The treatment of allergic rhinitis has been revolutionized by the introduction of topical nasal steroids, which are one of the commonest prescriptions from otolaryngology departments. With so many different sprays available on the market, the literature was reviewed for the efficacy, side-effect profile and relative cost of each product and the following conclusions made: (1) A meta-analysis of randomized controlled trials comparing the efficacy of intranasal corticosteroids and oral antihistamines in the treatment of allergic rhinitis showed a clear benefit in favour of intranasal steroids in relieving nasal symptoms. (2) There is no clear evidence to support the suggestion that one steroid spray is more effective than another in the treatment of seasonal or perennial allergic rhinitis. (3) All the sprays have a similar side-effect profile; the commonest being epistaxis with a reported incidence between 17 and 23 per cent. In all the clinical trials, the placebo spray had an appreciable rate of epistaxis of between 10 to 15 per cent. (4) Fluticasone causes a reduction in endogenous cortisol secretion but no significant adrenal suppression was seen with triamcinolone, beclomethasone, budesonide or mometasone. (5) There is little evidence that skeletal growth is restricted by the administration of topical nasal steroid sprays. (6) There is considerable variation in the daily cost of each spray. Beclomethasone, dexamethasone and budesonide are significantly cheaper than fluticasone, mometasone or triamcinolone.
Forty-one adults were entered into a prospective study to investigate the pattern of pain over 10 days after elective dissection tonsillectomy. The severity of pain was scored by the patient on a visual analogue scale. The results confirm that tonsillectomy is a very painful experience and the provision of adequate analgesia is of paramount importance, especially if day-case tonsillectomy is performed.
Rhinocerebral mucormycosis is a rare but often fatal condition characterized by an aggressive necrotizing infection spreading from the nose to the paranasal sinuses, orbit and hence to the central nervous system. A case is reported in which a diabetic male with advanced mucormycosis was successfully treated by a combination of surgery, supportive therapy and liposomal amphotericin B. Liposomal delivery allows the drug to be both less toxic and more effective, and this is the first reported case of its use in rhinocerebral mucormycosis.
The accuracy and confidence of diagnosis of common ENT emergency radiological investigations using mobile phone digital images seem compatible with X-ray box. Financially it is a much cheaper than conventional telemedicine technology. It may be used to augment information sent to non-resident specialists in the management of emergency ENT cases.
To investigate the hypothesized relationship between various daily atmospheric pollutant concentrations and hospital epistaxis presentation. A retrospective analysis of all presentations of non-traumatic epistaxis to our institution was performed, and the results were cross-referenced with London air quality data supplied by the National Air Quality Data Archive at the National Environmental Technology Centre (NETCEN) at the multi-centre tertiary referral ENT Department. An analysis of epistaxis presentation to St George's Hospital during the 5-year period January 1997-2002 was made from the patient administration system and accident and emergency records. The study includes 1373 emergency patients after traumatic and iatrogenic epistaxis were excluded. Factors measured were atmospheric ozone (O(3)), carbon monoxide (CO), sulphur dioxide (SO(2)), nitrogen dioxide (NO(2)) and particulate matter less than 10 mum in diameter (PM(10)). Hospital epistaxis presentation and atmospheric pollutant concentration were documented for each day of the 5-year period, weekly change in both parameters was recorded and statistical analysis was performed. The statistical methods used are linear correlation using Pearson's coefficient. Increased hospital epistaxis presentation was strongly associated with increased concentration of airborne particulate matter (r = 0.289, P < 0.001; significant if P < 0.05) and less strongly associated with increased concentrations of atmospheric O(3) (r = 0.150, P = 0.019; significant if P < 0.05). There was no association between epistaxis attendance and atmospheric concentrations of CO, NO(2) and SO(2) in this study. The concentrations of local airborne particulate matter and atmospheric O(3) in the days preceding hospital attendance for epistaxis are relevant when considering the associations of the episode. This further increases understanding of the pathophysiology of spontaneous epistaxis.
Hyperbaric oxygen therapy is associated with a risk of barotrauma to the middle ear. This prospective study of 82 patients undergoing long-term therapy for chronic conditions was designed to measure the incidence and severity of middle ear barotrauma. Twenty-four patients (29.3%) required the insertion of ventilation tubes for otalgia, significantly more of whom were suffering from radionecrosis of the head and neck region (P< 0.01). Thirty-two of the remaining 58 patients (55%) underwent specialist ENT assessment by otoscopy and tympanometry. Five ears (8%) showed the otoscopic changes of barotrauma (TEED grade 3 or 4), and one ear (2%) showed tympanometric evidence of a middle ear effusion (Type B tympanogram). We conclude that despite careful tuition in pressure equalization and the appropriate use of ventilation tubes, up to 8% of ears sustain significant barotrauma. Tympanometry is unreliable in detecting these changes, otoscopy provides the most reliable screening technique.
We report a case of primary tuberculosis affecting the nasolacrimal apparatus presenting with a medial canthal mass. This report highlights the need for high index of suspicion, and initial CT imaging in order to avoid invasive procedures such as external dacryocystorhinostomy, which may cause extra surgical morbidity and delay diagnosis and treatment.
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