Securing a paediatric airway with a nasal sucker for laser surgery.

The administration of anaesthetic gases to an infant undergoing an endolaryngeal laser procedure can be difficult. We describe the use of a Magill's nasal sucker and an anaesthetic connector to maintain anaesthesia during laser surgery.

Hydrostatic balloon dilatation of pharyngeal stricture under local anaesthetic.

Balloon dilatation is well established in the management of enteric strictures. The use of this technique in the pharynx has been reported under radiological and endoscopic guidance. We describe the hydrostatic dilatation of a benign pharyngeal stricture in a laryngectomy patient under local anaesthetic, without radiological guidance, in the ENT out-patient department. This procedure was effective and well tolerated in a patient who required regular dilatations.

Speech therapist led voice clinic: which patients may be suitable?

Joint Voice clinics run by an ENT surgeon (Laryngologist) and Voice therapist avoid repetition of clinical assessment, better planning of patient management and early initiation of treatment. Although is perceived as optimal management of voice patients it is perhaps not necessary for all patients as it is time consuming for the clinicians involved. The aim of this study was to investigate whether it was possible to identify any subgroup of patients that could potentially be seen in a Voice therapist-led new patient clinic by reviewing the outcome of 96 patients referred to a Joint Voice clinic. Forty-four patients were referred for voice therapy out of which 13 (30%) were teachers or lecturers (total number: 16 (81%)). Two others in this subgroup required medical treatment and the other surgery. The most common aetiology in these professional voice users was muscle tension dysphonia (10 patients, 63%). It is concluded that experienced Voice therapists appropriately trained in laryngostroboscopic assessment could potentially receive and manage direct referrals from primary care physicians. They should however work as part of a multi-professional Voice Disorders Team where the patients could be reviewed by an ENT surgeon if necessary. This would significantly improve the patient pathway for these patients, be cost-effective and make the best use of therapist's and ENT surgeon's time.

Using a swimmer's nose clip in the treatment of epistaxis in the A&E department.

A swimmer's nose clip is a very useful adjunct when treating patients with spontaneous, anterior epistaxis. This clip is extremely efficient at providing constant, localised pressure over the bleeding vessel, in Little's area, and alleviates the need to pinch the nose. This allows for haemostasis to occur. This should alleviate the need for nasal packs and thus for admission into hospital. Any medical practitioner treating epistaxis patients can apply it.

Infections following cochlear implantation.

Cochlear implantation has become routine in the management of children and adults with profound sensorineural hearing loss. In rare cases postoperative infections necessitate removal of the implant. We present six such cases that have been managed within our programme. Extensive infected granulation tissue was found around the implant at exploration despite prolonged intravenous treatment with appropriate antimicrobial agents. All devices were explanted and three have been reimplanted at our unit. We discuss our management of these cases, the need for explantation, consideration for reimplantation and their functional outcome following reimplantation. We also highlight how systemic inflammatory markers can be unhelpful in detecting significant infection surrounding a cochlear implant.