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Nasal stenosis is a rare but significant complication of chemoradiation treatment for nasopharyngeal carcinoma. It can cause distressing obstructive symptoms for the patient and potentially interfere with monitoring for recurrence. Quality-of-life indicators are known to be very poor in this group of patients; however, there is very little evidence in the literature as to management of this complication.
This paper presents an endoscopic day-case surgical procedure to address total posterior nasal stenosis, as conducted in three patients, which involves division of adhesions and removal of the posterior septum and posterior inferior turbinates, without the need for packing or stenting.
In this series, there was resolution of obstructive symptoms and no recurrence of stenosis during follow up (up to 20 months).
This endoscopic procedure performed to manage total nasal stenosis differs from those previously described in the literature, as post-operative stenting or packing is not required, and removal of the posterior aspect of the septum is performed routinely.
To gather and analyse information concerning the aetiology and pathology of otitis media with effusion in adults.
A review of the English language literature from 1970 to the present was conducted.
The available evidence suggests that otitis media with effusion in adult life is best viewed as a syndrome with a number of causes, including: infiltration of the eustachian tube by nasopharyngeal carcinoma and other local malignancies; changes in the middle ear and eustachian tube induced by radiotherapy; and systemic disease.
There is now a body of evidence specifically related to the aetiology and pathology of otitis media with effusion in adult life. However, further research is required to fill in the gaps in our knowledge and understanding of this condition.
There is no consensus as to whether all routine bilateral polypectomy specimens should be sent for formal histopathological diagnosis to exclude underlying neoplastic pathology. This study assessed the necessity for histopathological investigation as routine practice in cases of bilateral and unilateral nasal lesions by estimating the incidence of unexpected pathologies. It also evaluated the ability of computed tomography to predict histopathological diagnosis in patients with unilateral nasal lesions.
A retrospective analysis was conducted of 98 patients undergoing nasal polypectomy over a 12-month period.
Five of 23 patients with a unilateral lesion on nasendoscopy had inverted papillomas on histopathological examination. None of the 75 patients with clinically bilateral lesions on nasendoscopy showed evidence of neoplasia on histopathological examination. Patients with inverted papillomas had significantly lower total Lund–Mackay scores than those with bilateral polyps. Asymmetry scores of inverted papilloma patients were significantly higher compared to both bilateral and unilateral polyps patients.
The results suggest that histopathological diagnosis is only necessary in unilateral lesion patients as no unexpected histopathological diagnoses were made in bilateral lesion patients. Computed tomography imaging may have a role in predicting histopathological diagnosis by demonstrating asymmetry and less overall sinus opacification in patients with neoplastic lesions.
We report a case of bilateral acute mastoiditis and subperiosteal abscesses successfully managed with simultaneous surgery.
A case report and literature review are presented.
A two-year-old boy presented with fever, otalgia, otorrhoea and bilateral protruding ears. He was treated for 72 hours with intravenous antibiotics but failed to improve. Computed tomography confirmed bilateral mastoid abscesses with destruction of the mastoid cortex. Bilateral drainage of the subperiosteal abscesses and bilateral cortical mastoidectomies were carried out. Post-operatively, he recovered well, and free field audiometry showed a normal hearing threshold of 20 dB across all test frequencies.
This is only the second reported case of bilateral mastoiditis and subperiosteal abscesses. This case illustrates the use of bilateral cortical mastoidectomy in the successful management of this condition following failed antibiotic therapy, and highlights important management considerations.
We present two cases of a hyoid bone fracture identified through careful clinical examination with a Valsalva manoeuvre during nasendoscopy.
Case reports and review of the literature, with emphasis on technique during nasendoscopy.
The first patient had sustained a blow to the neck with a stick, six months prior to presentation with a globus sensation. External examination and standard nasendoscopy were unremarkable. The second patient had been struck across the neck by a wire whilst riding a motorbike at low speed. Endoscopy revealed swelling of the supraglottis. He recovered and was asymptomatic at review one month later. Computed tomography scans on both patients were unremarkable. During nasendoscopy, both patients were asked to forcibly expire with their mouths closed (the so-called nasal Valsalva manoeuvre), and the hyoid bone was seen to swing into view on the side where the first patient complained of symptoms, and in the second case where swelling had been noticed previously.
