Smoking and Obesity are Risk Factors for Thirty-Day Readmissions Following Skull Base Surgery.

 Thirty-day readmission has become a significant health care metric reflecting the quality of care and on the cost of service delivery. There is little data on the impact of complications following skull base surgery (SBS) on emergency readmission. Identifying modifiable risk factors for readmission may improve care and reduce cost.

Trigeminal neuropathy in vestibular schwannoma: a treatment algorithm to avoid long-term morbidity.

Background: Trigeminal neuropathy (TGN) can occur as a presenting feature of vestibular schwannoma (VS) or as an adverse effect of radiosurgery. This study was designed to evaluate a treatment algorithm for presenting symptoms of TGN in patients with VS, and a new radiosurgery dosimetric tolerance to avoid TGN after treatment. Outcome was measured after microsurgery (MS), stereotactic radiosurgery (SRS), hypofractionated stereotactic radiotherapy (HSRT), and fractionated radiotherapy (FRT).

Vestibular schwannomas - when should conservative management be reconsidered?

Objective: To document the natural history of vestibular schwannomas treated conservatively, and to find if there are any predictive factors for growth and need for active intervention.

Design: A retrospective review of patient notes and radiology, mostly MRIs.

Subjects: Eighty-eight patients managed conservatively for unilateral vestibular schwannoma and that have had at least two radiological investigations.

Effects of ageing on smell and taste.

Disorders of taste and smell commonly present diagnostic dilemmas to the medical profession. This may be secondary to the lack of knowledge and understanding of these conditions. There seems to be a low level of interest in the disorders, when compared with disruption of the other senses such as sight and hearing.

Ageing and the auditory system.

There are a number of pathophysiological processes underlying age related changes in the auditory system. The effects of hearing loss can have consequences beyond the immediate loss of hearing, and may have profound effects on the functioning of the person. While a deficit in hearing can be corrected to some degree by a hearing aid, auditory rehabilitation requires much more than simply amplifying external sound.

Venous angioma of the facial nerve: a case report.

Background: Lower motor neurone type facial nerve palsy is a common condition that is very rarely caused by a neoplastic lesion.

Case Description: This case report describes a progressive facial palsy in a 62-year-old man because of a vascular tumor of the facial nerve. Histologic examination confirmed it to be a venous angioma.

[Tortuosity of the internal carotid artery and its implications for the oropharyngeal and skull base surgery].

Conventional textbooks on anatomy emphasize the consistency in the pathway of the cervical internal carotid artery (ICA) from the carotid bifurcation to the skull base. Deviations in its route as result of developmental and acquired conditions have received little attention in the literature. A case of a tortuous cervical ICA presenting as pharyngeal pulsatile swelling is presented.

Angiolymphoid hyperplasia with eosinophilia of the parapharyngeal space.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon benign condition characterized by cutaneous nodules with a predeliction for the head and neck region. Extracutaneous involvement is rare. We report a 44-year-old woman who had a large submucosal ALHE tumour in the parapharyngeal space.

Pharyngocutaneous fistula following total laryngectomy and post-operative vomiting.

The significance of post-operative vomiting as a risk factor in the development of a pharyngocutaneous fistula was examined. The case records of 50 consecutive patients undergoing laryngectomies (39 men, 11 women, average age 64 years) were examined, 17 also underwent a simultaneous radical neck dissection. A fistula developed in eight patients (16%) and the median time to its diagnosis was 11 days (range 3-15 days).

Severe dysphagia associated with major tranquillizer treatment.

A 56 year old patient with psychiatric complications of systemic lupus erythematosus developed severe dysphagia complicated by weight loss and aspiration. Following investigation it was concluded that the addition of haloperidol to her treatment was the major precipitating cause and withdrawal of the drug was followed by an objective improvement in swallowing. Patients taking major transquillizers may be at increased risk of severe dysphagia; regular observation of swallowing is suggested as a useful addition to the clinical examination of these patients.

Hereditary deafness occurring in cd/1 mice.

