Outcomes in open structure septorhinoplasty.

OBJECTIVES: This study assessed the patient-related outcome measures and complications of post-open structure septorhinoplasty. It also investigated the factors associated with the need for revision surgery. METHODS: We prospectively reviewed the case notes of patients who underwent septorhinoplasty performed by a single rhinologist at our institute between August 2011 and August 2013. Patient satisfaction was assessed using the Rhinoplasty Outcomes Evaluation (ROE) tool. RESULTS: A total of 120 patients were included with a mean follow-up time of 28.2 months. Eight patients (6.7%) required revision nasal surgery. There was a significant increase in the mean post-operative ROE score of all patients who underwent surgery (19.5 ± 9.41 vs. 68.4 ± 23.7,p < 0.001). The rate of revision surgery was significantly higher in patients with complex surgeries (3/12 vs. 5/108, p = 0.03). There were higher rates of nasal tip deformity surgery and augmentation surgery in the revision surgery group compared to the primary surgery group: 8/17 vs. 20/103, p = 0.03 for nasal tip and 10/17 vs. 27/103, p = 0.01 for augmentation. CONCLUSIONS: Open structure septorhinoplasty significantly increased the ROE score. Our rate of revision surgery, 6.7%, was lower than the average rate of 10%-18% reported in the literature. The rate of revision surgery was higher in cases judged pre-operatively to be more complex.

Deafness in Vogt-Koyanagi-Harada syndrome.

Sudden onset sensorineural hearing loss is a well recognized entity frequently encountered in otolaryngological practice. However, the combination of such deafness as part of a wider systemic disorder is fortunately rare. Almost 100 years after the syndrome was classified, we describe a case of Vogt-Koyanagi-Harada syndrome occurring unusually in a Caucasian woman and characterized by sudden hearing loss. A brief review of this rare condition is presented.

Comparison of quality of life outcomes following different mastoid surgery techniques.

BACKGROUND: Mastoid surgery carried out to treat chronic otitis media can lead to improvement in objective and subjective measures post-operatively. This study investigated the subjective change in quality of life using the Glasgow Benefit Inventory relative to the type of mastoid surgery undertaken. METHOD: A retrospective multicentre postal survey of 157 patients who underwent mastoid surgery from 2008 to 2012 was conducted. RESULTS: Eighty-three questionnaire responses were received from patients who underwent surgery at one of three different hospitals (a response rate of 53 per cent). Fifty-seven per cent of patients had a Glasgow Benefit Inventory score of 0, indicating no change in quality of life post-operatively. Thirty-five per cent scored over 50, indicating significant improvement. The only significant difference found was that women fared worse after surgery than men. CONCLUSION: The choice of mastoid surgery technique should be determined by clinical need and surgeon preference. There is no improvement in quality of life for most patients following mastoid surgery.

Malignant transformation in a laryngeal hemangioma.

Laryngeal angiosarcoma is uncommon, with only 19 previously reported cases. Malignant transformation in nonirradiated hemangiomas is extremely rare, with only five equivocal cases reported, all of which occurred in the skin. We report the first documented case of malignant transformation in a laryngeal hemangioma, and review the literature.

Investigation of the physiological basis of summating potential changes in endolymphatic hydrops.

An increase in the ratio of the summating potential to the action potential components of the electrocochleogram is known to be a feature of endolymphatic hydrops. We investigated the value of the SP/AP ratio in response to condensation and rarefaction click stimuli delivered separately. In patients with electrophysiological evidence of endolymphatic hydrops there was found to be a significantly greater SP/AP ratio to condensation clicks than rarefaction clicks. This finding supports the hypothesis that the increased SP/AP ratio in hydrops is due to mechanical asymmetry of the basilar membrane.

Respiratory problems in acromegaly.

