A prospective study was carried out on 25 consecutive patients referred to an outpatient clinic at The Royal National Throat, Nose and Ear Hospital, with a medical letter suggestive of sinusitis, to test the hypothesis that the diagnosis of inflammatory sinus disease could be made simply and accurately by employing systematic nasal endoscopy and a series of plain sinus X-rays.The study compared the diagnostic yields of the history, rigid nasal endoscopy and plain sinus films with computed tomography. All the investigations were performed on the same day. The interobserver variability between consultant ENT surgeon, senior registrar and registrar were compared.With heightened concern over the radiation exposure patients are receiving for medical investigations, the radiation exposure was determined for a selected group of patients. This study demonstrated that in the diagnosis of inflammatory sinonasal disease the clinical assessment correlated with the CT findings in over 90 per cent of cases. This accuracy was dependent on the experience of the clinician in using rigid nasal endoscopy. Interobserver variability ranged from 71 to 90.4 per cent in the correct diagnosis of underlying sinus disease. Close agreement was seen with the interpretation of CT scans. The concordance rate between plain films and CT scans was 87 per cent when reported by a consultant radiologist. This is in close agreement with previously reported studies. The average radiation exposure of coronal CT scanning was 218 times the dose for plain sinus X-rays.
Although spontaneous resolution of MCC has been described for other head neck sites, there has not been any published case of nasal MCC regression. We present this rare case of nasal MCC with neck metastases and its regression.
We report a case of 'horseshoe-shaped' pressure-induced post-operative alopecia following a lengthy head and neck procedure. Post-operative hair loss is rare and to our knowledge has only previously been found in fields of surgery where careful head positioning is not an inherent part of the procedure. In these cases there has been a single area of hair loss from the central occipital area and per-operative pressure effects of the head resting on the operating table have been postulated as the likely cause. The case presented shows an area of hair loss closely corresponding to the shape of the head rest used during a long procedure. This strongly supports the theory that prolonged pressure is the likely cause. The mechanism of pathogenesis is discussed together with a suggested strategy for its avoidance. The single most important aspect of prevention of this complication of surgery is the knowledge of its existence and aetiology.
One hundred and sixteen children with otitis media with effusion underwent myringotomy and insertion of a conventional pattern of Shah grommet in one ear and the much smaller Mini Shah grommet in the other. Close observation post-operatively determined the comparative rate of extrusion, recurrence of effusion, and of onset and degree of tympanosclerosis. At one year review, the Mini Shah shows a significantly earlier extrusion and a greater tendency to recurrence of otitis media with effusion. However, this is compensated by a decreased incidence of tympanosclerosis and reduced severity in those affected. This tends to support the view that shear forces produced by heavier patterns of ventilation tube promote tympanosclerosis.
It is commonly stated that operative closure of large perforations of the tympanic membrane is less successful than closure of small perforations. Few authors mention the exact size of the perforations studied, and fewer still give their method of measuring perforations. We describe a photographic method of assessing the size of perforations relative to the total drumhead, measuring them with a computerized digitizing pad. Thirteen temporal bones were selected at random. Perforations of different sizes, shapes and at different sites were fashioned in the tympanic membranes. These were assessed by clinicians of all grades, who were asked to draw the perforations and give estimates of the perforation size as a percentage of the total drumhead. Visual estimates and drawings were compared with a photographic objective method. Gross errors (some in excess of 100%) were apparent in both estimates and drawings. There was a highly significant statistical difference between the objective method and visual estimates and drawings (P < 0.001). Greater clinical experience was not correlated with better performance in estimating the size of perforations.
One hundred and sixteen children with otitis media with effusion (OME) underwent surgery with grommet insertion. A conventional Shah grommet was used in one ear, and a Mini-Shah grommet in the other. Final review of the subjects two years after surgery revealed a significantly lesser degree of tympanosclerosis in the ear into which the Mini-Shah grommet had been inserted. This benefit might have resulted from the lesser mass of the mini-tube or its shorter duration in situ.
Oesophageal foreign bodies are commonly encountered in otolaryngology practice. Such circumstances are often compounded by pre-existing psychiatric problems such as bulimia and/or anorexia nervosa. Patients with bulimia may often present with a very similar pattern of multiple episodes of ingestion of large foreign bodies. Identification of this eating disorder (especially when there is a recurrent history of large, accidentally ingested foreign bodies) and prompt psychiatric referral is essential for efficient long-term management of this condition.
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