Different strains of mice provide a valuable research tool for studying both hereditary and acquired forms of deafness. The cd/1 strain has been found to demonstrate hereditary cochlear pathology. The characteristics of hearing loss in cd/1 mice have not previously been reported.

The effect of noise exposure on the aging ear.

The effect of noise exposure on auditory sensitivity and inner ear morphology was compared in aged and young mature mice. Hearing thresholds were obtained by auditory evoked brain stem responses (ABR) before and after noise exposure, and hair cell loss was quantified. The study was done in two parts: first to assess the effect of noise exposure on subjects with presbycusis, and second to assess its effect on aged subjects without measurable presbycusis.

An audit into the incidence of handicap after unilateral radical neck dissection.

Forty-six patients who had undergone a radical neck dissection more than six months previously were assessed to determine the degree of handicap that results from division of the accessory nerve. Employment problems, amount of pain, and social and recreational difficulties were assessed. Forty-six per cent of those in employment prior to their operation gave up their work specifically because of problems with their shoulder; this affected more manual than non-manual workers (11 out of 20 manual compared with zero out of four non-manual).

Prognostic significance of hearing loss as a lateralizing indicator in the surgical treatment of vertigo.

In patients with peripheral vertigo the presence of an asymmetrical hearing loss is an important lateralizing sign, having both diagnostic and prognostic significance. In a consecutive series of 83 patients undergoing retro-labyrinthine vestibular nerve section for uncontrolled vertigo, asymmetrical hearing loss was associated with an 83 per cent incidence of complete control of vertigo and a 49 per cent incidence of complete relief from dysequilibrium. In the absence of a lateralizing hearing loss, the figures were 50 per cent and 24 per cent respectively (p less than 0.

Non-secretory adenomas of the pituitary treated by trans-ethmoidal sellotomy.

A consecutive series of 35 clinically non-secretory pituitary adenomas treated surgically by the transethmodial approach is presented. Mean age at presentation was 60 years, with a male-to-female ratio of 2:1. These tumours present later than hormone secreting tumours: 90% were over 2 cm in diameter at operation.

Mucociliary function in the early weeks after nasal surgery.

A prospective trial was carried out to assess whether mucociliary clearance (MCC) is either adversely affected or improved in the early weeks after nasal surgery. Three different subgroups of patients were studied: those having septoplasty, nasal polypectomy, or turbinectomy. MCC was assessed by the saccharine transport method.

Titanium grommets: a trial to assess function and extrusion rates.

Titanium grommets have been promoted as having the advantage of a slower extrusion rate than other types of ventilation tube. A prospective trial was therefore designed to compare the function and extrusion rates of these grommets with those of the widely used Shepard design of Teflon grommet in a single group of patients. Thirty-one children had one type of grommet inserted in one ear and the other type in the opposite ear.

Maxillary sinus aspiration in children. What are the indications?

The results of sinus aspiration in 100 children were analysed retrospectively. There was no correlation between a positive aspiration and the patients' symptoms, signs or previous radiograph.

The effect of lignocaine on nasal resistance and nasal sensation of airflow.

The effect of lignocaine on nasal sensation of airflow and nasal resistance was assessed in twenty-five subjects. A randomised crossover trial was conducted with lignocaine as the active drug and saline as the placebo. Both substances were delivered to the nasal mucosa as a nasal spray.

Oto-admittance measurements in the diagnosis of otosclerosis.

Theoretical considerations show that admittance measurements are likely to be more sensitive in differentiating between middle-ear pathologies than compliance measurements. Thirty-five ears in 20 patients with clinical otosclerosis were studied to assess the usefulness of admittance measurements in contributing to diagnosis.

The iodination of methyl sterculate and deiodination of the product to reform the cyclopropenoid ring.

Unlike the addition of iodine to alkenes, the radical addition of iodine to methyl sterculate has been shown to be facile at room temperature. The 1,2-diodocyclopropanoid material produced has been deiodinated to regenerate the cyclopropenoid ring.