Extreme laryngeal candidiasis: airway obstruction.

We describe the case of a 33-year-old female smoker who presented to the Accident and Emergency department with a 1-day history of rapidly evolving airway compromise. She had no preceding illness or other objective signs/symptoms on presentation, had a history of Chronic Obstructive Pulmonary Disease (COPD) and a previous opioid addiction. Following failed endotracheal intubation, the airway was secured with an emergency surgical tracheostomy. Subsequent direct laryngoscopy revealed a severely diseased glottis and supraglottic area, from which biopsy samples revealed a multiple drug-resistant strain of Candida albicans requiring specialist microbiology input and antifungal treatment. We describe the presentation, investigation, management and outcome of this rare case, along with a literature review of the subject.

Bilateral submandibular gland nodular oncocytic hyperplasia with papillary cystadenoma-like areas.

A 57-year-old man presented in 2016 with a 4-month history of a right submandibular mass, having undergone left submandibular gland (SMG) excision in 2003. Imaging suggested a benign tumour and subsequent core biopsy findings suggested a nodular oncocytic hyperplasia, similar to the tumour removed from the contralateral side. This was confirmed on histological analysis following right submandibular gland excision which showed characteristic features of nodular oncocytic hyperplasia along with an unusual diffuse papillary cystadenoma-like ductal proliferation, similar to that seen in the 2003 specimen. A diagnosis of multinodular adenomatous oncocytic hyperplasia (MAOH) was rendered in order to communicate the unique histological features that have otherwise not been described in the literature. We believe that this is the first reported case of non-synchronous multinodular oncocytic hyperplasia and the first case affecting the submandibular glands.

Post-tonsillectomy dietary advice and haemorrhage risk: Systematic review.

OBJECTIVES: Tonsillectomy remains one of the commonest operations performed in children. Post-operative diet may affect post-tonsillectomy haemorrhage rate, although post-operative dietary advice varies. We undertook a systematic review of the published literature to assess if and how different post-operative diets were associated with differences in PTH rates following paediatric tonsillectomy, to provide an evidence base to inform individual otorhinolaryngologists' practice and for future guideline development. METHODS: A systematic review of the published English literature of the PubMed, Medline and Cochrane Collaboration databases, using search terms used included 'post-tonsillectomy', 'diet', 'dietary advice', 'bleeding', 'haemorrhage', 'paediatric' &'children'. RESULTS: Eight publications were included in the review, including 5 randomised controlled trials, 2 case-control studies and 1 cohort study. These involved 1039 patients with 545 patients following a restricted/non-additive diet after tonsillectomy and 494 patients following an unrestricted/additive diet. The average reported PTH rate of patients in the restricted diet groups was 2.3% and 0.8% in patients in the unrestricted diet groups, which is not statistically significant (p = 0.12, one tailed t-test). CONCLUSION: PTH following paediatric surgery does not appear to be affected by different post-operative diets or regimes followed by patients. Clinicians should not change the advice provided regarding oral intake and diet following tonsillectomy surgery in children.

Paediatric haemoptysis and the otorhinolaryngologist: Systematic review.

OBJECTIVES: Childhood haemoptysis is an uncommon presentation to the otolaryngologist but has a varied aetiology and can be life-threatening. We performed a systematic review of the literature to assess paediatric otolaryngologists' experience with haemoptysis, the aetiology involved, investigations performed and management provided. Using this, we produce an evidence-based treatment algorithm to guide clinicians. METHODS: Systematic literature review of the PubMed, EMBASE and Cochrane Collaboration using the search terms 'paediatric', 'child', 'neonate', 'adolescent', 'haemoptysis', 'coughing blood', 'spitting blood' and 'otorhinolaryngology'. RESULTS: Five articles were retrieved meeting the search criteria including 106 patients (age range 3 weeks to 18 years). The 3 most common aetiologies were bronchitis (n = 9), idiopathic/ no cause found (n = 9) and pneumonia (n = 7). Flexible bronchoscopy was the commonest investigation performed in non-active cases whilst rigid bronchoscopy was performed for active haemoptysis to provide therapeutic interventions. Chest x-ray was performed as a screening investigation rather than CT scan, which was reserved to assess pathology further, in recurrent cases and when x-ray is inconclusive. Management depended on aetiology. There was no difference in aetiology between age ranges. CONCLUSIONS: Haemoptysis aetiology is varied and non-cancerous but is life-threatening in cases of pulmonary agenesis and vasculature abnormalities. No cause may be found. Clinicians' investigations and management plans should be based on the established care of haemoptysis. There is no difference between otolaryngologists and respiratory physicians' experience.

