Magnetic Resonance Imaging (MRI) is considered the gold standard in detecting cerebellopontine angle (CPA) or internal acoustic meatus (IAM) lesions such as vestibular Schwannoma in patients presenting with unilateral audiovestibular symptoms - sensorineural deafness, tinnitus and vertigo. However, vestibular Schwannoma is rare in both patients with audiovestibular symptoms and in the healthy population. It is therefore much more likely for otolaryngologists to encounter the report of an incidental finding in the imaged brain than a vestibular Schwannoma itself.
Introduction: Oesophageal foreign bodies are a potential emergency, due to the risk of oesophagealperforation leading to mediastinitis which has a significant mortality rate. After negative direct examination, first line investigation is a lateral soft tissue neck x-ray, however interpretation of these by doctors in training can be difficult and there can be misleading non-pathological calcification of the laryngeal framework.
Case Series: We present 3 cases of upper oesophageal obstruction secondary to dental plate ingestion. In all three cases a foreign body was not initially noted on lateral soft tissue x-ray but due to the high index of clinical suspicion, all three underwent intervention. Two required rigid oesophagoscopy and removal in theatre and the third tolerated removal under local anaesthetic using McGills forceps.
Discussion: The case series highlights the potential difficulty in identifying oesophageal foreign bodies lodged at the level of the cricopharyngeus. Inclusion of a radio-opaque marker on dental plates would allow for easy identification of dental foreign bodies and avoid unnecessary procedures on a vulnerable and often frail patient group. If there are no visible radiological signs, patients should still undergo rigid oesophagoscopy if there is a high index of clinical suspicion.
Objectives: To communicate a case of bilateral haemotympanum in a patient diagnosed with chronic myeloid leukaemia (CML).
Methods: We describe a patient presenting with hearing loss who was found to have bilateral haemotympanum in the background of CML. This was managed conservatively with resolution of symptoms and signs. In this context we discuss aetiology, pathophysiology and management of haemotympanum.
Conclusions: To our knowledge this is the first reported case of conductive deafness in CML due to bilateral haemotympanum. This condition resolves with conservative management.
Objective: To report a case of vocal cord actinomycosis and provide a systematic review of the literature to provide a reference for its diagnosis and management.
Review Methods: Relevant cases from a PubMed search were reviewed for age/gender, risk factors, clinical manifestations, and treatment.
Results: Thirty-two cases of laryngeal actinomycosis have been reported in the literature. Most (80%) cases presented in patient with known risk factors. The majority presented with dysphonia (61.5%). Thirteen (58.3%) involved the true vocal cords. Penicillin based therapy was treatment of choice.
Conclusion: A structured assessment revealed 32 cases of laryngeal actinomycosis in the literature. Actinomycosis should be considered on the differential, even in healthy individuals with symptoms of laryngeal impairment.
Following on from the well known European Position Papers on Rhinosinusitis and Nasal Polyps (EPOS1 and EPOS 20122), and the European Position Paper on Endoscopic Management of Tumours of the Nose, Paranasal Sinuses and Skull Base,3 this latest position paper is also available free to download from the Rhinology journal website www.rhinologyjournal.com.
Despite popular belief, chronic rhinosinusitis is rarely the cause of chronic headache or facial pain. Many patients who report facial pain are therefore mistakenly given this diagnosis. Instead, they may be suffering from a myofascial pain syndrome, such as midfacial segment pain. These syndromes share similarities with tension-type headache. Medical therapy, including a low-dose tricyclic antidepressant, can be beneficial to many patients. The Sinonasal Outcome Test and Brief Pain Inventory-Facial can be used to assess patients and monitor treatment response. Those whose symptoms are refractory to medical therapy may benefit from adjunctive treatments such as regional anaesthesia or neuromodulation. We also present our experience of setting up a multidisciplinary facial pain clinic.
A slightly late last issue of 2016, which I hope you will find of interest. We have had a good year at The Otorhinolaryngologist with some excellent papers submitted for which I am very grateful. The production department are continuously improving the on-line facility which I would encourage you to use; all of us are having to provide more evidence for our appraisals and the journal along with the on-line questions remain a good vehicle to obtain CPD.
Simon Carr has now graduated to becoming a consultant and leaves the trainee section in the capable hands of Sandeep Mistry. I am grateful to Simon for his excellent work over the years and he has kindly agreed to continue working with the journal as a reviewer.
With best wishes for 2017.
Editor in Chief