Volume 11 Issue 2 - 2018

Welcome again to the second edition of The Otorhinolaryngologist. Summer and BACO has come and gone and I hope everyone has enjoyed both. We have a superb selection of articles to read and digest which I hope will prove to be excellent reading. I draw your attention also to the CPD section that we are trying to improve as clearly demonstrable CPD is part of our professional lives from now on.

As ever, Sanjai and myself are always keen to hear from anyone interested in publishing within the journal and submissions can now be directly be submitted to RILA or contact us with any ideas if you wish.

As ever I thank all my section editors and contributors to the journal for their diligence and excellent work and look forward to the next edition.

My Best wishes

Francis Vaz

Co-Editor of The Otorhinolaryngologist

Paediatric orbital cellulitis is an ENT emergency. It is managed by Otolaryngologists, Paediatricians and Ophthalmologists, however management options may differ. Here we have attempted to identify and understand the antimicrobial regimes most commonly employed throughout the UK.

ENT teams in 40 units were contacted through a questionnaire-based survey. Twenty-eight units responded (response rate 70%) of which ten trusts reported no policy requiring joint input from paediatrics, ENT and ophthalmology and six trusts had no antimicrobial guidelines. Commonest antibiotic regimes were ceftriaxone with metronidazole, ceftriaxone alone, or co-amoxiclav.

Furthermore, a literature search of the various antimicrobial policies was carried out and advice was sought from a specialist microbiology department.

The evidence suggests no general consensus on antibiotic policy of this ENT Emergency. We discuss the rationale behind the various antimicrobial regimes commonly employed from the evidence and expert microbiology advice.

Laryngo-tracheo-oesophageal clefts are rare congenital malformations of the upper aerodigestive tract. A high index of suspicion is required to appropriately diagnose these patients. Management is tailored to the patient’s symptomology, severity and extent of the cleft. Options include conservative, medical and surgical options, with the latter involving endoscopic or open surgical approaches.

In this article, common otolaryngological procedures that are now being completed with the aid of three main types of lasers – potassium titanyl phosphate (KTP), Carbon Dioxide (CO2) and the neodymium-doped yttrium aluminium garnet (Nd:YAG laser) are discussed. Clinical benefits, safety precautions and problems associated in the use of these lasers are also covered.

Neck lumps are a very common presentation to hospital in paediatric patients. Lymphadenitis secondary to atypical mycobacterium infections are rare but recently there has been an increase in prevalence in the UK. The treatment of such cases is controversial; the options of medical, surgical or combination of both are practised, with variations, in different centres around the world. We report a case of a 4 year old girl who presented with a short history of a neck lump due to Mycobacterium Avium Complex (MAC) infection which was surgically excised, with good post-op and aesthetic outcome. This article aims to educate upon the background, clinical features and management of patients presenting with MAC associated neck lumps.

Background: Olfactory dysfunction affects a significant proportion of the population but appears to be more common in the elderly population (>20% of adults over 60 years old). Unfortunately, many sufferers face an apparent lack of therapeutic options when consulting with medical professionals. 

Method: We searched various electronic medical databases for the treatment of non-conductive olfactory dysfunction. After careful review of the abstracts and the full articles, we included publications that fulfilled our inclusion criteria and analysed the results.

Results: A total of 38 publications were included in our review including 6 randomised control trials, 14 cohort studies and 18 observational studies.

Conclusion: Olfactory training appears to improve non-conductive olfactory dysfunction irrespective of the aetiology. Steroids appear to have some benefit, but this may be aetiology dependent and vitamin A and sodium citrate have shown some promise. High quality randomised control trials are still required to determine their place in managing this patient population.

Mucoceles are benign expansile cystic lesions containing mucin or mucopus. They grow gradually and exert pressure on surrounding structures, causing bony remodelling. Bony remodelling around the orbit can lead to pressure on the orbital structures, vessels or nerves causing visual impairment. We describe a case of infected frontoethmoidal and sphenoidal mucoceles causing opthalmological symptoms including visual loss.

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