Death from respiratory causes in acromegaly is three times more common than in the general population and is most often the result of upper airways obstruction, although less commonly pulmonary dysfunction and disturbance of the central nervous system may occur. These factors may be found alone or in combination. Despite several reports of laryngeal involvement, upper airway obstruction in acromegaly is usually regarded as being due to macroglossia and pharyngeal soft tissue hypertrophy. We present four cases of acromegaly in which tracheostomy was required for laryngeal obstruction, with a review of the literature concerning the nature of respiratory problems in acromegaly.

Temporal bone laboratory training for stapedectomy.

Practice in the Temporal Bone laboratory is a fundamental part of Otological training. Performing a stapedectomy on a normal temporal bone is handicapped by the mobility of the footplate. We describe a simple method of producing stapes footplate fixation in a normal temporal bone so that the operative conditions found in otosclerosis are more closely simulated.

Endoscopic dacrocystorhinostomy: long-term results and evolution of surgical technique.

This study evaluated the long-term results of endoscopic dacrocystorhinostomy (DCR) performed as a day-case procedure under local anaesthesia. It assessed the patient satisfaction with the procedure by retrospective review and a questionnaire survey. Seventy patients were referred for endoscopic DCR to the senior author between 1997 and 2000. A success rate of 92 per cent was achieved at three months and it was possible to perform 85 per cent of cases under local anaesthetic; 91 per cent were discharged on the same day. Long-term follow up by postal survey revealed that the watering eye had improved following surgery in 83 per cent (follow up range = eight to 66 months; mean = 28.6 months). Eighty-eight per cent were satisfied with the tolerability of the procedure under local anaesthesia. The authors describe changes in technique, which evolved with their experience of the procedure. Endoscopic dacrocystorhinostomy can be performed safely and successfully as a day-case procedure under local anaesthesia with excellent results and with great satisfaction to the patients.

Survey of computed tomography scanning and endoscopic sinus surgery in a group of district general hospitals in south Essex.

The management of chronic sino-nasal disease has changed significantly in the last 15 years with the advent of topical nasal steroids and minimally invasive endoscopic surgery, but survey data from district hospitals in the UK have not been published to date. We examined the current management of 383 consecutively scanned patients with sino-nasal symptoms in three district hospitals. Survey standards were set, and were attained in 56 per cent for symptom recording, 60 per cent for pre-scan diagnosis, 62 per cent for endoscopic examination in out-patients, and 73 per cent for topical steroid use before scanning. The variability of sinus disease makes it difficult to be dogmatic about proper indications for surgery, but subsequent surgical management, as ascertained from the notes, showed large differences between consultants in the three hospitals. The rate of minor complications was 2.2 per cent, there were no major complications, and the vast majority of patients stated that their nasal symptoms were improved by surgery. The survey showed that endoscopic sinus surgery is safe and effective when practised in a district hospital setting.

Septoplasty as a day-case procedure--a two centre study.

Day-stay surgery is an integral part of Otolaryngology. Many procedures which have traditionally been thought to require overnight stay can be carried out on a day care basis. We report our experience of treating 163 patients admitted for septal surgery as a day-case procedure. The paper summarizes the experience of two centres. One of these is a London Teaching Hospital, where surgery was performed through a dedicated day-case unit, and the other is a District General Hospital where patients were admitted to a day-case unit but had their surgery on a routine in-patient list. As the result of this study we conclude that day-stay septoplasty is associated with a low complication rate and is a safe and acceptable procedure provided that strict selection criteria are followed. The cost implications are discussed.

Congenital cholesteatoma.

We present a British series of eleven patients with primary cholesteatoma, including one patient with bilateral disease. Eight children presented with a history of hearing loss, while one child had had recurrent otitis media and another had had earache. Operative findings were: in five ears, cholesteatoma confined to the antero-superior segment with intact ossicles, in a further four, cholesteatomas extending throughout the mesotympanum with ossicular erosion in one, and in two ears posterior disease throughout the middle ear and mastoid, which had eroded the ossicles in both cases. The five cases of antero-superior cholesteatoma lend most support to Michaels' concept of epidermoid formation as a possible source of congenital cholesteatoma. With a greater awareness of the problem and careful examination of the antero-superior quadrant of the tympanic membrane, earlier diagnosis may be possible enabling removal of small intact cholesteatoma sacs and preserving the structures of the middle ear and therefore the hearing. A screening programme for infants included as part of their routine examination which would be undertaken by examiners who are trained to be more aware of the problem and skilled at otoscopy, would help in the earlier detection of such cases as is shown by reports from the U.S.A.

