Carcinoma is a rare but recognized complication of posterior pharyngeal pulsion (Zenker's diverticulum). Such diverticula merit radiological and endoscopic examination before operation. Surgery is preferred to radiotherapy in the treatment of carcinoma, the choice of operation resting between one-stage diverticulectomy for cancer confined to the body of the sac and pharyngolaryngectomy for more extensive lesions.
'Second look' surgery following primary intact canal wall mastoid surgery for cholesteatoma is considered mandatory for most cases in modern otological practice. The morbidity of the second look can be reduced by the use of the rigid otoendoscope. Forty-three patients undergoing 'second look' surgery were studied with an average age of 24.7 years. Prior to surgery a computed tomography (CT) scan was performed to assess the anatomy and pneumatisation of the cavity. The mean interval between primary and secondary surgery was 16 months and in all cases CT scans were performed within 6 months of 'second look' surgery. The presence of an opaque mastoid did not correlate with residual or recurrent cholesteatoma. The sensitivity of CT in diagnosing residual or recurrent cholesteatoma was 42.9% with a specificity of 48.3% and a predictive value of 28.6%. These results are explained by the fact that it is radiologically impossible to differentiate between recurrence, scar tissue or fluid with a CT scan. Nevertheless it was possible to inspect the cavity with the otoendoscope even in the presence of an opaque mastoid whether due to scar tissue or residual/recurrent cholesteatoma.
Pseudohypacusis is a condition in which a hearing loss is exhibited in the absence of any organic disease. The mainstay of diagnosis is a lack of consistency in audiological testing. It is usually easier to diagnose in children than in adults, as children are less able to produce consistently erroneous results on repeated testing. In spite of this, the diagnosis is often missed in children, probably due to a lack of awareness of the condition. We present the findings in ten children seen in the past year. Initially they had average pure tone thresholds of 51.3 db in the right ear and 51.4 db in the left ear. All of the children underwent repeat pure tone audiometry and speech audiometry. In nine cases the speech audiograms confirmed the diagnosis. In one child the speech audiogram was consistent with a mild hearing loss subsequently confirmed as a 30-40 db low frequency sensorineural hearing loss. Following a programme of close follow up and support, the pure tone thresholds returned to within normal limits in nine children and to a level consistent with the clinical impression in the child with a sensorineural loss. None of the children required brain stem evoked response audiograms to confirm the diagnosis.
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