Pub Date : 2017-02-09DOI: 10.1017/S0022215117000214
A. Ellinas, P. Jervis, G. Kenyon, Liam M Flood
Abstract Background: Endoscopic sphenopalatine artery ligation is widely accepted as effective and safe for acute spontaneous epistaxis that is unresponsive to conservative management. As with many new procedures, it has been progressively adopted as common practice, despite a limited evidence base for its efficacy. Early reviews called for comparative trials to support its adoption, but subsequent literature largely consists of case series and narrative reviews. These have attempted to derive an algorithm to establish its place in management, but consensus is still lacking. Intuitively, although there are theoretical objections, an operation regarded as relatively simple, fast and safe hardly seems to demand high-level evidence of efficacy. Rhinologists may be influenced by years of personal experience and success with the technique. However, estimates of the effect size and the added contribution to traditional surgical management are lacking. If the procedure could be shown to dramatically influence outcome, it should be standard practice and indispensable for all patients requiring operative intervention. Objectives: This paper systematically examined the literature, appraising the anatomical basis for such an approach and evidence for its efficacy. It questions whether any units unable to consistently offer endoscopic sphenopalatine artery ligation should be undertaking surgical management of acute epistaxis.
{"title":"Endoscopic sphenopalatine artery ligation for acute idiopathic epistaxis. Do anatomical variation and a limited evidence base raise questions regarding its place in management?","authors":"A. Ellinas, P. Jervis, G. Kenyon, Liam M Flood","doi":"10.1017/S0022215117000214","DOIUrl":"https://doi.org/10.1017/S0022215117000214","url":null,"abstract":"Abstract Background: Endoscopic sphenopalatine artery ligation is widely accepted as effective and safe for acute spontaneous epistaxis that is unresponsive to conservative management. As with many new procedures, it has been progressively adopted as common practice, despite a limited evidence base for its efficacy. Early reviews called for comparative trials to support its adoption, but subsequent literature largely consists of case series and narrative reviews. These have attempted to derive an algorithm to establish its place in management, but consensus is still lacking. Intuitively, although there are theoretical objections, an operation regarded as relatively simple, fast and safe hardly seems to demand high-level evidence of efficacy. Rhinologists may be influenced by years of personal experience and success with the technique. However, estimates of the effect size and the added contribution to traditional surgical management are lacking. If the procedure could be shown to dramatically influence outcome, it should be standard practice and indispensable for all patients requiring operative intervention. Objectives: This paper systematically examined the literature, appraising the anatomical basis for such an approach and evidence for its efficacy. It questions whether any units unable to consistently offer endoscopic sphenopalatine artery ligation should be undertaking surgical management of acute epistaxis.","PeriodicalId":22781,"journal":{"name":"The Journal of Laryngology & Otology","volume":"106 1","pages":"290 - 297"},"PeriodicalIF":0.0,"publicationDate":"2017-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79556029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-08DOI: 10.1017/S0022215117000160
S. Mulazimoglu, R. Flury, S. Kapila, T. Linder
Abstract Background: A distinct nerve innervating the external auditory canal can often be identified in close relation to the facial nerve when gradually thinning the posterior canal wall. This nerve has been attributed to coughing during cerumen removal, neuralgic pain, Hitselberger's sign and vesicular eruptions described in Ramsay Hunt's syndrome. This study aimed to demonstrate the origin and clinical impact of this nerve. Methods and results: In patients with intractable otalgia or severe coughing whilst inserting a hearing aid, who responded temporarily to local anaesthesia, the symptoms could be resolved by sectioning a sensory branch to the posterior canal. In a temporal bone specimen, it was revealed that this nerve is predominantly a continuation of Arnold's nerve, also receiving fibres from the glossopharyngeal nerve and facial nerve. Histologically, the communicating branch from the facial nerve was confirmed. Conclusion: Surgeons should be aware of the posterior auricular sensory branch and its clinical implications.
