Volume 11 Issue 3 - 2018

I hope you enjoyed a good break over the New Year and have returned to work rejuvenated. Despite the uncertainty of Brexit dominating the political arena the juggernaut that is the NHS continues to cope with demands on an ever-tightening budget, putting more strain on clinicians to deliver the service and finding the time to maintain CPD becomes more challenging for us all.

It is difficult to keep updated on the vast subject of Otorhinolaryngology- Head & Neck Surgery and I am always delighted to hear from colleagues from all grades that the journal’s review articles are a good and useful read. We do try and keep an eye on the subject of review articles so that over a period of a few years much of the ‘syllabus’ of ORL is covered. There are plans to work more closely with ENT UK also to achieve this. If you have any suggestions for topics you would like to see review articles on please feel free to let me know.

However, we would like to move the journal forward by including more original research as well and I encourage you to submit any such work to the journal. Of course, we will continue with the regular review articles, viva articles, training related articles, case reports as well as publishing abstracts from various meetings. This issue has some very interesting articles and we are trying to include some more basic science in the journal. I hope you find it an enjoyable and useful read.

With best wishes for 2019,

Sanjai Sood

Co-Editor of The Otorhinolaryngologist

Drooling is a common paediatric condition which normally resolves by school age. Abnormal, persistent drooling is often initially managed in primary care or community paediatrics, with referral to ENT specialists being reserved for those requiring intervention. It is important to have an understanding about the conservative means of reducing drooling and then know when to intervene with medical treatments; anti-cholinergics or botulinum toxin. Surgical intervention is reserved for the most problematic of cases and various methods are currently in use, re-routing surgery, formal gland excision and the more recent salivary duct ligation or clipping.

Metabolic bone disease refers to a spectrum of disorders characterized by abnormal bone formation or absorption. These diseases tend to present with generalized effects on the skeleton system. Direct involvement of the temporal bone can occur in these diseases, with resulting symptoms such as hearing loss, dysequilibrium, tinnitus, otorrhea, headaches, cosmetic deformities and cranial nerve deficits. These can often mimic other Otological diseases and a diagnosis requires an awareness of the key clinical features and radiological findings. A systematic review is presented in this twopart series. In the first part of this series, we focus on fibrous dysplasia, osteitis deformans (Paget’s disease), osteoporosis and osteomalacia.

Metabolic bone disease refers to a spectrum of disorders characterized by abnormal bone formation or absorption. These diseases tend to present with generalized effects on the skeleton system. Direct involvement of the temporal bone can occur in these diseases, with resulting symptoms such as hearing loss, dysequilibrium, tinnitus, otorrhea, headaches, cosmetic deformities and cranial nerve deficits. These can often mimic other Otological diseases and a diagnosis requires an awareness of the key clinical features and radiological findings. A systematic review is presented in this two-part series. In the first part of this series, we discussed fibrous dysplasia, osteitis deformans (Paget’s disease), osteoporosis and osteomalacia. In part two of this review, the topics of otosclerosis, osteogenesis imperfecta, osteopetrosis and other rarer metabolic bone diseases are presented.

We present a patient with intractable frontal headache and intranasal polyposis, who was found to have a massive, complex osteoma arising within a concha bullosa.

A 22 year old male presented with nasal obstruction, fontal headache, diplopia and imbalance. His symptoms were severe and poorly responsive to medical management and CT imaging revealed a large osteoma (59 x 33 x 32 mm), arising within a pneumatised middle turbinate and extending into the nasopharynx. The patient underwent urgent image-guided modified endoscopic Lothrop’s procedure which facilitated complete excision of the osteoma. To date only 8 previous cases of middle turbinate osteomalacia have been described. The presented case described the first experience of endoscopic excision with a Lothrop’s approach.

Objective: Presentation of a case of cervical hibernoma.

Methods: Case report and review literature.

Subject: A 16-year-old woman with a right posterior triangle neck mass.

Results: Hibernoma is a rare, benign tumour of brown fat. The cervical area is an unusual localization. The presented case posed difficulties in the differential diagnosis of cervical masses, particularly with other hypervascular lesions such as sarcomatous tumours. A US-guided core biopsy was decisive in the identification of hibernoma. No meaningful bleeding or other complications biopsy related have been noticed.

Conclusion: Image-guided core biopsy is an indispensable tool to obtain an accurate preoperative diagnosis of cervical hibernoma.

You may be shown a radiograph, photograph or object to start the viva discussion. Be prepared to discuss diagnosis, investigations, treatment options – pros and cons - and prognosis, with and without treatment.

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