Informed consent in balloon Eustachian tuboplasty: a systematic review of possible complications and preventive measures.

OBJECTIVE: To systematically identify the complications associated with balloon Eustachian tuboplasty and their frequency of occurrence. This study will also highlight the measures that can be employed to avoid these complications and perform this procedure more safely. METHODS: Systematically reviewed relevant papers published until January 2023. Each reference was checked and evaluated for any potential manuscripts. There was no registered protocol; the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used. RESULTS: Sixty-nine publications were found, from which 14 publications met our inclusion criteria: 2 randomised clinical trials, 5 retrospective studies, 2 systematic reviews, 2 case series and 3 case reports. Studies with balloon Eustachian tuboplasty procedure only were included, regardless of ethnicity, gender and age. All studies were excluded in which more than one procedure was performed. CONCLUSION: Balloon Eustachian tuboplasty is a relatively safe procedure with an overall complication risk of 1.66 per cent. Major complication rate was 0.43 per cent. Surgical emphysema was the most common, around 0.40 per cent.

Ototoxicity of Topical Antibiotic Ear Drops in Chronic Suppurative Otitis Media in Humans: A Review of the Literature.

An electronic search of the literature was performed for reported cases of ototoxicity associated with the use of topical antibiotic ear drops in humans. The dosage, duration, and type of ototoxic preparations involved were recorded. Due to the scant quantity of low-quality information that is currently available, there was uncertainty about the usefulness of topical antibiotics in enhancing the resolution of ear discharge in patients with chronic suppurative otitis media. However, despite this uncertainty, there are some data to show that using topical antibiotics in comparison to a placebo or in conjunction with a systemic antibiotic may be useful. Additionally, there is ambiguity regarding the relative efficacy of various kinds of antibiotics; it is impossible to say with absolute certainty whether quinolones are superior to or inferior to aminoglycosides. Although the adverse impact profiles of these two classes of chemicals varied, there are not enough data from the included trials to draw any conclusions about them. Negative effects were generally underreported.

Mucosal lichen planus simultaneously involving oral mucosa, conjunctiva and larynx.

Lichen planus is an autoimmune disease that typically involves skin and the mucosa of the mouth and genitalia. The involvement of conjunctival and laryngeal is rare. A young patient presented with hoarseness of voice, oral ulcerative lesions and symblephron. Mucosal biopsies (buccal mucosa and supraglottic area) revealed the diagnosis of lichen planus and he was managed accordingly. Although oral lichen planus is frequently reported but simultaneous involvement of oral, ocular and laryngeal mucosa has not been reported earlier.

To Scan or Not to Scan-A Cross-Sectional Analysis of the Clinical Efficacy and Cost-Effectiveness of Audiometric Protocols for Magnetic Resonance Imaging Screening of Vestibular Schwannomas.

INTRODUCTION: Vestibular schwannomas (VS) are a rare cause of asymmetrical hearing loss, and routine screening with magnetic resonance imaging (MRI) can be costly. At present, no consensus exists on what qualifies as "asymmetrical sensorineural hearing loss" (ASNHL) and when a patient should be referred for screening. OBJECTIVES: 1) Evaluation of published audiometric protocols on the basis of sensitivity and specificity when applied to local clinical cohort of patients with ASNHL; 2) determination of clinical risks of missing VS and potential wastes in screening "radiologically normal" cases; 3) assessment of the cost of MRI screening. METHODS: Cross-sectional study with chart review in a 2-year (2015-2016) cohort of 1059 patients who underwent MRI screening and audiometry indicating sensorineural hearing loss. Fourteen previously published audiometric protocols were assessed for their sensitivity and specificity in guiding radiological diagnosis of VS, and cost analysis was performed. RESULTS: 6/14 audiometric protocols had a sensitivity greater than 85%. Diagnostic specificity ranged from 22.91 to 82.76%, clinical risks from 0 to 50%, and potential wastes from 17.24 to 77.09%. Average annual cost of screening was £64,069. Application of proposed local screening protocol had a projected cost saving of 32.19%. Cost of screening patients that benefit from treatment was compared with a utility function that quantified expected benefit. CONCLUSIONS: Development of an easy-to-apply algorithm incorporating high-sensitivity audiometric protocols may result in significant cost saving, with minimal clinical risk of missing cases. There was disparity between screening costs and monetary "benefit" of hearing.

Multiple thyroid ectopics in a single patient: a rare presentation.

