George Leventon

Peritonsillar abscess: Recurrence rate and the indication for tonsillectomy

Two hundred ninety patients treated for peritonsillar abscess (PTA) between 1970 and 1982 were reviewed. The patients were divided into those with a history of recurrent tonsillitis prior to developing PTA (72 patients, 25%), and those without (218 patients, 75%). The patients in the first group had four times more recurrences than those in the second group (40% versus 9.6%). Patients older than 40 years were found to have a lower incidence of throat infections than younger patients, and no PTA recurrences were observed. Neither subsequent tonsillitis nor recurrent PTA was observed among 72 patients (25%) who underwent tonsillectomy 6 to 12 weeks after PTA. The pre-PTA history was found to be a dominant factor in determining the need for tonsillectomy. In patients who suffered from recurrent tonsillitis prior to PTA, tonsillectomy is recommended. In those with a single episode of PTA and no history of tonsillitis, tonsillectomy is not indicated.

Rapidly progressive hearing loss as a symptom of polyarteritis nodosa

The hearing loss that occurs in polyarteritis nodosa is due largely to middle ear effusion but usually appears as a mixed type. Pure perceptive hearing loss is rare; only two cases have been reported previously in which sensorineural hearing loss was the initial sign of the disease. A case of profound, rapidly deteriorating perceptive hearing loss in which the etiology was not clear is described. One year after the onset of hearing loss, other manifestations of polyarteritis nodosa led to the diagnosis.

Vocal cord paralysis as a presenting sign in the Shy-Drager syndrome

A 70-year-old patient with bilateral vocal cord paralysis, accompanied by inspiratory stridor and increased snoring, is presented. Respiratory dysfunction, deteriorating over 18 months, necessitated permanent tracheostomy. Only two and a half years after the onset of symptoms the patient developed extrapyramidal signs combined with severe autonomic failure, suggesting a diagnosis of Shy-Drager syndrome. Vocal cord palsy preceding any other neurological or autonomic manifestations of that syndrome has been infrequently described. This diagnosis should be considered in cases of vocal cord palsy of undetermined etiology, especially when associated with increased snoring or episodes of sleep apnea.

Peritonsillar abscess in children and its indication for tonsillectomy

38 children aged 1-15 years treated for peritonsillar abscess (PTA) between 1976 and 1986 have been reviewed. The patients were divided into those with a history of recurrent tonsillitis prior to developing PTA (T+) (10 patients = 26.3%) and those without such history (T-) (28 patients = 73.4%). 19 patients were surgically drained, 2 abscesses ruptured spontaneously, 2 patients were treated by repeated needle aspirations and 15 patients were treated by medication only. Neither the pre-PTA history (T+ versus T-) nor the mode of treatment during the acute event showed any significant differences in comparing the recurrency rate of PTA or tonsillitis. Therefore, it seems that a single event of PTA among pediatric population should not be considered an indication for tonsillectomy.

Malignant oncocytic tumour of the parotid salivary gland

A 49-year-old man developed a tumour mass in his right parotid salivary gland nine years after a histologically proven benign mixed tumour of the same salivary gland had been surgically removed. Radical resection of the right parotid salivary gland and associated lymph nodes and soft tissues of the neck was performed. The parotid tumour was composed of oncocytic cells which infiltrated the surviving salivary gland tissue. Most of the excised lymph nodes contained metastatic deposits of oncocytic cells identical to the tumour seen in the parotid. There are no previous reports of the occurrence of both pleomorphic adenoma and malignant oncocytoma in the same salivary gland.

Sialadenoma papilliferum of the parotid gland

Sialadenoma papilliferum is a rare, benign exophytic tumour of salivary glands. The preferred site of this tumour is usually the hard palate. A case of sialadenoma papilliferum occurring in the parotid gland of a 49-year-old man is presented; only one such case has been previously described.

Symptom Producing Anomalies of the Sigmoid Sinus: Report of Two Cases

Two cases of anomaly of the sigmoid sinus, both superficial and with hernia-like bulging are reported. In the first case, this appeared to be an ctiological factor in facial nerve palsy, of which the true etiology was recognized only at the time of intervention. In the second, vertigo and hearing loss were the main clinical features and, similarly, the role of the sinus anomaly was recognized only by the improvement resulting from its decompression. As far as we are aware this is the first description of an anomaly of the sigmoid sinus causing facial nerve palsy.

Congenital webbing of the larynx plus multiple anomalies: A new genetic syndrome**

An 18-year-old woman had had congenital webbing of the larynx since infancy. Over the years other physical abnormalities had been found, including scleroderma-like skin and a variety of connective tissue defects. Several of the probands siblings and her father showed in varying degrees many of the other abnormalities the proband had but not the laryngeal involvement. The authors believe this consteliation of findings represents a new genetic syndrome, thought to be transmitted as an autosomal dominant trait with marked variability in expressivity.