Noise levels generated within the external auditory canal during microsuction aural toilet and the effect on hearing: a prospective controlled series.

OBJECTIVES: To measure the noise generated during suction aural toilet and to determine whether there is any clinically measureable effect on audiometric thresholds. STUDY DESIGN: Prospective, controlled study with 14 patients. SETTING: The study was conducted in an aural toilet clinic in a district general ENT department. PARTICIPANTS: Fourteen patients who attend regularly for suction aural toilet to clear cerumen. MAIN OUTCOME MEASURES: Live direct measurement of noise levels during treatment. Pre-treatment and post-treatment pure tone audiometry. RESULTS: Microsuction generated a broadband sound with a peak at 2 kHz. Sound levels peaked at over 120 dB(A) in two patients. We found no evidence of any shift in audiometric thresholds following microsuction aural toilet. CONCLUSIONS: Microsuction is a noisy procedure that is uncomfortable for some patients. However, it does not appear to be sufficiently noisy to produce a clinically detectable threshold shift. We would suggest that it is safe but that the use of non-suction methods or a fine end may on occasion be preferable to improve patient comfort.

Tonsillectomy may cause altered tongue sensation in adult patients.

OBJECTIVES: To determine the frequency of altered tongue sensation following tonsillectomy, and its relationship to different surgical techniques. DESIGN: Case-control study. SETTING: District general hospital. PARTICIPANTS: One hundred and four consecutive adults undergoing tonsillectomy, and 43 control patients. MAIN OUTCOME MEASURES: Altered tongue sensation. RESULTS: Twenty-eight of 100 patients described altered tongue sensation post-tonsillectomy. No patients in the control group experienced altered tongue sensation. There was a difference in rates of altered sensation between tonsillectomy patient groups undergoing bipolar diathermy and 'cold steel' techniques (p < 0.019). Three months after surgery, 22/23 contactable patients reported complete recovery of tongue sensation. One patient experienced tongue paraesthesia persisting until one year post-tonsillectomy. CONCLUSION: Tonsillectomy resulted in altered tongue sensation in 28 per cent of our study group. Bipolar diathermy dissection was significantly more likely to cause altered sensation than cold steel dissection. Ninety-six per cent of these disturbances resolved by three months, all by one year. Possible alteration of tongue sensation should be discussed whilst obtaining consent for tonsillectomy.

How we do it: coblation tonsillectomy complication rates from a single ENT department compared with the National Prospective Tonsillectomy Audit.

Coblation tonsillectomy is a relatively new technique, the results of which need auditing within practising units, to justify its continued usage. * The National Prospective Tonsillectomy Audit provides an excellent source of data for individual units to compare their results to. * This retrospective audit of 391 coblation tonsillectomies shows that our units haemorrhage and return to theatre rates are similar to the National rates for cold steel & ties data. * Resolution of training issues and patient selection may lead to increased use of this technique.

Endonasal laser dacryocystorhinostomy: its role in anticoagulated patients.

OBJECTIVE: To report the results of endoscopic laser-assisted dacryocystorhinostomy in anticoagulated patients. STUDY DESIGN: A retrospective study of 16 consecutive anticoagulated patients with distal nasolacrimal duct obstruction treated by endoscopic laser-assisted dacryocystorhinostomy. METHODS: A case note review was made of all patients treated with endoscopic laser-assisted dacryocystorhinostomy who were taking coumadin in two centers between 1993 and 2000. The parameters of age, gender, indications for surgery, surgical findings, complications, and outcome were analyzed. The mean follow-up time was 14 months (range, 9-26 mo). RESULTS: Fifteen of the 16 patients who were treated had an eventual successful outcome, but 6 patients required revision surgery. The patient whose symptoms were not improved was shown to have functional epiphora. No patient had a problem with primary or secondary epistaxis, and no patient required admission. A major benefit was the lack of disruption of anticoagulant therapy. CONCLUSIONS: Endoscopic laser-assisted dacryocystorhinostomy is a safe, efficient technique for the relief of distal nasolacrimal duct obstruction in anticoagulated patients. Not only does it avoid any disruption to their anticoagulant therapy, but it also can be performed as an outpatient procedure.

Acne prevalence, knowledge about acne and psychological morbidity in mid-adolescence: a community-based study.

BACKGROUND: Acne vulgaris is a distressing condition that affects the majority of adolescents, but its impact on mental health in this age group is poorly understood. OBJECTIVES: To determine the prevalence of acne, knowledge about acne and rates of help-seeking behaviour in English teenagers. It was hypothesized that presence of acne would be associated with higher rates of emotional and behavioural difficulties. METHODS: Three hundred and seventeen pupils (80% response rate) aged 14-16 years participated from a comprehensive school in Nottingham. An age-appropriate, validated measure of emotional well-being, the Strengths and Difficulties Questionnaire (SDQ), and an Acne Management Questionnaire were used to assess participants' psychological health, level of acne knowledge and help-seeking behaviour. Acne severity was by graded by visual facial examination using an adaptation of the Leeds Acne Grading Technique. RESULTS: There was a prevalence of acne in 50% of the study sample, with 11% of participants having moderate to severe acne (> 20 inflammatory lesions). Participants with definite acne (12+ lesions) (P < 0.01) and girls (P < 0.05) had higher levels of emotional and behavioural difficulties. Participants with acne were nearly twice as likely as those without acne to score in the abnormal/borderline range of the SDQ (32% vs. 20%; odds ratio 1.86, 95% confidence interval 1.03-3.34). Knowledge about the causes of acne was low (mean 45%), and was unrelated to acne status. Fewer than a third of participants with definite acne had sought help from a doctor. CONCLUSIONS: Acne is a common disorder in English adolescents and appears to have a considerable impact on emotional health in this age group. Low levels of acne knowledge and poor acne management are concerns that could be amenable to a school-based education programme.