A rare case of multiple thyroid ectopics has been presented. A 16 years old girl presented with swelling on the right side of neck and sense of lump in the throat. Oral examination confirmed presence of lingual thyroid. Examination of neck confirmed a 4 cm rounded soft mass on upper right side of patient's neck. Thyroid scan with I131 showed uptake of radio-iodine at the tongue base and also on right side of neck. Biopsy of mass from tongue dorsum and FNA from neck mass confirmed presence of thyroid tissue at both sites. Hormonal assay showed high TSH and low T3 and T4 level. Treatment with thyroxin for 3 months caused regression of thyroid tissue from both sites and improvement of patient's symptoms. Thyroid hormonal profile improved with thyroxin therapy and patient soon became euthyroid. The patient remained on long-term hormonal replacement with no recurrence of symptoms.

Transnasal flexible laryngo-oesophagoscopy: an evaluation of the patient's experience.

The aim of this study was to evaluate the patient's experience of transnasal flexible laryngo-oesophagoscopy under local anaesthetic in an out-patient setting. This was a clinical observational study using a patient questionnaire and visual analogue score. Subjects were 50 patients seen in the hospital's ENT outpatient clinic between March and August 2004 in whom transnasal flexible laryngo-oesophagoscopy was performed and who completed pain discomfort questionnaires. Any patient undergoing transnasal flexible laryngo-oesophagoscopy, for either diagnostic or therapeutic purposes, was included in the study. Patients in whom transnasal flexible laryngo-oesophagoscopy was not necessary as part of their investigation or treatment were excluded. Patients completed a questionnaire, providing a simple visual analogue score for discomfort during the procedure. Any operative complications were noted by the surgeon. All patients completed transnasal flexible laryngo-oesophagoscopy, and the upper aerodigestive tract was clearly visualized. The procedure is well tolerated, with mean score of <1 out of 10 for all forms of discomfort. There was a complication rate of 2 per cent (one patient with epistaxis); no other complications occurred. Transnasal flexible laryngo-oesophagoscopy is a new diagnostic and therapeutic technique which is well tolerated by patients. It compares favourably with other flexible endoscopic techniques. This report documents for the first time a detailed description of patients' experience of this technique.

Dentigerous cyst presenting as facial pain.

A rare case is presented in which a maxillary dentigerous cyst had eroded the posterior wall of the right maxillary sinus into the pterygo-palatine fossa causing facial pain due to pressure on the nerves. It had also eroded the lateral wall of sinus and into the oral cavity and got infected resulting in foul smelling oral discharge. The case was dealt with complete removal of cyst using Caldwell Luc's approach.

Subcutaneous emphysema of the neck in infancy: under-recognized presentation of child abuse.

Two cases of subcutaneous emphysema of the neck as a result of abuse in infancy are presented to add to the variety of findings associated with the maltreatment of infants. Pharyngeal perforations as a result of abuse are rare. These cases are presented as a reminder to the attending clinician that although most cases of subcutaneous emphysema may resolve without any complications a detailed examination for the cause should be performed and the history carefully verified.

Necrotizing sialometaplasia of the nasopharynx with parapharyngeal extension: Case report and brief review of the literature.

We report a rare case of necrotizing sialometaplasia of the right lateral nasopharynx with extension into the right parapharyngeal space in a 39-year-old man. Since this is a self-limiting condition, the patient began to improve spontaneously over the next few weeks, and he experienced a complete recovery. Necrotizing sialometaplasia is an uncommon condition that is known to involve the palate; nasopharyngeal involvement is very rare, and to the best of our knowledge, extension into the parapharyngeal area has not been previously reported in the English-language literature. This condition poses a diagnostic dilemma because it closely mimics a malignancy, and failure to recognize it can result in unnecessary investigations and extensive surgery. We also review the literature on necrotizing sialometaplasia of the oropharyngeal area.

Audit of otitis externa referrals and management in a tertiary care setting.

OBJECTIVE: To assess the initial management of acute otitis externa (AOE) in primary care and the appropriateness of referrals to the otolaryngology department. STUDY DESIGN: Prospective audit. SETTING: Tertiary referral centre. METHODS: Data were collected from 100 consecutive patients referred by their general practitioners (GPs) during a 6-week period to our otolaryngology department. A working diagnosis of AOE was made either by the GP or in the otolaryngology urgent referral clinic. MAIN OUTCOME MEASURES: The referring diagnosis, time lag before referral, investigations prior to initial management, and any patient advice given. RESULTS: Of 100 patients referred, 98% had AOE, 60% were referred with a correct diagnosis, and 30% referred had no diagnosis. Of all the referrals, nearly half were prescribed oral antibiotics, with 11% being treated with oral antibiotics exclusively; 59% had topical antimicrobials prescribed; and 24% were given no treatment. Seventy-three percent of patients were referred within 2 weeks following initial presentation to primary care, and the majority received no advice regarding their condition and/or precautions. CONCLUSIONS: AOE is one of the most common adult otologic conditions presenting to the GP. Based on our results, most patients presenting with this common problem are not receiving optimal initial management or advice prior to otolaryngology referral. Greater awareness of the correct management of AOE in the community is needed. An overview of AOE and its management is provided.