remains the only definitive treatment for the condition. The timing of surgery remains controversial, with ongoing debate regarding the safety of surgery during the third trimester. A case of symptomatic primary hyperparathyroidism treated by parathyroidectomy in the third trimester is described. The clinical features, investigations and treatment options are discussed.

Postauricular cutaneous mastoid fistula is a rare condition. The cutaneous mastoid fistula is a very rare complication of chronic suppurative otitis media. The fistula tracts are typically difficult to manage because of the surrounding necrotic skin edges. We describe an unusual case of a postauricular cutaneous mastoid fistula and outline the surgical technique used for closure.

Infrasellar craniopharyngioma is an uncommon neoplasm. Rarely, it presents with epistaxis. To date, 39 cases of infrasellar craniopharyngioma have been reported in the world literature. Involvement of the maxillary sinus has only been reported once. We report a second case exclusively involving the nasal cavity, ethmoid sinus and maxillary sinus. Excision was performed using a Denker’s medial maxillectomy approach.

The laryngeal mask airway is a widely used, non-invasive, general purpose airway. We report the case of a temporary vocal cord palsy following the use of such an airway. The development of inappropriately high cuff pressures secondary to nitrous oxide diffusion into the cuff is proposed as the most likely cause. Knowledge of the existence of nerve injuries complicating laryngeal mask use is particularly important when counselling certain patients. Mandatory intraoperative cuff pressure monitoring should lower the risk of subsequent voice problems.

Several internal auditory canal (IAC) anomalies have been reported. To our knowledge, only one case with an abnormal direction of the IAC has been reported in an infant with Pierre Robin syndrome. In this paper, we present the first report of two non-syndromic cases with abnormal IAC direction.

An unusual case of epistaxis resulting from post-transplant lymphoproliferative disorder is described.

A 30-year-old woman who had undergone renal transplantation 12 years previously presented with profuse, posterior, unilateral epistaxis. The initial findings, workup and treatment are presented. A post-nasal space (PNS) mass was detected and biopsy showed this to be an Epstein-Barrvirus-positive polymorphous B-cell post-transplant lymphoproliferative disorder. Computed tomography findings showed a polypoid lesion protruding from the sphenoethmoidal recess and filling the left PNS.

Post-transplant lymphoproliferative disorder is well known to involve tonsil tissue. Commonly, this is the first presentation of the disease in children. However, until now post-transplant lymphoproliferative disorder has not been described in the PNS or nasal cavity presenting as epistaxis. We conclude that all transplant patients presenting with epistaxis should be followed up for an accurate examination of the PNS and nasal cavity after the acute episode.

Autoimmune inner ear disease is a well described entity. We report a case of sudden-onset sensorineural hearing loss in association with psoriatic arthritis, which has not been reported in the literature. The case satisfies the criteria for the presumptive diagnosis of autoimmune hearing loss. A high index of suspicion, with early diagnosis and aggressive treatment with steroids and/or immunosuppressive agents, is essential to prevent irreversible hearing loss. The condition of psoriatic arthritis must be added to the pantheon of autoimmune diseases that can lead to sensorineural hearing loss.

Arteriovenous malformations (AVM) of the head and neck are rare. They usually occur intracranially and derive their vascular supply from the intracranial vessels. In the English literature there has not been any documented case of AVMs in and around the external auditory meatus (EAM). The authors present the first case, a spontaneous AVM deriving its vascular supply from the posterior auricular artery. The diagnostic difficulties and management strategies of spontaneous AVMs are discussed.