Two hundred and twenty-two children with chronic, bilateral middle ear effusions were assessed during a 2 year follow-up period. At initial myringotomy the middle ear aspirate was found to be serous in 44 children and mucoid in 178 children. Evaluation at 1 and 2 years post-operatively showed no difference in otoscopic fluid clearance or mean hearing threshold at either follow-up time in relation to either type of fluid. There was no greater need for ventilation tube reinsertion in either group during the overall follow-up period. There was found to be no significant difference between the children with serous or mucoid effusions in relation to a range of pre-operative and operative variables. The study suggests that outcome in terms of fluid clearance and hearing thresholds is independent of the fluid type and there appears no greater need for revision ventilation tube insertion in relation to the findings at myringotomy. The type of effusion found on aspiration prior to ventilation tube insertion has no prognostic value. Children with serous fluid should be managed in an identical manner to those in which the fluid is thicker and mucoid in character.
Cholesteatoma is a well recognized cause of a facial nerve palsy. The usual mechanism for this complication is direct pressure on the nerve. We present a case in which the facial nerve has been transected by cholesteatoma and discuss the possible causes.A 69-year-old female patient presented to the otolaryngology clinic in 1997 with a chronic discharge from her left ear. Her past medical history included grand mal epilepsy, Parkinson's disease and manic depression. A cholesteatoma was observed and she was noted to have normal facial nerve function.Three months later she returned to the clinic with an acute onset partial weakness of all divisions of her left facial nerve. Five days later she had a modi ed radical mastoidectomy at which it was noted that cholesteatoma was surrounding the descending portion of an intact nerve.Her facial nerve was surgically skeletonized from the second genu to near the stylomastoid foramen but the nerve function was unchanged in the immediate postoperative period.For two years her facial nerve function was seen to decline gradually until in late 1999 it was noted to have no function (House Brackman grade 6). The ear was further explored under general anaesthesia and a transected end of the descending portion of her left facial nerve was found embedded in recurrent cholesteatoma near the mastoid tip Fig. 1 Descending portion of the facial nerve in the left ear.Fig. 2 Deflected descending portion of the facial nerve in the left ear. 214
In a prospective investigation of the treatment of glue ear in children, the possible role of persistent infection in the tonsils and adenoids was assessed by comparing bacterial cultures of swabs and resected tissue from the tonsils and adenoids of patients with cultures of swabs from similar sites in control subjects without ENT abnormality. For almost all potential pathogens, including Streptococcus pneumoniae and Haemophilus influenzae, no statistically significant differences were demonstrated between patients and controls. The same was true of Streptococcus pyogenes in tonsil specimens, while in adenoid specimens rather more isolates were obtained in patients than controls. This difference was just statistically significant at the 5% level, but only when all isolations, including very scanty growths, were compared. On present evidence, persistent infection should not be invoked to explain the success of adenoidectomy in otitis media with effusion or to justify adenotonsillectomy.
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