Longus colli tendinitis: acute neck pain with retropharyngeal swelling.

Longus colli tendinitis (LCT) has been described in several case reports, and is likely underdiagnosed due to its non-specific symptoms and self-limiting nature. It usually presents as acute neck pain with retropharyngeal swelling seen on nasoendoscopy and imaging studies. This may lead to unnecessary invasive interventions if physicians are unaware of the disease course. We discuss a case of LCT in a young woman who was treated at our institution, with recommendations on how to identify and treat such cases accurately without overtreatment.

Teaching arms and screens for microscope and fibreoptic nasendoscope: are they effective teaching devices and are we utilising them?

With training time for junior doctors now reduced, it is crucial to optimise training opportunities during elective clinical activities. Teaching ENT examination skills presents unique challenges as often, only the examiner can observe what's going on. We set out to explore the utilisation of microscope and nasendoscope teaching devices for ENT junior doctors. Telephonic survey of 102 English ENT units. ENT junior doctors spent an average of 7 h per week in elective ENT outpatient clinics. 92% of them felt that spending time in outpatient clinics helped improve their confidence in patients' management. 81% of ENT junior doctors stated that being able to observe others or being observed themselves would help to improve their clinical abilities. The availability and utilisation of nasendoscopy and microscopy teaching tools are currently suboptimal. Doctors working in departments that utilised the teaching tools stated that their educational needs were more likely to be met. Most ENT junior doctors found it beneficial to attend elective outpatient clinics although their learning needs were more likely to be met should ENT teaching devices be available. The availability and utilisation of ENT teaching devices are currently suboptimal and needs addressing.

Ear microbiology reports: a need for better communication with the microbiologists.

Most ENT surgeons treat discharging ears with topical antibiotics but many may not routinely utilise ear microbiology specimens. One reason could be that ear microbiology reports may not reflect their usual therapeutic options. This paper explores how microbiology departments in England process ear swabs. We carried out a telephone questionnaire of 104 microbiology departments in England. Results were obtained from 95 hospitals. Various culture methods are used, with sensitivity testing for up to 51 different antibiotics. Only five are licensed for topical use. Systemic antibiotics seemed to be preferentially tested for over topical antibiotics. Anaerobes and fungus are routinely tested. Many microbiology departments do not routinely report on all sensitivities tested. Antibiotic sensitivity testing for various micro-organisms cultured from ear swabs seemed to be guided by protocols for systemic infections. Microbiologists may not fully appreciate ENT surgeons' preferential usage of topical antibiotics in treating discharging ears, albeit there are other factors in their consideration for antibiotics to test. To gain better guidance from swab results, and to reduce needless lab costs, discussion with the microbiologists may be of benefit.

Experience with the longer (8.5 mm) abutment for Bone-Anchored Hearing Aid.

BACKGROUND: Use of the longer (8.5 mm) abutment for a Bone-Anchored Hearing Aid has been helpful for a certain group of patients. The most common reason for its use is soft tissue problems with tissue overgrowth interfering with device function. The longer abutment has been used in our institution, a tertiary referral center, on a named patient basis since 2002, and more than 100 patients have received it. OBJECTIVES: This paper will review this subgroup of patients and describe their demographics. Comorbidity, smoking history, graft failure, infection, and index of deprivation will be looked at as contributing factors for this group with soft tissue problems. PATIENTS: We identified 111 patients who had longer abutments ordered for them, and a retrospective case review was performed. RESULTS: Eighty-one patients required soft tissue reduction surgery because of overgrowth, and all but one (80/81 [98.8%]) of these patients required no further surgery after having their 5.5-mm abutment changed to the 8.5-mm version. One patient underwent further surgery 10 months after the longer abutment was inserted but has been problem-free for 16 months since then. Length of follow-up ranged from 6 months to 5 years after converting to the longer abutment. CONCLUSION: We have found the longer abutment to be very successful for the small proportion of patients with troublesome soft tissue overgrowth. We would advocate its use when topical management and surgical intervention have failed to control the skin reaction.

Unexpected exit of a cochlear implant electrode through the wall of the basal turn of the cochlea - a report on two patients.

We describe the unusual complication of the cochlear implant electrode eroding through the lateral bony wall of the cochlear basal turn in 2 different patients. This complication, occurring during life, has not been previously described in the literature. Radiological investigations were vital in making this diagnosis. We also discuss the likely pathophysiology behind this complication.