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Biomedical subjects

N S Jones

Publications and source records attributed to N S Jones.

At least 55 records · Page 3Linked to original sources
PubMed2002

Pneumosinus dilatans of the frontal sinuses: two cases and a discussion of its aetiology.

Pneumosinus dilatans is a rare condition with the dilatation of aerated paranasal sinuses. We present two cases and discuss its aetiology, the radiological classification of enlarged aerated sinuses, and its treatment. One much quoted hypothesis for the cause of this condition has been that it is due to a 'ball valve' effect of mucosal closure at the frontal recess. However, one of our subjects has started, and done, a considerable amount of subaqua diving since presenting with their condition and has had no symptoms on diving, or progression of their frontal swelling. This observation, along with the fact that retained secretions are not seen within the sinuses in this condition, raises doubt about the theory that a one-way valve is responsible.

Adult↗
PubMed2002

Melkersson-Rosenthal syndrome.

Melkersson-Rosenthal syndrome (MRS) is a rare idiopathic non-caseating granulomatous condition. It is rarely described in otorhinolaryngology-related journals, although facial palsy, lip-swelling, and lingua plicata, are its most common presenting features. This classical triad however is not always present in MRS. Other forms of orofacial swelling exist. This paper describes a patient with a variant of MRS, treated by us with intra-lesional steroid injection. We also discuss the other differential diagnoses that may mimic MRS.

Adult↗
PubMed2002

Solitary plasmacytoma and extramedullary plasmacytoma of the paranasal sinuses and soft palate.

Solitary plasmacytoma of the paranasal sinuses are uncommon neoplasms of B lymphocyte origin. They comprise one per cent of all head and neck tumours of the upper respiratory tract. They can be solitary plasmacytomas of the bone (SPB), an extramedullary plasmacytoma or a local manifestation of multiple myeloma. Conversion to multiple myeloma happens more frequently in SPB. Radiotherapy is the common modality of treatment with, or without, adjuvant chemotherapy. Extramedullary plasmacytoma carries a better prognosis than a solitary plasmacytoma of the bone. We report four cases of solitary plasmacytoma of the bone and an extramedullary plasmacytoma of the paranasal sinuses and soft palate.

Female↗
PubMed2002

Spontaneous CSF rhinorrhoea from separate defects of the anterior and middle cranial fossa.

Multiple congenital dehiscence of the skull base is rare and can give rise to spontaneous CSF rhinorrhoea. A search of the world literature revealed only five reports of CSF leak with more than one concomitant skull base defect. When treating a patient with spontaneous CSF rhinorrhoea the possibility of its originating from the middle ear and eustachian tube should be considered. An intrathecal injection of fluorescein is useful in establishing the site of a CSF leak especially when a computed tomography scan (CT) or magnetic resonance image (MRI) has not localized the site. We discuss a case of a 72-year-old lady presenting with CSF rhinorrhoea, who had an anterior skull base defect localized with the help of intrathecal fluorescein and repaired surgically. Subsequent to this she had a further episode of CSF rhinorrhoea that originated from a middle-ear meningocele that was then repaired.

Aged↗
PubMed2002

Septic cavernous sinus thrombosis secondary to sinusitis: are anticoagulants indicated? A review of the literature.

This article reviews the contemporary literature for septic cavernous sinus thrombosis (CST) with a focus on anticoagulation. Modern emphasis is placed on suspecting and treating this condition early, which is aided by recognizing clinical features attributable to sepsis, orbital venous congestion, and involvement of cranial nerves within each cavernous sinus. Established treatments include high dose broad-spectrum parenteral antibiotics, and selective surgery for concurrent suppurations. The role of anticoagulation is contentious because its efficacy is undetermined and it may cause or exacerbate concurrent intracranial haemorrhage in patients with septic CST. Moreover, prospective trials of anticoagulation may never be performed due to the rarity of this condition. Nevertheless, retrospective reviews of published reports indicate that haemorrhage caused by anticoagulation is rare, and that early adjunctive anticoagulation is beneficial in these patients if commenced after excluding the haemorrhagic sequelae of CST radiologically.

