Topical aminoglycoside ear drops are theoretically acknowledged to be potentially ototoxic when administered in the presence of a tympanic membrane perforation. Although the development of clinical ototoxicity appears to be rare, nine well-documented and incontrovertible cases (12 ears in total) of iatrogenic topical vestibulotoxicity are presented, representing the largest series in the English language world literature to date. All patients were treated with the topical gentamicin-containing ear drops Garasone, (betamethasone sodium phosphate and gentamicin sulphate) for prolonged periods. Toxicity was found to be primarily vestibular rather than cochlear. Further review of five previously reported cases in addition to the findings from another four patients identified with topical ototoxicity are described. Although compensation occurred in unilateral cases the disability in bilateral cases was typically severe and often resulted in litigation.
Snoring is a common complaint in the community. Its psychosocial effect upon the relationship between sleeping partners is not known. This study examines prospectively by detailed tailored questionnaires the differences in the physical, psychological and social aspects in 27 snoring patients and their partners presenting to a snoring clinic and compares them with a control group of 24 patients who had undergone successful Laser-Assisted Uvulopalatoplasty (LAUP) and their partners. All areas examined showed improvement in the non-snoring group, particularly for the patient. Improvement was demonstrated in the non-snoring group's quality of marital state (P < 0.01). Quality of life was improved (P < 0.05). Perceived inadequacies in support were significantly higher in the snoring group (P < 0.05). Evidence of psychiatric disorder apparent in the snoring group was not present in the control group (P < 0.01). This is the first study to demonstrate significant improvement in the quality of life in both patients and their partners, after successful surgery for simple snoring.
The effect on nasal mucosal blood flow of ice packs on the forehead and ice packs within the mouth was investigated in 16 healthy subjects. The laser Doppler flowmeter was used to record changes in blood flow to the inferior turbinate, as measured by change in the flux. Ice packs within the mouth produced a significant decrease in nasal mucosal blood flow (p less than 0.05). The average fall was 23% (SEM 5.9) compared with the control measurements. No significant change was recorded following the application of ice packs to the forehead. The results of this study question the scientific rationale behind the use of forehead ice packs in clinical practice.
In order to determine whether patients having pharyngeal packing experience more or less post-operative throat pain when tampons were used, 80 patients were randomized into two groups to receive either gauze or tampon pharyngeal packing. A third control group of 40 patients were intubated but did not have any throat packs. Post-operative throat pain was subjectively rated at both 6 hours and at 24 hours by an independent observer. Thirty-eight per cent of patients had moderate or severe throat pain in the gauze group, whilst in the tampon and control groups these amounted to only 15% and 1% respectively. A significantly higher proportion of patients also had a moderate or severe sore throat at 24 hours in the former group. Intubation alone resulted in a sore throat post-operatively in 50% of patients, but 85% of those had a mild sore throat only. No differences in pain ratings in any group could be shown between men or women or between age groupings. Endotracheal intubation often causes post-operative throat pain which is exacerbated by the use of pharyngeal packing. The results presented suggest that tampons are a safe, effective alternative to gauze and result in less severe post-operative throat pain.
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