Outcomes in open structure septorhinoplasty.

Objectives: This study assessed the patient-related outcome measures and complications of post-open structure septorhinoplasty. It also investigated the factors associated with the need for revision surgery.

Methods: We prospectively reviewed the case notes of patients who underwent septorhinoplasty performed by a single rhinologist at our institute between August 2011 and August 2013.

Comparison of quality of life outcomes following different mastoid surgery techniques.

Background: Mastoid surgery carried out to treat chronic otitis media can lead to improvement in objective and subjective measures post-operatively. This study investigated the subjective change in quality of life using the Glasgow Benefit Inventory relative to the type of mastoid surgery undertaken.

Method: A retrospective multicentre postal survey of 157 patients who underwent mastoid surgery from 2008 to 2012 was conducted.

Atypical incus necrosis: a case report and literature review.

Objective: We report an atypical case of ossicular necrosis affecting the incus, in the absence of any history of chronic serous otitis media. We also discuss the current theories of incus necrosis.

Case Report: A male patient presented with a history of right unilateral hearing loss and tinnitus.

Use of intranasal corticosteroids in sinonasal infection and after surgery.

The use of intranasal steroids by otolaryngologists in the treatment of patients with infective rhinosinusitis and after endonasal surgery, particularly endoscopic sinus surgery, is unlicensed, as stated in the British National Formulary and in the manufacturers' leaflets supplied with nasal steroid medications. However, despite this, nasal steroids continue to be prescribed in these circumstances. Debate continues as to the exact role of intranasal steroids in sinonasal infection and after sinonasal surgery and whether their use in these circumstances should still be unlicensed.

Deafness in Vogt-Koyanagi-Harada syndrome.

Sudden onset sensorineural hearing loss is a well recognized entity frequently encountered in otolaryngological practice. However, the combination of such deafness as part of a wider systemic disorder is fortunately rare. Almost 100 years after the syndrome was classified, we describe a case of Vogt-Koyanagi-Harada syndrome occurring unusually in a Caucasian woman and characterized by sudden hearing loss.

Endoscopic dacrocystorhinostomy: long-term results and evolution of surgical technique.

This study evaluated the long-term results of endoscopic dacrocystorhinostomy (DCR) performed as a day-case procedure under local anaesthesia. It assessed the patient satisfaction with the procedure by retrospective review and a questionnaire survey. Seventy patients were referred for endoscopic DCR to the senior author between 1997 and 2000.

Management of globus pharyngeus: review of 699 cases.

The principal reason for performing investigations in patients with globus pharyngeus is to detect a pharyngeal or upper oesophageal malignancy presenting this way. There is uncertainty regarding both the necessity for investigation in globus patients and the first line investigation of choice in the screening of such patients. The authors therefore undertook a retrospective study of 699 patients who presented with globus sensation.

Haemangioma of the frontal sinus.

A 71-year-old lady underwent successful excision of a haemangioma of the frontal sinus, via an osteoplastic flap approach. Haemangioma of the paranasal sinuses is an extreme rarity. A case is presented and the literature reviewed.

Survey of computed tomography scanning and endoscopic sinus surgery in a group of district general hospitals in south Essex.

The management of chronic sino-nasal disease has changed significantly in the last 15 years with the advent of topical nasal steroids and minimally invasive endoscopic surgery, but survey data from district hospitals in the UK have not been published to date. We examined the current management of 383 consecutively scanned patients with sino-nasal symptoms in three district hospitals. Survey standards were set, and were attained in 56 per cent for symptom recording, 60 per cent for pre-scan diagnosis, 62 per cent for endoscopic examination in out-patients, and 73 per cent for topical steroid use before scanning.

A unique parotid adenocarcinoma.

A large number of different types of benign and malignant tumours of the salivary glands are recognized, and rare and unusual variants arise from time to time that can be difficult to interpret. We report an apparently unique parotid neoplasm that does not fit any of the currently recognized diagnostic groups and can best be termed lymphadenocarcinoma. Clinical and pathological features are described, and its possible relationship to recognized tumour types is examined.

Spontaneous internal jugular vein thrombosis and recurrent laryngeal nerve palsy: a rare simultaneous presentation of an occult malignant neoplasm.

Internal jugular vein thrombosis is an uncommon potentially life-threatening disorder caused by various conditions. Non-spontaneous internal jugular vein thrombosis is an uncommon condition associated in the pre-antibiotic area with deep-neck infections. Currently iatrogenic trauma to the internal jugular vein from catheterisation and repeated intravenous injections by drug abusers are the leading causes of thrombosis.

Septoplasty as a day-case procedure--a two centre study.

Day-stay surgery is an integral part of Otolaryngology. Many procedures which have traditionally been thought to require overnight stay can be carried out on a day care basis. We report our experience of treating 163 patients admitted for septal surgery as a day-case procedure.

Audiovestibular complications of non-otological surgery.

Post-operative dizziness or imbalance is often regarded as 'trivial' and self-limiting and vaguely ascribed to the drugs used in anaesthesia or to haemodynamic changes. While hearing loss after anaesthesia has been documented in several studies, very little attention has been paid to a possible vestibular cause for post-operative dizziness. Twelve patients with post-operative vestibular disorders, with or without concomitant hearing loss, and one patient with tinnitus are described.

Congenital cholesteatoma.

We present a British series of eleven patients with primary cholesteatoma, including one patient with bilateral disease. Eight children presented with a history of hearing loss, while one child had had recurrent otitis media and another had had earache. Operative findings were: in five ears, cholesteatoma confined to the antero-superior segment with intact ossicles, in a further four, cholesteatomas extending throughout the mesotympanum with ossicular erosion in one, and in two ears posterior disease throughout the middle ear and mastoid, which had eroded the ossicles in both cases.

Hearing loss in chronic renal failure-hearing threshold changes following haemodialysis.

The prevalence of sensorineural hearing loss, measured by pure tone audiometry, was determined in 66 patients with chronic renal failure and threshold changes following haemodialysis were measured in 31 patients. The incidence of hearing loss was 41% in the low, 15% in the middle and 53% in the high frequency ranges respectively. No correlations with weight changes, haematocrit, metabolic bone disease or ototoxic drug history were found.

Time course of cellular infiltration in the nasal mucosa during the immediate allergic reaction.

In 23 patients with allergic rhinitis, biopsies of the nasal mucous membrane were taken at one of the following times after challenge of one nostril with allergen: 0 (baseline) (n = 7), 1/2 h (n = 6), 1 h (n = 5), and 2 h (n = 5). In the nostril stimulated by allergen there was a transient early phase influx of eosinophils while the numbers of stainable mast cells decreased, probably due to their degranulation. In the contralateral unstimulated nostril, there was no change in numbers of eosinophils but the numbers of stainable mast cells decreased.

Malignant transformation in a laryngeal hemangioma.

Laryngeal angiosarcoma is uncommon, with only 19 previously reported cases. Malignant transformation in nonirradiated hemangiomas is extremely rare, with only five equivocal cases reported, all of which occurred in the skin. We report the first documented case of malignant transformation in a laryngeal hemangioma, and review the literature.

Respiratory problems in acromegaly.

Death from respiratory causes in acromegaly is three times more common than in the general population and is most often the result of upper airways obstruction, although less commonly pulmonary dysfunction and disturbance of the central nervous system may occur. These factors may be found alone or in combination. Despite several reports of laryngeal involvement, upper airway obstruction in acromegaly is usually regarded as being due to macroglossia and pharyngeal soft tissue hypertrophy.

Allergen-induced changes in the nasal mucous membrane in seasonal allergic rhinitis: effect of nedocromil sodium.

We have obtained biopsy specimens of the nasal mucous membrane before and during the grass-pollen season in 22 patients with seasonal allergic rhinitis to grass pollen to assess the effects on cellular infiltration of natural exposure to allergen. Biopsy sections were examined by light microscopy, and quantitative assessment was made of numbers of mast cells and eosinophils. The patients were divided into 11 who were treated with placebo and 11 patients who were treated with topical nedocromil sodium.

Button batteries in the ear, nose and cervical esophagus: a destructive foreign body.

Button batteries spontaneously leak alkaline electrolyte solution on exposure to moisture, causing liquefaction necrosis of adjacent tissue. We describe two cases in which a button battery in the external auditory meatus caused skin, bone and tympanic membrane necrosis. Review of the world literature on button batteries acting as foreign bodies reveals lower motor neurone facial nerve palsy, nasal septal perforation and fatal esophago-aortic fistula as among the ENT complications.

Temporal bone laboratory training for stapedectomy.

Practice in the Temporal Bone laboratory is a fundamental part of Otological training. Performing a stapedectomy on a normal temporal bone is handicapped by the mobility of the footplate. We describe a simple method of producing stapes footplate fixation in a normal temporal bone so that the operative conditions found in otosclerosis are more closely simulated.