No abstract

Five patients with large arteriovenous malformations (AVM) of the head and neck, which were too large or inconveniently placed for operation alone, were treated by embolisation after direct puncture; two of them were subsequently operated upon. They all recovered without complications. Embolisation of the nidus and subsequent operation is a good alternative for the treatment of large AVM. Ligating the supplying arteries is not a treatment. If the arterial routes to the nidus have previously been closed by ligatures selective catheterisation is impossible, though direct puncture of the nidus is a possibility. The nidus of the AVM can then be obliterated by embolisation either as a treatment, or as a preoperative procedure.

A series of myringoplasties is presented and those cases that did not heal perfect are discussed.In order to evaluate whether some changes in the technique could further improve the results, another series incorporating these changes was operated after and the results are presented. Differences in healing and post-operative hearing between the two groups of patients are evaluated.

Paragangliomas from 22 patients with extraadrenal tumours of this type were studied. Neuroendocrine features were examined using immunohistochemical techniques. Twenty-two antisera raised against neuroendocrine "markers", regulatory peptides, serotonin and intermediate filament proteins were studied in this group and cytometric DNA assessments were made by means of image cytometry. One normal and 5 hyperplastic carotid bodies were used as controls in the DNA cytometric investigations. Clinical and/or histopathological evidence of "malignancy" was present in 5 cases. The tumour cells showed heterogeneity with regard to their expression of different peptides, and the immunohistochemical analyses did not permit differentiation between benign and malignant paragangliomas. An euploid nuclear DNA distribution pattern was found in all controls and in 17 of the tumours; all except 1 were clinico-pathologically benign. An aneuploid DNA pattern was observed in 5 of the cases and some malignant features were present in 4 of these cases. DNA data may give further information apart from that obtained from the histopathological findings which may be of value in predicting the biological behaviour of this tumour type.

In closing an uncomplicated central drum defect the technique known as an ‘underlay’is widely used. This method has certain advantages and yields good results as far as both healing and hearing are concerned. In an attempt further to improve reults the authors give an account of a series of myringoplasties and specifically discuss the unsuccessful cases. By a slight alteration in the operative technique used in the series presented, the authors believe that some failures can be avoided.

No abstract

The objective of this study was to examine the outcome of unilateral stapes surgery in one patient group with bilateral hearing loss and one group with unilateral hearing loss. The patients' own estimations of improvement in hearing ability and the occurrence of other ear-related symptoms were examined retrospectively and in a follow-up study. Ninety-five of 123 patients operated for otosclerosis in only one ear between 1987 and 1992 responded to a follow-up examination. Observed audiometric findings and changes thereof, along with the patients' own estimations of their hearing handicap pre- and postoperatively, and the occurrence of other ear-related symptoms were studied. Despite good surgical results (closure of air-bone gap within 20 dB in 94%), 33% of the patients had severe hearing disabilities postoperatively, and many of these patients needed further amplification with a hearing aid. Mild dizziness occurred in 33% of the patients postoperatively and did not decrease over time. Discomfort in the operated ear due to strong sounds was reported in 20%. Change in sound quality occurred in 80% of the operated ears, but tended to disappear over time. From the results of this study it may be concluded that surgery in one ear only, leaving the other ear with poor hearing, is not an optimal hearing rehabilitation of patients with otosclerosis. It is important endevour to achieve bilateral hearing in order to give the patient good social hearing. Postoperative dizziness and unpleasant hearing quality do occur frequently, and the patients need to be informed about these problems preoperatively.

Agenesis of the cervical portion of the internal carotid artery (ICA) may result in blood supply to the ipsilateral cerebral hemisphere being provided by an enlarged inferior tympanic branch of the ascending pharyngeal artery. This enlarged vessel, passing through Jacobson's canal and anastomosing with the likewise enlarged caroticotympanic branch of the ICA in front of the promontorium, may simulate a middle ear mass. We present five patients with this unusual anatomical variant, three of which underwent biopsy of what was believed to be a middle ear tumour. One patient experienced rupture of an arterial aneurysm in the middle ear successfully treated with endovascular application of detachable platinum coils. It is mandatory for ENT-surgeons and radiologists who perform head-and-neck examinations to recognize this anatomical variant, not mistaking it for a tumour, since biopsy of a large artery supplying the brain may have disastrous consequences. In patients with otorrhagia, an arterial aneurysm must be considered as a possible source of bleeding, in some cases amenable for treatment with an endovascular technique. The diagnosis of “aberrant internal carotid artery” is usually made with CT of the temporal bone or MR of the skull base. Cerebral angiography is in most cases not necessary, unless an endovascular procedure is planned.