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Journal of Laryngology and Otology

E Haapio, I Kinnunen, J K E Airaksinen, H Irjala, T Kiviniemi
OBJECTIVE: Post-operative bleeding in the head and neck area is potentially fatal. This 'real world' study sought to assess factors that increase the risk of re-operation for post-operative bleeding in head and neck cancer surgery. METHODS: A total of 456 patients underwent surgery for head and neck cancer (591 operations). The primary endpoint was re-operation for bleeding. RESULTS: The rate of re-operation for bleeding was 5 per cent of all operations...
March 8, 2018: Journal of Laryngology and Otology
C J McCaffer, L Pabla, C Watson
OBJECTIVE: The use of lasers in cholesteatoma surgery is common and well accepted. The most commonly used laser fibres are straight and non-adjustable; these have several limitations. This paper describes the use of an alternative laser fibre. METHOD: This 'How I Do It' paper describes and illustrates the use of an alternative curved adjustable fibre-optic diode laser in microscopic cholesteatoma surgery. RESULTS: The curved, adjustable laser fibre allows accurate and atraumatic disease removal when the use of a straight laser fibre may be less effective or accurate...
March 8, 2018: Journal of Laryngology and Otology
L Nip, M Tan, K L Whitcroft, R Gupta, T S Leung, P Andrews
BACKGROUND: The correlation between objective and subjective nasal obstruction is poor, and dissatisfaction rates after surgery for nasal obstruction are high. Accordingly, novel assessment techniques may be required. This survey aimed to determine patient experience and preferences for the measurement of nasal obstruction. METHOD: Prospective survey of rhinology patients. RESULTS: Of 72 questionnaires distributed, 60 were completed (response rate of 83 per cent)...
March 7, 2018: Journal of Laryngology and Otology
L McCadden, C G Leonard, W J Primrose
BACKGROUND: Oesophageal disorders and osteonecrosis of the jaw are recognised complications of the commonly prescribed medication bisphosphonate. Despite these diagnoses being seen comparatively frequently within the ENT clinic, osteonecrosis of the external ear is a less well reported complication. METHODS: The current literature is reviewed and our experience with six cases of bisphosphonate-related ear canal osteonecrosis is presented. RESULTS: Six cases were identified as suffering from ear canal osteonecrosis as a result of bisphosphonate treatment...
February 28, 2018: Journal of Laryngology and Otology
E Eski, M F Sökmen, I Yilmaz
OBJECTIVE: To evaluate the efficacy and safety of segmental superficial parotidectomy in the surgical treatment of benign parotid tumours. METHODS: Patients who underwent parotidectomy for benign primary parotid tumours limited to the superficial lobe were retrospectively reviewed. Tumour location, size, surgical procedure, follow-up period, complications and recurrence rates were noted. RESULTS: The study included a total of 39 patients: 22 underwent segmental superficial parotidectomy (group 1) and 17 underwent superficial parotidectomy (group 2)...
February 21, 2018: Journal of Laryngology and Otology
H Walijee, M Krishnan, R Sharma, S De
BACKGROUND: During tonsillectomy, one of the key concerns is establishing adequate haemostasis. Intra-operative haemorrhage from the upper pole of the tonsil fossae can be a challenge to deal with because of an inability to clearly visualise bleeding points. Laryngeal mirrors are readily available in an ENT operating theatre and routinely used for indirect visualisation of the post-nasal space during adenoidectomy. OBJECTIVE: This paper describes a technique, utilising a laryngeal mirror placed within the tonsil fossa (after having removed the palatine tonsil), to visualise the upper pole and any bleeding points...
February 21, 2018: Journal of Laryngology and Otology
M Chroni, E Prappa, I Kokkevi
BACKGROUND: Septic emboli are an unusual cause of sudden sensorineural hearing loss, for which few reports exist in the literature. CASE REPORT: This paper presents two cases of sudden sensorineural hearing loss, initially considered as idiopathic, but which were caused by septic emboli. Hearing loss in these cases was bilateral, sequential and total. The first patient had mild fever one week prior to their presentation with sudden sensorineural hearing loss; the other patient had no additional symptoms at presentation...
