Nasal spirometry, after decongestion, was used to assess the severity of septal deviation in 31 patients before and after nasal septal surgery. Patients were divided into two groups on the basis of their preoperative nasal partitioning of airflow ratio (NPR). The NPR ranges from 0.00 (equality of airflow) to 1.00 (total unilateral obstruction) with the normal range defined as 0.00-0.34. In 14 patients with a preoperative NPR within the normal range, the median NPR was not influenced by surgery (preop 0.14 to postop 0.12, P= 0.07). In 17 patients with a preoperative NPR outside the normal range, there was a significant reduction of the median NPR after surgery (preop 0.50 to postop 0.16, P < 0.01). The correlation of NPR with subjective assessment of the deviation was r = 0.85 (P < 0.01), and with patient subjective symptom assessment r= 0.94 (P < 0.01) preoperatively and r= 0.51 (P < 0.01) postoperatively. The findings indicate that nasal spirometry may be useful in patient selection for septal surgery.

Possum (the physiological and operative severity score for the enumeration of mortality) is used in many surgical specialities for comparative audit. We investigated its validity in relation to head and neck surgery by retrospectively scoring 301 operative interventions. We also applied the P-Possum (Portsmouth Possum) equation for mortality. We compared our observed with the predicted outcomes. We introduced two new variables, radiotherapy and previous surgery to the operative site, to test their association with outcome. We found that Possum is valid for morbidity but predicts more accurately for high-risk than for low-risk groups. Neither Possum or P-Possum accurately predicts mortality. Radiotherapy and previous surgery were both significant for the development of postoperative complications (P = 0.002, P = 0.007 respectively) and are worthy of inclusion in a Possum score for head and neck surgery.

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Nasal spirometry was used to measure the effect of acute rhinitis associated with upper respiratory tract infection (URTI) on the changes in nasal airflow that occur with postural change. Results in 12 healthy subjects and 12 subjects with URTI were expressed as the nasal partitioning of airflow ratio (NPR), a new measure of nasal airflow. Values of NPR range from 0 (equality of airflow) to 1 (unilateral nasal obstruction). In subjects with URTI there was a significant change (P < 0.006) in the median NPR from 0.19 sitting to 0.87 supine, with five subjects having complete unilateral nasal obstruction. The change in the median NPR in the healthy subjects from 0.09 sitting to 0.13 supine was not significant. The results illustrate the incidence of complete unilateral nasal obstruction associated with URTI when lying flat and demonstrate the usefulness of nasal spirometry in studying nasal airflow partitioning in health and disease.

Traumatic orbital complications of endonasal surgery, although rare, are a cause of significant morbidity. Although a variety of methods of monitoring eye function during surgery have been described, the best method remains direct perioperative observation of the eye. However, the eye must also be protected during surgery otherwise corneal drying will occur and corneal abrasion may result. This article describes and illustrates the use of Geliperm, a sterile, transparent, pliant hydrogel dressing, as a corneal protector allowing continuous observation of the eye during endonasal surgery.

ObjectivePre-operative imaging is often used to predict the extent of a cholesteatoma and anatomical variation to plan for surgery. This study aimed to measure the predictive accuracy of computed tomography findings.MethodsA retrospective cohort study was conducted of all patients in a district general hospital undergoing mastoid surgery within a consecutive 12-month period, in whom computed tomography had been performed prior to operative intervention. The study measured the key findings of pre-operative computed tomography imaging and compared them to the intra-operative findings.ResultsA total of 106 patients were included. The sensitivity and specificity for predicting cholesteatoma were 79 per cent and 81 per cent respectively. The positive predictive value was 90 per cent and the negative predictive value was 65 per cent. In predicting complications of cholesteatomas, the sensitivity was 70 per cent, whereas the specificity was 91 per cent. The positive predictive value was 88 per cent and the negative predictive value was 76 per cent.ConclusionPre-operative computed tomography conducted prior to mastoid surgery has high positive predictive values for both predicting cholesteatomas and complications (90 per cent and 88 per cent respectively).

The presence of heterotopic gastric mucosa in the upper oesophagus has been reported to occur in up to 10 percent of individuals but it is usually asymptomatic. We present two pateints with symptomatic oesophageal heterotopic gastric mucosa and discuss the aetiology, pathogenesis, and management of the condition.