A rare case of necrotising epiglottitis.

We report a case of an acute necrotizing supraglottitis in a healthy patient. Only seven cases of necrotizing epiglottitis/supraglottitis have been reported in medical literature; all in immunocompromised patients. The features and characteristics of necrotizing epiglottitis are discussed with review of all previously reported cases.

Airway compromise secondary to vagus nerve stimulator: case report and implications for otolaryngologists.

INTRODUCTION: Vagus nerve stimulators are devices used in the management of patients with drug-refractory epilepsy unsuitable for resective or disconnective surgery. Implanted usually by neurosurgeons, these devices are infrequently encountered by otolaryngologists. Despite significant anti-seizure efficacy, side effects related to laryngopharyngeal stimulation are not uncommon. CASE REPORT: A 28-year-old man with a history of effective vagus nerve stimulator use presented with a cluster of seizures and respiratory distress associated with intermittent stridor. The duration of stridor corresponded to the period of vagus nerve stimulation. Endoscopy revealed forced adduction of the left vocal fold against a medialised right vocal fold. The device was switched off and the stridor immediately resolved. CONCLUSION: Airway compromise is an under-recognised side effect of vagus nerve stimulation. We describe the first known case of stridor and contralateral vocal fold palsy in a vagus nerve stimulator user. We highlight the need for better understanding amongst otolaryngologists of the laryngopharyngeal side effects of this technology.

Self-limiting benign paroxysmal positional vertigo following use of whole-body vibration training plate.

OBJECTIVE: We describe a case of benign paroxysmal positional vertigo which occurred after use of a whole-body vibration training plate. METHOD: Case report and literature review concerning the secondary causes of benign paroxysmal positional vertigo and the physiological effects of whole-body vibration training plates. RESULTS: A 44-year-old woman was referred with classic symptoms of benign paroxysmal positional vertigo following use of a whole-body vibration training plate, a popular form of fitness equipment widely used in sports, rehabilitation and beauty treatments. The condition resolved spontaneously after several days. There have been reports of negative side effects in users of this equipment, such as dizziness, headache and a sensation of imbalance; however, there have been no reported cases involving vertigo. Based on a literature review, this equipment may cause side effects, including vertigo, by generating forces that can increase the original amplitude of internal organs, which may potentially cause labyrinthine trauma or dislocation of otoconia, leading to benign paroxysmal positional vertigo. CONCLUSIONS: We suggest that whole-body vibration training plates may potentially induce benign paroxysmal positional vertigo. Manufacturers may need to make users of this equipment aware of this risk, and remind them to use it with caution.

Laryngeal squamous cell carcinoma presenting as a prelaryngeal, air-filled structure (pseudolaryngocoele).

OBJECTIVE: We report a unique case of a squamous cell carcinoma of the larynx presenting as a large pseudolaryngocoele, arising through a thyroid cartilage defect. METHOD: Case report and review of the literature. CASE REPORT: A 47-year-old man presented with a two-month history of hoarseness and a large, midline neck swelling. Endoscopic examination revealed a transglottic carcinoma involving the anterior commissure. Fine needle aspiration of the neck mass showed it to be an air-filled structure which transiently collapsed but refilled within minutes. Subsequent computed tomography scanning and histopathological examination revealed that the air-filled mass was created by a defect in the thyroid cartilage, with formation of a pseudolaryngocoele. CONCLUSIONS: The anatomy of the anterior commissure region and its effect on the spread of laryngeal carcinoma is reviewed in order to explain the pathophysiology of this unusual presentation. We highlight the need for a high index of suspicion of malignancy if a laryngocoele or pseudolaryngocoele is detected clinically.

Parental satisfaction with health services provided to children with Down syndrome in north-west England: an ENT perspective.

AIMS: To evaluate parents' satisfaction with medical and allied health services provided to children with Down syndrome in north-west England, comparing ENT and its allied services with other areas of health service provision. METHODS: A questionnaire survey of parents attending a north-west England Down syndrome association conference. Demographic data, departments visited, satisfaction with each service (scored one to five), waiting times for each service (scored one to five), service need (scored one to three) and accessibility (scored one to three) were recorded. RESULTS: Otolaryngology had been used by 50 per cent of children, with a satisfaction of 2.63 (the second worst score). Speech and language therapy was used by 90 per cent of the children, with a satisfaction of 3.26 (the worst score). The service felt to be most needed and also most difficult to access was speech and language therapy. CONCLUSION: Otorhinolaryngology departments should assess how they can improve their service to this population with specific ENT needs. Speech and language services for children with Down syndrome should be expanded.

Randomized-controlled study comparing post-operative pain between coblation palatoplasty and laser palatoplasty.

