Hans H. Elverland

Influence of adenoid hypertrophy on secretory otitis media.

The prognostic influence of adenoidectomy on the clinical course of chronic secretory otitis media (SOM) is reported after an observation period of five years in 166 children. Adenoidectomy was performed in connection with the first tubulation on the basis of concurrent symptoms of nasal obstruction, and resulted in a significant reduction in the need for repeated insertion of tympanostomy tubes in patients younger than eight years of age. The tubulation rate was also significantly reduced when adenoidectomy was performed in association with the first recurrence of SOM. This effect was, however, absent when the operation was performed at later stages, and both the otoscopic and audiological findings after five years revealed no significant differences between the adenoidectomy and nonadenoidectomy groups. Possible pathogenetic mechanisms leading to the development of SOM in the presence of large adenoids are discussed.

Recurrent Meningitis, Congenital Anacusis and Mondini Anomaly

Temporal bone polytomography should be performed in cases of recurrent meningitis, anacusis and vestibular areflexia. The finding of a Mondini-type anomaly is indicative of an oval window fistula. A further case is described, and scanning electron microscopic views of the defect in the stapedial footplate presented. Dysplasia of the otic capsule is considered to be the probable cause of this syndrome.

Hereditary Deafness in the Cat

The free amino acid and sugar content of cat perilymph was studied from 11 normal and 17 deaf ears, and compared with simultaneous estimations from cerebrospinal fluid and serum. Each fluid has a dist

Acute orbit from ethmoiditis drained by endoscopic sinus surgery

Orbital complications from sinusitis are briefly reviewed. Acute orbit is suggested as the common term for all stages in the development. Four patients with acute orbit and ethmoiditis are presented. All had transnasal ethmoidectomy and drainage of the orbit performed by functional endoscopic sinus surgery (FES). Surgical indications are discussed based on clinical signs and CT examination. The operation can easily be staged according to the needs of the individual patient, starting with drainage of the primary cause, the sinusitis. Orbital skin incisions are avoided. Postoperative regression of clinical symptoms has been rapid.

Chronic Secretory Otitis Media

Of 242 children and teenagers treated surgically for chronic secretory otitis media in 1972, 212 presented for evaluation 5 years later. Although the pure-tone audiometric threshold was 20 dB HL or better in 87.7% of the ears, only 40.6% were judged to be otoscopically normal. The findings at the first myringotomy for insertion of tympanostomy tubes were of no prognostic value for the course of the disease, and the presence of characteristics of middle ear fluid at subsequent myringotomies varied unpredictably. Adenoidectomy performed at an early stage, and in the presence of nasal obstruction, resulted in a significant reduction in the need for re-insertion of tympanostomy tubes.

Idiopathic Facial Palsy and Pregnancy

Idiopathic peripheral facial paralysis is a common clinical condition, but the etiology and preferred mode of treatment are still undecided. The currently popular etiological theory centers around disturbances of microvascular circulation. The literature contains conflicting statements on the incidence of this condition in pregnancy. Six cases are reported, one bilateral, in all of which the paralysis developed within six weeks of delivery. The incidence of facial paralysis was not significantly different in our pregnant and nonpregnant populations of similar age groups. A battery of tests failed to reveal any specific etiologic factors. None of the patients had toxemia, therefore, hypertension is not a causative factor. Comparison with the Melkersson-Rosenthal syndrome would indicate that tissue edema is not involved in the pathogenesis of the idiopathic paralysis of pregnancy. Both idiopathic sudden deafness and idiopathic facial paralysis occur preferentially in the later stages of pregnancy and the early puerperium. Further research into the pathophysiology of this stage of pregnancy may clarify some of the etiological problems of these two conditions.

Sudden deafness and vaccination

A 16-year-old female developed sudden unilateral deafness and acute vertigo two days after routine revaccination against tetanus and diphtheria. Eight other cases culled from the literature are reviewed, and the symptoms and findings from the VIIIth cranial nerve discussed. It is postulated that a local hypersensitivity reaction may account for this and some other forms of sudden sensorineural deafness.

Kartagener's Syndrome—A Reappraisal

Congenital lack of dynein arms in cilia has recently been associated with Kartageners syndrome. Ultrastructural findings from six patients with chronic stagnant secretion in the respiratory tract are briefly reported. Only one of the patients had the complete syndrome. The term Immotile-cilia syndrome has been coined, and it is suggested that Kartageners syndrome should be included in this entity.

Benign lipoblastomatosis: a cervical tumor of children

Two cases are presented by a rarely reported cause of a supraclavicular mass in the neck of young children. Benign lipoblastomatosis has usually been confused clinically with cystic hygroma. The literature is reviewed and the histological differential diagnosis discussed.

Chronic secretory otitis media

212 of 242 patients (88%) treated for chronic secretory otitis media in 1972 were re-examined 5 years later. A total of 668 otological procedures has been performed, 99 patients being treated only once, while one patient received 12 procedures. The pure tone threshold was 20 dB or less in 88% of the ears in 1977, whilst only 57% had a type A tympanogram. Normal otoscopy was found in 40.5% of the ears, persisting secretory otitis in 11%, atelectasis in 2.8% and chronic suppurative otitis in 2.6%; the remaining 42.9% showed varying degrees of scarring and myringosclerosis.