Castleman's disease in ear, nose, and throat practice

Castleman's disease, also called angiofollicular lymph node hyperplasia or benign giant lymphoma, is a rare lymphoproliferative disorder of unknown etiology. Three histologic subtypes are described--hyaline vascular (80-90%), plasma cell (10-20%), and mixed (rare). In the clinical setting, localized and multicentric entities are distinguished. Due to the lack of tumor-specific clinical, biochemical, and radiological features, final diagnosis of Castleman's disease depends on histopathology. Surgical tumor resection is the treatment of choice for localized disease. Prognosis is good, and adjuvant therapy is not required. Therefore, early invasive removal and histopathological differentiation from neoplasia is mandatory. In contrast, the prognosis for multicentric Castleman's disease remains poor even if multimodal treatment regimens are employed. Major clinical symptoms, histology, and therapy are summarized, and the disease characteristics are highlighted presenting the case of an 11-year-old girl. On admission, the patient complained of a painless pharyngeal tumor mass and ipsilateral lymph node swelling. Magnetic resonance imaging revealed a parapharyngeal contrast-enhancing lesion extending from the hypopharynx to the skull base without signs of infiltration and accompanied by ipsilateral lymph node hyperplasia of the neck. Laboratory test results were within normal limits. After tumor resection, histopathological examination, and clinical staging, localized Castleman's disease was diagnosed (hyaline vascular subtype).     

Tuberculosis in ear, nose, and throat practice: its presentation and diagnosis

PURPOSE: The aim of this study was to increase awareness of the different presentations of head and neck tuberculosis (TB) and to discuss its diagnostic difficulties. MATERIALS AND METHOD: A retrospective analysis of patients who presented to us, at a secondary referral hospital, primarily with TB of head and neck was done from January 1999 to July 2003. RESULTS: A total of 117 patients presented with primary head and neck TB during the study period. Most of these (95%) had cervical lymphadenopathy, 2 patients had laryngeal TB, and there was 1 patient each of TB of cervical spine, oropharynx, ear, and retropharyngeal abscess. Forty-one were males, and 76 were females. Thirty percent of cases had associated lung or other organ TB. Nine percent gave history of previous or subsequent TB. CONCLUSIONS: 1) Diagnosing TB requires a high index of suspicion. 2) Tuberculosis of the cervical lymph nodes is the commonest presentation followed by laryngeal TB. 3) Fine needle aspiration cytology (FNAC) is a reliable and easy way to diagnose TB. However, newer diagnostic tests will increase the yield of positive cases and should be used whenever required. 4) In the larynx, the vocal cords were the commonest site affected and laryngeal TB need not be associated with lung TB or positive sputum always. 5) Patients who have TB of head and neck must be investigated to exclude pulmonary or systemic TB. 6) In cases of previous or subsequent TB infection, culture and drug sensitivity is indicated to reduce the problem of multiple drug resistance.     

Informed consent in ear, nose and throat practice

Changes in society's mentality have made health professionals get involved in legal aspects. In order to perform a correct medical proceeding, two premises must be fulfilled (Spanish Health General Law, 25th April 1986). First that it is carried out according to lex artis and second patient's consent. Consent needs as a prerequisite the adequate information; it is temporal, it can be revoked and it must be freely given and in writing (although it can be guaranteed by other means). Consent includes, on the patient's side, his/her acceptance of those risks inherent to the treatment. Nevertheless, it does not assure its results since doctor-patient's agreement is just related to means. If it were necessary, it is the doctor the one responsible to prove the consent was appropriately given. This would not be necessary when there is any kind of risk for public health or when the urgency allows no delay. Likewise, the assumption of the patient being under age or not able to take any decision will also be analysed. Features to be fulfilled by informed consent models are also analysed and a prototype is proposed.     

