Journal of Laryngology and Otology
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Evidence-based review of aetiopathogenic theories of congenital and acquired cholesteatomaAbstract Cholesteatoma is a non-neoplastic, keratinising lesion which has two forms: congenital and acquired. Congenital cholesteatoma develops behind a normal, intact tympanic membrane, whilst acquired cholesteatoma is associated with a defect in the tympanic membrane. The pathological substrate of cholesteatoma is keratinising stratified squamous epithelium, but the origin of this epidermal tissue in the middle ear is controversial. Here, we review the most relevant and recent evidence for the principal aetiopathogenic theories of both forms of cholesteatoma, in the light of recent otopathological findings. Congenital cholesteatoma is most plausibly explained by the persistence of fetal epidermoid formation. Conclusive ‘proof’ awaits the unambiguous demonstration of the metamorphosis of an epidermoid nidus into a lesionin vivo . Acquired cholesteatoma may develop by various mechanisms: immigration, basal hyperplasia, retraction pocket and/or trauma (iatrogenic or non-iatrogenic). However, squamous metaplasia of the normal cuboidal epithelium of the middle ear is a highly unlikely explanation. Chronic inflammation seems to play a fundamental role in multiple aetiopathogenic mechanisms of acquired cholesteatoma. Therefore early treatment of inflammatory conditions might reduce their sequelae, perhaps by preventing the development of hyperplastic papillary protrusions. Continued otopathological, cellular and molecular research would enhance our limited understanding of cholesteatoma and may lead to new therapeutic strategies for this erosive disease, which often defies surgical treatment.
Journal of Laryngology and Otology - Tập 121 Số 11 - Trang 1013-1019 - 2007
Evaluation of cochlear implantation in post-meningitic adultsAbstract Meningitis is an important cause of deafness and in some studies has been associated with poorer outcomes in adult patients following cochlear implantation. Of the first 100 adults implanted under the Midland Cochlear Implant Programme, 28 were deafened as a result of meningitis. We compare our experience with these patients with patients with a non-meningitic aetiology. A degree of cochlear ossification was a more common finding in the meningitic group. In six cases (four meningitics, two non-meningitics) ossification was encountered only during surgery, not being apparent on pre-operative radiology. The average scores achieved on auditory tests by the meningitic group were similar to those achieved by non-meningitic patients. At nine months, using only the implant, users were able to identify 54 per cent of common environmental sounds, achieved an average score of 30 words per minute on connected discourse tracking and identified an average of 42 per cent of words correctly in BKB sentences. Poorer outcomes were more commonly associated with cochlear ossification. In patients with cognitive and neurological sequelae, benefits with the implant were not always apparent in the early months, however, with intensive therapy these patients can obtain measurable sustained benefit from their implant.
Journal of Laryngology and Otology - Tập 113 Số 24 - Trang 27-33 - 1999
Vocal cord polyps: Incidence, histology and pathogenesisAbstract On the basis of clinical and histologic examination, history and epidemiologic survey of 591 patients with vocal cord polyps, the authors evaluate the morphology of the pathologic substrate, indicate possible pathogenesis and analyse the most frequent factors in the formation of polyps such as vocal abuse and unfavourable microclimate at work. Sex does not play any role in the incidence, and the histologic structure is not related to the time factor.
Journal of Laryngology and Otology - Tập 95 Số 6 - Trang 609-618 - 1981
Neck lump clinics: is on-site assessment of fine needle aspirate diagnostic adequacy cost-effective?Abstract Objectives: To establish the diagnostic adequacy of ultrasound-guided fine needle aspiration cytology samples at the East Berkshire neck lump clinic, and to perform a cost-benefit analysis related to the hypothetical addition of an on-site cytology technician (required to review fine needle aspiration specimen adequacy). Method: The adequacy of all ultrasound-guided fine needle aspiration procedures was reviewed from 1 January to 30 June 2011. These results were used in the cost-benefit analysis related to on-site cytology assessment. Results: Of the 307 ultrasound-guided fine needle aspiration cytology procedures performed over 6 months, 67 (22 per cent) were reported to be non-diagnostic. Operator experience was found to correlate significantly with diagnostic adequacy (p < 0.001). Only 5 per cent of all fine needle aspirations were initially non-diagnostic but diagnostic on repeat sampling. This suggests that the financial and time costs of on-site fine needle aspirate adequacy assessment would outweigh any benefit. Conclusion: In this series, the experience of individuals performing fine needle aspirations was the most important factor related to adequacy.
Journal of Laryngology and Otology - Tập 127 Số 11 - Trang 1122-1126 - 2013
Top-cited articles of the last 30 years (1985–2014) in otolaryngology – head and neck surgeryAbstract Background: The frequency with which a scientific article is cited by other studies is one way to measure its academic influence. Methods: A comprehensive search was performed to identify journal articles in the otorhinolaryngology subject category of the 2013 Journal Citation Report Science Edition over the last 30 years (1985–2014). The 100 most cited articles were reviewed and basic information including the publication year, country of origin, source journal, article type and research field was collected. Results: The 100 most cited articles were published in 15 of the 44 otorhinolaryngology journals. The number of citations per article ranged between 208 and 1559. The leading research field was otology and neurotology (n = 50), followed by rhinology (n = 23) and head and neck surgery (n = 11). Most papers originated in the USA (n = 64). Conclusion: The possibility of an article being cited is influenced by the publication language, country of origin and source journal.
