Welcome to the last issue of 2017, which I hope you will find time to read over the festive season. It has been a hectic year for many of us with record numbers of patients seen in the NHS and anecdotally it does appear that there is an ever increasing amount of paperwork and bureaucracy adding to the workload for clinicians. There is the added uncertainty of what Brexit will bring or take from the NHS. On top of all this there is as ever the need for clinicians to keep our paperwork in good order for appraisals and revalidation, which is where hopefully the CPD provided by The Otorhinolaryngologist is helpful to our readers. This we feel is a key feature of the journal and in addition to the verifiable CPD the articles and accompanying MCQs are a very helpful aid for revision for exams. It is really pleasing to see more trainees reading the journal and also submitting excellent high quality papers.
With best wishes for 2018,
Editor in Chief
Objective: The purpose of this paper is to review the current literature for intratympanic therapies in the treatment of vertigo in Ménière’s disease. There currently seems to be little consensus about the dosing or the regime in which intratympanic therapies, such as intratympanic gentamicin (ITG) and intratympanic steroids (ITS) including methyl prednisolone and dexamethasone, are delivered. The aim is to review the evidence and suggest effective options.
Methods: A literature search of PubMed and the Cochrane library was conducted and the reference lists were reviewed for additional material. Only papers from 2012 were included in the review to try and give the most up to date picture of current practice.
Results: A total of 30 papers were found and tabulated. 12 papers were included from 2012 onwards.
Conclusion: Both ITG and ITS appear to be effective in controlling vertigo in Ménière’s disease, although ITG appears to be more effective. However, ITG is also associated with more side effects than ITS.
Balance disorders are typically treated by a combination of balance therapy and medication. However, not all patients with intractable and debilitating vertigo respond to therapy or are appropriate for this. In such instances surgery can have a role in management. The treating clinician must exercise extreme care in prescribing a surgical option to the patient, since operating on the inner ear inappropriately can be potentially devastating. Key to the decision making process is being certain of the precise diagnosis and being confident which ear is active. This decision to offer surgery is based largely on the diagnosis and the impact that the patient's symptoms are having on their lifestyle.
Introduction: Jugular paragangliomas are rare neuroendocrine tumours of the lateral skull base, comprising only 0.6% of all head and neck tumours. Their indolent nature together with their deep seated anatomical location can result in delayed presentation. The challenge in management lies in determining the risk/benefit ratio of treatment as surgery is frequently associated with high morbidity in a disease with an overall low mortality.
This paper includes a thorough review of the current literature reviewing epidemiology, presentation, investigation and treatment.
Objectives: To review literature on the use of hydrogen peroxide gargles in treating primary and secondary post-tonsillectomy bleeding (PTB), and investigate its rationale.
Method: A literature search was performed on PubMed and Medline databases. Articles in English focusing on hydrogen peroxide use in PTB were identified.
Results: 7 articles were found and 3 were selected. Two articles showed no correlation between hydrogen peroxide use and outcomes following PTB. One highlighted significant communal disparity in the use of hydrogen peroxide and the rationale for its use amongst ENT consultants.
Conclusion: Hydrogen peroxide use in PTB is prevalent, but without clear evidence if it works and through what mechanism. Further research must be undertaken to consolidate knowledge and make PTB treatment more efficient.
Objectives: To look for any change in trends in the country of origin of papers published by UK Otorhinolaryngology journals over a twenty-year period.
Methods: Articles published in Clinical Otolaryngology(CO) and the Journal of Laryngology and Otology(JLO) in 1992,2002 and 2012 were analysed and the country of origin of the lead author recorded comparing the contributions from UK authors to those from the Rest of the World(ROW).
Results: 1073 articles were published from both journals originating from 53 different countries. Both CO and JLO showed a statistically significant decrease in the proportion of contributions from the UK compared with the ROW with a drop from 63% to 47% and 53% to 39% respectively from 2002 to 2012.
Conclusions: An increasing proportion of articles in both journals are originating abroad, likely due, in part, to the internet. It may become harder for UK based surgeons to have their work published.
Background: The morbidity and mortality (M&M) meeting should be an agent for robust selfaudit and quality improvement within the local surgical department. Recent recommendations have been published on this subject by the Confidential Reporting System in Surgery (CORESS).
Method: An audit was performed to assess the effectiveness of the Ear, Nose and Throat departmental M&M meeting. Changes were then implemented to reduce wasted time, and to spend more of the time available discussing adverse events and learning outcomes.
Results: Following these changes the mean participant score for the meeting’s educational value rose from 6.2 to 8.9 out of a maximum of ten, while the mean score for impact on patient safety rose from 6.0 to 8.7.
Desmoid tumors are benign neoplasms that show locally aggressive growth but lack the potential to metastasize. Histopathologically these tumors lie between exuberant fibroproliferations and low grade fibrosarcomas and are classified as abdominal, extra-abdominal and intra-abdominal. Little is reported about clinical features and outcome of desmoids tumors of head and neck. They are rarely fatal but have a high propensity for local recurrence causing significant patient morbidity and complex patient management issues. We describe a rare case of external nasal desmoid tumor in a 10 year old male child which was managed with surgical resection and the child has been in follow up for 1 year without recurrence.
Image A is a noncontrast CT scan of paranasal sinuses in the coronal plane showing opacification of the ethmoid sinuses with heterogeneous areas of hyperattenuation which is often described as a ‘double density’ appearance. Image B is an endoscopic view during sinus surgery and shows thick tenacious secretions being removed from the right paranasal sinuses using a sinus sucker.