Volume 8 Issue 1 - 2015

The Otorhinolaryngologist V8 N1

Welcome to the first issue of 2015, which has a very eclectic mix of articles. I am delighted to inform you that the British Laryngological Association has agreed to develop links with The Otorhinolaryngologist and we would like to welcome Yakubu Karagama to the Editorial Board. I have known Yakubu for many years and there is no doubt he will be an excellent addition to our team. As always, the NHS is a key matter being discussed by politicians as we near an election. Thankfully it seems that it is an institution that the country as a whole values immensely and therefore remains towards the top of priorities for all political parties. It may not always seem that way to those of us facing the daily struggles with bureaucracy and funding issues, but at least for now it looks as if the NHS is here to stay. Jarrod Homer has decided to step down from the Editorial Board this year due to other commitments; he has been a great contributor to the journal and I am very grateful to him for his support over the last few years. James Moor, who has recently moved from Sunderland to Leeds, will be lead for the Head & Neck section and we look forward to working with him in his new role.

Sanjai Sood
Editor in Chief

Non organic hearing loss is a poorly recognised phenomenon, and the current literature suggests that particularly in the paediatric population this is underdiagnosed. There are potential implications of missing such a diagnosis, such as unnecessary aiding or even cochlear implantation. Here we discuss principles of assessment and management of nonorganic hearing loss.

Bell’s palsy, which is a partial or complete idiopathic lower motor neuron facial paralysis is the commonest diagnosis amongst the myriad of possible causes of this distressing and functionally debilitating condition. A clinical diagnosis is usually possible, with classical features in the history and examination. Investigations are usually only required in those cases which do not present or recover in the classical manner: such investigations aim to exclude other less common causes of facial palsy. Treatment primarily involves corticosteroid and antiviral regimens, with a very limited role for surgery, perhaps in recurrent palsy or in individuals with incomplete recovery. Recent studies have provided evidence for these medical interventions.

Stability of Bone Integrated implants is influenced by the bond between bone and implant. This can be evaluated using Resonance Frequency Analysis (RFA). Disagreement exists amongst experts concerning time to activate or ‘load’ the implant. Current practice is 6 to 12 weeks. Particular caution is exercised in revision surgery. Here we present a case of a 62 year-old gentleman implanted with a Bone Anchored Hearing Aid (BAHA). RFA measurements identified instability in the first implant, loading was postponed and the implant lost. RFA identified higher stability following revision BAHA. These values facilitated successful loading at two weeks. This is the first report of the clinical usefulness of RFA to expedite loading time well below standard protocol in revision surgery.

Paediatric patients with difficult airways can be a challenge to both the otolaryngologist and anaesthetist. Appropriate recognition, assessment and management require knowledge of the differences between the adult and paediatric airway, as well as an understanding and proficiency in airway manoeuvres, use of adjuncts and emergency guidelines. Good communication and teamwork is vital and is demonstrated in the successful management of complex scenarios such as the EXIT (ex-utero intra-partum treatment) procedure.

Inflammatory pseudotumours are rare neoplasms of unknown aetiology. They often mimic malignancy, both clinically and radiologically, can be locally invasive, recur, metastasise and undergo malignant change. In this article we report a classical example of inflammatory pseudotumour with multiple foci, discuss the radiological and pathological findings and the management of these patients.

Oropharyngeal dermoids are an unusual manifestation of germ cell tumours. Exceedingly rare, they can cause considerable morbidity in infancy, particularly in the post-natal period and by anatomical location, may be the source of considerable aero-digestive compromise. We present the peculiar case of a young girl with a pedunculated dermoid polyp, lateralised to the tonsillar fossa with a likely missed diagnosis in early infancy.

A 30 year old woman has been referred by her GP, complaining of nasal obstruction and discharge. You are seeing her at her first clinic appointment – what will you do?

Introduction: ENT is an under-taught specialty at medical schools, with some even having completely removed it from the curriculum. This may have an impact on how doctors in the Accident & Emergency (A&E) Department manage patients with ENT problems at first contact.

Method: Clinical audit. We assessed whether relevant interventions and appropriate management of patients had taken place prior to referring to ENT from A&E. Appropriate interventions were actioned based on the results of the first cycle of the audit and management was then re-audited, thus completing the audit cycle.

Results: Our results showed that 58.6% of referrals from A&E had satisfactory interventions and the rest needed further support, particularly pertaining to the circulation. A group-specific induction programme was implemented, involving a 2-hour lecture on common ENT emergencies and their management. On re-auditing, a significant improvement in the interventions started for patients prior to referral and thus an overall improvement in patient care was seen.

Conclusion: Junior doctors working in the A&E Department are usually the first contact in managing ENT patients despite lacking basic ENT knowledge. A group-specific induction programme is an effective way of addressing this deficit a safeguarding patient care.

Abstracts of the oral presentations of the South West ENT Academic Meeting (SWEAM), 6th June 2014 at the Postgraduate Centre, Royal United Hospital, Bath, UK

Objectives: To explain the pathophysiology of Lemierre’s syndrome. To demonstrate the importance of detailed clinical analysis and request of appropriate investigations in its diagnosis. To discuss treatment regimens for the management of this potentially fatal condition.

Case report: Andre Lemierre first published his case series of 20 patients afflicted by his eponymous syndrome in 1936.1 We now report 3 cases of Lemierre’s syndrome over 3 years at Queen’s Medical Centre, Nottingham, a large teaching hospital. Two of the cases resulted from oropharyngeal infections and the other from an otitis media.

Conclusion: Mortality rates from Lemierre’s syndrome have reduced drastically in the advent of antibiotics. Early diagnosis and intravenous antibiotic therapy remain the key to successful treatment. The use of anticoagulation, although contentious, prevents thrombus extension.

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