Journal of Laryngology and Otology - Tập 130 Số 2 - Trang 121-127 - 2016
Prognostic factors for secondary recurrence of pleomorphic adenoma: a 20-year, retrospective studyAbstract Purpose: To evaluate the results of treatment of parotid pleomorphic adenoma, and the risk factors for secondary recurrence. Materials and methods: Single-centre, retrospective study of 32 patients with pleomorphic adenoma recurrence managed between 1988 and 2008. Results: The mean age at diagnosis of primary pleomorphic adenoma recurrence was 43.4 years. Twenty-eight per cent of patients had secondary recurrence; 32 per cent had undergone two or more surgical resections and external adjuvant radiotherapy. An age of less than 25 years was significantly associated with an earlier primary recurrence (p = 0.008). The most significant histopathological risk factor for secondary recurrence was the presence of a multifocal tumour (p = 0.019). Other histopathological criteria (i.e. cellularity and capsule rupture) were not significant. Radiotherapy was not associated with a decrease in recurrence. Nine per cent of patients progressed to malignancy. The main surgical complication was definitive facial palsy (14 per cent). Conclusion: Pleomorphic adenoma recurrence requires surgery, with greatly increased risk to the facial nerve. Resection with clear surgical margins is required, especially in young patients with multifocal tumours. Radiotherapy may delay second recurrence in cases of multifocal tumour.
Journal of Laryngology and Otology - Tập 127 Số 9 - Trang 902-907 - 2013
Role of limited parotidectomy in management of pleomorphic adenomaAbstract There is continued controversy over the extent of parotidectomy required for removal of a benign pleomorphic adenoma from the parotid gland. Currently, consensus exists that the integrity of the facial nerve must be preserved when the tumour is totally removed. As a result of experience gained in the first half of the twentieth century, it was recommended that superficial parotidectomy with facial nerve dissection should be the minimal biopsy for pleomorphic adenoma. Since that time, however, research has indicated that partial parotidectomy or extracapsular dissection of benign pleomorphic adenoma can be accomplished with preservation of the facial nerve without an increase in tumour recurrence. Partial parotidectomy or extracapsular dissection results in impaired cosmetic results and a lower incidence of Frey's syndrome, and thus may be the preferred approach when undertaken by experienced surgeons.
Journal of Laryngology and Otology - Tập 121 Số 12 - Trang 1126-1128 - 2007
Hypoparathyroidism after the treatment of laryngopharyngeal carcinomaAbstract Thirty patients with squamous cell carcinoma of the laryngopharynx were treated with surgery (total laryngectomy and hemithyroidectomy) and radiotherapy. Group 1 (n = 7) patients had surgery only; Group 2 (n = 7) had radiotherapy followed by salvage surgery while Group 3 (n = 16) had surgery followed by radiotherapy. Parathyroid hormone and calcium levels were measured pre- and post-operatively and pdstradiotherapy. In Group 1 no patients were hypoparathyroid. In Group 2, 29 per cent of patients preoperatively and 57 per cent post-operatively, were hypoparathyroid. In Group 3, no patients were hypoparathyroid pre-operatively, while 25 per cent were hypoparathyroid post-operatively and postradiotherapy. Parathyroid honnone and calcium levels were averaged and compared within and between each group. There was no significant difference within each group, when comparing levels postoperatively and post-radiotherapy from those of pre-operatively. There was no significant difference in levels between each of Groups 1, 2 or 3 (p >0.05).
Journal of Laryngology and Otology - Tập 112 Số 11 - Trang 1058-1060 - 1998
High recovery ofHaemophilus influenzaeand group A streptococci in recurrent tonsillar infection or hypertrophy as compared with normal tonsilsAbstract One hundred and twenty-six patients who underwent tonsillectomy because of recurrent acute tonsillitis, tonsillar hypertrophy or sleep apnoea were evaluated by tonsillar core culturing. The sleep apnoea patients served as controls, since none of them had tonsillar hypertrophy at ENT examination or any history of recurrent acute tonsillitis, and thus their tonsillar core flora could be regarded as normal. The isolation rate ofH. influenzae was much lower among sleep apnoea controls (2.7 per cent) than among either the patients with recurrent acute tonsillitis (20.3 per cent) or those with tonsillar hypertrophy (36.7 per cent) (p<0.05), as was that of group A streptococci, 5.4 per centversus 16.9 and 20 per cent, respectively (though the latter differences were not statistically significant). The isolation frequencies ofB. catarrhalis , pneumococci, group C and G streptococci did not differ between the three groups. The high tonsillar core recovery rates ofH. influenzae and group A streptococci both in patients with recurrent acute tonsillitis and in those with tonsillar hypertrophy, as compared with normal controls, suggests the possible involvement of these bacteria in both conditions.
Journal of Laryngology and Otology - Tập 105 Số 6 - Trang 439-441 - 1991
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