OBJECTIVES: This study aimed to evaluate differences in post-operative pain comparing KTP laser-assisted uvulopalatoplasty without tonsillectomy (LAUP) with a new described surgical method: coblation uvulopalatoplasty with tonsillectomy (CP). We also evaluate the impact of each surgical technique in reduction of snoring loudness. MATERIAL AND METHODS: Single blind randomized-controlled trial. From a population of 41 consecutive patients on the waiting list for uvulopalatoplasty for simple snoring, the study group was reduced to 17 CP and 13 LAUP. Post-operative pain and reduction of snoring loudness were recorded using visual analogue scales (VAS) during the first 15 post-operative days. Post-operative snoring loudness was documented for 1-year period. RESULTS: Both groups had similar post-operative pain during the first seven post-operative days. A statistically significant reduction in post-operative pain was observed in the CP group after day 8, and maintained until the end of the study. Reduction of snoring loudness was significant in both groups, but no differences were observed between them. DISCUSSION: Coblation uvulopalatoplasty compared with LAUP demonstrates a reduction in post-operative pain, significant after the first post-operative week. The collateral thermal injury caused by laser is responsible for the slow-healing rate and maintained post-operative pain. Coblation dissociates tissue at lower temperatures with minimal collateral thermal injury and consequently faster and less painful recovery. Both surgical procedures have significant and similar reduction in snoring loudness. CONCLUSIONS: Both methods are adequate treatment options for snoring. The less painful recovery in CP promotes this surgical technique as our preferred choice for palate surgery.

Randomized controlled trial comparing Merocel and RapidRhino packing in the management of anterior epistaxis.

OBJECTIVES: A prospective non-blinded randomized controlled trial to compare the efficacy of Merocel and RapidRhino nasal packs in the treatment of anterior epistaxis. METHODS: Fifty-two consecutive participants admitted with anterior epistaxis refractory to digital pressure or nasal cautery were randomized to treatment using one or other of the nasal packs. Patients who required repacking because of continued bleeding, only the first packs were included in the analysis. Haemostatic properties of the packs were measured by grading bleeding during and after removal of the pack (0-4, where four is uncontrollable) and by noting if the nose was re-packed or not. The difficulty of insertion and removal (graded 0-3 by clinician where 3 is the most difficult) and the participant's perception of discomfort (graded 0-10, where 10 is the worst pain) during insertion and removal of the pack were also measured. RESULTS: For bleeding, the mean values for Merocel and RapidRhino during packing and after pack removal were not significant (P = 0.38 and 0.82 respectively). The mean values of patient discomfort on insertion were 6.9 and 5.0 (P = 0.01), and for discomfort on removal were 4.6 and 3.4 (P = 0.05) respectively. The mean values of insertion graded by the clinician were 1.7 and 0.9 (P = 0.0003), and for removal were 1.4 and 0.4 (P < 0.0001). CONCLUSIONS: RapidRhino and Merocel are equally effective in the control of anterior epistaxis but RapidRhino is significantly more comfortable for the patient and easier for the healthcare worker during insertion and removal.

New method for raising the mucoperichondrial flap in septal surgery: microscope-assisted hydrodissection technique.

An essential step in septal surgery is the correct identification of the subperichondrial plane. Access to this plane can be improved by hydrodissection under enhanced vision. Hydrodissection consists of pressure insufflation of fluid into an anatomical space with a consequent increase in the hydrostatic pressure that separates the tissue planes. In septal surgery, the subperichondrial plane is hydrodissected by infiltration of 2 ml of xylocaine with adrenaline. This creates a bloodless and wide surgical field that facilitates surgery. With the use of a surgical microscope equipped with a teaching arm, it is possible to teach nasal anatomy and septal surgery to trainees.

Transient quadriplegia following re-puncture of tracheo-oesophageal fistula.

We present a case of a laryngectomized patient who underwent re-puncture of tracheo-oesophageal fistula for speaking valve voice restoration, resulting in a previously unreported inherent complication of this procedure: extradural abscess of the cervical spine with transient quadriplegia.

Epistaxis in children with vascular malformations--commentary of two cases and literature review.

Vascular anomalies can cause epistaxis in children. The authors present two cases of recurrent epistaxis secondary to rare causes and discuss their presentations. Both cases were managed conservatively since intervention in these vascular lesions carries a high risk of damaging adjacent structures.

Rheumatoid nodule of the nasal septum.

Necrotizing granulomatous nodules are a common feature in patients with rheumatoid disease, affecting 20 per cent of seropositive patients. Although most commonly found subcutaneously at points of pressure, these nodules may occur in the connective tissues elsewhere in the body. In the upper aerodigestive tract, nodules have been described in diverse locations, but commonly in the trachea, larynx and the ear. We present the first reported case of a rheumatoid nodule affecting the nasal septum.

Rare case of naso-oral fistula with extensive osteocartilaginous necrosis secondary to cocaine abuse: review of otorhinolaryngological presentations in cocaine addicts.

We report what we believe to be only the 10th case of palatal necrosis secondary to cocaine abuse in a 33-year-old female patient. Extensive necrosis also involved the cartilaginous and bony septum and paranasal sinuses. Following exclusion of other mid-line destructive diseases her treatment involved saline douches and cessation of cocaine. She remains under review within the department with no evidence of progressive disease. We present a review of the other nine cases of palatal necrosis reported in the world literature and demonstrate a greater incidence in female users. The various presenting conditions of cocaine abuse encountered within the head and neck region by the otorhinolaryngologist are then discussed.