{"title":"Effects of a sensory branch to the posterior external ear canal: coughing, pain, Ramsay Hunt's syndrome and Hitselberger's sign","authors":"S. Mulazimoglu, R. Flury, S. Kapila, T. Linder","doi":"10.1017/S0022215117000160","DOIUrl":"https://doi.org/10.1017/S0022215117000160","url":null,"abstract":"Abstract Background: A distinct nerve innervating the external auditory canal can often be identified in close relation to the facial nerve when gradually thinning the posterior canal wall. This nerve has been attributed to coughing during cerumen removal, neuralgic pain, Hitselberger's sign and vesicular eruptions described in Ramsay Hunt's syndrome. This study aimed to demonstrate the origin and clinical impact of this nerve. Methods and results: In patients with intractable otalgia or severe coughing whilst inserting a hearing aid, who responded temporarily to local anaesthesia, the symptoms could be resolved by sectioning a sensory branch to the posterior canal. In a temporal bone specimen, it was revealed that this nerve is predominantly a continuation of Arnold's nerve, also receiving fibres from the glossopharyngeal nerve and facial nerve. Histologically, the communicating branch from the facial nerve was confirmed. Conclusion: Surgeons should be aware of the posterior auricular sensory branch and its clinical implications.","PeriodicalId":22781,"journal":{"name":"The Journal of Laryngology & Otology","volume":"14 1","pages":"329 - 333"},"PeriodicalIF":0.0,"publicationDate":"2017-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80375373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-08DOI: 10.1017/S0022215116010008
K. S. Mikkelsen, T. Ovesen, C. Z. Swan
Abstract Objective: To determine the pre- and post-operative prevalence of dizziness, tinnitus and taste disturbances in adult cochlear implant recipients. Methods: A questionnaire regarding pre- and post-operative dizziness, tinnitus and taste disturbances was sent to 170 cochlear implant recipients implanted between January 2003 and March 2009. Seventy-seven patients (41 per cent) responded. Results: Pre-operatively, 20 per cent of the participants experienced dizziness, 52 per cent experienced tinnitus and 3 per cent experienced taste disturbances. Post-operative dizziness developed in 46 per cent of patients and resolved in the majority of these; however, 15 per cent reported dizziness more than six months after implantation. Tinnitus worsened in 25 per cent of patients, whereas 73 per cent reported attenuation or termination of tinnitus. Post-operatively, tinnitus developed in 12 per cent and taste disturbances developed in 17 per cent of the patients. Conclusion: The high prevalence of dizziness, tinnitus and taste disturbances reported by cochlear implant recipients necessitates that assessment of symptoms related to inner ear and chorda tympani damage are included when evaluating operative results.
{"title":"Pre- and post-operative dizziness, tinnitus, and taste disturbances among cochlear implant recipients","authors":"K. S. Mikkelsen, T. Ovesen, C. Z. Swan","doi":"10.1017/S0022215116010008","DOIUrl":"https://doi.org/10.1017/S0022215116010008","url":null,"abstract":"Abstract Objective: To determine the pre- and post-operative prevalence of dizziness, tinnitus and taste disturbances in adult cochlear implant recipients. Methods: A questionnaire regarding pre- and post-operative dizziness, tinnitus and taste disturbances was sent to 170 cochlear implant recipients implanted between January 2003 and March 2009. Seventy-seven patients (41 per cent) responded. Results: Pre-operatively, 20 per cent of the participants experienced dizziness, 52 per cent experienced tinnitus and 3 per cent experienced taste disturbances. Post-operative dizziness developed in 46 per cent of patients and resolved in the majority of these; however, 15 per cent reported dizziness more than six months after implantation. Tinnitus worsened in 25 per cent of patients, whereas 73 per cent reported attenuation or termination of tinnitus. Post-operatively, tinnitus developed in 12 per cent and taste disturbances developed in 17 per cent of the patients. Conclusion: The high prevalence of dizziness, tinnitus and taste disturbances reported by cochlear implant recipients necessitates that assessment of symptoms related to inner ear and chorda tympani damage are included when evaluating operative results.","PeriodicalId":22781,"journal":{"name":"The Journal of Laryngology & Otology","volume":"90 1","pages":"309 - 315"},"PeriodicalIF":0.0,"publicationDate":"2017-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85817305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-02DOI: 10.1017/S0022215116009531
S. A. R. Nouraei, A. Hudovsky, J. Virk, H. Saleh
Abstract Objective: This study aimed to develop a multidisciplinary coded dataset standard for nasal surgery and to assess its impact on data accuracy. Method: An audit of 528 patients undergoing septal and/or inferior turbinate surgery, rhinoplasty and/or septorhinoplasty, and nasal fracture surgery was undertaken. Results: A total of 200 septoplasties, 109 septorhinoplasties, 57 complex septorhinoplasties and 116 nasal fractures were analysed. There were 76 (14.4 per cent) changes to the primary diagnosis. Septorhinoplasties were the most commonly amended procedures. The overall audit-related income change for nasal surgery was £8.78 per patient. Use of a multidisciplinary coded dataset standard revealed that nasal diagnoses were under-coded; a significant proportion of patients received more precise diagnoses following the audit. There was also significant under-coding of both morbidities and revision surgery. Conclusion: The multidisciplinary coded dataset standard approach can improve the accuracy of both data capture and information flow, and, thus, ultimately create a more reliable dataset for use outcomes and health planning.