We would not ordinarily have reached a diagnosis in these patients, as radiography and examination were otherwise unremarkable. The use of the nasal Valsalva manoeuvre during routine nasendoscopic examination is recommended, as unusual pathology may be demonstrated and the need for direct laryngoscopy under general anaesthesia may, in some instances, be avoided.
To establish the safety and effectiveness of nurse-led triage of otolaryngology out-patient referrals.
One hundred consecutive general practitioner referrals were reviewed by two consultants, two specialist registrars, two foundation year two senior house officers and two otolaryngology nurses. One of the nurses had received triage training. All referrals were triaged as ‘urgent’, ‘soon’ or ‘routine’ by each rater.
The triage-trained nurse's results demonstrated good agreement with those of the senior consultant (80 per cent). This agreement was similar to that with the other consultant (77 per cent) and the specialist registrars (79 and 82 per cent). Weighted κ statistics (correcting for chance agreement) showed that the triage-trained nurse had the second closest agreement to the senior consultant (0.66). After the actual out-patient appointments, retrospective review of the patients' case notes revealed that none had been triaged inappropriately by the trained nurse, and no urgent cases had been missed.
Triage of out-patient referrals by trained ENT nurses is safe and effective, and is an acceptable alternative to traditional consultant vetting of referrals.
We report a rare UK case of laryngeal leishmaniasis, mimicking laryngeal candidiasis, associated with long term steroid inhaler use.
Case report and review of the world literature concerning leishmaniasis.
Laryngeal leishmaniasis is a protozoal infection which is rare in the Western world. It is becoming more common, however, with increased foreign travel. The disease can be difficult to diagnose histologically, and diagnosis is often delayed because of its rarity. It can mimic malignant laryngeal disease, and patients may therefore be subjected to significant and inappropriate treatment interventions.
A diagnosis of leishmaniasis should be considered if initial treatment for persistent hoarseness is ineffective, particularly in a patient who is at low risk of malignancy.
Exogenous bovine pituitary somatotropin (GH) can influence markedly body composition in fattening lambs. However, neither the effects of biosynthetic somatotropin nor the effects of dose and method of administration have been reported. Fifty Dorset-cross lambs (female and castrated male) were given concentrate ad libitum and treated between 10 and 22 weeks of age with biosynthetic bovine somatotropin either dissolved in buffer and injected subcutaneously (s.c.) in proportion to body weight (0·025, 0·1 or 0·25 mg/kg per day), dissolved in buffer and continuously infused s.c. (0·1 mg/kg per day) or suspended in olive oil and injected s.c. (0·1 mg/kg per day), and compared with 10 untreated control lambs. Somatotropin had little effect on live-weight gain (controls = 228 g/day; final live weight 37 kg), food intake and food conversion efficiency, and only marginally increased the weight of muscle and bone dissected from the shoulder joint. The weights of the major fat depots in the abdominal cavity and of fat dissected from the shoulder joint were linearly related to dose of somatotropin (P < 0·001). Lambs given the highest dose had less visceral fat (1·18 v. 2·84 kg; P < 0·001) and proportionately less fat (285 v. 374 g/kg; P < 0·001) and more muscle (542 v. 447 g/kg) and bone (172 v. 149 g/kg; P < 0·001) in the shoulder joint than control lambs. There was a positive curvilinear relationship (P < 0·01) between clean wool growth (mid-side patch sample) and dose; lambs injected daily with 0·1 mg somatotropin per kg grew one-third more wool than control lambs. Method of administration affected plasma somatotropin profiles but had no significant influence on any of the responses measured. The anabolic actions of somatotropin may have been limited in this experiment by a low sodium concentration in the diet. It is concluded that the lipolytic/anti-lipogenic effect of somatotropin can occur in the absence of conditions conducive to the stimulation of muscle protein deposition and that the response is dose dependent but not influenced by method of administration of the hormone.
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