The underdeveloped palate in ear,nose and throat practice

The purpose of this study is to assess the incidence of palatal underdevelopment in children undergoing tonsillectomy and adenoidectomy. Signs of underdevelopment were found in 24 out of 1,500 consecutive children admitted for tonsil and adenoid surgery (1.6%). Bifid uvula was found in 15 children (1%). Five palates showed deficiency in length or thickness (0.33%) and submucous cleft palate was found in 4 children (0.27%). The palatopharyngeal sphincter was often compensated and adequate. Middle ear disease attributable to Eustachian tube dysfunction, with or without infection, was found in the majority of the children with underdeveloped palate. Tonsil and adenoid surgery was modified according to the palatopharyngeal condition.     

The bifid uvula in ear,nose and throat practice

Out of 2,000 consecutive ear, nose and throat patients, 44 were found with bifid uvulas. Five of the cleft uvulas were associated with submucous cleft palate, and eight were associated with short palates; however, dyslalia was evident in only one case. Compensation for the wide palato-pharyngeal space can occur by hyperplasia of the nasopharyngeal tonsil and hypertrophy and increased mobility of the pharyngeal constrictors and Passavant's ridge. On the other hand, otologic manifestations were complained of in 13 cases. The asymptomatic cases were examined under magnification and audiometrically and a further three cases were, then, diagnosed as secretory otitis media. Hypoplasia of the tensor palati is the probable explanation of otologic manifestations in bifid uvula     

Eye protection in ear, nose and throat surgery

The aim of this study was to quantify the risk of blood splashes to the conjunctiva during ear, nose and throat surgery. Two hundred and sixty consecutive operations by three surgeons were assessed for contamination of safety glasses and other factors. We found that 15 per cent of operations resulted in blood droplet contamination of safety glasses. In 92 per cent of these, contaminations were on the exterior of the glasses and eight per cent were on both sides. We concluded that about one and a half per cent of operations would result in droplet contamination of the conjunctiva and that safety spectacles reduced the risk by a factor of about 10. This study generally concurs with that of previous research in the areas of general and orthopaedic surgery and necropsies. We substantiate the need for eye protection for all ear, nose and throat procedures. Spectacles do provide a reasonable degree of protection but where absolute protection is needed i.e. in high risk groups, goggles should be used in preference to safety spectacles.     

Robotic surgery in ear nose and throat

The arrival of a commercial surgical robotic platform at our institution has raised the question of its application and usefulness within the department of otolaryngology head and neck surgery. In order to answer this question, we sought to perform a qualitative review to examine the evolution of commercial surgical robotics and examine present and future applications of this emerging technology within our specialty. The main objective of this study is to examine the development and application of robotic surgery in otolaryngology, head and neck surgery. The study includes a qualitative systematic review. We have reviewed research papers and studies that specifically relate to the use of robots in otorhinolaryngology. More specifically, we have attempted to review those studies that have significantly added to the development of this field. In summary, we have examined eight animal studies, six cadaveric studies, nine human trials. Robotic surgery in ENT is a safe and feasible option. In certain procedures, it offers significant benefits over conventional surgery. Instrument and robotic arm size, and costs are limiting factors that prevent the use of robots being applied to many additional ENT procedures. We feel the development of new speciality-specific robots will yield a new era in the common use of robotics in ENT.     

Child abuse within the ear, nose and throat

Non-accidental injuries to the ear, nose and throat are inevitably difficult to detect because of their covert nature. A survey of 50 hospitals and all NSPCC child abuse units in England was carried out to determine the type of injuries that were inflicted to these regions in verified cases of abuse. The importance of detecting these injuries is emphasized to permit intervention and prevent escalation of injury.     

Endoscopic photography of the ear,nose, and throat

The ability to view and photograph the ears, nose, nasopharynx, hypopharynx, and larynx has been revolutionized by the advent of the flexible fiberoptic nasopharyngolaryngoscope. For the first time the otolaryngologist has a one-instrument capability for examination and photodocumentation of the structures with which the specialty deals. This should not imply that the conventional means of examination should be relegated to museums, but rather that a new instrument has been added to the diagnostic armamentarium. The real visual images may be readily adapted for photography. The author will detail a straightforward and inexpensive method for obtaining high quality color transparencies, and color and sound video tapes.