{"title":"Impact of developing a multidisciplinary coded dataset standard on administrative data accuracy for septoplasty, septorhinoplasty and nasal trauma surgery","authors":"S. A. R. Nouraei, A. Hudovsky, J. Virk, H. Saleh","doi":"10.1017/S0022215116009531","DOIUrl":"https://doi.org/10.1017/S0022215116009531","url":null,"abstract":"Abstract Objective: This study aimed to develop a multidisciplinary coded dataset standard for nasal surgery and to assess its impact on data accuracy. Method: An audit of 528 patients undergoing septal and/or inferior turbinate surgery, rhinoplasty and/or septorhinoplasty, and nasal fracture surgery was undertaken. Results: A total of 200 septoplasties, 109 septorhinoplasties, 57 complex septorhinoplasties and 116 nasal fractures were analysed. There were 76 (14.4 per cent) changes to the primary diagnosis. Septorhinoplasties were the most commonly amended procedures. The overall audit-related income change for nasal surgery was £8.78 per patient. Use of a multidisciplinary coded dataset standard revealed that nasal diagnoses were under-coded; a significant proportion of patients received more precise diagnoses following the audit. There was also significant under-coding of both morbidities and revision surgery. Conclusion: The multidisciplinary coded dataset standard approach can improve the accuracy of both data capture and information flow, and, thus, ultimately create a more reliable dataset for use outcomes and health planning.","PeriodicalId":22781,"journal":{"name":"The Journal of Laryngology & Otology","volume":"16 1","pages":"341 - 346"},"PeriodicalIF":0.0,"publicationDate":"2017-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74428084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-01DOI: 10.1017/S0022215116009774
R. Nash, N. Amiraraghi, R. Roplekar, M. Yaneza, S. Ansari, C. Huins, A. Narula, H. Kubba, C. Murray, A. Cain, Gillian McDougall
Results A total of 5042 patients were seen. Of these patients, 84.5 per cent were referred by the general practitioner. This one-stop first referral clinic assessed both routine and urgent cases, with mean referral-to-clinic time of 26 days. A huge variety of conditions were encountered, but over 50 per cent of patients were definitively managed with just one out-patient appointment. In addition, we found that clinical examination alone was not sufficiently accurate. In our representative sample, one-third of the patients with clinically diagnosed salivary tumours were over-diagnosed.
{"title":"ENT trainee papers presented at the Association of Otolaryngologists in Training Conference, 7–8 July 2016, Glasgow, Scotland, UK","authors":"R. Nash, N. Amiraraghi, R. Roplekar, M. Yaneza, S. Ansari, C. Huins, A. Narula, H. Kubba, C. Murray, A. Cain, Gillian McDougall","doi":"10.1017/S0022215116009774","DOIUrl":"https://doi.org/10.1017/S0022215116009774","url":null,"abstract":"Results A total of 5042 patients were seen. Of these patients, 84.5 per cent were referred by the general practitioner. This one-stop first referral clinic assessed both routine and urgent cases, with mean referral-to-clinic time of 26 days. A huge variety of conditions were encountered, but over 50 per cent of patients were definitively managed with just one out-patient appointment. In addition, we found that clinical examination alone was not sufficiently accurate. In our representative sample, one-third of the patients with clinically diagnosed salivary tumours were over-diagnosed.","PeriodicalId":22781,"journal":{"name":"The Journal of Laryngology & Otology","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91203815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-01DOI: 10.1017/S0022215116010045
J. Soh, M. Thalayasingam, S. Ong, E. Loo, L. Shek, S. Chao
{"title":"Sublingual immunotherapy in patients with house dust mite allergic rhinitis: prospective study of clinical outcomes over a two-year period – CORRIGENDUM","authors":"J. Soh, M. Thalayasingam, S. Ong, E. Loo, L. Shek, S. Chao","doi":"10.1017/S0022215116010045","DOIUrl":"https://doi.org/10.1017/S0022215116010045","url":null,"abstract":"","PeriodicalId":22781,"journal":{"name":"The Journal of Laryngology & Otology","volume":"121 1","pages":"187 - 187"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81066349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-01DOI: 10.1017/S002221511700010X
E. Fisher, R. Youngs, M. Hussain, J. Fishman
