The Utility of the Sino-Nasal Outcome Test (SNOT) as a Treatment Outcome Measure in Nonsinogenic Facial Pain Syndrome.

INTRODUCTION: The purpose of this study was to assess the strength of correlation between the Sino-Nasal Outcome Test (SNOT) subdomains to determine which bore the greatest disease burden so that it could be used as a suitable measure of clinical response. METHODS: Prospective clinical audit of patients attending the Liverpool Multi-Disciplinary Facial Pain Clinic. The Brief Pain Inventory-Facial (BPI-F) was used as a comparator and surrogate measure of quality of life. RESULTS: Fifty patients (38 female) were reviewed, of whom 66% had midfacial segment pain. The total SNOT score was highly correlated with the BPI-F. Both the sleep function and psychological issues were the most highly correlated SNOT subdomains with the BPI-F, followed by ear-facial symptoms. The rhinologic symptom subdomain had a weak correlation with the BPI-F. The total SNOT score was most significantly correlated with the sleep function and psychological issues subdomains. CONCLUSION: This study supports the utility of the SNOT questionnaire as a measure of clinical outcome for nonsinogenic facial pain. The total SNOT score is highly correlated with the BPI-F, which has been used as a surrogate measure of quality of life. In addition, the sleep function and psychological issues subdomains are suitable variables to measure response to treatment.

Treatment outcomes of midfacial segment pain: experience from the Liverpool multi-disciplinary team facial pain clinic.

OBJECTIVES: Midfacial segment pain (MSP) has the characteristics of tension-type headache which is confined to the midface cor- responding to the second division of the trigeminal nerve. This review presents treatment outcomes of MSP patients managed at the Multi-disciplinary Team (MDT) Facial Pain Clinic in Liverpool. METHODOLOGY: Prospective clinical outcome performed in a tertiary referral centre for complex facial pain syndromes. MAIN OUTCOME MEASURES: Sino-Nasal Outcome Test (SNOT). Clinical "success" was defined as an improvement in total SNOT score of >9 points and a reduction of the ear-facial symptoms sub-domain score by ≥50% from baseline. RESULTS: The average age of the cohort was 49 years, with an average follow-up of 12 months. The overall pre-treatment total SNOT-22 score was 59.5 which improved significantly to 42 at latest follow-up. Although the average scores of all sub-domains improved, only the ear-facial symptoms and psychological issues sub-domains achieved statistical significance. When the criterion for success was applied, nine patients fulfilled this definition at an average of 12 months follow-up. The baseline total SNOT score in this cohort improved from 60.6 to 19.7. Half of these patients achieved success within 18 months of commencing treatment and the probability of attaining success at long-term follow-up was high. CONCLUSIONS: Treatment of midfacial segment facial pain is complex and requires follow-up to achieve any meaningful clinical outcome.

Serious complications during aural impression-taking for hearing aids: a case report and review of the literature.

OBJECTIVES: Complications during aural impression-taking for hearing aids are relatively rare. We present a case to highlight the need for vigilance when taking an aural impression and review the literature to identify other cases in order to assess the range of complications encountered and the sequelae of this potentially serious problem. METHODS: We present a case report and a review of the literature. RESULTS: The most common complication was the entry of mold material into the middle ear cavity. This frequently occurred in patients with a preexisting perforation of the tympanic membrane, although traumatic perforation occurred in 5 cases. Spread of the mold material within the middle ear cavity was frequently extensive, with 46% of cases involving the eustachian tube. There were 6 cases of ossicular chain involvement: encasement of the ossicles in 5 and extensive ossicular erosion in 1. The extent of the surgical procedures performed varied widely, ranging from simple removal of the foreign body in the mastoid cavity to tympanomastoidectomy with a facial recess approach and ossiculoplasty. In 50% of cases, the patient recovered without any complication. However, further hearing loss was observed in 36% of cases. CONCLUSIONS: When mold material is impacted in the ear canal and visualization of the middle ear is obscured, we advise against simple piecemeal removal. Such cases are best managed by an experienced otologist.

Streptococcal toxic shock syndrome secondary to a deep neck space infection presenting with no throat or neck symptoms.

A previously fit and well 44-year-old gentleman was admitted with a 3-week history of parotid swelling, malaise and feeling generally unwell. His only medical history was α-thalassaemia trait. Initial ear, nose and throat examination was unremarkable. Routine observations highlighted tachycardia, hypotension and a raised respiratory rate. Despite fluid resuscitation, his hypotension failed to resolve and he was admitted to intensive care for inotropic support. He was started on broad spectrum antibiotics and blood cultures isolated Lancefield group A Streptococcus. No obvious source of sepsis was identified. A CT scan from neck to pelvis highlighted a collection around the right tonsil, splenomegaly and widespread small volume lymphadenopathy. A right tonsillectomy, intraoral drainage of parapharyngeal and retropharyngeal abscesses and excision of an axillary lymph node were performed. With continued intravenous antibiotics and supportive measures, he recovered fully. Histology showed reactive lymphadenitis, but no cause of immunocompromise.