Spontaneous internal jugular vein thrombosis and recurrent laryngeal nerve palsy: a rare simultaneous presentation of an occult malignant neoplasm.

Internal jugular vein thrombosis is an uncommon potentially life-threatening disorder caused by various conditions. Non-spontaneous internal jugular vein thrombosis is an uncommon condition associated in the pre-antibiotic area with deep-neck infections. Currently iatrogenic trauma to the internal jugular vein from catheterisation and repeated intravenous injections by drug abusers are the leading causes of thrombosis. Spontaneous internal jugular vein thrombosis may occur when there are no apparent pre-disposing mechanical or inflammatory causes although a few of these patients may harbour an occult malignant neoplasm. Hence, careful investigation and follow-up are vital. Thrombosis in Trousseau's syndrome is usually confined to the vascular system of the extremities and the viscera. However, secondary to the paraneoplastic hypercoagulable state, thrombosis can occur in the large veins of the head and neck region. We understand this to be the first case where spontaneous internal jugular vein thrombosis and ipsilateral recurrent laryngeal nerve paralysis were the only initial manifestations of an occult malignancy.

A unique parotid adenocarcinoma.

A large number of different types of benign and malignant tumours of the salivary glands are recognized, and rare and unusual variants arise from time to time that can be difficult to interpret. We report an apparently unique parotid neoplasm that does not fit any of the currently recognized diagnostic groups and can best be termed lymphadenocarcinoma. Clinical and pathological features are described, and its possible relationship to recognized tumour types is examined.

Haemangioma of the frontal sinus.

A 71-year-old lady underwent successful excision of a haemangioma of the frontal sinus, via an osteoplastic flap approach. Haemangioma of the paranasal sinuses is an extreme rarity. A case is presented and the literature reviewed.

Management of globus pharyngeus: review of 699 cases.

The principal reason for performing investigations in patients with globus pharyngeus is to detect a pharyngeal or upper oesophageal malignancy presenting this way. There is uncertainty regarding both the necessity for investigation in globus patients and the first line investigation of choice in the screening of such patients. The authors therefore undertook a retrospective study of 699 patients who presented with globus sensation. Of these, 451 patients (64.5 per cent) had a typical history and in these patients, outpatient examination, including fibre-optic nasendoscopy was able to detect all pathologies, except one insignificant pharyngeal pouch, which required no intervention and one patient with a distal peptic stricture. In patients with atypical symptoms the combination of fibre-optic nasendoscopy and barium swallow identified all pathologies (five aerodigestive tract malignancies) except one distal peptic stricture. The authors concluded that if out-patient examination is adequate, no further investigation of typical globus symptoms is required. Such a policy would produce significant savings for both out-patient and radiology services.

Hearing loss in chronic renal failure-hearing threshold changes following haemodialysis.

The prevalence of sensorineural hearing loss, measured by pure tone audiometry, was determined in 66 patients with chronic renal failure and threshold changes following haemodialysis were measured in 31 patients. The incidence of hearing loss was 41% in the low, 15% in the middle and 53% in the high frequency ranges respectively. No correlations with weight changes, haematocrit, metabolic bone disease or ototoxic drug history were found. Of 62 ears studied, 38% had a decrease in low frequency threshold after dialysis and 9% had an increase. Threshold in 22/31 ears with pre-existing low frequency loss altered after dialysis with little change in other frequencies and no correlation with weight changes. In conclusion, we find a high incidence of low and high frequency hearing losses in chronic renal failure patients. Fluctuation in low frequencies with dialysis is common. Possible mechanisms include treatment induced changes in fluid and electrolyte composition of endolymph.