The root and development of otorhinolaryngology in traditional Chinese medicine.

There is an increasing trend in society to look beyond conventional medicine to find answers to problems in health. Traditional Chinese medicine (TCM) is one of the most popular alternative, complementary therapies worldwide. It is becoming a popular alternative in otorhinolaryngology where its use in the treatment of sinusitis, tinnitus, deafness and Meniere's disease is growing. Despite the general awareness of TCM, the literature relating specifically to otorhinolaryngology is relatively scarce. In this review, we have traced the origin and development of otorhinolaryngology with respect to TCM and have provided a few interesting insights into otorhinolaryngology, as it used to be practised. Archaeological sources have shown that diseases affecting the ear, nose and throat were of medical concern as early as the 18th century BC. The first practising otorhinolaryngologist can be traced back to the 5th century BC. Acupuncture, moxibustion, herbal therapy and massage were amongst his treatments. Otorhinolaryngology was recognised as a major specialty when formal medical education began in the 7th century AD. Therapeutic measures since then expanded to include exercise, food therapy and surgery. References to using oesophageal speech as a substitute voice generator, the use of copper wire to excise nasal polyps, procedures for removal of sharp foreign bodies in the oropharynx, repair of lacerated trachea and treatment of cancer of lips can be found in historical notes. In conclusion, from its primitive roots, TCM has developed into a distinct branch of health care system in China today that works alongside Western medicine.

Microvascular decompression of cochleovestibular nerve.

The role of microvascular decompression (MVD) in the management of trigeminal neuralgia, hemifacial spasms and glossopharyngeal neuralgia is well-established. However, controversy persisted as to the use of MVD in cochleovestibular neurovascular compression syndrome. This report provides a review of all the published studies on MVD of the eighth (8th) nerve in alleviating cochleovestibular symptoms and presents three additional patients who underwent MVD of the eighth nerve for tinnitus or vertigo. Nineteen studies were identified. Five were case reports. The remaining have sample sizes ranging from 4 to 207 patients. Quantitative and qualitative reviews of all studies were performed, focusing on the selection criteria for surgery, efficacy and safety of the procedure. Selection criteria for surgery were variable. No standardised outcome measures were used and all studies rely on patient subjective assessment of surgical outcome. Nonetheless, the results suggest that MVD of the eighth nerve produces good outcome with low morbidity in selected cases.

Falls and vestibular impairment.

Unexplained fall is one of the commonest presentations to the Accident and Emergency (A & E) department of a hospital. The objective of this study is to assess the proportion of patients with symptoms of vestibular impairment among those presenting to an A & E department with an unexplained fall. Out of the total 3139 patients (fallers) presenting to an A & E department in 6 months, 546 had no known cause for the fall. Of these, 428 (76%) completed the vestibular symptom scale questionnaire. The presence and severity of vestibular symptoms for the past 12 months were assessed. The results showed that 80% of these patients had symptoms of vestibular impairment. We conclude that a large proportion of unexplained fallers suffered from symptoms of vestibular impairment within the last year, which may be responsible for their imbalance and falls. Identifying this group of patients is important as their symptoms and the resultant postural instability can be ameliorated by vestibular rehabilitation exercises.

Vestibular schwannomas in children.

OBJECTIVE: This article highlights the clinical presentation and management issues of unilateral vestibular schwannomas in children. We demonstrate how the presentation differs from neurofibromatosis type 2 (NF2) and from adult unilateral vestibular schwannomas. STUDY DESIGN: This article is composed of a series of three cases and a literature review. SETTING: The study was performed at a university hospital (tertiary referral center). PATIENTS: Three children, aged 9, 11, and 13 years, with histologically confirmed vestibular schwannomas were studied. All children under 16 years of age in the world literature with unilateral vestibular schwannomas were reviewed. INTERVENTION: Analysis of presentation and surgical management of these three children and those children reported in the literature. MAIN OUTCOME MEASURE: Pattern of presentation relative to children with NF2 and people with adult unilateral vestibular schwannomas. RESULTS: Two patients had multiple cranial nerve weakness and recurrence, and one patient had successful removal of the tumor with preservation of all functions of the cranial nerves, including the facial nerve. CONCLUSION: Vestibular schwannomas in children are very uncommon. It is likely that it is the first manifestation of NF2, but it may also be a variant of sporadic vestibular schwannomas. A presentation of three cases and a review of 36 other cases in the literature demonstrates how the presentation is different from adult sporadic vestibular schwannomas and NF2 because it lacks primary audiological symptoms. The study also provides evidence of non-NF2 vestibular schwannomas presenting in children and suggests that it is likely that these are a variant of unilateral sporadic vestibular schwannomas. The search for the features of NF2 in these cases remains mandatory.

Otology in ancient India.

Sushrutra Samhita is essentially a multi-volume textbook reporting the surgical practices of ancient India. It covers all aspects of surgery. However, specific references are made to otorhinological conditions, their description and subsequent treatments often being described in some detail. In this paper we outline the structure of the document and attempt to explain its underlying philosophies. We highlight the specific references to otological diseases and their treatment and draw the obvious comparisons with modern otological practice.

Carotico-cavernous fistula following septorhinoplasty.

Septorhinoplasty is a very common operation in otolaryngological practice. We report the second case of a carotico-cavernous fistula following septorhinoplasty. This case presented with very severe epistaxis before the appearance of the typical pulsating exophthalmos, ophthalmoplegia, headache and engorged veins on the right side of the face. Our case was treated by endovascular thrombosis with electrolytically detachable coils.

Verrucous squamous carcinoma of the nasal septum.

We document only the second reported case of verrucous squamous carcinoma of the nasal septum. In both cases previous surgical treatment for assumed squamous papillomata had resulted in multiple recurrences necessitating formal surgical resection. Our patient has remained tumour-free during long-term follow-up.