Anti-Bacterial Agents↗
PubMed2001

Evidence for an inflammatory pathophysiology in idiopathic rhinitis.

BACKGROUND: The pathophysiology of idiopathic rhinitis is unknown but the disease is classified as being non-allergic on the basis of negative serum IgE radioallergosorbent assay (RAST) and skin prick tests. In contrast, allergic rhinitis has a Th2 type inflammatory pathology mediated by IgE and mast cells. OBJECTIVE: To test the null hypothesis that there would be no difference in the cellular infiltrate for key Th2-associated inflammatory cells between allergic and idiopathic rhinitis. METHODS: We applied strict selection criteria in the recruitment of allergic and idiopathic rhinitis cases. In contrast to previous studies which used cytology or small biopsies, we studied all layers of the mucosa by using whole, full-thickness nasal turbinate specimens with an average length of 2.5 cm. Immunohistochemistry and in situ hybridization techniques were used to compare the distribution and cell populations of mast cells, IgE positive (IgE+) cells, eosinophils and plasma cells in perennial allergic (n = 11) and idiopathic (n = 17) rhinitis, and control nasal mucosal tissue (n = 9). RESULTS: Mast cells and IgE+ cells were significantly increased within the epithelium of allergic and idiopathic mucosa compared to normal mucosa (P < 0.05). More IgE+ cells were present in the allergic group compared to the idiopathic group with the majority of IgE+ cells being mast cells. Both rhinitic groups showed increased eosinophilia localized to the superficial submucosa compared to normal mucosa (P < 0.05). More plasma cells were present in the allergic rhinitic tissue. CONCLUSION: Idiopathic and allergic rhinitic mucosa show similarities in their inflammatory infiltrate suggesting that both groups share a highly localized Th2, IgE-mediated cellular immunopathology.

Adolescent↗
PubMed2001

A prospective case-control study of 50 consecutive patients presenting with hyperlipidaemia.

The literature contains many references which refer to a causal relationship between hyperlipidaemia and hearing loss, but the majority of reports lack adequate controls, or are based on a series of cases which may represent incidental findings. This prospective case-control study compared a restricted population of 50 consecutive hyperlipidaemic patients attending a lipid clinic whose fasting lipid levels were > 2 SDs above the population mean with a control population recruited from patients undergoing nasal surgery for structural abnormalities (n = 159). The National Study of Hearing data was also compared with both groups in order to provide external validity to the control group. This study showed no consistent differences in the hearing thresholds of the hyperlipidaemic group compared with either control group. The Null hypothesis that sensorineural hearing loss is no greater in a population whose fasting blood lipids are raised > 2 SDs above the population mean level than in a control population cannot be refuted given the variability of the data.

Adult↗
PubMed2001

The effect of the nasal cycle on mucociliary clearance.

The nasal cycle is a well-recognised physiological phenomenon where each side of the nose alternates through phases of congestion and decongestion. Although many physiological properties of the nose alternate with the nasal cycle whether this has any effect on the nasal mucociliary clearance is less clear. As the nose is a potential site for the administration of pharmaceuticals, it is essential that any factors that could affect clearance (and hence absorption) are identified. This study set out to investigate if mucociliary clearance rates differed between the clear and obstructed airway at a morning peak of the nasal cycle in five healthy volunteers with normal nasal anatomy using a dual-radioisotope labelling procedure that allows both sides of the nose to be assessed simultaneously. The clearance of the radiopharmaceutical formulations from the nasal cavity was monitored using gamma scintigraphy and decay-adjusted 50%-clearance times were calculated for each nostril. The ratios of clearance times from the patent nostril when compared to the obstructed nostril were statistically significant (two-tailed t-test; P = 0.039), the mean ratio being 2.5 : 1 (SEM +/- 0.5). It can be concluded that the nasal cycle has a marked effect on the mucociliary clearance patterns of the nose. This may have both theoretical and practical implications for the nasal delivery of drugs.