February 21, 2018: Journal of Laryngology and Otology
L Pabla, J Duffin, L Flood, K Blackmore
BACKGROUND: Despite the plethora of publications on the subject of paediatric obstructive sleep apnoea, there seems to be wide variability in the literature and in practice, regarding recourse to surgery, the operation chosen, the benefits gained and post-operative management. This may reflect a lack of high-level evidence. METHODS: A systematic review of four significant controversies in paediatric ENT was conducted from the available literature: tonsillectomy versus tonsillotomy, focusing on the evidence base for each; anaesthetic considerations in paediatric obstructive sleep apnoea surgery; the objective evidence for the benefits of surgical treatment for obstructive sleep apnoea; and the medical treatment options for residual obstructive sleep apnoea after surgical treatment...
February 21, 2018: Journal of Laryngology and Otology
T N Chao, A Mahmoud, K Rajasekaran, N Mirza
BACKGROUND: Medialisation thyroplasty is considered the 'gold standard' treatment for unilateral vocal fold paralysis, enabling improvement of voice and swallowing function, and preventing life-threatening aspiration events. The most commonly used laryngeal implants induce some degree of local tissue inflammatory response, and carry the risk of immediate or delayed implant extrusion. METHODS: This paper describes a novel approach for medialisation thyroplasty. Specifically, it utilises a ribbon of autologous tensor fascia lata harvested at the time of surgery...
February 21, 2018: Journal of Laryngology and Otology
S Elwany, A A Ibrahim, A I Soliman, R Bazak, H A Ibrahim
BACKGROUND: The relationship between hypertension and epistaxis is controversial and poorly understood. The present research investigated atherosclerosis as a potential risk factor in hypertensive patients with epistaxis. METHODS: A prospective study of 141 hypertensive patients with epistaxis was conducted. The laboratory tests included full blood count, lipid profile and coagulation profile. All patients underwent funduscopic examination of the eye and were classified in terms of four retinopathy grades...
February 15, 2018: Journal of Laryngology and Otology
Y Kamhieh, H Fox, E Hallett, S Berry
BACKGROUND: Pharyngocutaneous fistula is a cause of significant morbidity following laryngectomy. Routine use of salivary bypass tubes during laryngectomy has been proposed to reduce the incidence of fistulae and neopharyngeal strictures. METHOD: Following a systematic search of Embase, Medline and Cochrane databases (1946 - current), included articles were assessed for bias according to the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: Three case-control trials showed reduced pharyngocutaneous fistula rates with the use of salivary bypass tubes; six case series reported widely varied fistula rates...
February 15, 2018: Journal of Laryngology and Otology
R Haye, L K Døsen, M Tarangen, O Shiryaeva
OBJECTIVE: Results from telephone interviews may be needed to supplement those from mailed questionnaires when response rates are inadequate. This study assessed the correlation between visual analogue scale ratings used in mailed questionnaires and numerical rating scale scores used in telephone interviews. METHODS: Patients scheduled for nasal septal surgery routinely respond to a visual analogue scale of obstruction during the day and at night. In this study, they were also asked to verbally rate their sense of obstruction using whole numbers...
February 15, 2018: Journal of Laryngology and Otology
L Pabla, J Duffin, L Flood, K Blackmore
BACKGROUND: Paediatric obstructive sleep apnoea is a common clinical condition managed by most ENT clinicians. However, despite the plethora of publications on the subject, there is wide variability, in the literature and in practice, on key aspects such as diagnostic criteria, the impact of co-morbidities and the indications for surgical correction. METHODS: A systematic review is presented, addressing four key questions from the available literature: (1) what is the evidence base for any definition of paediatric obstructive sleep apnoea?; (2) does it cause serious systemic illness?; (3) what co-morbidities influence the severity of paediatric obstructive sleep apnoea?; and (4) is there a medical answer? RESULTS AND CONCLUSION: There is a considerable lack of evidence regarding most of these fundamental questions...