Adenoid cystic carcinoma is an uncommon tumour for which management can be difficult as few individual clinicians have a wide personal experience of dealing with it. Bishop and international colleagues have put together cases from around the world to try to answer the question of whether elective neck surgery is needed for this group of patients, and they conclude that it can often be avoided. The general topic of management of neck nodes in head and neck cancer is summarised by Paleri et al. in the recent UK guidelines. As health services face manpower, resource and organisational difficulties, ensuring a safe emergency service in all specialties is high on the agenda for providers. The Journal of Laryngology & Otology has included many articles on educational aspects of ENT, recently by Whitcroft and colleagues, demonstrating a shortfall in confidence of junior doctors in dealing with emergencies. Swords and her group from Addenbrooke’s have evaluated a short course, which is being mirrored around the country. This included important simulation components during an intensive training day. This course has not only been shown to be an effective learning experience, but the authors demonstrated a sustained effect on trainees’ confidence after two to four months, which is crucial for any such intervention. The matter of the heat generated by endoscopes in ENT has been raised in a previous article in The Journal by MacKeith and colleagues in 2008, and has been taken up by colleagues in Birmingham in this issue, specifically in relation to potential thermal dangers in endoscopic ear surgery. They conclude that the danger is real and give some useful tips on how to minimise the damage to tissues. This article should be read by anyone who picks up an endoscope for use in ear surgery, even if only occasionally. Harju and Numminen’s paper on secondary tonsillar haemorrhage investigates over 1700 patients, and concludes that regardless of the indication, the risk of secondary haemorrhage is greater in patients over the age of 15 years, which will resonate with clinicians as being intuitively true. On the same topic, we also include a report of yet another unusual complication after tonsillectomy. As our book review highlights, the world is ‘scary’ out there.
{"title":"Training for emergencies, endoscopic ear surgery and post-tonsillectomy complications: beware ‘scary’ otolaryngology","authors":"E. Fisher, R. Youngs, M. Hussain, J. Fishman","doi":"10.1017/S002221511700010X","DOIUrl":"https://doi.org/10.1017/S002221511700010X","url":null,"abstract":"Adenoid cystic carcinoma is an uncommon tumour for which management can be difficult as few individual clinicians have a wide personal experience of dealing with it. Bishop and international colleagues have put together cases from around the world to try to answer the question of whether elective neck surgery is needed for this group of patients, and they conclude that it can often be avoided. The general topic of management of neck nodes in head and neck cancer is summarised by Paleri et al. in the recent UK guidelines. As health services face manpower, resource and organisational difficulties, ensuring a safe emergency service in all specialties is high on the agenda for providers. The Journal of Laryngology & Otology has included many articles on educational aspects of ENT, recently by Whitcroft and colleagues, demonstrating a shortfall in confidence of junior doctors in dealing with emergencies. Swords and her group from Addenbrooke’s have evaluated a short course, which is being mirrored around the country. This included important simulation components during an intensive training day. This course has not only been shown to be an effective learning experience, but the authors demonstrated a sustained effect on trainees’ confidence after two to four months, which is crucial for any such intervention. The matter of the heat generated by endoscopes in ENT has been raised in a previous article in The Journal by MacKeith and colleagues in 2008, and has been taken up by colleagues in Birmingham in this issue, specifically in relation to potential thermal dangers in endoscopic ear surgery. They conclude that the danger is real and give some useful tips on how to minimise the damage to tissues. This article should be read by anyone who picks up an endoscope for use in ear surgery, even if only occasionally. Harju and Numminen’s paper on secondary tonsillar haemorrhage investigates over 1700 patients, and concludes that regardless of the indication, the risk of secondary haemorrhage is greater in patients over the age of 15 years, which will resonate with clinicians as being intuitively true. On the same topic, we also include a report of yet another unusual complication after tonsillectomy. As our book review highlights, the world is ‘scary’ out there.","PeriodicalId":22781,"journal":{"name":"The Journal of Laryngology & Otology","volume":"18 1","pages":"95 - 95"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82443485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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