Adolescent↗
PubMed2001

Investigation for immunodeficiency in patients with recurrent ENT infections.

Patients suffering with primary immunodeficiency frequently present to ear, nose, and throat (ENT) clinics, but the diagnosis is rarely made at this time. Early diagnosis of these patients would help to prevent morbidity and even mortality. Normal results from a simple panel of blood tests will exclude the commonest immune deficiencies. An abnormal result from these tests, or a strong suspicion despite normal initial testing, should prompt discussion with an immunologist.

Humans↗
PubMed2001

Autoanti-IgE antibodies in patients with allergic and idiopathic rhinitis.

The pathophysiology of idiopathic rhinitis is unknown although evidence is accumulating to suggest that, in a proportion of patients, it may be a more localized form of allergic rhinitis in the absence of other atopic symptoms and markers. Anti-IgE is thought to be a systemic marker of atopy. This study compared serum IgG autoanti-IgE levels in patients with idiopathic rhinitis, perennial allergic rhinitis and normal controls. Serum samples were obtained from 19 patients with idiopathic rhinitis, 17 patients with perennial allergic rhinitis and 10 normal non-rhinitic controls. The presence or absence of IgG1 and IgG4 anti-IgE antibodies was detected using enzyme-linked immunosorbent assays. Eighty-eight percent of the patients with perennial allergic rhinitis had raised levels of autoanti-IgE antibodies in their serum. None of the controls or patients with idiopathic rhinitis showed raised levels (P < 0.001). Although patients with idiopathic rhinitis may exhibit clinical and pathological features of allergy, they do not show raised levels of anti-IgE in their serum.

Autoantibodies↗
PubMed2001

Does stimulation of nasal mucosa cause referred pain to the face?

Ten healthy volunteers (five men and five women, mean age 30 years 3 months), with no nasal contact points, had pressure, adrenaline (1 : 1000), substance P (10 and 80 nmol/mL) and placebo topically applied to their nasal mucosa. Areas stimulated were the nasal floor, septum and lateral wall as well as the inferior and middle turbinates in both nasal cavities. The application of stimuli was randomized and single-blinded. A numerical score of the subjective severity of pain was used to assess outcome. Pressure caused variable local nasal discomfort limited by the duration of application and the site of pressure. Substance P caused variable nasal itching and sneezing. None of the stimuli caused referred pain to the face. The results question the role of mucosal contact points in facial pain.

Administration, Intranasal↗
PubMed2001

Nasal polyposis and facial pain.

A cohort of 973 patients with symptoms of rhinosinusitis and/or facial pain was followed up for a mean of 2 years 2 months and, within this, was a group of 220 with nasal polyps. Only 39 (18%) had pain or pressure as a symptom. Out of the 220 with nasal polyps, 190 had polyps without any purulent secretions and, of these, only 5 (2.6%) had pain attributable to their paranasal sinus disease. Ten out of the 15 with pain and polyps without pus were found to have pain as a result of neurological or medical cause after endoscopic sinus surgery and a trial of medical nasal treatment and, where necessary, drugs to treat neurological conditions. Thirty patients (13.6%) had nasal polyposis and purulent secretions, and, within this subgroup, 24 (79%) had pain as well. Of the 24 with pain and purulent secretions, 19 (80%) responded to treatment for their paranasal sinus disease, a far higher proportion than with nasal polyps without pus. In conclusion, in patients who have nasal polyps without purulent secretions, be cautious about attributing any symptoms of facial pain or pressure as being due to their paranasal sinuses as it is more probable that it is coincidental and the result of a neurological cause.

Adolescent↗
PubMed2001

Aggressive sino-nasal non-Hodgkin's lymphoma diagnosed in Nottinghamshire, UK, between 1987 and 1996.