Radiologically-guided balloon sialoplasty for treatment of salivary duct stricture: A novel technique in young children.

OBJECTIVES: To describe our experience using radiologically-guided balloon sialoplasty to successfully treat sialadenitis in two children as a single modality intervention. METHODS: A retrospective case series. RESULTS: Both children were successfully treated using balloon sialoplasty with complete and lasting resolution of their symptoms. CONCLUSION: Paediatric sialadenitis secondary to salivary strictures are traditionally managed surgically. We believe that this is the first article to describe this intervention in such a series of children and that balloon sialoplasty is a safe technique and can be repeated as necessary, which should be considered as a management option in such paediatric cases.

Insertion of percutaneous endoscopic gastrostomy by head and neck surgeons: systematic review.

Percutaneous endoscopic gastrostomy to maintain nutrition in patients with cancer of the head and neck is increasingly being done by head and neck surgeons. We have reviewed published papers to assess the success rate of insertion and the incidence of complications.

Safety of the haemostatic agent Surgiflo® in excisions of the submandibular gland: our experience in 17 cases.

Excision of the submandibular gland is a common operation. A surgical drain is usually inserted into the wound to prevent the formation of a haematoma, but this may not be necessary. We retrospectively studied 17 patients whose submandibular glands had been excised and haemostasis achieved with Surgiflo® (Ethicon, Somerville, USA). There were no complications or side effects. Surgiflo® established good haemostasis, and can safely be used in place of a surgical drain.

Papillary-cystic variant of acinic cell carcinoma in the lacrimal gland.

Papillary-cystic variant of acinic cell carcinoma is a rare tumour confined to salivary gland tissue. Here, we report the first case ever to manifest in a tumour affecting the lacrimal gland, a completely different tissue type, and review the current published literature on this type of tumour.

Tonsillitis caused by vomiting in a patient with bulimia nervosa: a case report and literature review.

A 32-year-old lady presented to our ENT service with worsening tonsillitis. This was one of multiple attacks; all of which had all followed periods of self-induced vomiting due to the patient suffering with bulimia nervosa. Here we present the first ever case report of such a case of tonsillitis and a review of the literature of otolaryngology manifestations and complications of bulimia nervosa.

Early complications of total hip and knee replacement: a comparison of outcomes in a regional orthopaedic hospital and two independent treatment centres.

INTRODUCTION: There is anecdotal evidence of poorer outcomes from prosthetic joint replacement performed in independent treatment centres but very few comparative studies. PATIENTS AND METHODS: We compared the early re-operation, dislocation, re-admission, major wound infection and audit rates of 880 total hip (THA) and 874 total knee (TKA) arthroplasties carried out at a regional orthopaedic hospital (Avon Orthopaedic Centre; AOC) with 368 THAs and 365 TKAs from an NHS (WGH) and 67 THAs and 86 TKAs from a private hospital (CNH) independent treatment centre. RESULTS: Early re-operation rates were 9% at CNH, 1.4% at WGH and 0.6% at AOC after THA and 8% at CNH, 1.9% at WGH and 1% at AOC after TKA. After THA, dislocation rates after THA were 6% at CNH and 1.8% at both WGH and AOC. Re-admission rates were 13% at CNH, 0.6% at WGH and 1.2% at AOC. Major wound problems were 20% at CNH, 3.8% at WGH and 0.4% at AOC after THA and 19% at CNH, 1.9% at WGH and AOC (1.1%) after TKA. After TKA, re-admission rates from CNH were 13%, 1% at WGH and 1.1% at AOC. AOC and WGH audited their outcomes. None were available from CNH. CONCLUSIONS: Results and audit from independent treatment centres are variable and patients should be warned of this before undergoing treatment at them.