摘要:

Post‐laryngectomy stomal recurrence: tumour implantation or paratracheal lymphatic metastasis?In the treatment of obstructing laryngeal cancer, an association has often been noted between emergency tracheotomy for airway relief and subsequent post‐laryngectomy stomal recurrence. It is however unclear whether this is due to tumour implantation in the tracheotomy track, or paratracheal lymph node metastasis.To investigate the pathophysiology of stomal recurrence, the recurrence rate and clinical outcome of 26 cases of TjNoMoglottic cancer treated with emergency tracheotomy and subsequent laryngectomy were analysed, and compared with 65 stage‐matched cases treated with laryngectomy alone.Analysis shows the ‘emergency tracheotomy’ group to have a very poor prognosis with a higher incidence of recurrence at the stoma, and also in the regional lymph nodes. These findings suggest that paratracheal lymph node metastasis is an important mechanism in the development of stomal recurrence and thus has considerable implications for the prevention of such a recurrence following laryngectomy in the patient presenting with malignant airway ob

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1991.tb01941.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Patterns of epithelial migration in the unaffected ear in patients with a history of unilateral cholesteatomaEpithelial migration in a centrifugal manner is an established phenomenon in the normal human tympanic membrane. This pattern of migration is symmetrical in both ears of any one individual. We present a prospective study on the pattern of tympanic ink dot migration on the normal drum, in patients with a history of cholesteatoma in one ear. It was demonstrated that patients who develop cholesteatoma have a normal migratory pattern and rate in the unaffected ear. The conclusion from this study is that defective migration is not the initiating factor in the development of acquired cholesteatoma.

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1991.tb01942.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Second radical neck dissectionWe report a series of 96 patients (62 men and 34 women) undergoing a second radical neck dissection for enlarged contralateral cervical nodes after primary treatment of a squamous cell carcinoma of the head and neck, including an ipsilateral radical neck dissection. The proportion of patients requiring a second later neck dissection varied from 0% for tumours of the nasopharynx, nasal cavity and paranasal sinuses, to 5% for tumours of the hypopharynx.The incidence of second neck dissection was not determined by the original T stage of the primary tumour, but patients with enlarged nodes at presentation were 5 times more likely to need a second neck dissection than those with no palpable nodes at presentation. Also, patients with a poorly differentiated tumour were twice as likely to need a second neck dissection as those with a well differentiated tumour.The overall 5‐year survival after second neck dissection was 35% and the perioperative mortality 1.92%. Significant factors predicting survival after a second neck dissection were the time to recurrence, the clinical neck node status at recurrence, the number of histologically invaded nodes in the neck and the presence of extra‐nodal dise

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1991.tb01943.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

A new approach to the management of acute epistaxisA new approach to the management of acute epistaxis is described using suction with the operating microscope to define the bleeding point prior to the application of hot wire cautery. This technique was shown to be completely successful in stopping haemorrhage in 82% of acute referrals in a prospective series of 33 patients. It resulted in a significant reduction both in the use of nasal packing and in the length of hospital stay compared with a group of controls treated by traditional means. It is proposed that in most cases of acute epistaxis the bleeding point is accessible to cautery and nasal packing should be reserved for a minority of refractory cases. This avoids unnecessary patient discomfort and the complications of prolonged nasal packing and hospitalization.

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1991.tb01944.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Polytomographic radiology in the diagnosis and management of maxillary antral disease as determined by antroscopyPlain radiology of the maxillary sinus correlates poorly with pathological conditions affecting it as shown by subsequent endoscopic assessment. Tomographic radiology provides a much higher diagnostic yield and in particular is of great value in assessing the opaque antrum*. The false positive rate is similar in the two techniques but tomography yielded no false negative diagnoses in this study compared with an incidence of 31% with plain radiology. Sinoscopy remains the definitive method of assessing antral disease but tomographic radiology is a highly accurate screening technique. It provides this accuracy at low cost, low orbital irradiation and more convenience than the newer techniques ofCTand MRI scanning which are still not widely available for routine ENT use.