In the 10-year period 1987 to 1996, 24 patients were diagnosed with aggressive non-Hodgkin's lymphoma of the nasal cavities or paranasal sinuses. The disease occurred in a relatively elderly population of median age 72 years (range 42 to 96) with a male predominance (male 15; female nine). The histology on review was mostly of the large B-cell subtype (21 patients); peripheral T-cell subtype (one), anaplastic large cell of T-cell type (one) and T/natural killer cell nasal lymphoma (one). The disease was localized in 20 patients (Stage IEA). The overall survival at 5 years was 40% (95% confidence interval (CI) 19-61); at 10 years it was 33% (95% CI 12-54). The cause-specific survival (excluding deaths from causes other than lymphoma) at 5 years and 10 years was 62% (95% CI 39-86).

Adult↗
PubMed2001

CSF rhinorrhoea: the place of endoscopic sinus surgery.

Cerebrospinal fluid (CSF) rhinorrhoea has been managed by both neurosurgeons and otorhinolaryngologists, with neurosurgeons often choosing an intracranial approach and otorhinolaryngologists an extracranial approach. Recently, transnasal endoscopic techniques have been introduced that significantly reduce the morbidity of surgical repair when compared with previous techniques. The sense of smell was preserved in all patients who underwent an endoscopic repair of their CSF leak where it was present preoperatively. The results of transnasal endoscopic repair now make it the treatment of choice for most anterior cranial and sphenoid CSF leaks, with the exception of defects in posterior wall of the frontal sinus or defects larger than 5 cm. It is vital that a diagnosis of a CSF leak is confirmed by immunofixation of beta 2 transferrin as unilateral rhinorrhoea can masquerade as a CSF leak. We illustrate our experience with 78 patients who were referred with a diagnosis of CSF rhinorrhoea.

Adult↗
PubMed2001

Endoscopy-negative, computed tomography-negative facial pain in a nasal clinic.

OBJECTIVES: To establish the etiology of facial pain in individuals attending the nasal clinic of the Department of Otorhinolaryngology, University Hospital, Nottingham, U.K., with normal nasal endoscopy and computed tomography of the paranasal sinuses. STUDY DESIGN: A retrospective analysis of a cohort of 973 patients consecutively presenting to the nasal clinic with symptoms of rhinosinusitis and/or facial pain. METHODS: We reviewed the case notes of 973 consecutive patients who presented to the nasal clinic with either symptoms of rhinosinusitis or facial pain, and in particular 101 who had facial pain without any objective evidence of nasal disease as detected by nasal endoscopy or computed tomography. The diagnosis was based on the outcome and response to treatment after a mean of 2 years 2 months. RESULTS: One hundred one patients had pain as a predominant symptom with normal nasal endoscopy and computed tomography of the paranasal sinuses. None of these patients responded to either medical or surgical treatment for what some workers have hypothesized could be "occult" sinonasal disease. A neurological diagnosis was made in 99 patients. Eighty patients received successful medical treatment for "neurological" diagnoses, 8 patients experienced spontaneous resolution of their symptoms, 7 failed to respond to any treatment modality, 2 were lost to follow-up, and 2 refused any treatment. CONCLUSION: The majority of patients presenting to a rhinologic clinic with facial pain and no objective evidence of sinus disease, as detected by endoscopy and computed tomography, responded well to neurological treatment and surgical intervention was unnecessary. These patients should receive a trial of medical therapy, such as low-dose amitriptyline for 6 weeks in the first instance, before any surgical intervention is considered.

Endoscopy↗
PubMed2001

Repair of nasal septal perforations using local mucosal flaps and a composite cartilage graft.

The surgical closure of a nasal septal perforation is recognized as being particularly challenging. A series of 11 consecutive patients who underwent closure of a septal perforation using a mucosal flap/composite conchal cartilage graft technique are reviewed, and the surgical technique described. The size of the perforation repaired varied, with eight cases being 2 cm or more in diameter. There was no significant graft donor site morbidity and complete perforation closure was achieved in eight cases after a mean observation time of 19.8 months. These results suggest that this is a suitable technique for closing nasal septal perforation.

Adult↗