February 14, 2018: Journal of Laryngology and Otology
A S Harris, R G Thomas, C D Passant
BACKGROUND: Oropharyngeal squamous cell carcinoma is thought to rarely metastasise to bone. This study hypothesised that in p16-positive disease there is a significant incidence of bony metastasis. METHODS: This was an ambispective cohort review. All patients with oropharyngeal squamous cell carcinoma diagnosed and treated at one centre were included. RESULTS: A total of 180 consecutive patients were identified over 5 years. Fifteen patients were excluded because of lack of p16 status, none of whom had bony metastasis...
February 12, 2018: Journal of Laryngology and Otology
E Heward, M Cullen, J Hobson
OBJECTIVE: Otitis externa is a common presentation to secondary care otolaryngology clinics. Despite this, few studies have investigated the microbiology and antimicrobial resistance of otitis externa. This study aimed to examine these issues. METHODS: Analysis identified 302 swabs taken from 217 patients (100 male, 117 female), between 1 January 2015 and 30 March 2016, at our rapid access otolaryngology clinic. RESULTS: In total, 315 organisms were isolated; the most frequent was Pseudomonas aeruginosa (31...
February 12, 2018: Journal of Laryngology and Otology
J Lau, H A Elhassan, N Singh
OBJECTIVE: Intranasal splints have long been utilised as a post-operative adjunct in septoplasty, intended to reduce the risk of adhesions and haematoma formation, and to maintain alignment during healing. METHODS: A Medline literature review of the history and evolution of intranasal splint materials and designs was performed. Advantages and disadvantages of various splints are discussed. RESULTS: Intranasal splints fashioned from X-ray film were first reported in 1955...
January 30, 2018: Journal of Laryngology and Otology
Y Song, J Long, T Wang, J Xie, M Wang, G Tan
OBJECTIVES: To observe the five-year efficacy of standardised specific subcutaneous immunotherapy for house dust mite allergy in monosensitised and polysensitised children with persistent allergic rhinitis. METHODS: From January 2007 to August 2009, 236 children with persistent allergic rhinitis were divided into 2 groups: 1 group received standardised specific subcutaneous immunotherapy using house dust mite extract; the other received pharmacotherapy with intranasal corticosteroids and oral antihistamines...
January 28, 2018: Journal of Laryngology and Otology
S Wijewickrema, Y Zhou, I Ioannou, B Copson, P Piromchai, C Yu, R Briggs, J Bailey, G Kennedy, S O'Leary
OBJECTIVE: To investigate the effectiveness and usability of automated procedural guidance during virtual temporal bone surgery. METHODS: Two randomised controlled trials were performed to evaluate the effectiveness, for medical students, of two presentation modalities of automated real-time procedural guidance in virtual reality simulation: full and step-by-step visual presentation of drillable areas. Presentation modality effectiveness was determined through a comparison of participants' dissection quality, evaluated by a blinded otologist, using a validated assessment scale...
January 24, 2018: Journal of Laryngology and Otology
D Mulvihill, R S Kumar, J Muzaffar, R Irving
BACKGROUND: Gorham-Stout disease of the skull is a very rare entity. It presents with gradual bone resorption, and proliferation of lymphoid and vascular channels within the bony matrix. This is often a diagnosis of exclusion confirmed with serial imaging and based on radiological evidence. CASE REPORT: A case of Gorham-Stout disease of the temporal bone involving the temporomandibular joint, and presenting with sensorineural hearing loss and recurrent temporomandibular joint dislocation, is reported...
January 24, 2018: Journal of Laryngology and Otology
A F Jahn
OBJECTIVE: A distinct subgroup of patients, presenting with apparently spontaneous onset of vertigo, is described. RESULTS: Although vestibular evaluation revealed caloric weakness, the proximate cause of vertigo was not labyrinthine dysfunction, but rather the loss of vestibular compensation for an older and previously compensated labyrinthine injury. CONCLUSION: Instead of addressing the vestibular weakness, effective management needs to focus on the condition that has caused the loss of compensation...
January 18, 2018: Journal of Laryngology and Otology
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