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1991.tb01945.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Unilateral otosclerosis and noise‐induced occupational hearing lossThe interaction between noise‐induced hearing loss and otosclerosis remains unclear and controversial. In the present study, the effect of chronic noise exposure was examined in 31 patients with unilateral otosclerosis. Consideration was given to hearing loss at specific frequencies, the influence of age, and the effect of the size of the air‐bone gap.A small, though statistically significant, protective effect of otosclerosis was demonstrated at 4 kHz. This effect was maintained despite advancing age. An apparent inverse relationship was found between the amount of hearing loss and the size of the air‐bone gap at 4 kHz, but multiple linear regression analysis suggested that this finding was contaminated by age

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1991.tb01946.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Intermediate hearing tests as predictors of hearing aid acceptanceThis prospective study analyses the ability of several different intermediate hearing screening techniques to predict hearing aid acceptance in a pre‐retirement population.In addition to the traditional methods of using sensitivity and specificity to analyse test performance, signal detection theory has been used to obtain a single detectability rate for each test.Questionnaires were able to identify individuals with hearing difficulties but included a significant group of people who ultimately would not accept a hearing aid. This group could be eliminated either clinically using free field speech testing, or audiometrically using warble tone thresholds, without the need for formal pure tone audiometr

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1991.tb01947.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Acoustic rhinometry, used as a method to demonstrate changes in the volume of the nasopharynx after adenoidectomyAcoustic rhinometry is a method of investigating the geometry of the nasal cavity and the nasopharynx. An acoustic impulse is transferred to the nasal cavity and the reflected signal is analysed expressing the cross‐sectional area in the nasal cavity and the nasopharynx as a function of the distance from the nostril. The method provides an accurate and objective measurement of the geometry of the nasal cavity and the nasopharynx in a non‐invasive way.In a series of 20 children, age range 4–16 years, it has been possible to demonstrate the changes in the volume of the nasopharynx after adenoidectomy. The relation between the volume of the adenoid and the calculated change of volume in the nasopharynx is found to be proportional and highly significant(P= 0.0005).It is concluded that acoustic rhinometry, which is very easy to perform, gives a reliable, objective measurement of the amount of adenoid tissue in the nasopharynx. The results from these and future studies may help reduce the number of unnecessary adenoidect

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1991.tb01948.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Malignant tumours of the middle earThe authors present 15 patients with middle ear malignant tumours, of which 13 were squamous cell carcinomas, one was a rhabdomyosarcoma and one a malignant lymphoma. In 11 of 13 patients with squamous cell carcinoma, long‐standing chronic otitis media preceded the malignant process and only in 2 patients did the tumour develop without previous chronic infection. Most of the patients presented at an advanced stage of the disease: in 6 the tumour had destroyed surrounding bone, commonly involving the endocranium; in 7 the facial nerve was paralysed and in 8 patients there was total hearing loss. The diagnosis of malignant tumour was established before surgery in 5 patients, but 8 patients were operated upon for suspected chronic otitis. Three patients died without treatment and 10 were treated: 3 with radiotherapy because the tumour was inoperable, 3 had surgery only and 4 patients had surgery and received radiotherapy post‐operatively. Of 7 operated patients only 2 are alive without signs of tumour. Our findings suggest that otologists should bear in mind this disease in patients with chronic suppurative otitis and accompanying suspected symptoms.In 2 patients with rare types of sarcoma of the middle ear the diagnosis of tumour was established at an advanced stage and they could not be trea

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1991.tb01949.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Use of serum markers in the diagnosis and management of laryngeal cancerMany neoplastic diseases are reported to be accompanied by the presence or associated with an increase in biological substances identified as tumour markers. The most common markers implicated in head and neck cancers are CEA, TPA, LASA, SCC, CA 19‐9, and ferritin. These markers (except SCC) were evaluated in SO patients with a laryngeal carcinoma, in 20 patients with benign lesions, and in 20 healthy subjects. The results show for each marker assayed the following sensitivity values (true positives): CEA, 10%; CA 19‐9, 30%; TPA, 30%; LASA, 90%; ferritin, 60%. Specificity (true negatives) was as follows: CEA, 85%; CA 19‐9, 99.4%; TPA, 98%; LASA, 99.8%; ferritin, 97%. LASA and ferritin seem to be the most suitable markers for patient monitoring because of their higher sensitivity in all phases of cancer di

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1991.tb01950.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY