Multidisciplinary Management of Lateral Skull Base Paragangliomas: A 20-Year Experience.

 Paragangliomas of the lateral skull base are rare, largely benign, neuroendocrine tumors. Little evidence exists to support clinicians in the management of these tumors. The present study evaluates considerations in the multidisciplinary workup and management of paragangliomas affecting the lateral skull base.

Use of the Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity ('P-POSSUM') to predict morbidity in patients undergoing surgery with reconstruction for temporal bone malignancy.

Objective: The Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity ('P-POSSUM') is a two-part scoring system that includes a physiological assessment and a measure of operative severity. This study sought to determine whether risk estimates for this scoring system could be used in major head and neck reconstructive surgery.

Method: A retrospective review was performed of patients undergoing resection for a temporal bone malignancy in a single head and neck centre in Dublin, Ireland, from 2002 to 2021.

Current trends in craniofacial reconstruction.

Reconstruction of the head and neck continues to pose a variety of difficult functional and aesthetic challenges to the plastic surgeon. While the surgical treatment for midfacial and skull base tumours continues to advance, the three-dimensional reconstruction predicaments continue to increase in complexity. Reconstructive strategies of the head and neck require the restoration of intricate skeletal architecture and large volumes of both internal and external soft tissue envelopes that can withstand adjuvant therapies.

Toward a Digital Health Intervention for Vestibular Rehabilitation: Usability and Subjective Outcomes of a Novel Platform.

Digital technologies are increasingly available and are reducing in cost. There is an opportunity to move to a digital health approach in vestibular rehabilitation (VR), but there is a paucity of suitable systems available and a consequent lack of evidence to support their use. This study aimed to investigate a novel digital platform developed specifically for VR (comprising clinician software, a wearable sensor, and a patient-facing app).

The Royal College of surgeons multidisciplinary guidelines on elective tracheostomy insertion in COVID-19 ventilated patients.

Background: The current COVID-19 pandemic has placed enormous strain on healthcare systems worldwide. Understanding of COVID-19 is rapidly evolving. Pneumonia associated with COVID-19 may lead to respiratory failure requiring mechanical ventilation.

Management of Temporal Bone Malignancy in Ireland.

 Lateral temporal bone malignancy remains a challenging rare disease. We report 17 years of multidisciplinary care of these tumors with univariate and multivariate analyses of key prognostic indicators for consideration in contemporary oncological management.  This is a retrospective cohort study.

The role of a virtual telephone clinic in the follow-up management of lateral skull base tumours.

Objective: The purpose of this article was to determine the impact of employing a telephone clinic for follow-up of patients with stable lateral skull-base tumours.

Method: An analysis of 1515 patients in the national lateral skull-base service was performed, and 148 patients enrolled in the telephone clinic to date were identified. The length of time that patients waited for results of their follow-up scans and the travel distance saved by patients not having to attend the hospital for their results was determined.

The shrinking vestibular schwannoma.

We present a case of spontaneous 79% regression in the size of a vestibular schwannoma (VS). A 41-year-old lady with a large (36 mm) vestibular schwannoma underwent serial follow-up MRI scans which demonstrated the shrinkage over 9 years; the highest relative spontaneous regression recorded in the literature for vestibular schwannoma of this size.

Changing Trends in the Management of Esthesioneuroblastoma: Irish and International Perspectives.

 Evaluation of the changing trends in esthesioneuroblastoma in an Irish context and review of management options nationally to clarify the best current therapeutic approach by comparing with international research on this uncommon malignancy.  Retrospective review.  Tertiary referral center.

Signs and Symptoms of Acoustic Neuroma at Initial Presentation: An Exploratory Analysis.

Introduction The objective of this study was to describe the most common clinical features associated with an acoustic neuroma diagnosis and to identify those features associated with larger tumour size at initial diagnosis. Methods The clinical information of 945 consecutive patients diagnosed with acoustic neuroma at a single centre between 1992 and 2015 was analysed. Clinical features were examined and the relationship between these features and tumour size (>2.

The Impact of Primary Treatment Strategy on the Quality of Life in Patients with Vestibular Schwannoma.

Objective: To assess the quality of life (QoL) in a representative sample of patients with vestibular schwannoma and to ascertain the differences in outcomes associated with distinct management strategies.

Patients And Methods: Patients with vestibular schwannoma attending a tertiary referral center were asked to complete the Functional Assessment of Chronic Illness Therapy-Brain Questionnaire, which assesses QoL in 5 domains: physical, social, emotional and functional, and a brain cancer-specific domain. Results were analyzed in the overall cohort and in surgery, stereotactic radiosurgery, and conservative management subgroups.

Effectiveness of conventional versus virtual reality-based balance exercises in vestibular rehabilitation for unilateral peripheral vestibular loss: results of a randomized controlled trial.

Objective: To compare the effectiveness of virtual reality-based balance exercises to conventional balance exercises during vestibular rehabilitation in patients with unilateral peripheral vestibular loss (UVL).

Design: Assessor-blind, randomized controlled trial.

Setting: Two acute care university teaching hospitals.

Effectiveness of conventional versus virtual reality based vestibular rehabilitation in the treatment of dizziness, gait and balance impairment in adults with unilateral peripheral vestibular loss: a randomised controlled trial.

Background: Unilateral peripheral vestibular loss results in gait and balance impairment, dizziness and oscillopsia. Vestibular rehabilitation benefits patients but optimal treatment remains unknown. Virtual reality is an emerging tool in rehabilitation and provides opportunities to improve both outcomes and patient satisfaction with treatment.

Virtual reality rehabilitation of balance: assessment of the usability of the Nintendo Wii(®) Fit Plus.

Purpose: The aim of this study was to investigate the usability of the Nintendo Wii Fit Plus(®) (NWFP) in the treatment of balance impairment in vestibular and other neurological disease.

Methods: This was a cross-sectional, quasi-experimental study. Participants (n = 26; mean age 43 ± 14, M13:F13) with quantified balance impairment took part in a 30-minute session on the NWFP using exercises and games that challenge balance.

Vestibular function testing.

Introduction: Vestibular symptoms of vertigo, dizziness and dysequilibrium are common complaints which can be disabling both physically and psychologically. Routine examination of the ear nose and throat and neurological system are often normal in these patients. An accurate history and thorough clinical examination can provide a diagnosis in the majority of patients.

Role of sphingosine 1-phosphate receptor expression in eosinophils of patients with allergic rhinitis, and effect of topical nasal steroid treatment on this receptor expression.

Objective: Recent research has indicated that sphingosine 1-phosphate plays a role in allergy. This study examined the effect of allergen challenge on the expression of sphingosine 1-phosphate receptors on the eosinophils of allergic rhinitis patients, and the effect of steroid treatment on this expression.

Study Design: A prospective, non-randomised study.

The Allergic Rhinitis and its Impact on Asthma system: a new classification of allergic rhinitis and nasal responsiveness.

Objectives And Hypothesis: Allergic rhinitis has traditionally been classified into seasonal and perennial rhinitis. However, many subjects with dual sensitisation do not fit neatly into either category. Recently, the Allergic Rhinitis and its Impact on Asthma workshop has proposed a new allergic rhinitis classification, into intermittent and persistent forms.

Recent consensus on the classification of rhinosinusitis--a way forward for research and practice?

Prior classification of rhinitis was into three categories: acute, subacute and chronic rhinosinusitis. The advantages of this classification were obvious but they were offset by some disadvantages. For example, the previous classification did not take account of the mechanisms underlying the condition or the clinical outcome.

Subjects with non-allergic non-infectious perennial rhinitis do not show nasal hyper-responsiveness to bradykinin.

Symptoms in non-allergic non-infectious perennial rhinitis (NANIPER) are characteristically trigged by non-specific irritants. Hyper-responsiveness to cold dry air has been demonstrated in NANIPER. Bradykinin is a peptide involved in allergic inflammation.

Facial nerve schwannoma of the internal auditory canal.

Background: Facial nerve schwannoma of the internal auditory canal is a very rare tumour.

Aim: While Bell's palsy is the commonest cause of a facial paresis, more serious causes should be excluded if recovery is delayed.

Method: A case report of a young man who presented with a long standing facial palsy.

The changing face of lateral sinus thrombosis.

Lateral sinus thrombosis is a life threatening complication of middle ear disease, the presentation, diagnosis and management of which has seen many changes in recent times. While the introduction of antibiotics has been associated with a reduction in the incidence and associated morbidity/mortality of this complication, their use has also altered the clinical features of presentation, consequently diagnosis requires a high index of suspicion. Radiological advances, in particular magnetic resonance imaging and magnetic resonance venography, have improved our ability to diagnose this complication pre-operatively, and now are the diagnostic investigations of choice.

An alternative technique for nasal biopsy.

Objectives/hypothesis: The objective was to investigate the effectiveness of co-phenylcaine as a topical anesthetic agent for nasal mucosal biopsy.

Study Design: A prospective study.

Methods: Nasal mucosal biopsy specimens were taken from a site just anterior to the inferior turbinate following topical anesthesia with co-phenylcaine.

Manipulation of nasal bone fractures under local anaesthetic.

This article describes the technique of manipulation of nasal bones under local anaesthesia. With increased demand on day ward and in patient hospital beds there is a growing need to treat fractured nasal bones under local anaesthesia at the ENT clinic. Ten patients were treated in this fashion in the out patient setting.