Tuberculosis presenting as bilateral vocal fold palsy: case report and review of otolaryngological manifestations of tuberculosis.

OBJECTIVE: We report a rare case of tuberculosis presenting with bilateral vocal fold palsy. METHOD: Case report and discussion of ENT manifestations of tuberculosis. CASE REPORT: A 39-year-old man presented with stridor and bilateral vocal fold palsies, and underwent an emergency tracheostomy. Intra-operatively, a mass was identified overlying the thyroid cartilage. Fine needle aspiration cytology of this mass showed well formed granulomas but negative Ziehl-Nielsen staining. Computed tomography showed the mass to be surrounding the thyroid cartilage, causing airway occlusion; pulmonary infiltrates were also seen. The patient was commenced on tuberculosis treatment. Subsequent sputum samples from the tracheostomy confirmed the diagnosis. The patient responded very well to treatment, and was successfully decannulated after one week. CONCLUSION: The incidence of tuberculosis in the UK is increasing, particularly in urban areas. The otolaryngologist may encounter a wide variety of presentations. Diagnosis requires a high index of clinical suspicion.

Case report: cochlear implantation in Mondini dysplasia with congenital footplate defect--implications for meningitis risks during implantation.

Following the reports of a cluster of meningitis cases in recently implanted patients the FDA issued cautionary advice relating to the risk of meningitis after cochlear implantation (US Food and Drug Administration, 2002). Similar advice and a national reporting call has been issued by the Department of Health in the UK (Medical Devices Agency, 2002) and universal prophylactic pneumococcal vaccination started. We present a case of bilateral Mondini-type dysplasia associated with a defective stapes footplate and highlight the need for surgical vigilance to reduce the risks of meningitis from undiagnosed anatomical defects.

Reversible sensorineural hearing loss after non-otological surgery under general anaesthetic.

Acute sensorineural hearing loss can occur after both otolaryngological and non-otolaryngological procedures. The mechanism of such hearing loss remains unproved; but nitrous oxide has been implicated and where used, attendants should be aware of its potential damage to hearing. It is essential that patients with sudden hearing loss are identified as soon as possible as the recovery rate had been shown to be higher in those who presented early; and as our case demonstrates, complete recovery is possible. Anaesthetists, non-otolaryngological surgeons, and ward nurses must be aware of this early postoperative complication if appropriate treatment is to be instituted.

Randomised trial of subcuticular suture versus metal clips for wound closure after thyroid and parathyroid surgery.

A randomised trial was conducted to compare the results of neck wound closure using metal (Michel) clips or subcuticular suture. All operations were performed using a standardised technique, which included wound infiltration with 10 ml bupivacaine and adrenaline solution, no strap muscle division and the use of suction drains. All the collar incisions and wound closures were performed by the same surgeon. At the end of each operation patients were randomised to wound closure by either metal clips (n = 38) or a continuous 3/0 prolene subcuticular suture (n = 42). Daily postoperative pain scores and the discomfort caused by clip/suture removal were recorded. The cosmetic appearance of each wound was scored by the patient, the surgeon, and an independent observer using verbal response and linear analogue scales. The two study groups were well matched for age, sex, indication for surgery and operation performed. There were no differences in postoperative pain scores between clips and sutures. Removal of subcuticular sutures was performed more quickly (P < 0.0001) and caused less pain (P < 0.0001, visual analogue scale; P = 0.0042, verbal response scale) than the removal of clips. At the time of discharge, the cosmetic appearance scores generated by the surgeon, patient and independent observer were higher for suture closed wounds than clips. However, by 3 and 6 months follow-up there were no differences in cosmetic appearance between the two methods of closure. Only very short-term cosmetic results are influenced by the type of wound closure in thyroid and parathyroid surgery, but sutures are quicker and less painful to remove than Michel clips.